International Journal of Environmental Research and Public Health

12 pages, 279 KB

Open AccessArticle

Self-Reported Diastasis Recti Abdominis and Associated Factors Among Jordanian Women: A Cross-Sectional Study

by Sami Elmahgoub, Wesam A. Debes, Rama Al-rawajfeh, Farah Abu Khadra, Bodor Bin Sheeha, Maya Alawneh, Bisan Albaik and Aseel Aburub

Int. J. Environ. Res. Public Health 2026, 23(10), 1255; https://doi.org/10.3390/ijerph23101255 - 24 Sep 2026

Abstract

Diastasis recti abdominis (DRA) is a common postpartum condition that may coexist with pelvic floor dysfunction and impact quality of life; however, data from Middle Eastern populations are scarce, and awareness among affected women remains poorly understood. This cross-sectional study included 248 Jordanian [...] Read more.

Diastasis recti abdominis (DRA) is a common postpartum condition that may coexist with pelvic floor dysfunction and impact quality of life; however, data from Middle Eastern populations are scarce, and awareness among affected women remains poorly understood. This cross-sectional study included 248 Jordanian women with at least one previous pregnancy who completed a structured questionnaire assessing demographic and obstetric characteristics, lifestyle factors, self-reported DRA prevalence, clinical presentation, and awareness regarding DRA. Chi-square tests and multivariate binary logistic regression were used to identify independent predictors. The prevalence of self-reported DRA-compatible signs among the study sample was 62.5% (n = 155). Multivariate analysis identified symptoms as the strongest predictor (≥3 symptoms: OR = 5.57, 95% CI: 2.68–11.57, p < 0.001; 1–2 symptoms: OR = 2.14, 95% CI: 1.20–3.83, p = 0.010), followed by heavy lifting after delivery (OR = 2.75, 95% CI: 1.44–5.26, p = 0.002), and younger age (18–25 years: OR = 4.37, 95% CI: 1.67–11.43, p = 0.003; 31–35 years: OR = 3.36, 95% CI: 1.25–9.03, p = 0.016). Regular physical activity was protective (OR = 0.40, 95% CI: 0.21–0.75, p = 0.005). While 58.9% had heard of DRA, only 17.7% had received professional advice, and 88.7% desired more education. DRA affects a substantial proportion of Jordanian women, with symptoms as the strongest independent predictor, followed by heavy lifting after delivery and younger age; regular physical activity was associated with lower odds of self-reported DRA-compatible signs. Despite high prevalence, awareness and professional advice are inadequate, highlighting an urgent need for targeted postpartum screening, patient education, and healthcare professional training to improve DRA recognition and management in Jordan and similar settings. Full article

(This article belongs to the Special Issue Advances in Women’s Health and Pelvic Health: Lifelong Care)

23 pages, 2783 KB

Open AccessArticle

Integrated Active Breaks Improve Discomfort, Cervicoscapular Electromyographic Responses, and Typing Performance in Computer Users at Risk of Neck Pain: A Randomized Crossover Trial

by Pattanasin Areeudomwong, Nayada Supornpipat, Nahathai Raungpimai, Wipada Klibngoen, Wiriya Mahikul, Yadanuch Boonyaratana and Vitsarut Buttagat

Int. J. Environ. Res. Public Health 2026, 23(10), 1254; https://doi.org/10.3390/ijerph23101254 - 24 Sep 2026

Abstract

Neck–shoulder disorders are common among computer users, yet the effects of integrated active breaks (IABs) on discomfort, electromyographic (EMG) responses, and typing performance remain unclear. This randomized crossover trial compared neck–shoulder discomfort, cervicoscapular EMG responses quantified using normalized median frequency (NMF), and typing [...] Read more.

Neck–shoulder disorders are common among computer users, yet the effects of integrated active breaks (IABs) on discomfort, electromyographic (EMG) responses, and typing performance remain unclear. This randomized crossover trial compared neck–shoulder discomfort, cervicoscapular EMG responses quantified using normalized median frequency (NMF), and typing performance among IABs, passive breaks (PBs), and uninterrupted computer work at prespecified measurement time points in computer users at risk of neck pain. Thirty-six eligible participants (50% female) completed three randomized 62 min typing sessions: (1) IABs, comprising two 1 min active breaks every 20 min; (2) PBs of identical duration; and (3) uninterrupted computer work (control group (CG)). Neck–shoulder discomfort and bilateral cervicoscapular muscle NMF were assessed throughout the measurement sessions, and typing performance was determined during active typing time. Neck–shoulder discomfort and NMF differed significantly across conditions and measurement time points (p < 0.05). NMF showed a significant overall decline over time (p < 0.05), while both IABs and PBs attenuated this decline compared with uninterrupted computer work (p < 0.05). IABs showed higher NMF values than PBs at several prespecified measurement time points, although changes in NMF across break intervals did not differ significantly between the two break conditions (p > 0.05). An IAB was also associated with lower neck–shoulder discomfort and higher typing performance at selected time points compared with the other conditions (p < 0.05). A brief IAB every 20 min was associated with lower neck–shoulder discomfort and differences in cervicoscapular NMF responses at selected time points during standardized computer work. Further investigation in real-world workplace settings is warranted. Full article

(This article belongs to the Section Exercise and Health-Related Quality of Life)

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31 pages, 11527 KB

Open AccessArticle

Translation, Cross-Cultural Adaptation, and Psychometric Evaluation of the Thai Family Management Measure Among Caregivers of Children with Chronic Conditions

by Sirikran Sutthisompohn, Kanokwan Tantraseneeratn, Jindarat Somjainuek, Pastraporn Keawpawong and Jom Suwanno

Int. J. Environ. Res. Public Health 2026, 23(10), 1253; https://doi.org/10.3390/ijerph23101253 - 24 Sep 2026

Abstract

The Family Management Measure (FaMM) assesses family management of childhood chronic conditions, but evidence on its measurement properties in Thailand is limited. This methodological study translated, culturally adapted, and evaluated the Thai FaMM among 350 primary family caregivers. Translation followed International Society for [...] Read more.

The Family Management Measure (FaMM) assesses family management of childhood chronic conditions, but evidence on its measurement properties in Thailand is limited. This methodological study translated, culturally adapted, and evaluated the Thai FaMM among 350 primary family caregivers. Translation followed International Society for Pharmacoeconomics and Outcomes Research Task Force guidelines; psychometric evaluation followed the Consensus-based Standards for the Selection of Health Measurement Instruments framework. Independent exploratory and confirmatory subsamples comprised 150 and 200 caregivers. Child’s Daily Life was unidimensional after post hoc residual-covariance respecification. Multidimensional first-order models of Condition Management Ability, Family Life Difficulty, View of Condition Impact, and Parental (Caregiver) Mutuality fitted better than one-factor alternatives; second-order models did not improve fit. Internal consistency varied across scales and dimensions; nine items across these five scales had corrected item–total correlations below 0.30. Reported scale-level test–retest intraclass correlations ranged from 0.92 to 1.00. Condition Management Effort had low internal consistency (Cronbach’s α = 0.28), failed original exploratory extraction, and an inadmissible confirmatory solution. These preliminary, scale-specific findings require further validation before separating dimensional scoring or clinical use. Full article

(This article belongs to the Topic Advances in Chronic Disease Management)

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12 pages, 687 KB

Open AccessArticle

Association Between Pre-Frailty and Falls Among Community-Dwelling Older Adults: A Cross-Sectional Study Comparing Pre-Frail and Robust Older Adults

by Akihiko Murayama, Ken Hirukawa and Tomoyuki Shinohara

Int. J. Environ. Res. Public Health 2026, 23(10), 1252; https://doi.org/10.3390/ijerph23101252 - 24 Sep 2026

Abstract

Background/Objectives: Pre-frailty may represent an important stage for fall prevention before the development of frailty; however, its association with falls, particularly in comparison with robust status, remains insufficiently understood. In this cross-sectional study, we aimed to examine the association between pre-frailty and falls [...] Read more.

Background/Objectives: Pre-frailty may represent an important stage for fall prevention before the development of frailty; however, its association with falls, particularly in comparison with robust status, remains insufficiently understood. In this cross-sectional study, we aimed to examine the association between pre-frailty and falls among community-dwelling older adults by comparing pre-frail and robust older adults. Methods: This cross-sectional study enrolled 218 community-dwelling older adults who participated in the survey between January 2024 and May 2025, of whom 192 were included in the analysis. Data were collected on age, sex, multimorbidity, Japanese Cardiovascular Health Study (J-CHS) criteria, Brief-Balance Evaluation Systems Test scores, Rapid Dementia Screening Test scores, Communicative and Critical Health Literacy scale scores, and falls within the previous year. Binary logistic regression analysis was conducted in the fall group using the forced-entry method, with fall reports within the past year (falls/non-falls) as the dependent variable and the J-CHS criteria (robust/pre-frail) as the independent variable. Two adjustment variables were pre-specified: age and multimorbidity. Results: After excluding three individuals with missing data (listwise deletion), 14 long-term care insurance users, and nine older adults with frailty, 192 participants (mean age, 76.2 ± 6.1 years; 58 men and 134 women) were included in the analysis. Of these, 35 (18.2%) reported a fall within the past year. In binary logistic regression analysis, with robust status as the reference category, pre-frail participants had higher odds of reporting a fall within the past year than robust participants (odds ratio, 2.72; 95% confidence interval, 1.18–6.28). Conclusions: Although some older adults with pre-frailty may recover spontaneously, pre-frailty was independently associated with falls within the past year after adjustment for age and multimorbidity. Given the cross-sectional design, temporal and causal relationships cannot be established. Prospective studies are needed to determine whether pre-frailty predicts future falls and to evaluate the potential contribution of pre-frailty assessment to fall-risk prediction. Full article

(This article belongs to the Special Issue Achieving Effective Fall Prevention and Intervention for Older Adults)

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33 pages, 785 KB

Open AccessSystematic Review

Navigating Trauma at Sea: A Systematic Review of Risk Factors and Interventions for Psychological Trauma Among Seafarers

by Maria Carrera-Arce, Raphael Baumler and Charles Watkins

Int. J. Environ. Res. Public Health 2026, 23(10), 1251; https://doi.org/10.3390/ijerph23101251 - 24 Sep 2026

Abstract

Traumatic experiences at sea are not uncommon and may arise from events such as piracy, war, accidents or deaths, as well as from harsh working conditions and social confinement. Although occupational stressors at sea and their potential traumatic and mental health impacts have [...] Read more.

Traumatic experiences at sea are not uncommon and may arise from events such as piracy, war, accidents or deaths, as well as from harsh working conditions and social confinement. Although occupational stressors at sea and their potential traumatic and mental health impacts have been recognised, there has been limited systematic categorisation of these stressors, as well as insufficient research on interventions to address seafarers’ traumatic experiences. The study conducted a systematic literature review of the causes, impacts, and interventions related to psychological trauma among seafarers. The review aimed to (1) examine the risk associated with psychological trauma among seafarers, and (2) critically assess the existing interventions designed to address or mitigate psychological trauma at sea. Twenty-eight studies were included in the review. Seafarers are exposed to a range of traumatic events, particularly piracy, occupational incidents, violence, and, recently, COVID-19-related stressors. Other potentially traumatic experiences, such as exposure to armed conflict and seafarer abandonment, have received comparatively little research attention. Such stressors are associated with PTSD symptoms, depression, anxiety, sleep disturbances, and occupational disturbances. Trauma support was reported to be limited, including low rates of help-seeking and scarce follow-up care. Interventions include crisis response, psychological support, psychoeducation, family involvement, and resilience-based approaches, although evidence on effectiveness is sparse. Psychological trauma is an under-recognised occupational health issue in seafaring, arising from both acute and chronic stressors. The findings highlight the need for trauma-informed maritime health frameworks, improved access to psychological support, and effective prevention, intervention, and recovery strategies. Full article

(This article belongs to the Special Issue Trauma-Informed Care for Disaster Response Personnel: Strategies and Interventions)

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13 pages, 694 KB

Open AccessArticle

Confidence Amid Constraints: Self-Efficacy, Provider Encouragement, Community Engagement, and Structural Barriers Among Filipino Adults from Underserved Communities with Chronic Disease

by Andrew Thomas Reyes, Marysol C. Cacciata, Reimund Serafica, Jennifer Kawi and Lorraine S. Evangelista

Int. J. Environ. Res. Public Health 2026, 23(10), 1250; https://doi.org/10.3390/ijerph23101250 - 24 Sep 2026

Abstract

Noncommunicable diseases (NCDs) are the leading cause of death worldwide and place a heavy burden on people living in low- and middle-income countries. Underserved communities in the Philippines face many challenges that make chronic disease self-management difficult. This secondary analysis examined the burden [...] Read more.

Noncommunicable diseases (NCDs) are the leading cause of death worldwide and place a heavy burden on people living in low- and middle-income countries. Underserved communities in the Philippines face many challenges that make chronic disease self-management difficult. This secondary analysis examined the burden of NCDs, self-efficacy, provider encouragement, community participation, and perceived barriers among 796 adults with one or more NCDs recruited from underserved communities in several regions of the Philippines. Trained bilingual barangay health workers conducted face-to-face interviews, and descriptive statistics summarized the findings. Cardiovascular disease was reported by 72.5% of participants, diabetes by 23.1%, chronic respiratory disease by 14.9%, and cancer by 1.9%; 44.6% had two or more chronic conditions. Participants reported moderate confidence in managing healthy behaviors but low participation in community health activities. Provider encouragement was more common for blood pressure monitoring than for cholesterol or blood glucose monitoring. The most common barriers were lack of medical insurance, financial instability, time constraints, and limited access to health care. Taken together, these descriptive findings suggest a possible self-management gap at the sample level, with moderate confidence occurring alongside limited community participation, variable provider encouragement, and structural barriers. Strengthening primary care and community-based services may help support chronic disease self-management and reduce health inequities. Full article

(This article belongs to the Section Global Health)

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22 pages, 404 KB

Open AccessArticle

Adverse Childhood Experiences and Cognitive Disability Across Adulthood: Associations with ACE Burden, Specific Adversities, and Age

by Ray M. Merrill and Jacob C. Palmer

Int. J. Environ. Res. Public Health 2026, 23(10), 1249; https://doi.org/10.3390/ijerph23101249 - 23 Sep 2026

Abstract

Background and Objective: Adverse childhood experiences (ACEs) are associated with adverse health outcomes across the life course, but associations with adult cognitive disability remain incompletely characterized. We examined associations between individual ACEs, cumulative ACE burden, and cognitive disability and assessed whether associations varied [...] Read more.

Background and Objective: Adverse childhood experiences (ACEs) are associated with adverse health outcomes across the life course, but associations with adult cognitive disability remain incompletely characterized. We examined associations between individual ACEs, cumulative ACE burden, and cognitive disability and assessed whether associations varied by age. Methods: We conducted a cross-sectional analysis of 2020–2024 Behavioral Risk Factor Surveillance System data from 329,392 adults from 27 states, the District of Columbia, Puerto Rico, and U.S. Virgin Islands that administered the ACE module. Survey-weighted logistic regression estimated associations between individual and cumulative ACE exposure and self-reported cognitive disability, adjusting for demographic, socioeconomic, behavioral, and health characteristics. Results: Cognitive disability was reported by 11.3% of participants. Several individual ACEs were associated with cognitive disability, with the strongest association being observed for living with someone who was depressed, mentally ill, or suicidal (adjusted odds ratio [aOR], 2.00; 95% CI, 1.87–2.13). Cognitive disability prevalence increased from 6.4% among adults reporting 0 ACE types to 30.0% among those reporting ≥5 ACE types. The association between cumulative ACE burden and cognitive disability differed by age (p for interaction < 0.0001), with stronger associations observed among younger adults. Among adults aged ≥45 years, greater cumulative ACE exposure was associated with higher odds of initial cognitive difficulties and several related cognitive and functional concerns, with the strongest and most consistently elevated associations being observed among those reporting ≥5 ACE types. Conclusions: ACEs were associated with adult cognitive disability, with stronger associations being observed with the increase in ACE burden and among younger adults. Among adults aged ≥45 years, greater ACE burden was also associated with several self-reported cognitive-related difficulties. Longitudinal research is needed to clarify the mechanisms underlying these associations. Full article

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

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21 pages, 5943 KB

Open AccessArticle

Spatial Accessibility to Health Services in the Argentina–Paraguay Border Region of the Gran Chaco

by Carla Rodríguez González, Susana Ávila, Karina Cardone, Mariana Fernández, Favio Crudo, M. Victoria Periago and Verónica Andreo

Int. J. Environ. Res. Public Health 2026, 23(10), 1248; https://doi.org/10.3390/ijerph23101248 - 23 Sep 2026

Abstract

Background: Geographical accessibility to health services is essential for equitable health systems. This cross-sectional study assessed spatial accessibility to health services in the Argentina–Paraguay border region of the Gran Chaco (estimated population 27,113). Methods: All 16 health posts and two hospitals in the [...] Read more.

Background: Geographical accessibility to health services is essential for equitable health systems. This cross-sectional study assessed spatial accessibility to health services in the Argentina–Paraguay border region of the Gran Chaco (estimated population 27,113). Methods: All 16 health posts and two hospitals in the area were surveyed. Structured surveys and field interviews with health staff, conducted in 2023, provided workforce and facility capacity data, combined with geospatial accessibility modelling. Travel times to hospitals and health posts were estimated under favourable and unfavourable conditions using road networks, land cover, terrain, and high-resolution population data from dasymetric mapping. Geographical coverage was evaluated using a 60 min travel time threshold, while effective coverage incorporated facility-specific workforce capacity. Results: Under favourable conditions, 31.7% of the population lived more than 60 min from hospital care, with accessibility worsening under seasonal road deterioration. Hospital capacity was sufficient combining physicians and nurses, but insufficient with physicians alone. Primary health posts substantially expanded geographical access, although 21.8% of the population remained outside effective coverage. Conclusions: Geographical isolation, seasonal constraints, and limited workforce capacity jointly restrict access to health services. Integrating accessibility modelling with workforce information provides evidence to guide equitable health planning in rural and cross-border settings. Full article

(This article belongs to the Section Global Health)

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22 pages, 3521 KB

Open AccessSystematic Review

Effects of Dynamic Resistance Training on Arterial Stiffness Assessed by Pulse Wave Velocity: A Systematic Review and Meta-Analysis

by Ricardo Cordeiro, Michel Oliveira, Bruno Oliveira, Sabrina Santos, Jeferson Rocha, José Cristiano Paes Leme da Silva and Paulo Farinatti

Int. J. Environ. Res. Public Health 2026, 23(10), 1247; https://doi.org/10.3390/ijerph23101247 - 23 Sep 2026

Abstract

Arterial stiffness predicts cardiovascular risk, but the chronic effects of dynamic resistance training (RT) remain unclear. This meta-analysis quantified RT effects on arterial stiffness assessed by pulse wave velocity (PWV) and explored moderators. Databases were searched through 26 August 2026. Studies included adults [...] Read more.

Arterial stiffness predicts cardiovascular risk, but the chronic effects of dynamic resistance training (RT) remain unclear. This meta-analysis quantified RT effects on arterial stiffness assessed by pulse wave velocity (PWV) and explored moderators. Databases were searched through 26 August 2026. Studies included adults (≥19 years) undergoing RT with pre–post PWV data. Random-effects models were used. Fourteen trials included 20 RT interventions and 10 controlled comparisons (n = 379: 278 RT and 101 control participants; age range 19–63 years; mean age, 33.3 ± 14.3 and 32.4 ± 15.1 years in the RT and control groups, respectively; baseline blood pressure range, 108/64 to 137/90 mmHg). Participants were predominantly physically inactive. Assuming a pre–post correlation of 0.50, pooled effects were non-significant for central PWV (g = −0.002; 95% CI, −0.213 to 0.209; p = 0.985), mixed PWV (g = −0.548; 95% CI, −1.168 to 0.071; p = 0.083), peripheral PWV (g = −0.110; 95% CI, −0.436 to 0.217; p = 0.511), and overall PWV (g = −0.102; 95% CI, −0.281 to 0.077; p = 0.265). Heterogeneity ranged from 43% to 70%. Sensitivity analyses using correlations of 0.30 and 0.70 did not alter statistical significance. Most moderator tests, including those involving participant characteristics and FITT-VP components, were not statistically significant. The few significant subgroup differences were exploratory and arose from small, unbalanced groups without multiplicity adjustment, precluding firm conclusions. Dynamic RT was not associated with a significant change in arterial stiffness; however, imprecision and heterogeneity preclude claims of equivalence or absence of physiological effects. Registration: PROSPERO CRD42022377587. Full article

(This article belongs to the Special Issue Optimizing Exercise Interventions for Cardiovascular Health: From Prescription to Personalization)

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23 pages, 666 KB

Open AccessSystematic Review

The Experience of Health Professionals in Healthcare Services for Transgender and Gender-Diverse People: A Systematic Review and Meta-Synthesis

by Manoel Antônio dos Santos, Felipe Gonçalves Campelo, Bruna Bortalozzi Maia, Elaine Campos Guijarro Rodrigues and Érika Arantes de Oliveira-Cardoso

Int. J. Environ. Res. Public Health 2026, 23(10), 1246; https://doi.org/10.3390/ijerph23101246 - 23 Sep 2026

Abstract

Transgender and gender-diverse (TGD) people continue to experience substantial barriers to accessing and receiving appropriate, equitable, and gender-affirming healthcare. Although the perspectives and experiences of TGD individuals have been increasingly incorporated into healthcare policy and practice, the perspectives of healthcare professionals involved in [...] Read more.

Transgender and gender-diverse (TGD) people continue to experience substantial barriers to accessing and receiving appropriate, equitable, and gender-affirming healthcare. Although the perspectives and experiences of TGD individuals have been increasingly incorporated into healthcare policy and practice, the perspectives of healthcare professionals involved in their care remain comparatively underexplored. This systematic review and meta-synthesis aim to synthesize and reinterpret findings from primary qualitative studies on healthcare professionals’ experiences of providing care to TGD people. The search was conducted without date restrictions, covering studies indexed from database inception through 2025. Searches in eight databases—LILACS, PsycINFO, PubMed/MEDLINE, CINAHL, Scopus, EMBASE, SciELO, and Web of Science—identified 1953 studies, of which 32 met the inclusion criteria. These were coded and analyzed using thematic synthesis, and methodological rigor was assessed via the CASP Qualitative Checklist. The meta-synthesis revealed four descriptive themes, which culminated in the analytical theme: “Professionals adrift: More than goodwill is needed to create exemplary services.” The findings suggest healthcare professionals often feel uncertain about addressing TAD-specific needs, influenced by individual and systemic factors. Incorporating gender/sexuality topics broadly into healthcare curricula is essential to improve service delivery, extending beyond specialized TAG-focused services. As a limitation of this meta-synthesis, most of the included studies were conducted in the Global North, which may constrain the transferability of the findings to other sociocultural contexts, particularly those in Latin America, Asia, and Africa. Understanding healthcare professionals’ perspectives, attitudes, perceptions, practices, and challenges is essential for identifying barriers to care delivery and informing the development of responsive and collaborative healthcare practices. Full article

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33 pages, 3330 KB

Open AccessArticle

by Christopher Kricorian and Karin Turner

Int. J. Environ. Res. Public Health 2026, 23(10), 1245; https://doi.org/10.3390/ijerph23101245 - 23 Sep 2026

Abstract

A cross-sectional study analyzed adults who reported hazard-related displacement within the past year (N = 5527) from the U.S. Census Bureau Household Pulse Survey. A Loss of Essential Services (LES) index combined self-reported disruption to food, drinking water, electricity, and sanitation during [...] Read more.

A cross-sectional study analyzed adults who reported hazard-related displacement within the past year (N = 5527) from the U.S. Census Bureau Household Pulse Survey. A Loss of Essential Services (LES) index combined self-reported disruption to food, drinking water, electricity, and sanitation during the month after displacement; respondents were classified as Minimal, Moderate, High, or Extreme LES. Cross-tabulations compared demographic, social, psychological, and functional measures across LES categories, and a person-weighted multinomial logistic regression, with Extreme LES as the reference outcome category, estimated adjusted associations describing the profile of each LES category. In unadjusted comparisons, greater LES was associated with more frequent depressive symptoms, anxiety, worry, loss of interest, loneliness, and functional difficulty, along with lower perceived support and less frequent in-person contact. In adjusted analyses, LES category was associated with gender at birth, household income, race/ethnicity, children in the household, social support, in-person contact, functional limitation domains, and PHQ-4 item responses; loneliness was not independently associated. Findings are interpreted through Pressure and Release, Conservation of Resources, and Capability Approach frameworks. LES may help characterize displaced adults reporting multiple post-disaster needs; because the design is cross-sectional and disaster exposure was self-reported and not independently verified, these findings should be regarded as descriptive and hypothesis-generating rather than causal. Full article

(This article belongs to the Special Issue Psychosocial Well-Being and Stress Related to Environmental Disaster and Climate Change)

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3 pages, 173 KB

Open AccessEditorial

HIV Impacts on Children and Adolescents Living with HIV and Their Families

by Nelsensius Klau Fauk

Int. J. Environ. Res. Public Health 2026, 23(10), 1244; https://doi.org/10.3390/ijerph23101244 - 23 Sep 2026

Abstract

Despite major gains in prevention and treatment using antiretroviral therapy, HIV has disproportionately affected various population groups, including children and adolescents [...] Full article

(This article belongs to the Special Issue Impact of HIV on Children and Adolescents Living with HIV and Their Families)

15 pages, 287 KB

Open AccessArticle

Sustained Telehealth Engagement in Chronic Disease Management in Jordan: A Qualitative Study of Patient Experiences

by Ahmad Rajeh Saifan, Ahmed Yahya Ayoub, Ibtisam A. Alarabyat, Zyad Saleh, Dana Anwer Abujaber, Nabeel Al-Yateem, Khulud Ahmad Rezq, Noor Hafiz Saleem, Eman Mohammed Amin, Osama Al-Kouri and Mohammad Naser Abunasrah

Int. J. Environ. Res. Public Health 2026, 23(10), 1243; https://doi.org/10.3390/ijerph23101243 - 23 Sep 2026

Abstract

Background: Telehealth can improve access to chronic disease care, but how patients maintain engagement beyond initial adoption remains insufficiently understood in Middle Eastern settings. Methods: This exploratory qualitative study interviewed 24 adults with chronic conditions receiving telehealth-supported care across three military/private hospitals in [...] Read more.

Background: Telehealth can improve access to chronic disease care, but how patients maintain engagement beyond initial adoption remains insufficiently understood in Middle Eastern settings. Methods: This exploratory qualitative study interviewed 24 adults with chronic conditions receiving telehealth-supported care across three military/private hospitals in Jordan. Participants had used telehealth for at least three months. Interviews were conducted in Arabic, transcribed verbatim, translated into English with back-translation quality checks, and analyzed using Braun and Clarke’s six-phase reflexive thematic analysis; NVivo 15 supported data organization. Results: Five interrelated interpretive patterns were identified: reduced physical access work alongside new connection and financial burdens; family-supported autonomy; reconfigured self-monitoring and preparation; relational reassurance alongside limits when physical examination was needed; and trust shaped by system reliability and coordination. Conclusions: The findings suggest that continued telehealth engagement in this Jordanian sample was associated with the balance between convenience and digital burden, family-mediated support, relational continuity, and reliable, coordinated services. Hybrid models may be appropriate but require evaluation in other settings and populations. Full article

(This article belongs to the Topic Advances in Chronic Disease Management)

41 pages, 502 KB

Open AccessReview

From Measurement to Health: A Synthesis of EMF Exposure, Biological Evidence, and Safety Guidelines in Electric Vehicles

by Peng-Hung Tsai and Xin Chen

Int. J. Environ. Res. Public Health 2026, 23(10), 1242; https://doi.org/10.3390/ijerph23101242 - 22 Sep 2026

Abstract

The expanding global adoption of electric vehicles (EVs) has raised an understudied public health concern regarding extended occupant exposure to complex electromagnetic fields (EMFs) from high-voltage components such as battery packs, electric motors, and power electronics within the enclosed vehicle cabin. This study [...] Read more.

The expanding global adoption of electric vehicles (EVs) has raised an understudied public health concern regarding extended occupant exposure to complex electromagnetic fields (EMFs) from high-voltage components such as battery packs, electric motors, and power electronics within the enclosed vehicle cabin. This study provides a risk assessment by integrating a review of international safety guidelines, recent in-cabin EMF measurements from battery electric vehicles, and current evidence on the biological and health effects of comparable EMF exposure. The synthesized data reveal that while EV magnetic fields remain well below the established safety limits, certain biological and adverse health outcomes may occur at levels measured in EV cabins. Notably, rear seat exposures frequently exceed the 0.4 µT level associated with an increased risk of childhood central nervous system tumors, while similarly weak magnetic fields can displace magnetic particles in human brain tissue, which may in turn contribute to cellular damage. Additionally, field levels near the EV footwell approach intensities reported to induce pro-inflammatory immune responses in human cells, and comparable occupational exposures are linked to higher blood pressure and poorer sleep quality. In addition, field levels tend to peak during acceleration and at higher speeds, creating conditions where maximum field exposure and driving-related stress may occur simultaneously. This dynamic closely parallels recent occupational findings showing that higher magnetic field exposure combined with mental stress significantly increases cardiovascular risks. This compounding effect represents an unexamined vulnerability for drivers that current safety frameworks do not address. Overall, the evidence suggests that magnetic field exposure during routine EV use should not be presumed harmless and highlights the need for targeted research priorities, including health tracking of frequent users, dedicated analysis of children as a vulnerable subgroup, and laboratory investigations using exposure patterns representative of real EV environments. Adopting standardized measurement protocols (e.g., IEC 62764-1:2022) and integrating new findings into future safety guidelines would further strengthen research comparability and regulatory adequacy, ultimately benefiting human health. Full article

11 pages, 1247 KB

Open AccessArticle

Serum Polychlorinated Biphenyl Burden and Prevalent Cardiovascular Disease in U.S. Adults: A Cross-Sectional Analysis Using Evidence from NHANES 1999–2002

by Ese Freeman Oghaghare and David O. Carpenter

Int. J. Environ. Res. Public Health 2026, 23(10), 1241; https://doi.org/10.3390/ijerph23101241 - 22 Sep 2026

Abstract

Background: Polychlorinated biphenyls (PCBs) persist in the environment and have been associated with cardiovascular disease (CVD). We examined whether routine cardiometabolic biomarkers statistically accounted for this association. Methods: This cross-sectional analysis used NHANES 1999–2002 data for 2815 adults aged 20 years or older. [...] Read more.

Background: Polychlorinated biphenyls (PCBs) persist in the environment and have been associated with cardiovascular disease (CVD). We examined whether routine cardiometabolic biomarkers statistically accounted for this association. Methods: This cross-sectional analysis used NHANES 1999–2002 data for 2815 adults aged 20 years or older. Lipid-adjusted total PCB burden was the sum of 21 congeners. Survey-weighted logistic regression estimated odds ratios for prevalent CVD, restricted cubic splines examined the exposure–response shape, and mediator-specific structural equation models evaluated indirect and residual pathways through CRP, HbA1c, waist circumference, central obesity, the total cholesterol/HDL ratio, and a binary high-ratio measure. Results: Weighted mean total PCB burden was 234.6 ng/g lipid, and weighted CVD prevalence was 8.9%. A 1-unit increase in the natural log of total PCB burden was associated with higher odds of prevalent CVD after full adjustment (aOR = 1.36, 95% CI: 1.01–1.84). Coronary heart disease and angina showed the clearest subtype associations. The spline analysis did not detect nonlinearity. Indirect estimates through CRP, waist circumference, and the TC/HDL ratio were negative, which is consistent with statistical suppression; estimates through the other biomarkers were small and imprecise. Conclusions: Higher serum PCB burden was associated with prevalent CVD after adjustment for major demographic and cardiometabolic factors. In cross-sectional pathway models, routine biomarkers did not account for most of this association. Longitudinal studies are needed before these statistical pathways can be interpreted as causal mechanisms. Full article

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32 pages, 1134 KB

Open AccessReview

Patient Safety in Primary Health Care: A Scoping Review of Characteristics, Thematic Dimensions, and Gaps in the Literature

by Luciano Garcia Lourenção, Luciano Silveira Pacheco de Medeiros, Daiani Modernel Xavier, Valéria Slongo de Souza, Adriana Kitajima, Adriene dos Santos Sá and Lara Helk de Souza

Int. J. Environ. Res. Public Health 2026, 23(10), 1240; https://doi.org/10.3390/ijerph23101240 - 22 Sep 2026

Abstract

Patient safety in primary health care (PHC) is a multidimensional and systemic phenomenon, although the literature retrieved under the specified search and eligibility criteria was heterogeneous and unevenly distributed across geographic contexts. This scoping review aimed to map, analyze, and synthesize how patient [...] Read more.

Patient safety in primary health care (PHC) is a multidimensional and systemic phenomenon, although the literature retrieved under the specified search and eligibility criteria was heterogeneous and unevenly distributed across geographic contexts. This scoping review aimed to map, analyze, and synthesize how patient safety is addressed in PHC by identifying the characteristics, thematic dimensions, reported or evaluated strategies, and gaps in the retrieved literature. The review followed the Joanna Briggs Institute methodological guidance and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted between 1 and 15 June 2026 in PubMed/MEDLINE, Scopus, Web of Science, CINAHL, LILACS, and SciELO for original empirical publications issued from January 2016 up to the search period in Portuguese, English, or Spanish. Of 497 records identified, 107 publications met the eligibility criteria. Publications were concentrated in Europe (48.6%) and the Americas (37.4%), whereas Asia and Africa accounted for 10.3% and 3.7%, respectively. Among single-country publications, Brazil had the highest frequency (29.0% of the corpus). Quantitative studies predominated (60.7%), and 72.9% of the publications were issued between 2019 and 2024. The thematic synthesis identified seven recurring dimensions: patient safety culture; adverse events and reporting systems; medication safety and polypharmacy; assessment tools and indicators; continuing education and professional training; user participation and person-centered care; and organizational strategies and risk management. Research gaps and future directions were synthesized as a cross-cutting component. The mapped literature addresses patient safety in PHC through clinical, organizational, technological, methodological, and relational perspectives. However, heterogeneity among the publications and the absence of formal critical appraisal preclude conclusions regarding effectiveness, causal effects, comparative superiority, certainty of evidence, or applicability of the mapped strategies across different PHC contexts. Full article

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21 pages, 1163 KB

Open AccessStudy Protocol

Development of a Pandemic-Resilient Framework to Optimise Childhood Routine Immunisation and Maternal Health Services Post-COVID-19 Pandemic in Sokoto State, Nigeria: A Mixed Method Study Protocol

by Clovis Nchinjoh Sangwe, Sibusiso Frank Nkosi, Kelebogile Leah Manjinja and Wilfred Njabulo Nunu

Int. J. Environ. Res. Public Health 2026, 23(10), 1239; https://doi.org/10.3390/ijerph23101239 - 22 Sep 2026

Abstract

The COVID-19 pandemic reduced access to childhood immunisation and maternal health services in Nigeria, which already reports some of the highest maternal and child mortality rates globally. This study seeks to develop a pandemic-resilient framework to optimise these services post-pandemic. An explanatory sequential [...] Read more.

The COVID-19 pandemic reduced access to childhood immunisation and maternal health services in Nigeria, which already reports some of the highest maternal and child mortality rates globally. This study seeks to develop a pandemic-resilient framework to optimise these services post-pandemic. An explanatory sequential mixed method study design will be used, consisting of three distinct but interconnected phases. In phase 1, an analytical retrospective cohort study using administrative data from Sokoto State from 2015 to 2023 will be analysed to inform the qualitative study design. Microsoft Excel 2013 worksheets will be used to collect and export secondary data into R Statistical Software (version 4.1.2) for analysis using descriptive statistics and dynamic time-series regression. In phase 2, qualitative data collection tools will be developed based on the socio-ecological model and the Health Belief Model and refined based on the outcome of the quantitative analysis. The data will be collected using key informant interviews and focus group discussions with purposively selected participants. Thematic analysis involving deductive coding will be employed. In the final phase, the pandemic-resilient framework will be developed using Strength, Weakness, Opportunity, and Threat (SWOT) analysis; the Threat, Opportunity, Weakness, and Strength (TOWS) model; and the Build, Overcome, Explore, and Minimise (BOEM) model. The resulting framework will be validated using the Delphi technique and used to inform policy on building resilience of childhood immunisation and maternal health services during public health emergencies, which is critical for future pandemic preparedness. Full article

(This article belongs to the Section Global Health)

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23 pages, 405 KB

Open AccessArticle

Beyond the Classroom: Factors Associated with Job-Related Suicide Among Educators

by Leanne M. Confer, Beth L. McGee, Katie M. Mercer, Edward B. Mondor, Jessica S. Schwind, Hadeer Hegazy and Jacquelyn Mesenbrink-Sainz

Int. J. Environ. Res. Public Health 2026, 23(10), 1238; https://doi.org/10.3390/ijerph23101238 - 22 Sep 2026

Abstract

Going beyond the classroom, this study emphasized the well-being and support of educators, shifting focus from the traditional emphasis on students. Leveraging the National Violent Death Reporting System (NVDRS) dataset, this study identified preceding factors and salient qualitative themes based on available coroner/medical [...] Read more.

Going beyond the classroom, this study emphasized the well-being and support of educators, shifting focus from the traditional emphasis on students. Leveraging the National Violent Death Reporting System (NVDRS) dataset, this study identified preceding factors and salient qualitative themes based on available coroner/medical examiner and police reports of primary and secondary educator suicides in the United States. Factors related to having a job-related problem among educators who died by suicide included the COVID-19 pandemic, age, being male, being married, teaching special education, experiencing depressed mood, financial problems, and/or the presence of criminal-legal problems (n = 1655). Additionally, qualitative themes extracted among those with a job-related problem preceding suicide (n = 136) included conduct-related issues or related investigations, the COVID-19 pandemic, financial strain, teaching-related issues, employment changes, and mental health problems. The findings of this study are connected to self-efficacy theory and teacher identity, and to broader global challenges among educators. We provide policy recommendations based on our findings for this important occupational group. Full article

(This article belongs to the Special Issue Research on Suicide Assessment, Prevention and Management)

22 pages, 1025 KB

Open AccessArticle

Associations of Cardiometabolic Risk Burden, Metabolic Syndrome, and Functional Exercise Capacity in Thai Older Adults: A Cross-Sectional Study

by Orachorn Boonla, Nutsupa Singhasoot, Sudarat Boonpitak, Oranat Sukkho, Puttipong Poncumhak, Promtpong Anuchitchanchai and Piyapong Prasertsri

Int. J. Environ. Res. Public Health 2026, 23(9), 1237; https://doi.org/10.3390/ijerph23091237 - 18 Sep 2026

Abstract

Metabolic syndrome (MetS) is highly prevalent among older adults and has been associated with impaired physical function and reduced exercise capacity. However, the relationships of binary MetS status and cumulative MetS component burden with different dimensions of functional capacity remain unclear. This cross-sectional [...] Read more.

Metabolic syndrome (MetS) is highly prevalent among older adults and has been associated with impaired physical function and reduced exercise capacity. However, the relationships of binary MetS status and cumulative MetS component burden with different dimensions of functional capacity remain unclear. This cross-sectional study examined these associations and evaluated whether they were attenuated after adjustment for body mass index (BMI) among community-dwelling Thai older adults. A total of 182 participants aged ≥ 60 years were included. The outcomes represented complementary dimensions of functional capacity: lower-extremity functional performance assessed using the Five-Times Sit-to-Stand Test (5TSTS), stepping endurance assessed using the 2-Minute Step Test (2MST), cadence-derived estimated oxygen uptake, and externally paced walking capacity assessed using the Incremental Shuttle Walk Test (ISWT). Overall, 55 participants (30.2%) had MetS. Functional outcomes did not differ significantly between participants with and without MetS. After false-discovery-rate (FDR) correction, BMI was inversely correlated with ISWT distance, waist circumference was correlated with slower 5TSTS performance and shorter ISWT distance, and cumulative MetS component burden was inversely correlated with ISWT distance. Binary MetS status was not independently associated with any outcome after FDR correction. In Model 1, each additional MetS component was associated with a 0.27-s longer 5TSTS completion time (95% CI: 0.07 to 0.46; p = 0.008; q = 0.030) and a 27.80-m shorter ISWT distance (95% CI: −45.01 to −10.59; p = 0.002; q = 0.014). Both associations were attenuated and no longer statistically significant after additional adjustment for BMI. These findings suggest that cumulative MetS burden was associated with sit-to-stand and walking performance before BMI adjustment. Both associations were attenuated and no longer statistically significant after additional adjustment for BMI. Full article

(This article belongs to the Special Issue Novel Exercise and Nutrition Interventions for Better Ageing and Preventing Metabolic Conditions)

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