International Journal of Environmental Research and Public Health

10 pages, 266 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

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, 609 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 at a [...] 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

13 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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21 pages, 2245 KB

Open AccessSystematic Review

Systematic Literature Review of Research on the Effectiveness of Art Therapy for Chinese Patients with Depressive Disorder

by Guochao Xu, Bo Ram Park and Bo Hyun Kim

Int. J. Environ. Res. Public Health 2025, 22(9), 1443; https://doi.org/10.3390/ijerph22091443 - 17 Sep 2025

Abstract

This study aimed to systematically review literature on the effects of art therapy in Chinese patients with depression. The review was conducted in accordance with the guidelines of the preferred reporting items for systematic reviews and meta-analyses. We used four Chinese databases (CNKI, [...] Read more.

This study aimed to systematically review literature on the effects of art therapy in Chinese patients with depression. The review was conducted in accordance with the guidelines of the preferred reporting items for systematic reviews and meta-analyses. We used four Chinese databases (CNKI, CBM, WF, and VIP) to identify studies and dissertations published in China between January 2008 and December 2023, retrieving 368 studies. We applied the inclusion/exclusion criteria based on the Participant, Intervention, Comparison, Outcome, Time, and Study Design criteria and assessed the risk of bias; 34 studies were included. Studies began in 2008 and their number increased in 2018. They mostly comprised research articles. Intervention targets were most often adolescents (≤19 years old) diagnosed with depressive disorder. Art therapy interventions were conducted and comprised 6–10 group therapy sessions that lasted 60–90 min each. Of the 12 techniques used, painting was the most common. Second, art therapy effectively improved affective, social, cognitive, self, and physical aspects. Given the slow development of art therapy in research and clinical practice, we believe our study makes valuable contributions to its advancement in China. Full article

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20 pages, 702 KB

Open AccessArticle

Exploring the Relation Between Nursing Workload and Moral Distress, Burnout, and Turnover in Latvian Intensive Care Units: An Ecological Analysis of Parallel Data

by Olga Cerela-Boltunova and Inga Millere

Int. J. Environ. Res. Public Health 2025, 22(9), 1442; https://doi.org/10.3390/ijerph22091442 - 17 Sep 2025

Abstract

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. [...] Read more.

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts. Full article

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22 pages, 1195 KB

Open AccessReview

Interventions to Reduce Mental Health Stigma Among Health Care Professionals in Primary Health Care: A Systematic Review and Meta-Analysis

by Lazzat Zhamaliyeva, Nurgul Ablakimova, Assemgul Batyrova, Galina Veklenko, Andrej M. Grjibovski, Sandugash Kudaibergenova and Nursultan Seksenbayev

Int. J. Environ. Res. Public Health 2025, 22(9), 1441; https://doi.org/10.3390/ijerph22091441 - 17 Sep 2025

Abstract

Background: Stigmatizing attitudes toward individuals with mental health conditions are common among healthcare professionals in primary healthcare (PHC) settings, posing a major barrier to early diagnosis, appropriate treatment, and recovery. Methods: This systematic review and meta-analysis evaluated the effectiveness of interventions aimed at [...] Read more.

Background: Stigmatizing attitudes toward individuals with mental health conditions are common among healthcare professionals in primary healthcare (PHC) settings, posing a major barrier to early diagnosis, appropriate treatment, and recovery. Methods: This systematic review and meta-analysis evaluated the effectiveness of interventions aimed at reducing mental health-related stigma among PHC professionals (general practitioners, nurses, community health workers, and allied providers). Eligibility was restricted to interventional studies targeting PHC staff; non-clinical populations and students without clinical practice were excluded. Comparators included usual training, waitlist control, or pre–post evaluation. A systematic search of PubMed, Scopus, and Web of Science was conducted in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO (CRD420251074412). Results: Twenty-five studies met the inclusion criteria, of which three contributed to the quantitative synthesis. Interventions included educational, contact-based, and multicomponent approaches. Risk of bias was assessed using tools appropriate to study design. Interventions generally improved knowledge and attitudes and, to a lesser extent, behavioral intentions. Meta-analysis of pre–post changes using the Opening Minds Scale for Health Care Providers (OMS-HC) demonstrated a significant reduction in stigma (MD = −0.27, 95% CI −0.40 to −0.14; p < 0.001; I² = 91%). A difference-in-differences analysis of studies with intervention and control groups confirmed this effect with moderate heterogeneity (MD = −0.18, 95% CI −0.25 to −0.11; p < 0.0001; I² = 50%). Conclusions: Contact-based and multicomponent interventions were associated with stronger and more sustained effects. The main limitations of the evidence were short follow-up periods, reliance on self-reported outcomes, methodological heterogeneity, and the possibility of publication bias. Our findings suggest that reducing stigma among PHC professionals can enhance patient engagement, timely diagnosis, and quality of care in routine clinical practice. Full article

(This article belongs to the Special Issue Mental Health Services in Primary Care Settings: Challenges, Opportunities and Best Practices)

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40 pages, 1450 KB

Open AccessArticle

Forest Therapy Trails: Development and Application of an Assessment Protocol

by Paul H. Gobster

Int. J. Environ. Res. Public Health 2025, 22(9), 1440; https://doi.org/10.3390/ijerph22091440 - 16 Sep 2025

Abstract

What key characteristics of forest sites and trails contribute to enjoyable and healthy immersive nature experiences for visitors? Previous research has helped identify the conceptual structure and criteria important in facilitating successful experiences, but there remains a knowledge gap in translating this information [...] Read more.

What key characteristics of forest sites and trails contribute to enjoyable and healthy immersive nature experiences for visitors? Previous research has helped identify the conceptual structure and criteria important in facilitating successful experiences, but there remains a knowledge gap in translating this information into operational guidelines. To address this gap, the present work used a descriptive inventory approach combining field research with a variety of secondary data to develop a protocol for assessing four site level criteria (beauty, integrity, tranquility, accessibility) and six trail level criteria (ease of travel, attractiveness of layout, natural features, built features, explorable nature, interpretation and stewardship). Through an iterative process, the protocol was refined and applied to selected sites (n = 56) and trails (n = 157) in two study areas in metropolitan Chicago, Illinois, and the rural Northwoods of Wisconsin. Qualitative and quantitative information describes preferred conditions across criteria, while quantitative ratings highlight commonalities and differences between urban and rural sites and trails. Although the principal focus was on foot trails, sub-analyses show how the criteria can apply to bike and paddle trails. With regional adaptations, the protocol has utility for the planning and design of new and management of existing trails for the growing practice of forest therapy and related forms of nature-based recreation. Full article

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16 pages, 674 KB

Open AccessArticle

Psychosocial Risk Factors and Burnout Among Teachers: Can Emotional Intelligence Make a Difference?

by Carla Barros, Carina Fernandes and Pilar Baylina

Int. J. Environ. Res. Public Health 2025, 22(9), 1439; https://doi.org/10.3390/ijerph22091439 - 16 Sep 2025

Abstract

Teaching is a complex profession that demands simultaneous cognitive and emotional efforts. The present study aims to determine whether teachers’ emotional intelligence moderates the relationship between psychosocial risk factors and burnout. A cross-sectional online survey was conducted among 215 secondary school teachers. Measurement [...] Read more.

Teaching is a complex profession that demands simultaneous cognitive and emotional efforts. The present study aims to determine whether teachers’ emotional intelligence moderates the relationship between psychosocial risk factors and burnout. A cross-sectional online survey was conducted among 215 secondary school teachers. Measurement instruments included the Burnout Assessment Tool (BAT-23) to assess burnout dimensions; the Health and Work Survey (INSAT) to evaluate psychosocial risk factors; and the Wong and Law Emotional Intelligence Scale (WLEIS-P) to assess emotional intelligence. A mediation/moderation analysis using the PROCESS macro was conducted to examine whether emotional intelligence mediates/moderates the relationship between psychosocial risk factors and burnout among teachers. The results show that psychosocial risk was a significant positive predictor of burnout (B = 0.313, p = 0.001), indicating that higher perceived risk was associated with higher burnout symptoms. Emotional intelligence did not significantly predict burnout on its own (B = 0.176, p = 0.364), and the interaction term (psychosocial risk × emotional intelligence) was not significant (B = 0.000, p = 0.995), suggesting that emotional intelligence does not moderate the relationship between psychosocial risks and burnout. These findings underscore a more holistic approach to address burnout, centered in intervention strategies that include a deeper analysis of organizational context determinants. Full article

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16 pages, 1801 KB

Open AccessArticle

Food Safety Management in Primary Schools for Ethnic Groups in Northern Thailand: A PDCA-Based Evaluation

by Vivat Keawdounglek, Warapon Paenkhokuard and Anuttara Hongthong

Int. J. Environ. Res. Public Health 2025, 22(9), 1438; https://doi.org/10.3390/ijerph22091438 - 16 Sep 2025

Abstract

Food safety management in rural ethnic schools remains underdeveloped in Northern Thailand. This study evaluates such systems in primary schools using the Plan Do Check Act (PDCA) framework, which can serve as a scalable and culturally sensitive tool to strengthen food safety systems [...] Read more.

Food safety management in rural ethnic schools remains underdeveloped in Northern Thailand. This study evaluates such systems in primary schools using the Plan Do Check Act (PDCA) framework, which can serve as a scalable and culturally sensitive tool to strengthen food safety systems in multi-ethnic school environments. Multi-criteria decision analysis was employed across nine schools representing the Hmong, Lisu, Lahu, Akha, Kamoo, Haw, Mien, Karen, and Lau communities. Data collection included (1) PDCA-based rubric scoring validated by three experts; (2) in-depth interviews and field observations; (3) food and water contamination testing; and (4) microbiological analysis of chefs’ hands and utensils (detected or non-detected). The results showed that only 45% of the schools involved had third-party food safety monitoring, and 45% lacked systems to gather student feedback. None could independently assess chlorine or food residue. Escherichia coli contamination was found on chefs’ hands (44%), utensils (56%), and drinking water (33%). Schools C (Lahu) and F (Haw) had the highest and lowest PDCA scores, respectively. Therefore, schools should (1) train employees, (2) work with a third party responsible for monitoring food safety, and (3) establish raw material and contamination self-assessment processes to improve food safety. Implementing PDCA to improve food safety in neglected schools is essential. Full article

(This article belongs to the Section Environmental Health)

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14 pages, 384 KB

Open AccessReview

Environmental Risk in American Indian Children, Including Cardiovascular and Hematologic Consequences of Cadmium Exposure: Possible Means of Mitigation

by Joseph Burns, Cesar E. Larancuent, Cian L. Jacob, Danielle A. Heims-Waldron, Whitney R. Lloyd, Justin P. Zachariah, Abraham Haimed, Ana Navas-Acien and Jason F. Deen

Int. J. Environ. Res. Public Health 2025, 22(9), 1437; https://doi.org/10.3390/ijerph22091437 - 16 Sep 2025

Abstract

Emerging evidence reveals that cadmium exposure is associated with hypertension, cardiovascular disease (CVD), and anemia, among others. Toxic metal exposure poses a particular threat to American Indian/Alaska Native populations, particularly given their proximity to mining waste. This review aims to summarize and organize [...] Read more.

Emerging evidence reveals that cadmium exposure is associated with hypertension, cardiovascular disease (CVD), and anemia, among others. Toxic metal exposure poses a particular threat to American Indian/Alaska Native populations, particularly given their proximity to mining waste. This review aims to summarize and organize evidence explaining the cardiovascular and hematologic consequences of cadmium exposure in children, including specific data on this exposure in AI/AN people, and strategies and policy actions to mitigate these consequences in AI/AN children. Full article

(This article belongs to the Special Issue Negative Health Impacts of Environmental Contaminant Exposure During Early Childhood)

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16 pages, 535 KB

Open AccessArticle

Effects of LED Versus Fluorescent Task Lighting on Sleep Quality and Daytime Function in Windowless Office Environments

by Juntae Jake Son

Int. J. Environ. Res. Public Health 2025, 22(9), 1436; https://doi.org/10.3390/ijerph22091436 - 16 Sep 2025

Abstract

This study investigated the effects of LED versus fluorescent task lighting on sleep quality and daytime functioning among office workers in a windowless environment. Using a within-subjects crossover design with 32 full-time employees, participants were exposed to both 4000 K LED and 4100 [...] Read more.

This study investigated the effects of LED versus fluorescent task lighting on sleep quality and daytime functioning among office workers in a windowless environment. Using a within-subjects crossover design with 32 full-time employees, participants were exposed to both 4000 K LED and 4100 K fluorescent lighting conditions over two one-week periods. Subjective sleep quality and alertness were assessed through the Pittsburgh Sleep Quality Index (PSQI) and daily sleep diaries. Results indicated significantly better global sleep quality, improved subjective sleep assessments, and reduced daytime dysfunction under LED lighting conditions. While sleep duration did not significantly differ, a positive trend was observed favoring the LED condition. These outcomes are likely due to differences in spectral power distribution between the two light sources, particularly the continuous, blue-enriched spectrum of the LED lamp, which supports circadian regulation. The findings suggest that biologically supportive lighting—such as continuous-spectrum LEDs—can positively impact sleep and daytime performance, even in the absence of natural daylight. This research contributes to the growing field of circadian lighting and offers practical implications for architects, designers, and workplace managers aiming to enhance employee well-being and productivity in enclosed office environments. Full article

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29 pages, 853 KB

Open AccessArticle

An International Comparative Reliability and Concurrent Validity Assessment of the Multi-Level Job Content Questionnaire (JCQ) 2.0

by Wilfred Agbenyikey, Jian Li, Sung-Il Cho, Sarven S. McLinton, Maureen Dollard, Maren Formazin, Bongkyoo Choi, Irene Houtman and Robert Karasek

Int. J. Environ. Res. Public Health 2025, 22(9), 1435; https://doi.org/10.3390/ijerph22091435 - 15 Sep 2025

Abstract

Background: This paper empirically tests the new multi-level Associationalist Demand Control (ADC) theory by applying the Job Content Questionnaire (JCQ) 2.0 that assesses both a wide range of task characteristics as well as work organizational and external-to-work psychosocial characteristics. Methods: The paper is [...] Read more.

Background: This paper empirically tests the new multi-level Associationalist Demand Control (ADC) theory by applying the Job Content Questionnaire (JCQ) 2.0 that assesses both a wide range of task characteristics as well as work organizational and external-to-work psychosocial characteristics. Methods: The paper is based on four JCQ 2.0 pilot studies among 16,125 workers in Korea, China, Australia, and Germany. All pilots used the original JCQ task-level scales and then added newly developed proposed items and scales, evolving more comprehensive higher-level scales from pilot to pilot from 2005 to 2011. A brief review of the analytic process is presented, followed by an assessment of the internal consistency and concurrent validity of the final 25 multi-level JCQ 2.0 scales at the task, the organizational, and the external levels. Results: Adequate psychometric properties were established for the JCQ 2.0 pilot scales. The extended set of task-level scales was found to be robust across all samples; the new organizational scales mainly showed adequate internal consistency with α > 0.7 in Australia and Germany (tested only there) and were associated with relevant work- and health-related outcome measures as expected. Similarly, the external-to-work scales (tested only in Germany) had adequate Cronbach’s Alpha values and showed expected associations to relevant outcome scales. Conclusions: Although not all scales were available in all countries, overall, the results support the “functional similarity” of the major scale areas across the four pilot countries and support the underlying extensions of the Demand–Control theoretical constructs to the multi-level psychosocial work assessment for the promotion of workers’ health and wellbeing as suggested by the new ADC model. Full article

(This article belongs to the Special Issue The Job Content Questionnaire 2.0: A Tool for Measurement of the Psychosocial Work Environment and Sustainable Work Globally)

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Open AccessCorrection

Correction: Wu et al. Bi-Directional Pollution Characteristics and Ecological Health Risk Assessment of Heavy Metals in Soil and Crops in Wanjiang Economic Zone, Anhui Province, China. Int. J. Environ. Res. Public Health 2022, 19, 9669

by Dun Wu, Hai Liu, Jian Wu, Ndhlovu kataza Nyasha and Wenyong Zhang

Int. J. Environ. Res. Public Health 2025, 22(9), 1434; https://doi.org/10.3390/ijerph22091434 - 15 Sep 2025

Abstract

Xia Gao and Guojun Cai were removed as authors in the original publication [...] Full article

17 pages, 302 KB

Open AccessArticle

Evaluating a Research Training Program in Environmental Health and Noncommunicable Diseases in Georgia

by Carla J. Berg, Lela Sturua, Amiran Gamkrelidze, Tina Beruchashvili, Tinatin Manjavidze, Givi Javashvili, Nino Kiladze, Levan Baramidze and W. Michael Caudle

Int. J. Environ. Res. Public Health 2025, 22(9), 1433; https://doi.org/10.3390/ijerph22091433 - 14 Sep 2025

Abstract

The Clean Air Research and Education (CARE) program, launched in 2020, aims to enhance environmental health (EH) and noncommunicable disease (NCD) research capacity in the Republic of Georgia. This paper evaluates the first 4.5 years of CARE, summarizing fellows’ activities and achievements to [...] Read more.

The Clean Air Research and Education (CARE) program, launched in 2020, aims to enhance environmental health (EH) and noncommunicable disease (NCD) research capacity in the Republic of Georgia. This paper evaluates the first 4.5 years of CARE, summarizing fellows’ activities and achievements to date and fellow and faculty reactions to CARE. In February 2025, CARE leadership anonymously surveyed fellows (100% response rate: n = 23/23; 4 Master’s of Public Health [MPH], 19 PhD) and faculty (66.7%: n = 10/15; 6 Georgia-based, 4 US-based). Thesis/dissertation topics included tobacco (43.5%), air pollution and respiratory outcomes (each 21.7%), lead exposure and cancer-related and cardiovascular outcomes (each 13.0%), and others. Fellows leveraged CARE’s financial support for research execution (78.3%), scientific conferences (34.8%), specific training (21.7%, n = 5/23), and/or publication fees (26.1%). Fellows indicated that the most valuable program aspects were opportunities for (1) building/expanding professional networks; (2) exposure to experts and training; and (3) instrumental support to pursue their PhD and conduct research. Fellows and faculty prioritized sustaining the following: structured mentor–mentee relationships; involvement of US-based mentors; support identifying research funding and preparing publications; and training in methods/data analysis. This study provides a model for evaluating other research training programs and highlights the important role such programs may play in developing the capacity to conduct relevant public health research in low- and middle-income countries. Full article

(This article belongs to the Section Global Health)

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International Journal of Environmental Research and Public Health

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