International Journal of Environmental Research and Public Health

11 pages, 665 KB

Open AccessArticle

Effects of Combined Training on Visceral Adiposity Index and Metabolic Phenotype in Obesity: A Randomized Clinical Trial

by Júlia Elena Fontana Ronsani, Mariana Papini Gabiatti, Anne Ribeiro Streb, Rodrigo Sudatti Delevatti, Giovani Firpo Del Duca and Fernanda Hansen

Int. J. Environ. Res. Public Health 2025, 22(9), 1462; https://doi.org/10.3390/ijerph22091462 - 22 Sep 2025

Abstract

Introduction: The role of obesity in developing metabolic alterations is related to the distribution of adipose tissue, and visceral fat predisposes people to a higher risk than subcutaneous fat. The effect of different forms of periodization of combined training is still unknown [...] Read more.

Introduction: The role of obesity in developing metabolic alterations is related to the distribution of adipose tissue, and visceral fat predisposes people to a higher risk than subcutaneous fat. The effect of different forms of periodization of combined training is still unknown in reducing cardiometabolic risk in adults with obesity. This randomized clinical trial aims to compare the effects of 16 weeks of periodized combined training with fixed and linear increase intensities on individuals with obesity, using the visceral adiposity index (VAI) and metabolic phenotype. Methods: In total, 59 adults with obesity (61.0% female) were allocated into three groups: control (CG, 34.4 ± 6.9 years; BMI, 33.0 ± 2.5 kg.m⁻²), combined training with fixed intensity (FG, 33.6 ± 8.4 years; BMI, 32.9 ± 2.3 kg.m⁻²), and linear increase intensity (LG, 34.5 ± 6.0 years; BMI, 33.4 ± 2.8 kg.m⁻²) in a 1:1:1 ratio. VAI equations were used with waist circumference, triglycerides, BMI, and HDL-c. The metabolic phenotype was defined by the presence of >3 abnormalities of the following: systolic/diastolic blood pressure, triglycerides, HDL-c, fasting blood glucose, and waist circumference, classified as metabolically healthy and unhealthy (MHO; MUO). Intra- and intergroup analyses were performed per protocol (PP) and intention-to-treat (ITT) using the Generalized Estimated Equations method. p < 0.10 was the level of significance adopted for interaction, and p < 0.05 was the level of significance for the isolated effect of time and/or group. Results: VAI decreased in FG (p < 0.001) in PP and ITT analyses, but not in LG in either analysis (p > 0.05). There was a higher number of MUO in FG compared to LG, only in PP, considering the effect of group analysis (p < 0.01), but not of time or group * time or ITT analyses (p > 0.05). Conclusions: Combined training with fixed intensity improved VAI but was insufficient to affect metabolic phenotype. These findings suggest minimal differences between fixed intensity and linear increase protocols in reducing the risk of metabolic complications during obesity treatment. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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22 pages, 938 KB

Open AccessArticle

Associations of Place-Based Factors with Service Use and Consumer-Reported Unmet Service Needs Among Older Adults Using Publicly Funded Home- and Community-Based Services in the United States

by Tetyana P. Shippee, Romil R. Parikh, Nicholas Musinguzi, Benjamin W. Langworthy, Jack M. Wolf, Stephanie Giordano and Eric Jutkowitz

Int. J. Environ. Res. Public Health 2025, 22(9), 1461; https://doi.org/10.3390/ijerph22091461 - 22 Sep 2025

Abstract

Access to home- and community-based services (HCBS) is critical for aging in place; yet many older adults continue to experience unmet needs. While individual-level factors are better-studied, less is known about how neighborhood-level place-based factors (PBFs, e.g., poverty, housing conditions, transportation, and internet [...] Read more.

Access to home- and community-based services (HCBS) is critical for aging in place; yet many older adults continue to experience unmet needs. While individual-level factors are better-studied, less is known about how neighborhood-level place-based factors (PBFs, e.g., poverty, housing conditions, transportation, and internet access) shape access to and adequacy of HCBS. This study addresses that gap by examining the added explanatory value of PBFs in predicting HCBS use and unmet needs. We analyzed data from 6558 community-dwelling adults aged ≥ 65 years using the 2022–2023 National Core Indicators–Aging & Disability Adult Consumer Survey. Outcomes included use of six HCBS types, consumer-reported unmet needs for each type, and overall unmet HCBS needs. PBFs were measured at the ZIP code level using the 2016–2020 American Community Survey. Nested logistic regression models estimated incremental variance (McFadden’s R²) explained by PBFs, adjusting for individual demographics, health status, state, and proxy response. Adding PBFs increased explained variance by 7.98–22.70% for HCBS use, 35.92–48.00% for unmet needs by service type, and 51.85% for overall unmet HCBS needs. PBFs meaningfully influence both access to and adequacy of HCBS. Using PBFs to guide resource allocation and targeting modifiable PBFs could improve HCBS access and efficiency. Full article

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14 pages, 517 KB

Open AccessProtocol

Designing, Developing, and Evaluating a Stakeholder-Informed Mobile App to Promote Physical Activity in Children

by Olga Papale, Emanuel Festino, Lamprini Papargyri, Cristina Cortis and Andrea Fusco

Int. J. Environ. Res. Public Health 2025, 22(9), 1460; https://doi.org/10.3390/ijerph22091460 - 20 Sep 2025

Abstract

Background: Prolonged sedentary behavior and associated obesity are recognized risk factors for poor health across the lifespan. Globally, data show that many children and adolescents aged 5 to 17 significantly increased their sedentary behaviors during the COVID-19 pandemic, failing to meet recommended physical [...] Read more.

Background: Prolonged sedentary behavior and associated obesity are recognized risk factors for poor health across the lifespan. Globally, data show that many children and adolescents aged 5 to 17 significantly increased their sedentary behaviors during the COVID-19 pandemic, failing to meet recommended physical activity levels and reporting increased smartphone use. While mobile devices and video games have been traditionally linked to physical inactivity, formats like exergaming, which combine gameplay with gross motor activity, offer potential to promote physical activity. However, many digital health tools for children are developed without incorporating feedback from key stakeholders and end-users (e.g., children, teachers, and guardians). Therefore, this paper, within the Walk around the Earth (E-Walk) project, describes a prospective study that aims (1) to identify the most influential factors or characteristics affecting engagement with and usability of a mobile application promoting physical activity among primary school students; (2) to develop a mobile application for children based on the identified factors and characteristics. Methods: This project will use a group concept mapping approach to identify the most influential features/factors/characteristics affecting engagement with and usability of an app. By involving primary stakeholders (e.g., children, teachers, guardians, and physical activity experts), the project seeks to align the app’s features with primary end-user needs and motivations. Following the app’s development, its effectiveness in increasing physical activity levels and reducing sedentary behaviors will be evaluated through a mixed-method design, incorporating anthropometric data, validated physical activity questionnaires (Physical Activity Questionnaire for Older Children (PAQ-C) and International Physical Activity Questionnaire (IPAQ)), and engagement metrics. Conclusions: The E-Walk project integrates participatory design with educational content and activity-based challenges, representing a multidimensional strategy for promoting health and learning in primary school students. Ultimately, this study contributes to the development of user-informed digital interventions that support sustainable behavioral changes, in line with broader goals of child well-being and digital health promotion. Full article

(This article belongs to the Special Issue Healthy Child, Healthy Adult—Children’s Nutrition and Physical Activity as a Public Health Concern)

24 pages, 830 KB

Open AccessReview

Strengthening Jordan’s Laboratory Capacity for Communicable Diseases: A Comprehensive Multi-Method Mapping Toward Harmonized National Laboratories and Evidence-Informed Public Health Planning

by Dalia Kashef Zayed, Ruba A. Al-Smadi, Mohammad Almaayteh, Thekryat Al-Hjouj, Ola Hamdan, Ammar Abu Ghalyoun, Omar Alsaleh, Tariq Abu Touk, Saddam Nawaf Almaseidin, Thaira Madi, Samar Khaled Hassan, Muna Horabi, Adel Belbiesi, Tareq L. Mukattash and Ala’a B. Al-Tammemi

Int. J. Environ. Res. Public Health 2025, 22(9), 1459; https://doi.org/10.3390/ijerph22091459 - 20 Sep 2025

Abstract

Infectious diseases remain a global threat, with low- and middle-income countries disproportionately affected due to socio-economic and demographic vulnerabilities. Robust laboratory systems are critical for early detection, outbreak containment, and guiding effective interventions. This study aimed to map and evaluate Jordan’s laboratory diagnostic [...] Read more.

Infectious diseases remain a global threat, with low- and middle-income countries disproportionately affected due to socio-economic and demographic vulnerabilities. Robust laboratory systems are critical for early detection, outbreak containment, and guiding effective interventions. This study aimed to map and evaluate Jordan’s laboratory diagnostic network for communicable diseases, identify gaps, and recommend strategies to strengthen capacity, harmonization, and alignment with international standards. A multi-method approach was employed in 2023 through collaboration between the Jordan Center for Disease Control and the Health Care Accreditation Council. Data were collected via (i) a desktop review of 226 national and international documents; (ii) 20 key informant interviews with stakeholders from the public, private, military, veterinary, and academic sectors; and (iii) 23 field visits across 27 laboratories in four Jordanian governorates. Data were analyzed thematically and synthesized using the LABNET framework, which outlined ten core laboratory capacities. Findings were validated through a multi-sectoral national workshop with 90 participants. The mapping revealed the absence of a unified national laboratory strategic plan, with governance dispersed across multiple authorities and limited inter-sectoral coordination. Standard operating protocols (SOPs) existed for high-priority diseases such as T.B, HIV, influenza, and COVID-19 but were lacking or outdated for other notifiable diseases, particularly zoonoses. Quality management was inconsistent, with limited participation in external quality assurance programs and minimal accreditation uptake. Biosafety and biosecurity frameworks were fragmented and insufficiently enforced, while workforce shortages, high turnover, and limited specialized training constrained laboratory performance. Despite these challenges, Jordan demonstrated strengths including skilled laboratory staff, established reference centers, and international collaborations, which provide a platform for improvement. Jordan’s laboratory network has foundational strengths but faces systemic challenges in policy coherence, standardization, quality assurance, and workforce capacity. Addressing these gaps requires the development of a national laboratory strategic plan, strengthened legal and regulatory frameworks, enhanced quality management and accreditation, and integrated One Health coordination across human, animal, and environmental health sectors. These measures will improve diagnostic reliability, preparedness, and alignment with the global health security agenda. Full article

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9 pages, 342 KB

Open AccessArticle

Development and Validity Evaluation of the Index of Social Work Process in Promoting Social Participation of Welfare Recipients (SWP-PSP) in Japan

by Yukiko Takagi and Hideki Hashimoto

Int. J. Environ. Res. Public Health 2025, 22(9), 1458; https://doi.org/10.3390/ijerph22091458 - 20 Sep 2025

Abstract

Social workers are required to have the capacity to effectively support welfare recipients to restore their labor participation for social inclusion. However, a systematic method for process evaluation of this capacity has not yet been established. In this study, we developed the Index [...] Read more.

Social workers are required to have the capacity to effectively support welfare recipients to restore their labor participation for social inclusion. However, a systematic method for process evaluation of this capacity has not yet been established. In this study, we developed the Index of Social Work Process in Promoting Social Participation of Welfare Recipients (SWP-PSP) to address this gap. Item domains and pools were prepared by referring to existing social work guidelines and human capital management theories, and content and face validity were confirmed by an expert panel review. The initial 75 items were revised to 44. We conducted a cross-sectional survey with 139 social workers working in public livelihood support at various municipal authorities in Japan. Item response theory analysis was performed for item selection, followed by the criterion-related validity test for convergent validation using Utrecht Work Engagement (UWE) scale scores as a reference. The selected 20 items with four domains were moderately correlated with UWE scores (Pearson’s correlation coefficient r = 0.35). Certified social workers demonstrated a stronger correlation with UWE (r = 0.44) than social workers without certification (r = 0.26). Cronbach’s alpha coefficients in each domain were over 0.77. These results indicate the reliability and validity of the SWP-PSP. This measure may be helpful for the evaluation of social workers’ capacity to promote social inclusion of welfare recipients. Full article

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19 pages, 316 KB

Open AccessArticle

Psychometric Validation of Trust, Commitment, and Satisfaction Scales to Measure Marital Relationship Quality Among Newly Married Women in Nepal

by Lakshmi Gopalakrishnan, Nadia Diamond-Smith and Hannah H. Leslie

Int. J. Environ. Res. Public Health 2025, 22(9), 1457; https://doi.org/10.3390/ijerph22091457 - 20 Sep 2025

Abstract

Marital relationship quality significantly influences health outcomes, but validated measurement tools for South Asian populations remain limited. To validate scales measuring trust, commitment, and satisfaction as key components of marital relationship quality among newly married women in Nepal, we conducted a two-wave psychometric [...] Read more.

Marital relationship quality significantly influences health outcomes, but validated measurement tools for South Asian populations remain limited. To validate scales measuring trust, commitment, and satisfaction as key components of marital relationship quality among newly married women in Nepal, we conducted a two-wave psychometric validation study in rural Nawalparasi district. The study included 200 newly married women aged 18–25 years, with 192 participants (96% retention) completing 6-month follow-up. We assessed factor structure, internal consistency, test-retest reliability, and criterion validity of trust (eight items), commitment (five items), and satisfaction (seven items) scales using exploratory and confirmatory factor analysis. Exploratory factor analysis identified single-factor solutions for trust and commitment scales and a two-factor model for satisfaction. Confirmatory factor analysis confirmed these structures, with satisfaction comprising marital conflict/dissatisfaction (four items) and general satisfaction (two items) subscales. All scales demonstrated good internal consistency (Cronbach’s α: 0.79–0.96) and significant criterion validity correlations with relationship happiness (r = 0.63–0.72, p < 0.001). Test-retest reliability showed moderate to low stability (r = 0.21–0.51), likely reflecting genuine relationship changes in early marriage. The validated scales provide reliable tools for assessing relationship quality in South Asian contexts, enabling research on marriage-health associations and evidence-based interventions. Full article

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

14 pages, 1569 KB

Open AccessArticle

A Summary of Pain Locations and Neuropathic Patterns Extracted Automatically from Patient Self-Reported Sensation Drawings

by Andrew Bishara, Elisabetta de Rinaldis, Trisha F. Hue, Thomas Peterson, Jennifer Cummings, Abel Torres-Espin, Jeannie F. Bailey, Jeffrey C. Lotz and REACH Investigators

Int. J. Environ. Res. Public Health 2025, 22(9), 1456; https://doi.org/10.3390/ijerph22091456 - 19 Sep 2025

Abstract

Background Chronic low-back pain (LBP) is the largest contributor to disability worldwide, yet many assessments still reduce a complex, spatially distributed condition to a single 0–10 score. Body-map drawings capture location and extent of pain, but manual digitization is too slow and inconsistent [...] Read more.

Background Chronic low-back pain (LBP) is the largest contributor to disability worldwide, yet many assessments still reduce a complex, spatially distributed condition to a single 0–10 score. Body-map drawings capture location and extent of pain, but manual digitization is too slow and inconsistent for large studies or real-time telehealth. Methods Paper pain drawings from 332 adults in the multicenter COMEBACK study (four University of California sites, March 2021–June 2023) were scanned to PDFs. A Python pipeline automatically (i) rasterized PDF pages with pdf2image v1.17.0; (ii) resized each scan and delineated anterior/posterior regions of interest; (iii) registered patient silhouettes to a canonical high-resolution template using ORB key-points, Brute-Force Hamming matching, RANSAC inlier selection, and 3 × 3 projective homography implemented in OpenCV; (iv) removed template outlines via adaptive Gaussian thresholding, Canny edge detection, and 3 × 3 dilation, leaving only patient-drawn strokes; (v) produced binary masks for pain, numbness, and pins-and-needles, then stacked these across subjects to create pixel-frequency matrices; and (vi) normalized matrices with min–max scaling and rendered heat maps. RGB composites assigned distinct channels to each sensation, enabling intuitive visualization of overlapping symptom distributions and for future data analyses. Results Cohort-level maps replicated classic low-back pain hotspots over lumbar paraspinals, gluteal fold, and posterior thighs, while exposing less-recognized clusters along the lateral hip and lower abdomen. Neuropathic-leaning drawings displayed broader leg involvement than purely nociceptive patterns. Conclusions Our automated workflow converts pen-on-paper pain drawings into machine-readable digitized images and heat maps at the population scale, laying practical groundwork for spatially informed, precision management of chronic LBP. Full article

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27 pages, 3500 KB

Open AccessReview

Nature-Based Solutions in Workplace Settings: A Scoping Review on Pathways for Integrated Quality, Environmental, Health, and Safety Management

by Marcos Vinícius de Castro, Rogerio Galante Negri, Fabiana Alves Fiore and Adriano Bressane

Int. J. Environ. Res. Public Health 2025, 22(9), 1455; https://doi.org/10.3390/ijerph22091455 - 19 Sep 2025

Abstract

Occupational environments often expose workers to physical and psychological stressors that compromise well-being and productivity. While biophilic design has gained attention, there remains limited systematic integration of Nature-Based Solutions (NbS) within workplace management frameworks. This review aims to map the empirical impacts of [...] Read more.

Occupational environments often expose workers to physical and psychological stressors that compromise well-being and productivity. While biophilic design has gained attention, there remains limited systematic integration of Nature-Based Solutions (NbS) within workplace management frameworks. This review aims to map the empirical impacts of NbSs on occupational health, productivity, and environmental quality, and to identify key barriers and facilitators for their integration into comprehensive Quality, Environmental, Health, and Safety (QEHS) management systems. A scoping literature review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search was performed in the Scopus and Web of Science databases for studies published between 2019 and 2024. A total of 2452 records were initially retrieved, with 39 studies retained for synthesis following screening, eligibility assessment, and critical appraisal using the Joanna Briggs Institute checklist. Findings indicate that NbSs can reduce stress, improve physical and cognitive health, and enhance workplace productivity. Reported benefits include reduced absenteeism, improved indoor air quality, and measurable financial returns. However, significant challenges persist, including high upfront costs, ongoing maintenance demands, a shortage of specialized labor, and methodological heterogeneity across studies. In particular, hybrid approaches combining physical natural elements and immersive technologies such as virtual reality emerged as promising alternatives for spatially constrained environments. Participatory co-design and stakeholder engagement were also identified as critical success factors for effective implementation. Integrating NbSs into QEHS frameworks has the potential to foster healthier, more resilient, and sustainable workplaces. Alignment with recognized certifications can further support systematic adoption and monitoring. Future research should prioritize longitudinal designs, standardized outcome metrics, and physiological markers, while addressing geographical gaps through studies in underrepresented regions. Embedding participatory processes and certification alignment can enhance stakeholder buy-in and practical scalability, advancing the integration of NbSs into holistic workplace management strategies. Full article

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20 pages, 697 KB

Open AccessReview

Evidenced Interventions Supporting the Psychological Wellbeing of Disaster Workers: A Rapid Literature Review

by Carolyn Deans and Shannon Carter

Int. J. Environ. Res. Public Health 2025, 22(9), 1454; https://doi.org/10.3390/ijerph22091454 - 19 Sep 2025

Abstract

This rapid literature review was conducted to better understand the evidence base for interventions aimed at improving psychological well-being in disaster response workers. Three databases were searched: MEDLINE, APA PsycArticles, and Embase. Grey literature reviewed included results of a Google Scholar search and [...] Read more.

This rapid literature review was conducted to better understand the evidence base for interventions aimed at improving psychological well-being in disaster response workers. Three databases were searched: MEDLINE, APA PsycArticles, and Embase. Grey literature reviewed included results of a Google Scholar search and organisation-recommended reports and articles. Of the 959 screened records, 25 studies were included, 13 of which evidenced the benefit of the studied intervention, and two included screening tools to identify at-risk workers. The results showed that evidence-based interventions exist to support disaster response workers to varying degrees in terms of perceived stress, anxiety, depression, post-traumatic stress symptoms, burnout, sleep quality, somatic symptoms, irrational performance beliefs, and emotional and social well-being. Identified interventions featured neurofeedback, psychoeducation, mindfulness, reflective practice, and adjustments to cognitions or behaviours. Interventions varied in delivery (online with pre-recorded content, asynchronous, and guided learning), context (delivered to groups, individuals, and in work or private settings), and facilitator (psychologists, mental health practitioners, and medical doctors). Several interventions improved aspects of psychological well-being in disaster response workers; however, most findings were produced by quasi- or non-experimental designs, suggesting further research is required to clearly ascertain their benefits. Full article

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12 pages, 767 KB

Open AccessArticle

Replication of a Culturally Tailored Tobacco Cessation Intervention for Arab American Men in North Carolina: An Exploratory Pilot Study

by Dana El Hajj, Linda Haddad and Anastasiya Ferrell

Int. J. Environ. Res. Public Health 2025, 22(9), 1453; https://doi.org/10.3390/ijerph22091453 - 19 Sep 2025

Abstract

(1) Introduction: Arab American (ArA) men have higher smoking rates than the general population, driven by cultural norms. Culturally tailored interventions that incorporate ArA cultural, linguistic, and social contexts are essential for addressing tobacco use and promoting health equity. This study aimed to [...] Read more.

(1) Introduction: Arab American (ArA) men have higher smoking rates than the general population, driven by cultural norms. Culturally tailored interventions that incorporate ArA cultural, linguistic, and social contexts are essential for addressing tobacco use and promoting health equity. This study aimed to evaluate a culturally tailored smoking cessation intervention for ArA men living in North Carolina. (2) Methods: This pilot study employed a one-group pre- and post-test design to evaluate program effectiveness within financial and time constraints. The participants completed questionnaires and Carbon monoxide measurements and were provided with Nicotine Replacement therapy. (3) Results: The study found that participants experienced anxiety and stress when delaying their first morning cigarette, which hindered cessation. Although smoking was reduced, relapse was common, highlighting the need for personalized support, especially for those with higher nicotine dependence. While telephone Motivational Interviewing helped reduce anxiety, it was insufficient for complete cessation, underscoring the need for tailored approaches addressing both psychological and physical factors. (4) Conclusions: The study suggests that culturally tailored telephone counseling did not show promise as a smoking cessation strategy for Arab Americans in North Carolina due to low participation. The sample size is really too small to test the efficacy of the intervention itself. It seems to have been more successful in another state. Future efforts should address cultural factors, emerging nicotine products, and expanded research. The project is significant for addressing health disparities among Arab Americans by integrating culturally relevant smoking cessation strategies with evidence-based methods like Nicotine Replacement Therapy. Full article

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20 pages, 321 KB

Open AccessArticle

Role of Field Epidemiology in Environmental and Climate Change-Related Health Incidents in Wales: A Qualitative Analysis Through Expert Interviews

by Omer Faruk Sonmez, Behrooz Behbod, Christopher Roberts, Marco Barracchia, Astghik Baghinyan, Lichita Indra and Katarzyna Czabanowska

Int. J. Environ. Res. Public Health 2025, 22(9), 1452; https://doi.org/10.3390/ijerph22091452 - 18 Sep 2025

Abstract

Climate change and environmental degradation pose significant challenges to public health globally, intensifying the frequency and severity of related health incidents. Field epidemiology, traditionally focused on infectious disease outbreaks, is now increasingly recognised as vital in addressing environmental and climate-related health threats. This [...] Read more.

Climate change and environmental degradation pose significant challenges to public health globally, intensifying the frequency and severity of related health incidents. Field epidemiology, traditionally focused on infectious disease outbreaks, is now increasingly recognised as vital in addressing environmental and climate-related health threats. This study explores how organisations like Public Health Wales (PHW) can develop field epidemiology services responsive to these emerging challenges. Semi-structured interviews were conducted with 18 global and national experts in field epidemiology, environmental health, and related disciplines. An inductive content analysis approach was used to identify themes relating to best practices, challenges, competencies, and future directions in environmental field epidemiology. Key findings emphasise the necessity for integrated, multi-sectoral collaboration, capacity building in One Health competencies, and innovative surveillance systems that incorporate environmental and climate data and exposure measures. Participants highlighted barriers such as fragmented governance, data quality issues, and resource constraints. The evolving role of field epidemiology includes applications of environmental and climate-related health phenomena to encompass prevention, preparedness, and recovery phases, supported by technological advancements and holistic health security frameworks. To effectively address environmental and climate-related health incidents, field epidemiology services must evolve towards integrated, multidisciplinary, and adaptive frameworks. Organisations like PHW may consider strengthening international collaboration, investing in workforce development, and implementing integrated surveillance systems that incorporate environmental drivers of health. These strategic priorities align with global public health functions and support resilient health systems capable of mitigating climate-related health risks. Full article

10 pages, 278 KB

Open AccessOpinion

Too Hot to Ignore: The Escalating Health Impact of Heatwaves in Brazil

by Jessica M. Neves, Klauss K. S. Garcia, Beatriz F. A. Oliveira and Marco A. Horta

Int. J. Environ. Res. Public Health 2025, 22(9), 1451; https://doi.org/10.3390/ijerph22091451 - 18 Sep 2025

Abstract

Heatwaves (HWs) are becoming more frequent and severe, posing a significant threat to human health. Studies have shown that extreme heat, whether as incremental temperature increases or prolonged HWs, is associated with an increased risk of heat-related illnesses. However, there is still limited [...] Read more.

Heatwaves (HWs) are becoming more frequent and severe, posing a significant threat to human health. Studies have shown that extreme heat, whether as incremental temperature increases or prolonged HWs, is associated with an increased risk of heat-related illnesses. However, there is still limited understanding of how these impacts unfold in Brazil, given its unique social, environmental, and health-system contexts. I this perspective article, we explore the effects of HWs on human physiology, examine the social and biological factors that contribute to heat stress, and identify vulnerable populations at disproportionate risk. We also discuss the potential consequences of extreme heat in other aspects of society, such as agriculture and energy, and assess the challenges of strengthening resilience in Brazil’s health sector. Our key contribution are to make visible the hidden burden of heat-related mortality, to examine how fragmented governance constrains the adaptive capacity of Brazil’s health sector, and to reflect on pathways to strengthen resilience to heatwaves. Full article

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

14 pages, 319 KB

Open AccessArticle

Attitudes Toward Older Adults: A Descriptive Cross-Sectional Study in Chilean University Students

by Igor Cigarroa, Jesus Alonso, María Gabriela Vallejos, Maria Antonia Parra-Rizo, Daniel Basoalto, Daniela Robles-Tapia, Yeny Concha-Cisternas, Rafael Pizarro, Juana Borja-González and Rodrigo Yañez-Yañez

Int. J. Environ. Res. Public Health 2025, 22(9), 1450; https://doi.org/10.3390/ijerph22091450 - 18 Sep 2025

Abstract

Background: Ageism is a growing concern in aging societies and can affect future professionals’ attitudes toward older adults. Objective: To analyze the association between attitudes toward old age, self-perceptions of aging, and contact with older adults in the community among students [...] Read more.

Background: Ageism is a growing concern in aging societies and can affect future professionals’ attitudes toward older adults. Objective: To analyze the association between attitudes toward old age, self-perceptions of aging, and contact with older adults in the community among students at a private university in Chile. Methods: A descriptive, cross-sectional study was conducted with 515 university students aged 18 to 42 years from 11 campuses of Santo Tomás University in Chile. Attitudes toward older adults were assessed using the Kogan’s Attitudes toward Older People Scale (KAOP), and additional data on self-perceptions of health and aging, and contact with grandparents or older adults, were collected through a self-designed questionnaire. Statistical analyses included chi-square tests, one-way ANOVA, and Bonferroni post hoc comparisons. Results: A majority of students (61.2%) exhibited low-level positive attitudes toward older adults. Female students and those aged 26–42 years had significantly more positive attitudes than male and younger students (p < 0.05). Students with a healthier self-perception of aging (p = 0.011) and those who maintained contact with grandparents or older adults (p = 0.006) showed significantly more favorable attitudes toward aging. Nationality was also associated with attitudes, with Chilean students scoring higher than their foreign counterparts. Conclusions: Positive attitudes toward older adults among university students were associated with gender, age, self-perception of aging, and intergenerational contact. These findings highlight the importance of integrating educational and intergenerational programs in higher education to reduce ageism and promote respectful and inclusive perceptions of aging. Full article

23 pages, 1225 KB

Open AccessArticle

The Luminos Project: Co-Designing a Short-Stay Suicide Support Model for Young People

by Aims Hansen, Samantha Speirs, Kirsten Panton, Jacinta Freeman, Zrinka Highfield, Kieren Marshall, Eleanor Tighe, Laura Hemming, Bep Uink, Francis Mitrou, Vu Vuong and Ashleigh Lin

Int. J. Environ. Res. Public Health 2025, 22(9), 1449; https://doi.org/10.3390/ijerph22091449 - 18 Sep 2025

Abstract

Background: Suicide was the leading cause of death among young Australians aged 15–24 years old in 2023, with 392 lives lost. The continued high numbers of youth suicide demand urgent exploration of alternative approaches to suicide intervention in this population. The United Kingdom-based [...] Read more.

Background: Suicide was the leading cause of death among young Australians aged 15–24 years old in 2023, with 392 lives lost. The continued high numbers of youth suicide demand urgent exploration of alternative approaches to suicide intervention in this population. The United Kingdom-based suicide service Maytree offers an innovative short-term stay for people experiencing suicidal thoughts. Grounded by the Maytree model-of-care, the aim of the current study was to co-design a short-stay service responsive to the specific needs of suicidal young people. Methods: Semi-structured and focus group interviews with young people (n = 38), caregivers (n = 11) and key local stakeholders (n = 26) in Perth, Western Australia. Results: Deductive and inductive thematic analysis identified 8 core themes: benefits, service design, staffing, operations, referrals, challenges and safety, measures of success, and language. Endorsement of the Luminos model as beneficial to young people experiencing thoughts of suicide was nearly unanimous. Conclusions: These findings provide actionable insights for the development of alternative, youth-informed suicide support services. Full article

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13 pages, 2355 KB

Open AccessArticle

Access to Food Establishments via Meal Delivery Applications: A Study of University and Non-University Settings in a Brazilian Metropolis

by Paloma Aparecida Anastacio Barros, Daniela Silva Canella and Paula Martins Horta

Int. J. Environ. Res. Public Health 2025, 22(9), 1448; https://doi.org/10.3390/ijerph22091448 - 18 Sep 2025

Abstract

This study aimed to characterize access to food establishments through a meal delivery application in university and non-university settings within a Brazilian metropolis. This cross-sectional study used data from a leading meal delivery platform. All establishments delivering to four public and four private [...] Read more.

This study aimed to characterize access to food establishments through a meal delivery application in university and non-university settings within a Brazilian metropolis. This cross-sectional study used data from a leading meal delivery platform. All establishments delivering to four public and four private university campuses in Belo Horizonte, Brazil were identified. For comparison, one corresponding non-university location was selected for each campus (yielding eight campus–location pairs). Each location corresponds to a central address within the paired neighborhood that was entered into the app to simulate delivery availability. Pairing criteria were based on geographic region and income levels. Information on establishment categories (classified by keywords), delivery distances, delivery fees, and geographic centrality was collected and analyzed descriptively. The number of available establishments ranged from 7176 to 11,440 across the assessed locations. Most establishments were categorized under keywords referring to snacks (e.g., burgers, savory snacks, pizza), regardless of location. Delivery distances ranged from 0 to 19.6 km, with shorter distances observed for university addresses and corresponding locations situated in central neighborhoods of the city, and longer distances for peripheral areas. Only 4.7% of establishments offered free delivery, and higher delivery fees were more frequent in non-university locations. No significant differences were observed between public and private universities. Food establishments are widely accessible via the app; however, central areas tend to have broader service coverage. Regardless of whether the location is a university or non-university setting, or whether it is central or peripheral, there is a predominance of establishments classified under keywords associated with unhealthy food options. Full article

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12 pages, 399 KB

Open AccessArticle

The Double Burden of Isolation and Unemployment: Suicide Risk in Structurally Vulnerable Populations in Japan—A Case Study of Akita Prefecture (2018–2022)

by Roseline Yong

Int. J. Environ. Res. Public Health 2025, 22(9), 1447; https://doi.org/10.3390/ijerph22091447 - 18 Sep 2025

Abstract

Suicide in Japan remains elevated and uneven across regions. We hypothesized that (H1) unemployment and (H2) living alone each increase suicide mortality, and that (H3) their combination yields more-than-additive risk, especially among middle-aged men. Using specially tabulated mortality data (2018–2022) from the Japan [...] Read more.

Suicide in Japan remains elevated and uneven across regions. We hypothesized that (H1) unemployment and (H2) living alone each increase suicide mortality, and that (H3) their combination yields more-than-additive risk, especially among middle-aged men. Using specially tabulated mortality data (2018–2022) from the Japan Suicide Countermeasures Promotion Center, we cross-classified deaths and denominators into 24 strata by sex, age (20–39, 40–59, ≥60), employment (employed/unemployed), and cohabitation (with others/alone). Five-year average rates per 100,000 were computed; between-group differences were tested with chi-square (Holm-adjusted contrasts). Additive interaction between unemployment and living alone was quantified with the Interaction Contrast (ICR) and Synergy Index (SI), and Akita rates were benchmarked against national strata. Prefecture-level quantification and national benchmarking are rarely reported in Japan. Rates differed significantly across employment-by-cohabitation groups in every sex-by-age stratum (p < 0.001). Unemployment and living alone each elevated risk, with the highest rate reported among unemployed men aged 40–59 who were living alone (317.1; >14× employed, cohabiting peers at 22.1). Additive interaction was strongest in men aged 40–59 (ICR = 198.3; SI = 3.05) and present in men aged 20–39 and ≥60; among women, interaction was most evident at the ages of 40–59 and sub-additive at ≥60. Compounded effects among men were consistently larger in Akita than nationally, whereas the largest absolute burden fell on unemployed men aged ≥60 who were living with others (203 deaths). The novelty of this investigation lies in quantifying additive interaction with national benchmarking and contrasting per capita risk with absolute burden to guide dual-track prevention. The findings are ecological. Full article

(This article belongs to the Special Issue Public Health Consequences of Social Isolation and Loneliness)

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10 pages, 260 KB

Open AccessArticle

Prevalence of Depressive Symptoms Amongst Pregnant Women Attending Antenatal Clinics at Quaternary Hospital in Johannesburg, South Africa: A Cross-Sectional Study

by Ugasvaree Subramaney and Lawrence Chauke

Int. J. Environ. Res. Public Health 2025, 22(9), 1446; https://doi.org/10.3390/ijerph22091446 - 18 Sep 2025

Abstract

Antenatal depression significantly contributes to maternal and neonatal morbidity worldwide; however, the rate of screening, particularly in low- and middle-income countries (LMICs), remains very low. This cross-sectional survey study was aimed at determining the prevalence of depressive symptoms among women aged 18 to [...] Read more.

Antenatal depression significantly contributes to maternal and neonatal morbidity worldwide; however, the rate of screening, particularly in low- and middle-income countries (LMICs), remains very low. This cross-sectional survey study was aimed at determining the prevalence of depressive symptoms among women aged 18 to 34 years attending antenatal clinics at a quaternary hospital in Johannesburg, South Africa, utilizing a Biographical Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). The study is based on a total of 151 questionnaires. The mean age of the study population was 27.6 years (range: 18–34). Majority of participants identified themselves as Black (138, 91.4%), had previously been pregnant (111, 73.5%), were in the third trimester of pregnancy (89, 58.9%), were unemployed or seeking employment (108, 71.5%), and had no pre-existing medical (107, 70.9%) or mental illnesses (143, 94.7%). The prevalence of antenatal depressive symptoms among the study population was 43.7% (66/151), and 18 (27.3%) of the women who screened positive had suicidal ideation. The prevalence of antenatal depressive symptoms in this study exceeds that reported in other regions, underscoring the urgent need for universal screening throughout pregnancy and provision of perinatal mental healthcare services for pregnant and postpartum women. Full article

(This article belongs to the Special Issue Promoting Healthy Pregnancy)

11 pages, 275 KB

Open AccessArticle

Anxiety and Depression Among University Students in Cali, Colombia: A Cross-Sectional Analysis of the Prevalence and Contributing Factors

by Florencio Arias-Coronel, Carlos Andres Garibello-Millan, Diana María Dávila-Vidal, María Fernanda Serna-Orozco and Mauricio Solórzano-Alarcón

Int. J. Environ. Res. Public Health 2025, 22(9), 1445; https://doi.org/10.3390/ijerph22091445 - 18 Sep 2025

Abstract

Depression and anxiety are mental health conditions that can significantly impact individuals’ well-being, with various risk factors contributing to their severity. This study aimed to characterise the prevalence of anxiety and depression among a university population and examine the associated sociodemographic factors. Methods: [...] Read more.

Depression and anxiety are mental health conditions that can significantly impact individuals’ well-being, with various risk factors contributing to their severity. This study aimed to characterise the prevalence of anxiety and depression among a university population and examine the associated sociodemographic factors. Methods: A descriptive cross-sectional study was conducted with 394 students from a higher education institution. Sociodemographic factors were analysed using two validated instruments: the Hamilton Anxiety Scale and the PHQ-9 (Depression Symptom Test). The statistical analyses included Pearson’s chi-square test and Fisher’s exact test to assess associations. Results: The mental health outcomes were significantly influenced by several factors. Key variables associated with anxiety and depression included academic overload (* p < 0.001), gender (* p < 0.001), father’s education level (* p < 0.001), socioeconomic status (* p < 0.001), and sexual orientation (* p < 0.001). These findings highlight the complex interplay between sociodemographic factors and mental health in university students. Conclusions: Early identification and interventions for anxiety and depression should be considered to provide timely and relevant mental health programmes for university students. Full article

12 pages, 530 KB

Open AccessArticle

The Healing Environment for Healthcare Staff in Paediatric Settings: A Cross-National Semi-Structured Survey on Healthcare Staff Satisfaction

by Silvia Mangili, Beatrice Pattaro, Andrea Brambilla, Gaia Ferraguzzi, Cristiana Caira and Stefano Capolongo

Int. J. Environ. Res. Public Health 2025, 22(9), 1444; https://doi.org/10.3390/ijerph22091444 - 17 Sep 2025

Abstract

Background: The existing literature emphasises that the hospital environment plays a critical role in the experiences of patients and healthcare workers. To better understand the perspectives of healthcare staff in such settings, a questionnaire-based study was conducted at two paediatric hospitals: Vittore Buzzi [...] Read more.

Background: The existing literature emphasises that the hospital environment plays a critical role in the experiences of patients and healthcare workers. To better understand the perspectives of healthcare staff in such settings, a questionnaire-based study was conducted at two paediatric hospitals: Vittore Buzzi Hospital (Milan, Italy) and Queen Silvia Children’s Hospital (Gothenburg, Sweden). Objective: The study had two main objectives: to collect feedback from healthcare staff via a post-occupancy evaluation focused on perceived environmental quality and to compare staff perceptions across different geographical and cultural contexts. Methods: A semi-structured survey tool consisting of 42 closed-ended items (40 of which used a 5-point Likert scale) and 2 open-ended questions was employed. The items assessed the presence and quality of specific environmental and functional features. Results: The findings reveal significant contrasts between the two hospitals. Staff at the Swedish hospital reported higher satisfaction levels across most areas, whereas the Italian hospital demonstrated significant shortcomings. Common concerns in both hospitals included limited space for medical and administrative staff and the absence of private offices for doctors. Conclusions: This study confirms that environmental quality affects not only patients, but also staff, impacting their satisfaction, perceived efficiency, and emotional well-being. The contrasting outcomes highlight the significant influence that differences in architectural design, spatial layout, and investment in staff-oriented spaces can have on the day-to-day experiences of healthcare professionals. Full article

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