International Journal of Environmental Research and Public Health

27 pages, 524 KiB

Open AccessArticle

Examining Perceptions Among Healthcare Providers on Their Awareness of and Experience with Prescribing and/or Referring Pre-Exposure Prophylaxis to Eligible Cisgender Black Female Patients: A Qualitative Inquiry

by Mandy J. Hill, Amber I. Sophus, Sarah Sapp, Jeffrey Campbell, Diane Santa Maria and Jamila K. Stockman

Int. J. Environ. Res. Public Health 2025, 22(3), 450; https://doi.org/10.3390/ijerph22030450 - 18 Mar 2025

Abstract

Prescriptions for and use of pre-exposure prophylaxis (PrEP), an available and accessible HIV prevention strategy, remain low among cisgender Black women (CBW). Given PrEP is only available through a prescription from a licensed healthcare provider (HCP), there is a need to identify factors [...] Read more.

Prescriptions for and use of pre-exposure prophylaxis (PrEP), an available and accessible HIV prevention strategy, remain low among cisgender Black women (CBW). Given PrEP is only available through a prescription from a licensed healthcare provider (HCP), there is a need to identify factors associated with HCP’s prescribing and/or referring PrEP to CBW. Qualitative methods (in-depth interviews) were used to examine factors shaping beliefs and behaviors among 12 HCPs that impact their willingness to prescribe or refer PrEP to CBW. Seven primary themes were identified during a thematic data analysis. The themes with the highest frequency of codes (fc) were the provider’s experience discussing sexual health (fc = 284), the provider approach to patient engagement (fc = 240), provider knowledge of PrEP (fc = 158), and the provider approach to determining PrEP eligibility (fc = 141). Findings indicate that prescribing and referral behaviors among HCPs can be influenced by their knowledge of PrEP; perceptions about PrEP for patients; comfort level in engaging/communicating with patients about PrEP; awareness of PrEP resources needed to improve PrEP access among patients; and patient–provider communication relative to sexual health, HIV vulnerability, and PrEP eligibility. Study findings illuminate how usual care practices contribute to gaps in PrEP access among CBW and highlight areas for intervention. Full article

(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)

15 pages, 612 KiB

Open AccessReview

Machine Learning in Predicting Child Malnutrition: A Meta-Analysis of Demographic and Health Surveys Data

by Bhagyajyothi Rao, Muhammad Rashid, Md Gulzarull Hasan and Girish Thunga

Int. J. Environ. Res. Public Health 2025, 22(3), 449; https://doi.org/10.3390/ijerph22030449 - 18 Mar 2025

Abstract

Background: Childhood malnutrition remains a significant global public health concern. The Demographic and Health Surveys (DHS) program provides specific data on child health across numerous countries. This meta-analysis aims to comprehensively assess machine learning (ML) applications in DHS data to predict malnutrition in [...] Read more.

Background: Childhood malnutrition remains a significant global public health concern. The Demographic and Health Surveys (DHS) program provides specific data on child health across numerous countries. This meta-analysis aims to comprehensively assess machine learning (ML) applications in DHS data to predict malnutrition in children. Methods: A comprehensive search of the peer-reviewed literature in PubMed, Embase, and Scopus databases was conducted in January 2024. Studies employing ML algorithms on DHS data to predict malnutrition in children under 5 years were included. Using PROBAST (Prediction model Risk Of Bias Assessment Tool), the quality of the listed studies was evaluated. To conduct meta-analyses, Review Manager 5.4 was used. Results: A total of 11 out of 789 studies were included in this review. The studies were published between 2019 and 2023, with the major contribution from Bangladesh (n = 6, 55%). Of these, ten studies reported stunting, three reported wasting, and four reported underweight. A meta-analysis of ten studies reported a pooled accuracy of 68.92% (95% CI: 66.04, 71.80; I² = 100%) among ML models for predicting stunting in children. Three studies indicated a pooled accuracy of 84.39% (95% CI: 80.90, 87.87; I² = 100%) in predicting wasting. A meta-analysis of four studies indicated a pooled accuracy of 73.60% (95% CI: 70.01, 77.20; I² = 100%) for ML models predicting underweight status in children. Conclusions: This meta-analysis indicated that ML models were observed to have moderate to good performance metrics in predicting malnutrition using DHS data among children under five years. Full article

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18 pages, 832 KiB

Open AccessArticle

Extending a COVID-19 Job Exposure Matrix: The SARS-CoV-2 or COVID-19 Job Exposure Matrix Module (SCoVJEM Module) for Population-Based Studies

by Ximena P. Vergara, Kathryn Gibb, David P. Bui, Elisabeth Gebreegziabher, Elon Ullman and Kyle Peerless

Int. J. Environ. Res. Public Health 2025, 22(3), 448; https://doi.org/10.3390/ijerph22030448 - 18 Mar 2025

Abstract

The risk of workplace SARS-CoV-2 transmission is increased by aerosolization or droplets and increased respiratory rates or increased viral stability in cold environments. Few methods exist for identifying occupational risks of SARS-CoV-2 transmission. We extended a SARS-CoV-2 job exposure matrix (JEM) into four [...] Read more.

The risk of workplace SARS-CoV-2 transmission is increased by aerosolization or droplets and increased respiratory rates or increased viral stability in cold environments. Few methods exist for identifying occupational risks of SARS-CoV-2 transmission. We extended a SARS-CoV-2 job exposure matrix (JEM) into four dimensions, talking loudly (Loud) (very loud, loud, somewhat loud, or not), physical activity (PA) (high, medium or low), and cold (Cold) (cold or not) and hot environments (Hot) (hot or not), using data from the Occupational Information Network (O*NET) and a priori questions for each and noise measurements for 535 occupations. We classified 70%+ occupations as loud or very loud (74.6%); whereas 13.8% were high PA, 18.5% exposed to cold, and 23.7% exposed to hot temperatures. Applying to California 2019 workforce data to explore by race/ethnicity and sex, we found 21.2% worked in very loud and 12.6% in high PA occupations and 15.7% in cold and 17.8% hot environments. Latino workers were highly represented in very loud and high PA levels among farming (83.8 and 78.4%) and construction (58.7% and 50.3%). More males worked in each highest exposure level than females. This JEM provides aerosol transmission proxies for COVID-19 risk factors and merits investigation as a tool for epidemiologic studies. Full article

(This article belongs to the Special Issue Health-Related Risk Caused by Occupational Environmental Exposure)

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11 pages, 2215 KiB

Open AccessArticle

Parent-Reported Health-Related Quality of Life (HRQoL) of NICU Graduates in Their First Year: A Prospective Cohort Study

by Parel Heuvink, Nienke H. van Dokkum, Koenraad N. J. A. Van Braeckel, Helene A. Bouma, Karianne E. Kraft, Arend F. Bos and Paul F. M. Krabbe

Int. J. Environ. Res. Public Health 2025, 22(3), 447; https://doi.org/10.3390/ijerph22030447 - 17 Mar 2025

Abstract

Health-related quality of life (HRQoL) in neonatal intensive care unit (NICU) graduates during the first year after birth is unknown. Gaining more insight into parental perspectives on HRQoL in this group may aid healthcare professionals in follow-up care. We aimed to assess HRQoL [...] Read more.

Health-related quality of life (HRQoL) in neonatal intensive care unit (NICU) graduates during the first year after birth is unknown. Gaining more insight into parental perspectives on HRQoL in this group may aid healthcare professionals in follow-up care. We aimed to assess HRQoL of NICU graduates during their first year after birth from a parental perspective using the newly developed Infant Quality of Life Instrument mobile application questionnaire. This was a prospective cohort study including NICU graduates of all gestational ages (N = 108). We assessed which of seven HRQoL domains, Sleeping, Feeding, Breathing, Stooling, Mood, Skin, and Interaction, proved most problematic during infants’ first year after birth and whether there were differences between the gestational age groups. The three domains proving most problematic from the parents’ perspective were Feeding (ranging from 14% to 43%), Sleeping (ranging from 23% to 42%), and Interaction (decreasing from 86% to 19%). The trajectories of extremely preterm infants were more frequently problematic than those of other groups. Healthcare professionals should focus on these most problematic domains in their follow-up care. Full article

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24 pages, 4776 KiB

Open AccessArticle

Spatial Analysis of HIV Determinants Among Females Aged 15–34 in KwaZulu Natal, South Africa: A Bayesian Spatial Logistic Regression Model

by Exaverio Chireshe, Retius Chifurira, Knowledge Chinhamu, Jesca Mercy Batidzirai and Ayesha B. M. Kharsany

Int. J. Environ. Res. Public Health 2025, 22(3), 446; https://doi.org/10.3390/ijerph22030446 - 17 Mar 2025

Abstract

HIV remains a major public health challenge in sub-Saharan Africa, with South Africa bearing the highest burden. This study confirms that KwaZulu-Natal (KZN) is a hotspot, with a high HIV prevalence of 47.4% (95% CI: 45.7–49.1) among females aged 15–34. We investigated the [...] Read more.

HIV remains a major public health challenge in sub-Saharan Africa, with South Africa bearing the highest burden. This study confirms that KwaZulu-Natal (KZN) is a hotspot, with a high HIV prevalence of 47.4% (95% CI: 45.7–49.1) among females aged 15–34. We investigated the spatial distribution and key socio-demographic, behavioural, and economic factors associated with HIV prevalence in this group using a Bayesian spatial logistic regression model. Secondary data from 3324 females in the HIV Incidence Provincial Surveillance System (HIPSS) (2014–2015) in uMgungundlovu District, KZN, were analysed. Bayesian spatial models fitted using the Integrated Nested Laplace Approximation (INLA) identified key predictors and spatial clusters of HIV prevalence. The results showed that age, education, marital status, income, alcohol use, condom use, and number of sexual partners significantly influenced HIV prevalence. Older age groups (20–34 years), alcohol use, multiple partners, and STI/TB diagnosis increased HIV risk, while tertiary education and condom use were protective. Two HIV hotspots were identified, with one near Greater Edendale being statistically significant. The findings highlight the need for targeted, context-specific interventions to reduce HIV transmission among young females in KZN. Full article

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19 pages, 1477 KiB

Open AccessArticle

“Understand the Way We Walk Our Life”: Indigenous Patients’ Experiences and Recommendations for Healthcare in the United States

by Melissa E. Lewis, Ivy Blackmore, Martina L. Kamaka, Sky Wildcat, Amber Anderson-Buettner, Elizabeth Modde, Laurelle Myhra, Jamie B. Smith and Antony L. Stately

Int. J. Environ. Res. Public Health 2025, 22(3), 445; https://doi.org/10.3390/ijerph22030445 - 17 Mar 2025

Abstract

Background: The quality of healthcare experiences for Indigenous communities is worse when compared to non-Indigenous patients. Bias and discrimination within healthcare systems relate to worsened care and worsened health outcomes for Indigenous patients. The purpose of this study was to learn about the [...] Read more.

Background: The quality of healthcare experiences for Indigenous communities is worse when compared to non-Indigenous patients. Bias and discrimination within healthcare systems relate to worsened care and worsened health outcomes for Indigenous patients. The purpose of this study was to learn about the experiences of Indigenous people within healthcare settings, as well as their viewpoints for improving healthcare delivery to this population. Methods: Indigenous research methods were employed in this study as clinic administrators and staff, elders, and Indigenous researchers collaborated on the study purpose, design, and analysis. Twenty Indigenous patients participated in one of four focus groups regarding their experiences with healthcare systems. Results: Seven main themes emerged, highlighting participants’ experiences during health encounters, in relation to healthcare systems, and Indigenous health beliefs. Participants discussed challenges and barriers in each area and offered recommendations for care delivery to this population. Conclusions: Participants in this study highlighted that biased care results in poor quality of healthcare delivery and that there are actionable steps that providers and systems of healthcare can take to reduce bias within healthcare systems. The provision of culturally congruent care is imperative in improving the health and well-being of Indigenous communities. Full article

(This article belongs to the Special Issue Advances in Indigenous and American Indian and Alaska Native Health and Wellness)

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13 pages, 2890 KiB

Open AccessArticle

Violet Light Is Abundant Outdoors but Deficient Indoors in Modern Lifestyle in Tokyo

by Shinichiro Kondo, Xiaoyan Jiang, Hidemasa Torii, Kiwako Mori, Kazuno Negishi, Toshihide Kurihara and Kazuo Tsubota

Int. J. Environ. Res. Public Health 2025, 22(3), 444; https://doi.org/10.3390/ijerph22030444 - 17 Mar 2025

Abstract

This study examines the role of violet light (VL) in preventing myopia progression, addressing a critical need in urban environments where VL exposure is limited. Recent research suggests that VL, within the 360–400 nm wavelength range, may reduce myopia risk. To investigate, we [...] Read more.

This study examines the role of violet light (VL) in preventing myopia progression, addressing a critical need in urban environments where VL exposure is limited. Recent research suggests that VL, within the 360–400 nm wavelength range, may reduce myopia risk. To investigate, we conducted spectroscopic measurements in various settings across Tokyo, quantifying VL irradiance in natural sunlight. The results showed high VL levels outdoors, averaging 583 μW/cm² on sunny days and 271 μW/cm² on cloudy days, leading to a weighted annual average of approximately 310 μW/cm². In contrast, indoor environments lacked VL due to UV-blocking materials in windows, glasses, and lighting. This deficiency may contribute to the rising incidence of myopia, particularly in urban areas with reduced outdoor exposure. Our findings highlight the need for innovative solutions to mitigate VL deficiency indoors, such as optimizing architectural designs and artificial lighting to better incorporate VL. This study provides foundational insights for future interventions aimed at reducing myopia risk through improved indoor light environments. Full article

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19 pages, 474 KiB

Open AccessArticle

Navigating Digital Geographies and Trauma Contexts: Conceptions of Online Communities and Experiences Among LGBTQ+ People During COVID-19

by Rachel M. Schmitz, Jennifer Tabler, Ruby Charak, Gabby Gomez, Reagan E. Cole and Joshua J. Schmitz

Int. J. Environ. Res. Public Health 2025, 22(3), 443; https://doi.org/10.3390/ijerph22030443 - 17 Mar 2025

Abstract

The coronavirus pandemic shaped challenges for marginalized groups. Specifically, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people experienced community-building constraints, notably in predominantly rural regions. People are also navigating digital geographies, or online social environments, in novel ways to develop virtual communities in [...] Read more.

The coronavirus pandemic shaped challenges for marginalized groups. Specifically, lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) people experienced community-building constraints, notably in predominantly rural regions. People are also navigating digital geographies, or online social environments, in novel ways to develop virtual communities in the face of prejudice, discrimination, and potential trauma. Through a minority coping approach, the present study explored LGBTQ+ people’s experiences navigating the dynamics of digital geographies during the pandemic while residing in socially conservative, highly rural physical spaces where they may be exposed to vicarious trauma. Using qualitative semi-structured interviews, data were gathered from 43 LGBTQ+ identifying individuals between 19 and 59 years old (M/SD = 27.7/9.2) between October 2020 and January 2021. Nearly 14% identified as transgender, nonbinary, or queer individuals, 35% as bisexual individuals, and 21% as people of color including Hispanic/Latina/o. Thematic analysis of the narratives described participants’ exposures to online discrimination and stigmatization of minority groups (racial and/or sexual/gender minority groups) during the COVID-19 pandemic, institutional constraints to identity expression, utilizing social technologies to manage their identities, and negotiating digital strategies to promote social ties. Findings emphasize improving marginalized people’s experiences with digital geographies through identity affirmation and community relationship-building to offset potentially traumatic experiences. Furthermore, service providers can utilize the findings to tailor effective virtual LGBTQ+ community programming to support underserved, marginalized populations. Full article

(This article belongs to the Special Issue Mental Health Challenges Affecting LGBTQ+ Individuals and Communities)

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18 pages, 338 KiB

Open AccessArticle

Assessment of Knowledge of Celiac Disease and Associated Conditions Among Dietitians in Jordan

by Hala K. Nawaiseh, Lisako J. McKyer, Dana N. Abdelrahim, Hayder A. Al-Domi, Furat K. AL-Nawaiseh, Mohammad S. AL-Assaf and Shatha A. Abu AL-Nadi

Int. J. Environ. Res. Public Health 2025, 22(3), 442; https://doi.org/10.3390/ijerph22030442 - 17 Mar 2025

Abstract

Background: Celiac disease (CD) is a type of systemic autoimmune condition triggered by gluten consumption among genetically predisposed individuals. Aim: To assess the knowledge, awareness, and practices pertaining to CD and associated conditions among dietitians in Jordan. Method: A cross-sectional web-based survey was [...] Read more.

Background: Celiac disease (CD) is a type of systemic autoimmune condition triggered by gluten consumption among genetically predisposed individuals. Aim: To assess the knowledge, awareness, and practices pertaining to CD and associated conditions among dietitians in Jordan. Method: A cross-sectional web-based survey was carried out between April and October 2023. The survey was an internet-based questionnaire with closed-ended questions. Results: The majority of dietitians answered correctly that CD is caused due to an immunological reaction to gluten, gliadin, and protamine (91.7%); it is an autoimmune disease (71.2%); and the risk of developing an autoimmune disease is higher among CD patients (78.8). The majority of respondents (93.6%) correctly identified that a strict gluten-free diet is the treatment approach for CD patients. However, only (18.9%) of dietitians correctly identified the FDA guidelines for “Gluten Free” food labeling. Approximately 53.4% of respondents identified immunoglobulin (IgA) antibody testing as the most reliable way to diagnose patients with CD. Conclusions: The dietitians have a good understanding of CD topics. The development of credentials in CD would ensure that dietitians practicing in CD are skilled. Full article

15 pages, 285 KiB

Open AccessArticle

Can a One-Time Subtle Attachment Security Priming Impact Outcomes in the Real World?

by Omri Gillath, Bruce S. Liese and Gery C. Karantzas

Int. J. Environ. Res. Public Health 2025, 22(3), 441; https://doi.org/10.3390/ijerph22030441 - 17 Mar 2025

Abstract

Although research exists on the impact of security priming, the vast majority of studies have been conducted in the laboratory and used repeated prime/priming sessions. The studies described in this paper test whether attachment security priming impacts people’s sense of security and related [...] Read more.

Although research exists on the impact of security priming, the vast majority of studies have been conducted in the laboratory and used repeated prime/priming sessions. The studies described in this paper test whether attachment security priming impacts people’s sense of security and related behaviors in the real world following a single exposure to a security prime. In the first two studies, participants were indirectly exposed to either security or control cues. In Study 1 (n = 53), exposure to security cues via posters near the entrance to the building where the study took place led to a higher sense of state security. In Study 2 (n~21,000), the same security primes (posters) led to a greater tendency to engage in helping behavior. In Study 3 (n = 200), exposure to similar security primes, embedded in a self-help guide, increased people’s positive evaluations of the health guide, which is known to be related to higher adherence to treatment. The implications for day-to-day security, well-being, and health are discussed. Full article

(This article belongs to the Special Issue Advances in Attachment Processes in Adolescence and Adulthood: Contexts and Developmental Trajectories at Risk)

16 pages, 591 KiB

Open AccessReview

Impact of Traditional Dance and Games on Cardiovascular Health: A Scoping Review of Outcomes Across Diverse Low- and Middle-Income Countries

by Adiele Dube, Ina Shaw, Musa L. Mathunjwa and Brandon S. Shaw

Int. J. Environ. Res. Public Health 2025, 22(3), 440; https://doi.org/10.3390/ijerph22030440 - 17 Mar 2025

Abstract

In low- and middle-income countries (LMICs), where healthcare resources may be limited, the elderly are especially vulnerable to the adverse effects of cardiovascular diseases (CVDs). The aging population in these regions presents unique challenges, highlighting the urgent need for effective, accessible, and culturally [...] Read more.

In low- and middle-income countries (LMICs), where healthcare resources may be limited, the elderly are especially vulnerable to the adverse effects of cardiovascular diseases (CVDs). The aging population in these regions presents unique challenges, highlighting the urgent need for effective, accessible, and culturally appropriate interventions to address this cardiovascular health challenge in older adults. We aimed to evaluate the impact of traditional dance and games on cardiovascular health outcomes in LMICs through a scoping review of existing literature. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, Scopus, ProQuest, EBSCO, SPORT Discuss, Web of Science, and the grey literature were searched from 2000 to 20 September 2024. Two reviewers independently screened the titles, abstracts, and full texts and conducted data extraction. All conflicts were resolved with a third reviewer. A total of 3465 records were identified, of which 12 full-text articles were included in the review. The studies, five randomised clinical trials and seven non-randomised clinical trials, included varied age groups and populations including healthy, sedentary and obese participants. The interventions were traditional dance and games interventions with some extension to nutrition education. All the interventions were short term, with less than 6 months follow-up. Any traditional dance styles and games that involve physical performance can induce positive health outcomes. Undertaking traditional dance and games (TDGs) is equally effective on cardiovascular, functional and metabolic adaptations, leading to comparable improvements in older adults as for other forms of structured exercise. Collaboration of health practitioners, legislators, non-governmental agencies and local communities in LMICs in using TDGs may reduce the burden of CVDs. Full article

(This article belongs to the Special Issue 2nd Edition: Physical Therapy in Geriatrics)

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14 pages, 298 KiB

Open AccessReview

Human Papillomavirus: A Narrative Review for Dental Providers in Prevention and Care

by Martin S. Lipsky, Geo Wolfe, Brisa A. Radilla and Man Hung

Int. J. Environ. Res. Public Health 2025, 22(3), 439; https://doi.org/10.3390/ijerph22030439 - 17 Mar 2025

Abstract

(1) Introduction: Human papillomavirus (HPV) is a significant public health concern associated with various cancers, including a rising incidence of oropharyngeal cancer (OPC). Despite the availability of effective vaccines targeting high-risk HPV types, vaccination rates remain suboptimal. Dental professionals are uniquely positioned to [...] Read more.

(1) Introduction: Human papillomavirus (HPV) is a significant public health concern associated with various cancers, including a rising incidence of oropharyngeal cancer (OPC). Despite the availability of effective vaccines targeting high-risk HPV types, vaccination rates remain suboptimal. Dental professionals are uniquely positioned to contribute to HPV prevention through education, vaccination advocacy, and early detection. (2) Methods: This narrative review synthesized the literature from 2006 to 2024 on HPV epidemiology, pathophysiology, vaccine efficacy, and the role of dental providers in HPV prevention. Sources included peer-reviewed articles listed in Pubmed and Google Scholar, including observational studies and review articles, guidelines, clinical trials, and governmental data. Key barriers to HPV-related care in dental practice and strategies for overcoming them were analyzed. (3) Results: The review underscores the critical role of dentists in HPV-related disease prevention, highlighting their ability to detect HPV-related lesions, promote vaccine uptake, and address patient concerns. Barriers such as limited knowledge, discomfort discussing HPV, and misinformation were identified. Strategies like incorporating HPV education into dental training, utilizing emerging diagnostic tools, and adopting effective communication approaches can enhance the role of dental professionals in reducing HPV-associated cancer risks. (4) Conclusion: By integrating HPV education, vaccination advocacy, and early detection into routine dental care, dental professionals can play a transformative role in public health. A dental provider’s endorsement can increase HPV vaccine uptake and help prevent oral cancer. These efforts align with broader health promotion goals, offering a significant opportunity to reduce the burden of HPV-associated cancers and improve long-term patient outcomes. Full article

(This article belongs to the Special Issue Oral Diseases: Prevention, Diagnosis and Treatment)

14 pages, 283 KiB

Open AccessArticle

The Impact of Home Interventions on Dry Eye Disease (DED) Symptoms and Signs in United States Veterans

by Drew C. Baeza, Johnathon Z. Penso, Dhariyat M. Menendez, Julio A. Contreras, Jr., Sarah Rock, Anat Galor and Naresh Kumar

Int. J. Environ. Res. Public Health 2025, 22(3), 438; https://doi.org/10.3390/ijerph22030438 - 17 Mar 2025

Abstract

Background: The indoor environment can contribute to dry eye disease (DED) risk, but the effects of environmental modifications on disease are still uncertain. This study evaluated the effect of home interventions that modify the indoor environment on DED symptoms and sign severity. Methods: [...] Read more.

Background: The indoor environment can contribute to dry eye disease (DED) risk, but the effects of environmental modifications on disease are still uncertain. This study evaluated the effect of home interventions that modify the indoor environment on DED symptoms and sign severity. Methods: The prospective study consisted of two visits (6 ± 1 months apart). At each home visit, indoor environmental conditions (temperature, humidity, and airborne particulate matter) were monitored and at each clinical visit, DED symptoms and signs were examined. After the first visit, all participants received a report of their home air quality and 10 recommendations to improve their home environment. At the 6-month visit, participants indicated which interventions they implemented. Results: A total of 99 subjects participated in the clinical evaluation and home monitoring at baseline and six-month follow-up. Their mean age was 61 years, and 26% identified as Hispanic. Most had mild or greater DED symptoms (5-Item Dry Eye Questionnaire, DEQ5 ≥ 6), with an average DEQ5 score of 10.49 ± 5.51 at baseline. In total, 77% (n = 76) implemented ≥1 intervention with home ventilation (42.4%), air conditioner filter change (36.4%), and exhaust fan use (31.3%) being the most frequent. Overall, with every intervention implemented, tear osmolarity (change from baseline to 6 months) declined by 2% (log-transformed β = 0.02; 95% confidence interval (CI) = 0.00–0.03; p < 0.05), and Meibomian gland (MG) plugging declined by 14% (log-transformed β = 0.14; CI = 0.05–24; p < 0.05). Specific interventions had specific impacts on DED signs and symptoms. For example, osmolarity declined by a greater degree in those that implemented home ventilation, while DED symptoms improved to a greater degree in those that utilized indoor plants compared to those that did not implement these interventions. Conclusions: When provided with an objective report of home environmental conditions and remediation strategies, most participants voluntarily implemented low-cost home interventions, which reduced the severity of select DED symptoms and signs. Full article

(This article belongs to the Special Issue Influence of the Environment on Ocular Diseases)

12 pages, 507 KiB

Open AccessArticle

Characteristics of Community-Dwelling Older People Who Are Less Likely to Respond to Mail Surveys Under Infection Countermeasures for New Strains of Coronavirus: The Takasaki Study

by Akihiko Murayama, Daisuke Higuchi, Kosuke Saida, Shigeya Tanaka and Tomoyuki Shinohara

Int. J. Environ. Res. Public Health 2025, 22(3), 437; https://doi.org/10.3390/ijerph22030437 - 16 Mar 2025

Abstract

This study aimed to identify the characteristics of community-dwelling older people who are difficult to reach by mail survey in anticipation of a future infectious disease crisis. A baseline survey of 1808 community-dwelling older people was conducted in May 2021, and a follow-up [...] Read more.

This study aimed to identify the characteristics of community-dwelling older people who are difficult to reach by mail survey in anticipation of a future infectious disease crisis. A baseline survey of 1808 community-dwelling older people was conducted in May 2021, and a follow-up survey of 935 respondents was conducted in May 2023. Factors predictive of responding to the follow-up survey included age at baseline, sex, comorbidities, living with family, long-term care insurance, a history of falls, the Simple Frailty Index, and a Questionnaire on Changes in Lifestyle in the Past Month (QCL). Participants were divided into the responding (n = 330) and non-responding (n = 605) groups. Binomial logistic regression analysis was used to analyze items that showed significant differences in the between-group comparison: odds ratios (ORs) of 2.36, 1.84, 1.69, 1.57, and 1.20 for living alone, having comorbidities, having long-term care insurance, fatigue, and reduced ability to communicate, respectively. If social distancing is required in the future, we believe that face-to-face support should be prioritized for people who live alone, have comorbidities, use long-term care insurance, or are aware of fatigue and limited communication, as it is highly unlikely that they will be able to continue exchanging written information. Full article

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20 pages, 2481 KiB

Open AccessArticle

Impact of Transitioning to Treated Water on Diarrhea Reduction: A Cross-Sectional and Ecological Study in Southwestern Goiás, Brazil

by Laise Mazurek, Camila Botelho Miguel, Henrique Polizelli Pinto Neto, Eduardo Henrique Vieira Araujo, Melissa Carvalho Martins de Abreu, Jamil Miguel Neto, Glicélia Pereira Silva, Mariana Santos Cardoso, Siomar de Castro Soares, Aristóteles Góes-Neto, Carlo José Freire Oliveira and Wellington Francisco Rodrigues

Int. J. Environ. Res. Public Health 2025, 22(3), 436; https://doi.org/10.3390/ijerph22030436 - 16 Mar 2025

Abstract

Access to safe drinking water is a global challenge, with significant disparities affecting public health and quality of life. This study evaluated the relationship between specific water parameters, public satisfaction with treated water, and diarrhea incidence in Southwestern Goiás, Brazil. The objectives were [...] Read more.

Access to safe drinking water is a global challenge, with significant disparities affecting public health and quality of life. This study evaluated the relationship between specific water parameters, public satisfaction with treated water, and diarrhea incidence in Southwestern Goiás, Brazil. The objectives were (1) to assess water parameters, including aluminum, iron, manganese, pH, hardness, fecal coliforms, and turbidity, in samples from springs, streams, and municipal supplies; (2) to evaluate residents’ satisfaction with municipal water and their reliance on untreated water sources; and (3) to analyze the impact of transitioning from untreated to treated water following the closure of a spring in 2017 on diarrheal diseases. A longitudinal observational study reviewed diarrhea cases from 2013 to 2019. Treated water met potability standards, while untreated springs showed significant contamination. Dissatisfaction with treated water correlated strongly with continued reliance on untreated springs (p < 0.05), increasing the diarrhea risk nearly ninefold (OR = 8.78; 95% CI = 4.37–18.29). The findings underscore the importance of transitioning to treated water for mitigating diarrheal diseases and enhancing public trust in water safety. This study provides a replicable and scalable approach for improving water sanitation management, addressing waterborne diseases, and supporting public health interventions in diverse global contexts. Full article

(This article belongs to the Section Global Health)

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13 pages, 1160 KiB

Open AccessArticle

Fostering Mental Health Literacy Among Primary School Professionals: Evaluating the Impact of an Online Training Program ‘Well@School’

by Joonas Korhonen, Mari Lahti, Kostadin Kostadinov, Karmen Erjavec, Natalja Istomina, Svetla Ivanova, Areti Lagiou, Valentina Lalova, Monika Makutienė, Venetia Notara, Hanna Ollikkala, Gergana Petrova, Evanthia Sakellari, Daiva Sukyte and Camilla Laaksonen

Int. J. Environ. Res. Public Health 2025, 22(3), 435; https://doi.org/10.3390/ijerph22030435 - 15 Mar 2025

Abstract

Mental health challenges among children and adolescents have become a pressing global concern, particularly in the wake of the COVID-19 pandemic and ongoing geopolitical instability. Addressing these issues requires innovative, cost-effective strategies, with schools serving as critical platforms for mental health promotion. This [...] Read more.

Mental health challenges among children and adolescents have become a pressing global concern, particularly in the wake of the COVID-19 pandemic and ongoing geopolitical instability. Addressing these issues requires innovative, cost-effective strategies, with schools serving as critical platforms for mental health promotion. This study evaluates the impact of an online training program, Well@School, designed to enhance Mental Health Literacy (MHL) among primary school professionals in Finland, Lithuania, Bulgaria, Slovenia, and Greece. Using a descriptive, cross-sectional design with pre- and post-test assessments, the study involved 223 health, education, and social care professionals. The revised Mental Health Literacy Scale (MHLS) was employed to measure changes in MHL. Results indicated a significant positive effect, with an average increase of 4 points (2.5%) in MHLS scores post-course. Bayesian analysis further confirmed this improvement, showing a high probability (99.92%) of a positive impact, with the most likely gain ranging between 3 and 5 points. The findings underscore the potential of online training programs to enhance MHL among school professionals, thereby improving their capacity to support students’ mental health. This study highlights the importance of equipping primary school staff with the necessary skills to recognize and address mental health challenges, reduce stigma, and foster a supportive school environment. Full article

(This article belongs to the Special Issue Digital Mental Health: Changes, Challenges and Success Strategies)

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18 pages, 5508 KiB

Open AccessArticle

Heat Illness and Extreme Weather Health Literacy: Communication Preferences and Effectiveness for Patients Living in Climate-Change-Vulnerable Communities

by Todd L. Sack, Aran R. Thiravialingam, Carlos Suanes Zubizarreta, Robby Felix, Rita Kanazeh, Innah Lachica, Eddy Hernandez Cuesta, Alan Martin, Frederick Anderson and Cheryl Holder

Int. J. Environ. Res. Public Health 2025, 22(3), 434; https://doi.org/10.3390/ijerph22030434 - 14 Mar 2025

Abstract

Health professionals are trusted information sources and could be valuable for improving climate change health literacy. Few studies address teaching patients about health risks associated with climate change, and no studies have focused on the medical office waiting room as a teaching site [...] Read more.

Health professionals are trusted information sources and could be valuable for improving climate change health literacy. Few studies address teaching patients about health risks associated with climate change, and no studies have focused on the medical office waiting room as a teaching site for populations from heat-vulnerable neighborhoods. We gave adult patients in primary care office waiting rooms printed teaching materials about heat-related illnesses. We asked them to read these at home and then complete an online confidential survey concerning their preferences among teaching methods and their preferences for communication during health emergencies. Ninety-one surveys were received from patients residing in heat-vulnerable neighborhoods. Patients liked receiving information in waiting rooms. Printed brochures were favored statistically by patients, but other teaching methods that are feasible for waiting rooms also rated well, including single-page printed fliers, posters, and video screens. Digital options were far less favored. We conclude that printed teaching materials may improve decisions that impact human health. The medical office waiting room appears to be an accepted, time-efficient, and effective site to communicate knowledge on climate change and health. Additionally, medical offices could play a role supporting government agencies to communicate with patients during weather-related health emergencies. Full article

(This article belongs to the Special Issue The Effects of Extreme Temperature, Pollution, and Climate Change on Human Health)

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29 pages, 4497 KiB

Open AccessSystematic Review

Oral Health and Hygiene Status of Global Transgender Population: A Living Systematic Review and Meta-Analysis

by Vaibhav Kumar, Jasleen Thakker, Abhishek Royal, Nikhil Bhanushali and Ziad D. Baghdadi

Int. J. Environ. Res. Public Health 2025, 22(3), 433; https://doi.org/10.3390/ijerph22030433 - 14 Mar 2025

Abstract

Due to several interpersonal, social, and organizational challenges, dental health has been occasionally compromised in the transgender population. There is a lack of awareness among transgender persons to access affordable trans-competent oral health care. More information is required to identify and assess the [...] Read more.

Due to several interpersonal, social, and organizational challenges, dental health has been occasionally compromised in the transgender population. There is a lack of awareness among transgender persons to access affordable trans-competent oral health care. More information is required to identify and assess the oral health condition of this population in order to encourage better access to oral healthcare and effectively influence public health policy and practice. This systematic review aims to provide evidence about the status of oral health and hygiene of the transgender population across the globe. A systematic literature search using keywords and MESH search terms was conducted using PubMed, Medline, Google Scholar, and EBSCO online databases. The references of included journal articles were manually searched and appropriate studies were included, which were then critically appraised using the Joanna Briggs Institute (JBI) tool and the Newcastle–Ottawa protocol for the risk of bias assessment of prevalence studies, with each study assessed by two independent reviewers. Based on the search procedures, a total of 2026 articles were initially screened and, after evaluation, 20 were included in the systematic review. Transgender persons often face stigma and discrimination in dental healthcare settings, which affects their oral health status. A greater prevalence of substance abuse stemming from anxiety, lack of adequate education, and poor socioeconomic status leads to an increased prevalence of oral health diseases in this marginalized population. There is a need for policies and reforms to appraise their oral health and hygiene status and improve access to oral health services in this population. Full article

(This article belongs to the Section Health Care Sciences)

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11 pages, 932 KiB

Open AccessArticle

The Prevalence of Falls Among Older Adults Living in Long-Term Care Facilities in the City of Cape Town

by Nabilah Ebrahim and Lloyd Leach

Int. J. Environ. Res. Public Health 2025, 22(3), 432; https://doi.org/10.3390/ijerph22030432 - 14 Mar 2025

Abstract

Falls are a prevalent health concern with a multi-factorial origin and causing numerous complications for older adults, especially those in low- and middle-income countries, such as South Africa. This study aimed to determine the prevalence of falls among older adults living in different [...] Read more.

Falls are a prevalent health concern with a multi-factorial origin and causing numerous complications for older adults, especially those in low- and middle-income countries, such as South Africa. This study aimed to determine the prevalence of falls among older adults living in different types of long-term care facilities in the City of Cape Town. A total of 258 males and females aged between 60 and 95 years were recruited. Data collection occurred from September 2021 to January 2022. Participants were categorized into low, moderate, or high fall risk using the fall-risk assessment tool. Descriptive statistics summarized participant characteristics and fall prevalence. The chi-squared test determined significant associations between facility type, marital status, and educational level, and their relationship to falling. Spearman’s rank correlation coefficient assessed associations between fall occurrence and various risk factors. Findings indicated that the prevalence of falls was 32.6%. Falls were significantly associated with behaviors such as agitation or confusion, and other unmentioned risk factors. Participants living in facilities run by non-profit organizations, and who had a lower education level or were single or widowed, had a higher fall prevalence. The use of anti-depressant and anti-diabetic medications was significantly linked to increased fall risk. These findings can inform future research and the development of strategies to prevent falls among older adults, particularly in LTC facilities. Full article

(This article belongs to the Special Issue The Role of Physical Activity in Falls and Injury Prevention Among Older Adults)

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International Journal of Environmental Research and Public Health

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