International Journal of Environmental Research and Public Health

31 pages, 357 KiB

Open AccessArticle

Māori Health, Wellbeing, and Disability in Aotearoa New Zealand: A National Survey

by Tristram R. Ingham, Bernadette Huatau Jones, Meredith A. Perry, Andrew Sporle, Tom Elliott, Paula Toko King, Gabrielle Baker, Barry Milne, Tori Diamond and Linda Waimarie Nikora

Int. J. Environ. Res. Public Health 2025, 22(6), 829; https://doi.org/10.3390/ijerph22060829 - 23 May 2025

Abstract

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often [...] Read more.

Māori, the Indigenous people of Aotearoa New Zealand, experience wide-ranging inequities compared with non-Māori. This survey aimed to explore the holistic health, wellbeing, and disability experiences of New Zealand’s Indigenous Māori population from a Māori worldview, addressing gaps in culturally relevant data often overlooked by standard health surveys. A robust cross-sectional survey was conducted with 7359 participants of Māori descent using Kaupapa Māori Research principles. Data were analysed using the Te Pae Māhutonga framework, a Māori health promotion model. Participants demonstrated strong cultural identity, with 32.3% understanding spoken Māori fairly well and 97.3% defining a broad non-nuclear concept of whānau (family). While over half reported high life satisfaction, 58.4% experienced discrimination, mainly based on ethnicity and appearance. Access to healthcare revealed that 32.6% were unable to contact a general practitioner due to cost. Socioeconomic challenges were prevalent; nearly a quarter borrowed from family or friends to meet daily living costs, and over a third economized on fresh produce to save money. This study reveals significant gaps in mainstream health data and demonstrates that a culturally aligned, methodological approach is feasible and crucial for informing policies that address the needs and rights of Māori, as guaranteed under Te Tiriti o Waitangi. These results could inform global, indigenous research addressing culturally relevant health, wellbeing and disability inequities. Full article

(This article belongs to the Special Issue Socio-Economic and Environmental Determinants of Health Disparities and Population Health)

14 pages, 290 KiB

Open AccessArticle

Frequent Users in Psychiatric Consultations: A 6-Year Retrospective Study in the Emergency Department

by Carla Maria Gramaglia, Eleonora Gambaro, Alessandro Feggi, Amalia Jona, Valentina Zanoli, Francesco Gavelli, Gian Carlo Avanzi, Daniela Ferrante, Silviana Maria Patratanu, Erica Valerio and Patrizia Zeppegno

Int. J. Environ. Res. Public Health 2025, 22(6), 828; https://doi.org/10.3390/ijerph22060828 - 23 May 2025

Abstract

The increasing prevalence of emergency room (ER) visits for mental health concerns presents a significant challenge for healthcare systems. This study aimed to analyze the socio-demographic and clinical characteristics associated with frequent users of psychiatric consultations in the ER of Maggiore della Carità [...] Read more.

The increasing prevalence of emergency room (ER) visits for mental health concerns presents a significant challenge for healthcare systems. This study aimed to analyze the socio-demographic and clinical characteristics associated with frequent users of psychiatric consultations in the ER of Maggiore della Carità University Hospital in Novara, Italy. A retrospective observational study was conducted over a six-year period (2017–2022), including all psychiatric consultations recorded in a hospital database. Frequent users were defined as individuals undergoing at least three psychiatric consultations in the ER within a year. Univariable and multivariable logistic models were employed to identify significant socio-demographic and clinical predictors of frequent use. Of the 1565 individuals who received psychiatric consultations in the ER, 92 (5.88%) were identified as frequent users. Factors associated with higher ER utilization included being unmarried (aOR 1.35, 95% CI 1.02–1.79), younger age (aOR 1.32, 95% CI 1.02–1.72), homelessness, diagnosis of schizophrenia, substance use disorder (aOR 1.49, 95% CI 1.06–2.09), and ongoing psychopharmacological treatment (aOR 1.56, 95% CI 1.12–2.18). These findings highlight the need for targeted interventions to improve care continuity and community-based support for individuals at risk of frequent ER visits for psychiatric reasons. Full article

12 pages, 327 KiB

Open AccessArticle

State Preemption and Local Tobacco Control: Constraints and Opportunities for Innovation in the US

by Rishika Chakraborty, Micah L. Berman, Y. Tony Yang, Yan Li, Yan Wang, Debra Bernat, Sabrina Zhang and Carla J. Berg

Int. J. Environ. Res. Public Health 2025, 22(6), 827; https://doi.org/10.3390/ijerph22060827 - 23 May 2025

Abstract

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and [...] Read more.

State preemption of local laws may impede tobacco control, yet little research has examined local policy activity before, during, and after preemption. This study addresses this gap. We summarized state laws preempting local smoke-free workplace, youth access, and licensure laws (CDC’s STATE) and local legislative activity before, during, and after preemption (Americans for Nonsmokers’ Rights Foundation) across 1999–2021. Preemption existed for smoke-free workplaces in 18 states, youth access in 21, and licensure in 13. Regarding smoke-free workplace laws, local laws were passed in 5 of 11 states with preemption throughout; among seven states with partial-period preemption, local laws were enacted before preemption or after repeal in three states but during preemption in two. Regarding youth access, localities adopted laws (e.g., addressing purchase/use/possession or e-cigarettes) in 11 of 18 states with preemption throughout; among the three states with partial-period preemption, localities passed laws before preemption in one state and during preemption in two. For licensure, localities passed laws (e.g., licensing requirements/penalties) in eight of nine states with preemption throughout and three of four states with partial-period preemption. Although state preemption reduced local activity, some localities advanced tobacco control during preemption, underscoring the need for localities to exercise autonomy permitted under preemption. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

12 pages, 265 KiB

Open AccessArticle

The Influence of Maternal Information Sources on Infant Oral Hygiene Practices for Six-Month-Olds in South Australia: A Cross-Sectional Study

by Meng-Wong Taing, Wanrong Li, Loc G. Do and Diep H. Ha

Int. J. Environ. Res. Public Health 2025, 22(6), 826; https://doi.org/10.3390/ijerph22060826 - 23 May 2025

Abstract

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, [...] Read more.

This study aimed to investigate the association between the different information sources on infant oral hygiene accessed by mothers and infant oral hygiene practices in South Australia. Information on the oral hygiene practices used in 6-month-old infants—gum/tooth cleaning in the past 3 months, frequency of brushing, and the usage of fluoridated toothpaste—were acquired from the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE) cohort survey. Descriptive statistics and multivariable logistic regression modelling were used to analyse the relationship between the information sources and infant oral hygiene practices. The majority of mothers (60.4%) reported not having cleaned their 6-month-old’s gums/teeth in the past 3 months. One-third of mothers with 6-month-olds did not seek information on infant oral hygiene. Mothers who sought advice from dentists were more likely to have cleaned their infant’s gums/teeth in the past 3 months, and those with infants whose teeth had erupted were also more likely to clean their infants’ teeth twice or more daily. We can conclude that mothers who sought information on infant oral hygiene from more than one source adopted generally better oral hygiene practices for their infants, with a dentist’s advice notably increasing the likelihood of mothers following the guidelines for cleaning their infants’ teeth. Full article

(This article belongs to the Special Issue Perceptions of Women, Child and Adolescents' Oral Health)

20 pages, 571 KiB

Open AccessSystematic Review

Barriers and Facilitators of Tobacco Cessation Interventions at the Population and Healthcare System Levels: A Systematic Literature Review

by Sanchita Sultana, Joseph Inungu and Shayesteh Jahanfar

Int. J. Environ. Res. Public Health 2025, 22(6), 825; https://doi.org/10.3390/ijerph22060825 - 23 May 2025

Abstract

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and [...] Read more.

Background: Tobacco use is responsible for eight million preventable deaths annually, making it a major modifiable risk factor for chronic conditions such as cardiovascular diseases, respiratory illnesses, and over 20 types of cancers. Objective: This study aimed to systematically review the barriers and facilitators of tobacco cessation interventions at both the population and healthcare system levels in the U.S. Understanding these determinants is critical for narrowing health disparities, optimizing resource allocation, and ultimately, enhancing tobacco cessation success rates across all demographic groups. Methods: A comprehensive literature search was conducted across the PubMed, Embase, and Web of Science databases, guided by the population, intervention, comparison, and outcome framework and quality assessment guided by PRISMA guidelines. Data extraction focused on study characteristics, intervention types, barriers, facilitators, and cessation outcomes at both the population and health system levels. The random effects forest plots were graphed to estimate pooled effect sizes for both medical and non-medical interventions. Results: A total of 35 studies met the inclusion criteria from an initial pool of 1555 identified records. Socioeconomic disadvantages, digital inequities, and low motivation constitute primary barriers at the individual level, while systemic factors such as healthcare access limitations, inadequate provider engagement, and lack of financial support further hinder cessation efforts. Financial incentives, culturally tailored interventions, and digital engagement strategies significantly improve tobacco cessation outcomes. Public health implications: as identified by the study, tailored interventions, the expansion of health coverage policies to include intervention, digital solutions, and healthcare resource workforce training will help improve tobacco cessation intervention outcomes. Full article

(This article belongs to the Special Issue Advancing One Health Approaches for Health Promotion and Disease Prevention: Transdisciplinary Perspectives)

28 pages, 813 KiB

Open AccessSystematic Review

Neuroscientific Insights into the Built Environment: A Systematic Review of Empirical Research on Indoor Environmental Quality, Physiological Dynamics, and Psychological Well-Being in Real-Life Contexts

by Aitana Grasso-Cladera, Maritza Arenas-Perez, Paulina Wegertseder-Martinez, Erich Vilina, Josefina Mattoli-Sanchez and Francisco J. Parada

Int. J. Environ. Res. Public Health 2025, 22(6), 824; https://doi.org/10.3390/ijerph22060824 - 23 May 2025

Abstract

The research aims to systematize the current scientific evidence on methodologies used to investigate the impact of the indoor built environment on well-being, focusing on indoor environmental quality (IEQ) variables such as thermal comfort, air quality, noise, and lighting. This systematic review adheres [...] Read more.

The research aims to systematize the current scientific evidence on methodologies used to investigate the impact of the indoor built environment on well-being, focusing on indoor environmental quality (IEQ) variables such as thermal comfort, air quality, noise, and lighting. This systematic review adheres to the Joanna Briggs Institute framework and PRISMA guidelines to assess empirical studies that incorporate physiological measurements like heart rate, skin temperature, and brain activity, which are captured through various techniques in real-life contexts. The principal results reveal a significant interest in the relationship between the built environment and physiological as well as psychological states. For instance, thermal comfort was found to be the most commonly studied IEQ variable, affecting heart activity and skin temperature. The research also identifies the need for a shift towards using advanced technologies like Mobile Brain/Body Imaging (MoBI) for capturing real-time physiological data in natural settings. Major conclusions include the need for a multi-level, evidence-based approach that considers the dynamic interaction between the brain, body, and environment. This study advocates for the incorporation of multiple physiological signals to gain a comprehensive understanding of well-being in relation to the built environment. It also highlights gaps in current research, such as the absence of noise as a studied variable of IEQ and the need for standardized well-being assessment tools. By synthesizing these insights, the research aims to pave the way for future studies that can inform better design and policy decisions for indoor environments. Full article

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15 pages, 289 KiB

Open AccessArticle

Influence of Socio-Ecological and Economic Correlates on Marijuana Legalization Policy Across the States of America

by Mashooq Salehin and Vijayan K. Pillai

Int. J. Environ. Res. Public Health 2025, 22(6), 823; https://doi.org/10.3390/ijerph22060823 - 23 May 2025

Abstract

Marijuana legalization has been at the center of debate in the social and political realm of the United States. So far, thirty nine states and the District of Columbia have legalized marijuana either for recreational or medical purposes. States are taking a cautious [...] Read more.

Marijuana legalization has been at the center of debate in the social and political realm of the United States. So far, thirty nine states and the District of Columbia have legalized marijuana either for recreational or medical purposes. States are taking a cautious approach to legalization in a policy context consisting of multi-layered sociopolitical systems. Strong arguments from advocacy groups supporting and opposing legalization highlight the significance of assessing the impact of marijuana use and its legalization on the well-being of the community and its members. Utilizing the social determinants of health and system perspectives, this study measures the cumulative effect of six socio-ecological and economic predictors, such as the state’s marijuana use prevalence and median household income, on the dependent variable of marijuana legality scores using discriminant analysis and One-way ANOVA. As hypothesized, the result shows a significant influence of the predictors on the state policy score of marijuana legality. Predicted associations between independent and dependent variables were also found. Findings suggest that without a supportive policy context comprising social, economic, and political factors, marijuana legalization might not have the desired impact on the community. Implications and recommendations for future research are provided. Full article

12 pages, 270 KiB

Open AccessProtocol

The Effectiveness of Indoor Residual Spraying for Malaria Control in Sub-Saharan Africa: A Systematic Protocol Review and Meta-Analysis

by Moses Ocan, Kevin Ouma Ojiambo, Loyce Nakalembe, Geofrey Kinalwa, Alison A. Kinengyere, Sam Nsobya, Emmanuel Arinaitwe and Henry Mawejje

Int. J. Environ. Res. Public Health 2025, 22(6), 822; https://doi.org/10.3390/ijerph22060822 - 23 May 2025

Abstract

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of [...] Read more.

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of insecticides, from mostly using dichlorodiphenyltrichloroethane (DDT) and pyrethroids from 1997 to 2010 to carbamates in 2011 and organophosphates in 2013. In addition, other vector control measures, like the use of long-lasting insecticide-treated bed nets (LLINs), have also been employed for malaria control. Despite the implementation of these mosquito vector control interventions, malaria remains a disease of public health concern, especially in sub-Saharan Africa, which bears over 90% of the disease burden. This review will thus collate evidence on the effectiveness of IRS for malaria control in sub-Saharan Africa. Methods and analysis: The systematic review will be conducted following a priori criteria developed using the PRISMA guidelines. Articles will be obtained through a search of the Web of Science, Google Scholar, Medline via PubMed, Scopus and Embase databases. Mesh terms and Boolean operators (“AND”, “OR”) will be used in the article search. Additionally, websites of malaria research institutions will be searched. The article search will be conducted by two independent librarians (AAK and RS). All identified articles will be transferred to EPPI-reviewer v6.15.1.0 software. Article screening and data abstraction will be performed in duplicate by four reviewers (KOO, LN, GK and MO), and any further disagreements will be resolved through discussion and consensus. We shall extract data on the country, region, study design, insecticide combination, season, susceptibility procedure used, vector control interventions, population, mosquito species, malaria incidence or prevalence, insecticide efficacy, susceptibility, genotypic resistance, vector mortality and knockdown effect. Data analysis will be performed using STATA v17.0. Effect sizes will be statistically pooled using inverse-variance-weighted random-effects meta-analysis. Heterogeneity and publication bias in the articles will be assessed using the I² statistic and a funnel plot, respectively. For the studies that will not be included in the meta-analysis, a narrative synthesis will be written following the Cochrane Consumer and Communication Review Group format. Results: The findings of this review will help generate evidence on the effectiveness of indoor residual spraying using WHO pre-qualified insecticides in malaria control in sub-Saharan Africa. This protocol was registered in PROSPERO, registration number CRD42024517119. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

11 pages, 469 KiB

Open AccessArticle

Medically Attended Outpatient Parainfluenza Virus Infections in Young Children from a Single Site in Machala, Ecuador

by Manika Suryadevara, Dongliang Wang, Freddy Pizarro Fajardo, Jorge Luis Carrillo Aponte, Froilan Heras, Cinthya Cueva Aponte, Irene Torres and Joseph Domachowske

Int. J. Environ. Res. Public Health 2025, 22(6), 821; https://doi.org/10.3390/ijerph22060821 - 23 May 2025

Abstract

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 [...] Read more.

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 and July 2023, we documented demographic and clinical information from children younger than 5 years seen in a single public health clinic with signs and symptoms consistent with an acute respiratory infection. Nasopharyngeal swabs collected at study enrollment underwent multiplex polymerase chain reaction-based diagnostic testing (Biofire FilmArray v. 1.7™). Regional meteorological data from the same period were provided by Ecuador’s Instituto Nacional de Meteorologia e Hidrologia. Parainfluenza viruses were detected in 9% of the 1251 enrolled subjects. PIVs were most frequently detected between March and July, with no change in seasonality following SARS-CoV-2 pandemic onset. Clinical manifestations of PIV infections included non-specific upper respiratory illness (82%), laryngotracheitis (3%), and bronchiolitis (11%). Events of PIV detection were negatively associated with ambient temperature and rainfall. Our findings highlight the contribution that PIVs play in the morbidity associated with pediatric medically attended outpatient respiratory tract infection and provide new insights into the seasonal epidemiology of PIV infections in coastal Ecuador. Full article

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30 pages, 436 KiB

Open AccessReview

Antecedents of Workplace Psychological Safety in Public Safety and Frontline Healthcare: A Scoping Review

by Emily Ip, Rani Srivastava, Liana Lentz, Sandra Jasinoski and Gregory S. Anderson

Int. J. Environ. Res. Public Health 2025, 22(6), 820; https://doi.org/10.3390/ijerph22060820 - 23 May 2025

Abstract

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces [...] Read more.

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces to identify key antecedents, workplace enhancements, and research gaps. A systematic search of studies published between 2010 and January 2025 was conducted across multiple databases, including CINAHL, Medline, ERIC, JSTOR, PsycInfo, Business Source Ultimate, and Sociological Abstract. Inclusion criteria focused on adult workers in high-risk workplace environments. Following screening and eligibility assessments, 16 studies from six countries were selected for analysis. Data were extracted and thematically analyzed based on leadership styles, organizational structures, and workplace culture related to psychological safety. The review identified three primary antecedents of psychological safety in high-risk workplaces: (1) inclusive and transformational leadership styles, (2) hierarchical structures and power dynamics, and (3) workplace climate and communication culture. Studies consistently found that inclusive leadership, ethical integrity, and transformational leadership were strongly associated with higher psychological safety levels. While hierarchical structures provided the necessary organization, overly rigid hierarchies often suppressed employee voice and innovation. A workplace culture characterized by trust, transparency, and open communication fosters greater psychological safety and improved teamwork and well-being. Full article

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12 pages, 316 KiB

Open AccessArticle

Exploring Vaccine Hesitancy in the Philippines: A Content Analysis of Comments on National TV Channel YouTube Videos

by Daniel Fritz Silvallana, Carlos Elias and Daniel Catalan-Matamoros

Int. J. Environ. Res. Public Health 2025, 22(6), 819; https://doi.org/10.3390/ijerph22060819 - 22 May 2025

Abstract

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze [...] Read more.

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze user comments to gain insights into vaccine perceptions. Analyzing the Philippines case is particularly significant as it provides insights into the attitudes towards COVID-19 vaccination in a country that has been heavily impacted by the pandemic. The current study investigates the discourse surrounding vaccine hesitancy in comments on YouTube videos announcing the COVID-19 vaccination campaign by the Philippines national TV channels and its impact on engagement levels. A total of 741 YouTube comments were analyzed, with 80% exhibiting vaccine-hesitant related discourse. The results indicate that those with negative attitudes towards COVID-19 vaccination exhibit higher engagement levels than those supporting vaccination (p < 0.05). Additionally, the most commonly used themes in vaccine-hesitant posts were “ingredients”, “health department control”, “pharmaceutical interest”, and “adverse effects”. Moreover, 134 sources were identified among the posts, with vaccine-hesitant posts utilizing more sources than supportive vaccine posts (p < 0.001). The most significant information sources utilized in the posts were related to other YouTube users, politicians, clinicians, and scientific papers. Finally, a total of 890 discourses were coded, with the most frequently used discourse types among vaccine-hesitant posts being negationist, institutional, preventive, political, and pharmaceutical. These findings offer valuable insights into the nature and prevalence of vaccine hesitancy discourse on social media platforms and its impact on public engagement. This study highlights the importance of targeted communication strategies and the provision of accurate information from reliable sources in addressing vaccine hesitancy. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

12 pages, 283 KiB

Open AccessReview

A Call to Integrate Measures of Environmental Context into Research on Maternal Brain Health

by Sofia I. Cárdenas and Bridget L. Callaghan

Int. J. Environ. Res. Public Health 2025, 22(6), 818; https://doi.org/10.3390/ijerph22060818 - 22 May 2025

Abstract

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a [...] Read more.

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a developmental phase in adult women’s lifespans marked by neurobiological shifts supporting fetal development and optimizing caregiving behaviors. While neurobiological shifts during this period are well-documented, pregnancy is also associated with a heightened risk for mental health challenges. This narrative review, focusing on the last 10 years, examines the research that underscores the importance of integrating environmental factors into research frameworks to comprehensively understand their effects on maternal neurobiology and mental health throughout pregnancy. Building on this research, authors discuss future research methodologies that will support a more comprehensive understanding of the intersection between environmental contexts, maternal neurobiology, and mental health. Full article

(This article belongs to the Special Issue How Reproductive Life Events Influence Women's Mental Health)

12 pages, 247 KiB

Open AccessArticle

Equitable Healthcare Access for Type 2 Diabetes Patients Under a Low-Income Group Health Care Scheme: A Sustainable Development Goal Perspective

by Sin Wei Tey, Kingston Rajiah, Mari Kannan Maharajan, Norasila Binti Zakaria and Nor Haslinda Binti Ishak

Int. J. Environ. Res. Public Health 2025, 22(6), 817; https://doi.org/10.3390/ijerph22060817 - 22 May 2025

Abstract

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key [...] Read more.

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article

(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)

21 pages, 1019 KiB

Open AccessReview

Health Knowledge About Early Diagnosis of Autism Spectrum Disorders: A Case for Soft Transdiagnostic Approaches to Better Represent the Clinical and Scientific Reality of ASD

by Mirah Dow and Ting Wang

Int. J. Environ. Res. Public Health 2025, 22(6), 816; https://doi.org/10.3390/ijerph22060816 - 22 May 2025

Abstract

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature [...] Read more.

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature review was conducted using MEDLINE, PsycINFO, and the Psychology and Behavioral Sciences Collection, focusing on peer-reviewed studies published between 2020 and 2023. The search followed PRISMA guidelines, selecting articles investigating ASD diagnosis in toddlers and preschoolers using DSM-5 criteria, behavioral assessments, and emerging diagnostic tools. Results: Findings indicate that DSM-5 provides a structured framework for ASD diagnosis, but it has limitations in early identification. It is necessary to integrate multiple assessment tools. Recent research highlights transdiagnostic models, which move beyond rigid diagnostic categories to capture the complexities of ASD presentation in young children. Conclusion: The literature supports a shift towards a transdiagnostic approach that combines behavioral, biological, and environmental assessments. This study underscores the need for interdisciplinary collaboration to refine ASD diagnostic frameworks to ensure more accurate and timely diagnoses that better serve affected children and their families. Full article

(This article belongs to the Section Behavioral and Mental Health)

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9 pages, 244 KiB

Open AccessEditorial

Integrating Exposome into Lifecourse Understanding of Cognitive Ageing and Dementia: Current Evidence, Methodological Challenges, and Future Directions

by Jessica Gong and Paola Zaninotto

Int. J. Environ. Res. Public Health 2025, 22(6), 815; https://doi.org/10.3390/ijerph22060815 - 22 May 2025

Abstract

Cognitive decline and dementia represent some of the most pressing challenges to global public health, especially amid rapidly ageing populations worldwide [...] Full article

(This article belongs to the Special Issue Exposomic Approach to Dementia and Cognitive Ageing)

12 pages, 273 KiB

Open AccessArticle

The Roles of Dissociation and Depression in PTSD Among Soldiers Exposed to Combat

by Leah Shelef, Nir Spira, Uzi Bechor, Jacob Rotschield and Eran Shadach

Int. J. Environ. Res. Public Health 2025, 22(6), 814; https://doi.org/10.3390/ijerph22060814 - 22 May 2025

Abstract

Exposure to severe combat situations significantly raises the risk of depression and post-traumatic stress disorder (PTSD). Trauma survivors may use dissociation as a defense mechanism, increasing the likelihood of PTSD. This study aims to explore the roles of dissociation and depression in PTSD [...] Read more.

Exposure to severe combat situations significantly raises the risk of depression and post-traumatic stress disorder (PTSD). Trauma survivors may use dissociation as a defense mechanism, increasing the likelihood of PTSD. This study aims to explore the roles of dissociation and depression in PTSD among soldiers exposed to combat who sought help from the Israel Combat Stress Reaction Unit. Method: This cross-sectional study involved 927 individuals who participated in a particular military operation in 2014 [98.5% male (n = 906); mean age = 27.08 (SD = 5.93)]. Participants completed three questionnaires: the Dissociative Experiences Scale (DES), the Beck Depression Inventory (BDI), and the Post-Traumatic Stress Symptom Checklist (PCL-5) for PTSD. Results: Our results showed that severe PTSD (PCL score ≥ 33) was found in 30.4% of participants, and 76.6% showed dissociative symptoms (DES score ≥ 30). Additionally, 23.5% experienced moderate depression, while 19.1% reported severe depressive symptoms. A Generalized Linear Model revealed that both depression and dissociation significantly contribute to PTSD. Individuals with depression were three times more likely to experience post-traumatic symptoms compared to 1.23 times for those with dissociative symptoms. Conclusions: Life-threatening situations significantly predicted higher PTSD symptoms, serving as a risk factor for depression and dissociation, which play important roles in PTSD, with depression having notably greater impact. Full article

(This article belongs to the Special Issue Mental Health and Psychological Resilience: The Mental Health Burden of Terrorism, Epidemiology, Risk Factors and Global Disparities)

17 pages, 316 KiB

Open AccessArticle

Exploring Sedentary and Nutritional Behaviour Patterns in Relation to Overweight and Obesity Among Youth from Different Demographic Backgrounds in Saudi Arabia

by Anwar Al-Nuaim and Ayazullah Safi

Int. J. Environ. Res. Public Health 2025, 22(5), 813; https://doi.org/10.3390/ijerph22050813 - 21 May 2025

Abstract

Background: The prevalence of overweight and obesity has increased over the last three decades, becoming a major public health concern. This issue is particularly pressing in terms of the impact it has on the population of the Kingdom of Saudi Arabia (KSA). Thus, [...] Read more.

Background: The prevalence of overweight and obesity has increased over the last three decades, becoming a major public health concern. This issue is particularly pressing in terms of the impact it has on the population of the Kingdom of Saudi Arabia (KSA). Thus, the aim of this research was to explore the nutritional and lifestyle habits of youth in the Al-Ahsa region of the KSA. Methods: This cross-sectional study included a total of 1270 secondary-school boys and girls (15–19 years) from all five of the Al-Ahsa Governorate districts. BMI and waist circumference measurements were recorded using anthropometric measurements, and the lifestyle–Arab Teens Lifestyle Survey (ATLS) was used to measure sedentary and eating habits. Results: Chi-square analysis revealed that a higher proportion of females (90.68%) than males (79.18%) exceeded two hours of daily sedentary time. Frequent sugary drink consumption (>3 times per week) was similar in males (67.40%) and females (66.11%). Students from different geographical locations showed significant differences in exceeding cut-off scores for fast food (χ² = 24.503, p < 0.001), cakes/doughnuts (χ² = 8.414, p = 0.015), sweets/candy (χ² = 19.613, p < 0.001), and energy drinks (χ² = 21.650, p < 0.001). Conclusions: Al-Ahsa is the largest governorate in the KSA. It has some of the largest health risks regarding obesity and poor lifestyle habits. This study highlights the major need for future research and policy interventions. Full article

26 pages, 3068 KiB

Open AccessReview

Impact of Climate Change on Schistosomiasis Transmission and Distribution—Scoping Review

by Kwame Kumi Asare, Muhi-Deen Wonwana Mohammed, Yussif Owusu Aboagye, Kathrin Arndts and Manuel Ritter

Int. J. Environ. Res. Public Health 2025, 22(5), 812; https://doi.org/10.3390/ijerph22050812 - 21 May 2025

Abstract

Schistosomiasis, a neglected tropical disease caused by parasitic worms of the genus Schistosoma and transmitted through freshwater snails, affects over 200 million people worldwide. Climate change, through rising temperatures, altered rainfall patterns, and extreme weather events, is influencing the distribution and transmission dynamics [...] Read more.

Schistosomiasis, a neglected tropical disease caused by parasitic worms of the genus Schistosoma and transmitted through freshwater snails, affects over 200 million people worldwide. Climate change, through rising temperatures, altered rainfall patterns, and extreme weather events, is influencing the distribution and transmission dynamics of schistosomiasis. This scoping review examines the impact of climate change on schistosomiasis transmission and its implications for disease control. This review aims to synthesize current knowledge on the influence of climate variables (temperature, rainfall, water bodies) on snail populations, transmission dynamics, and the shifting geographic range of schistosomiasis. It also explores the potential effects of climate adaptation policies on disease control. The review follows the Arksey and O’Malley framework and PRISMA-ScR guidelines, including studies published from 2000 to 2024. Eligible studies were selected based on empirical data on climate change, schistosomiasis transmission, and snail dynamics. A two-stage study selection process was followed: title/abstract screening and full-text review. Data were extracted on environmental factors, snail population dynamics, transmission patterns, and climate adaptation strategies. Climate change is expected to increase schistosomiasis transmission in endemic regions like Sub-Saharan Africa, Southeast Asia, and South America, while some areas, such as parts of West Africa, may see reduced risk. Emerging hotspots were identified in regions not currently endemic. Climate adaptation policies, such as improved water management and early warning systems, were found effective in reducing transmission. Integrating climate adaptation strategies into schistosomiasis control programs is critical to mitigating the disease’s spread, particularly in emerging hotspots and shifting endemic areas. Full article

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26 pages, 1764 KiB

Open AccessReview

A Horizon Scan of Neurotechnology Innovations

by Shona Haston, Sean Gill, Katie Twentyman, Elizabeth Green, Opeyemi Agbeleye, Claire Eastaugh, Dawn Craig, Sonia Garcia Gonzalez-Moral and Andrew Mkwashi

Int. J. Environ. Res. Public Health 2025, 22(5), 811; https://doi.org/10.3390/ijerph22050811 - 21 May 2025

Abstract

Neurotechnology is a rapidly emerging field with vast potential within healthcare, but also has inherent concerns. There is, therefore, a need to ensure the responsible and ethical development and regulation of these technologies. This horizon scan aimed to provide an overview of neurotechnologies [...] Read more.

Neurotechnology is a rapidly emerging field with vast potential within healthcare, but also has inherent concerns. There is, therefore, a need to ensure the responsible and ethical development and regulation of these technologies. This horizon scan aimed to provide an overview of neurotechnologies in development and those approved by the FDA as of June 2024 for a range of conditions relating to mental health, healthy ageing, and physical disability. Searches of clinical trials, conferences, journals, and news were performed in March 2024. Relevant technologies were identified through a process of screening, data extraction and synthesis. A total of 81 unique neurotechnologies were identified, with 23 relating to mental health, 31 to healthy ageing, and 42 to physical disability. A total of 79% percent did not yet have FDA approval and 77.4% were at earlier stages of development (pilot/feasibility studies), with 22.6% at pivotal or post-market stages. Digital elements were common features of the technologies, including software, apps, and connectivity to other devices; however, there were only three technologies with an identifiable AI component. A complex regulatory landscape and unique ethical and safety concerns associated with neurotechnology could pose challenges to innovators, though the emerging nature of the field also provides an opportunity to pre-emptively address potential issues. Full article

(This article belongs to the Special Issue Digital Innovations for Health Promotion)

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International Journal of Environmental Research and Public Health

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