International Journal of Environmental Research and Public Health

17 pages, 570 KB

Open AccessArticle

Associations Between Walking in the Third Trimester of Pregnancy and Maternal Mental Health During the COVID-19 Pandemic

by Angélique Brun, Stephanie-May Ruchat, Sophie Chaput-Langlois, Linda Booij, Raphaëlle Giac, Katherine Séguin, Andréanne Bernier, Anne-Sophie Morisset, Isabelle Boucoiran, Cathy Vaillancourt, Sarah Lippé and Catherine M. Herba

Int. J. Environ. Res. Public Health 2025, 22(10), 1538; https://doi.org/10.3390/ijerph22101538 - 8 Oct 2025

Abstract

Prenatal physical activity (PA) has well-established benefits for maternal mental health. However, PA levels are generally low among pregnant individuals and were even lower during the COVID-19 pandemic. Since walking is the most popular form of prenatal PA, we aimed to examine associations [...] Read more.

Prenatal physical activity (PA) has well-established benefits for maternal mental health. However, PA levels are generally low among pregnant individuals and were even lower during the COVID-19 pandemic. Since walking is the most popular form of prenatal PA, we aimed to examine associations between walking in the third trimester of pregnancy and mental health symptoms of depression, anxiety, pregnancy-related anxiety and perceived stress during the pandemic. Relevant pandemic-related factors (e.g., COVID-19 waves, population density) associated with walking were also studied. Pregnant individuals were recruited across Quebec (Canada) between October 2020 and September 2022, as part of the Resilience and Perinatal Stress during the Pandemic (RESPPA) study. Analyses were conducted on data collected via online questionnaires during the third trimester (n = 1086). Results revealed that higher levels of walking were significantly associated with lower symptoms of generalized anxiety (β = −0.06, p = 0.035), and perceived stress (β = −0.07, p = 0.007). Living in a more densely populated area, living with fewer children at home and having a university degree were associated with higher levels of walking. Those who completed their questionnaire in the second pandemic wave also reported higher levels of walking. Our results highlight the potential of walking in the third trimester to support maternal mental health. Full article

(This article belongs to the Special Issue The Impact of Physical Activity on Mental Health and Well-Being)

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26 pages, 1105 KB

Open AccessReview

A Review of the Human Health Risks from Microbial Hazards in Recreational Beach Sand

by Nicola King and Margaret Leonard

Int. J. Environ. Res. Public Health 2025, 22(10), 1537; https://doi.org/10.3390/ijerph22101537 - 8 Oct 2025

Abstract

At many recreational beaches, the health of visitors is protected through water quality monitoring programmes. However, visitors may also be exposed to microbiological pathogens in sand via ingestion, inhalation and skin contact. Microbiological pathogens that can cause human illness may be naturally found [...] Read more.

At many recreational beaches, the health of visitors is protected through water quality monitoring programmes. However, visitors may also be exposed to microbiological pathogens in sand via ingestion, inhalation and skin contact. Microbiological pathogens that can cause human illness may be naturally found in beach sands, or introduced with people, animals or water entering the beach. The World Health Organization has recommended that recreational water safety plans consider microbial pathogens in beach sand. This review shows that a range of faecal and non-faecal pathogens can be detected in beach sand, but difficulty in determining whether exposure occurred via the sand or water means that there is insufficient evidence to link their presence with adverse human health effects. Proactively integrating beach sand testing into recreational water safety programmes will generate data to assess the impact of risk management activities. The use of faecal indicator bacteria to indicate elevated risk from faeces should be a priority where there are potential sources of contamination. This should be complemented with sanitary surveys and analyses that elucidate faecal contamination sources. The inclusion of non-faecal pathogens into monitoring programmes needs further, locally relevant justification through evidence from epidemiological studies and human health risk assessment. Full article

(This article belongs to the Section Environmental Health)

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10 pages, 268 KB

Open AccessArticle

SESS Model for Adolescent Sexual Health Promotion: A Quasi-Experimental Two-School Evaluation in Thailand

by Jun Norkaew, Pissamai Homchampa, Souksathaphone Chanthamath and Ranee Wongkongdech

Int. J. Environ. Res. Public Health 2025, 22(10), 1536; https://doi.org/10.3390/ijerph22101536 - 8 Oct 2025

Abstract

Background: Unintended adolescent pregnancy and sexually transmitted infections (STIs) remain pressing public health concerns in Northeastern Thailand. Although school-based sexuality education is widespread, risk behaviors persist, underscoring the need for innovative approaches. This study evaluated the SESS (System–Empowerment–Support–Social Network) model, a multi-component framework [...] Read more.

Background: Unintended adolescent pregnancy and sexually transmitted infections (STIs) remain pressing public health concerns in Northeastern Thailand. Although school-based sexuality education is widespread, risk behaviors persist, underscoring the need for innovative approaches. This study evaluated the SESS (System–Empowerment–Support–Social Network) model, a multi-component framework designed to strengthen adolescent sexual health. Methods: A quasi-experimental, two-school study was conducted among 240 students aged 15–19 years in Nakhon Ratchasima Province. One school (n = 120) implemented a 16-week SESS program, while a comparison school (n = 120) continued with the standard curriculum. The SESS model combined system coordination, empowerment workshops, peer and institutional support, and digital platforms (Facebook, LINE). Data were collected with validated questionnaires and analyzed using ANCOVA, adjusting for baseline values. Exploratory analyses reported mean differences with 95% confidence intervals (CIs). Results: Groups were comparable at baseline. Post-intervention, the intervention school showed higher perception scores (mean difference = +13.0; 95% CI: 10.5–17.0) and preventive practice scores (mean difference = +14.0; 95% CI: 10.1–17.9). Attitudes showed minimal change. No pregnancies or self-reported STI cases were documented among intervention participants during the follow-up period. Conclusions: In this two-school quasi-experimental evaluation, the SESS model was associated with improvements in perceptions and practices, though attitudinal changes were limited. Findings suggest the feasibility of integrating empowerment, social support, and digital engagement into school-based programs while highlighting the need for multi-school trials to establish effectiveness. Full article

20 pages, 1956 KB

Open AccessReview

Interoperability as a Catalyst for Digital Health and Therapeutics: A Scoping Review of Emerging Technologies and Standards (2015–2025)

by Kola Adegoke, Abimbola Adegoke, Deborah Dawodu, Akorede Adekoya, Ayoola Bayowa, Temitope Kayode and Mallika Singh

Int. J. Environ. Res. Public Health 2025, 22(10), 1535; https://doi.org/10.3390/ijerph22101535 - 8 Oct 2025

Abstract

Background: Interoperability is fundamental for advancing digital health and digital therapeutics, particularly with the integration of technologies such as artificial intelligence (AI), blockchain, and federated learning. Low- and middle-income countries (LMICs), where digital infrastructure remains fragmented, face specific challenges in implementing standardized and [...] Read more.

Background: Interoperability is fundamental for advancing digital health and digital therapeutics, particularly with the integration of technologies such as artificial intelligence (AI), blockchain, and federated learning. Low- and middle-income countries (LMICs), where digital infrastructure remains fragmented, face specific challenges in implementing standardized and scalable systems. Methods: This scoping review was conducted using the Arksey and O’Malley framework, refined by Levac et al., and the Joanna Briggs Institute guidelines. Five databases (PubMed, Scopus, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched for peer-reviewed English language studies published between 2015 and 2025. We identified 255 potentially eligible articles and selected a 10% random sample (n = 26) using Stata 18 by StataCorp LLC, College Station, TX, USA, for in-depth data charting and thematic synthesis. Results: The selected studies spanned over 15 countries and addressed priority technologies, including mobile health (mHealth), the use of Health Level Seven (HL7)’s Fast Healthcare Interoperability Resources (FHIR) for data exchange, and blockchain. Interoperability enablers include standards (e.g., HL7 FHIR), data governance frameworks, and policy interventions. Low- and Middle-Income Countries (LMICs) face common issues related to digital capacity shortages, legacy systems, and governance fragmentation. Five thematic areas were identified: (1) policy and governance; (2) standards-based integration; (3) infrastructure and platforms; (4) emerging technologies; and (5) LMIC implementation issues. Conclusions: Emerging digital health technologies increasingly rely on interoperability standards to scale their operation. Although global standards such as FHIR and the Trusted Exchange Framework and Common Agreement (TEFCA) are gaining momentum, LMICs require dedicated governance, infrastructure, and capacity investments to make equitable use feasible. Future initiatives can benefit from using science- and equity-informed frameworks. Full article

(This article belongs to the Special Issue uHealth Interventions and Digital Therapeutics for Better Diseases Prevention and Patient Care)

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15 pages, 563 KB

Open AccessArticle

The Relationship Between Technology Use and Medication Access in Older Adults in Puerto Rico

by Joseph Badillo-Salcedo, Gabriela M. Vélez-Jiménez, Ethan G. Rosado-Martínez, Kyle Melin and Jonathan Hernández-Agosto

Int. J. Environ. Res. Public Health 2025, 22(10), 1534; https://doi.org/10.3390/ijerph22101534 - 7 Oct 2025

Abstract

The recent shift from in-person to digital pharmacy services is transforming how patients interact with their pharmacists but has the potential to disadvantage older adults (aged ≥ 65) who often face barriers when using technology. This study aimed to assess digital inequalities affecting [...] Read more.

The recent shift from in-person to digital pharmacy services is transforming how patients interact with their pharmacists but has the potential to disadvantage older adults (aged ≥ 65) who often face barriers when using technology. This study aimed to assess digital inequalities affecting medication access among older adults. A Spanish-language questionnaire was developed and psychometrically validated, revealing a two-factor latent structure comprising: (1) Technology Use, and (2) Medication Access. Item discrimination analysis confirmed that all significantly differentiated between those that used technology to facilitate their medication access and those that did not (p < 0.001). Participants with higher education reported greater income levels (p < 0.001), and income was in turn related to both internet access and digital skills. Age played a key role in perceptions of technology. Participants who considered technology helpful were younger (

\bar{x}

= 72.9) than those who did not (

\bar{x}

= 76.6; p = 0.001). There was no significant relationship between perceived technological usefulness and reporting not being able to acquire medications because of technological barriers (p = 0.788). This newly created and validated questionnaire identified gaps related to digital pharmacy services and may be a useful tool in future clinical, community, and investigative contexts. Full article

(This article belongs to the Special Issue Addressing Social Determinants of Health to Improve Latino Health Outcomes)

11 pages, 468 KB

Open AccessReview

Walking Football as a Multidimensional Intervention for Healthy Aging: A Scoping Review of Physical and Functional Outcomes in Older Adults

by Paulo Sérgio Machado Rodrigues, Antônio Ribeiro Neto, Leandro Alonso do Espírito Santo, Sheilla Tribess and Jair Sindra Virtuoso Junior

Int. J. Environ. Res. Public Health 2025, 22(10), 1533; https://doi.org/10.3390/ijerph22101533 - 7 Oct 2025

Abstract

Population aging presents pressing public health challenges, calling for accessible and effective interventions to preserve functional capacity and prevent frailty. Walking football, an adapted sport for older adults, has emerged as a promising approach by combining aerobic activity, neuromuscular stimulation, and social engagement. [...] Read more.

Population aging presents pressing public health challenges, calling for accessible and effective interventions to preserve functional capacity and prevent frailty. Walking football, an adapted sport for older adults, has emerged as a promising approach by combining aerobic activity, neuromuscular stimulation, and social engagement. This scoping review aimed to synthesize experimental evidence on its effect on physical and functional outcomes in older adults. Following PRISMC-ScR and Joanna Briggs Institute guidelines, a systematic search across seven databases identified 10 studies with 332 participants (mean age 68.7 years, 85.2% male). Interventions lasted 6–16 weeks, with two to three weekly sessions. The outcomes assessed included strength, agility, cardiorespiratory fitness, body composition, and clinical parameters. Six studies reported improvements in at least one component of physical fitness, particularly handgrip strength, abdominal fat reduction, and aerobic capacity. Among the included studies, three were randomized controlled trials, four quasi-experimental designs, and three intervention studies without control groups, highlighting the methodological heterogeneity of the field. Some studies also reported benefits in blood pressure, glucose, cholesterol, and quality of life. Despite promising results, the literature lacks large-scale randomized trials, female representation, and long-term assessments. Walking football appears to be a safe, multicomponent, and low-cost strategy to support healthy aging and warrants integrations into public health policies. Full article

(This article belongs to the Special Issue How Sport and Physical Activity Contribute to Healthy Lifestyle and Physical Fitness for Public Health)

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8 pages, 231 KB

Open AccessReview

Peer Support Programs for First Responders: A Critical Review and Research Roadmap

by Clint Bowers, Deborah C. Beidel and Victoria L. Steigerwald

Int. J. Environ. Res. Public Health 2025, 22(10), 1532; https://doi.org/10.3390/ijerph22101532 - 7 Oct 2025

Abstract

First responders face adverse health effects because they regularly encounter stressful situations and potentially traumatic events. Peer support programs have emerged as a method to reduce these adverse outcomes. A growing interest in peer programs exists despite a restricted body of research in [...] Read more.

First responders face adverse health effects because they regularly encounter stressful situations and potentially traumatic events. Peer support programs have emerged as a method to reduce these adverse outcomes. A growing interest in peer programs exists despite a restricted body of research in this field. Additionally, the current research on this topic faces significant conceptual and methodological shortcomings. This paper conducts an extensive analysis of present peer support research gaps before proposing future study directions to improve our understanding of this intervention. Full article

(This article belongs to the Special Issue Prevention and Treatment of Trauma-Related Mental Illness)

0 pages, 332 KB

Open AccessArticle

Associations Between Obesity and the Severity of Occupational Allergic Rhinitis: A Cross-Sectional Study

by Imène Kacem, Amen Moussa, Chaima Sridi, Amene Fki, Mohamed Ajmi, Maissa Thabet, Olfa El Maalel, Maher Maoua, Mohamed Kahloul and Najib Mrizek

Int. J. Environ. Res. Public Health 2025, 22(10), 1531; https://doi.org/10.3390/ijerph22101531 - 6 Oct 2025

Abstract

Introduction: Occupational allergic rhinitis (OAR) is a common respiratory condition that can lead to varying degrees of symptom severity, significantly impacting workers’ quality of life and productivity. While occupational risk factors are well established, the influence of nonoccupational factors, such as obesity, that [...] Read more.

Introduction: Occupational allergic rhinitis (OAR) is a common respiratory condition that can lead to varying degrees of symptom severity, significantly impacting workers’ quality of life and productivity. While occupational risk factors are well established, the influence of nonoccupational factors, such as obesity, that contribute to OAR severity remains largely unexplored. Aims: This study aims to study the association between obesity and the severity of OAR. Methods: A cross-sectional analytical study was conducted among patients diagnosed with OAR at the Occupational Medicine Department of Farhat Hached University Hospital of Sousse. It combines a retrospective review of medical records (2013–2021) with prospective structured telephone interviews (January–March 2023). Data were collected from medical records and supplemented with telephone interviews. The severity of OAR was assessed via the PAREO score and rhinomanometry results. Results: A total of 196 patients were included. The mean age was 39.69 ± 7.92 years, with a sex ratio of 0.53. The most frequently reported symptoms were nasal obstruction (78.6%) and sneezing (88.8%). The mean PAREO score was 5.78 ± 1.61, with severe OAR reported in 59.2% of the patients. Obesity was significantly associated with increased severity of OAR symptoms (p < 0.001; OR = 5.4; 95% CI [2.6–11.1]), a finding confirmed after adjustment for variables such as age, sex, and occupational seniority. Conclusion: Obesity appears to be a modifiable risk factor influencing OAR severity. Integrating weight management strategies into the treatment of OAR patients may contribute to significant symptom relief and improved quality of life. Further longitudinal studies are needed to confirm these findings and explore the underlying mechanisms involved. Full article

0 pages, 1261 KB

Open AccessArticle

Restrictive Lung Function Patterns and Sex Differences in Primary School Children Exposed to PM2.5 in Chiang Mai, Northern Thailand

by Pakaphorn Ngamsang, Anurak Wongta, Sawaeng Kawichai, Natthapol Kosashunhanan, Hataichanok Chuljerm, Wiritphon Khiaolaongam, Praporn Kijkuokool, Putita Jiraya, Puriwat Fakfum, Wason Parklak and Kanokwan Kulprachakarn

Int. J. Environ. Res. Public Health 2025, 22(10), 1530; https://doi.org/10.3390/ijerph22101530 - 6 Oct 2025

Abstract

Northern Thailand experiences annual haze events with fine particulate matter (PM2.5) exceeding standards, posing risks to schoolchildren. This cross-sectional study (Chiang Mai, 2024) evaluated respiratory impacts among primary school children aged 8–12 years. Daily mean PM2.5 concentrations were obtained from a single fixed-site [...] Read more.

Northern Thailand experiences annual haze events with fine particulate matter (PM2.5) exceeding standards, posing risks to schoolchildren. This cross-sectional study (Chiang Mai, 2024) evaluated respiratory impacts among primary school children aged 8–12 years. Daily mean PM2.5 concentrations were obtained from a single fixed-site monitoring station (36T) located within 2 km of the spirometry site. Among 93 children with acceptable spirometry, 52% exhibited restrictive, 18% obstructive, and 30% had normal function. After adjustment for BMI, males had significantly lower odds of any pulmonary abnormality than females (AOR = 0.084; 95% CI 0.017–0.417; p = 0.002). The mean FEV₁/FVC ratio was normal (86.30 ± 13.07%), whereas mean FVC, FEV₁, and PEF were significantly below predicted values, indicating a predominantly restrictive pattern. This predominance likely reflects cumulative exposure to biomass-burning related PM2.5 during the haze season, infiltration of outdoor PM2.5 into indoor environments alongside indoor sources, and the vulnerability of developing lungs in children’s factors that reduce lung volumes while largely preserving the FEV₁/FVC ratio. The exposure assessment provides pragmatic, proximity-based estimates but is limited by reliance on one station and one season, which may not capture spatial or temporal variability. These findings highlight sex-based susceptibility and support stronger air quality protections for children. Full article

(This article belongs to the Special Issue Air Pollution Exposure and Its Impact on Human Health)

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0 pages, 1181 KB

Open AccessArticle

Occupational Pesticide Exposure Risks and Gendered Experiences Among Women in Horticultural Farms in Northern Tanzania

by Baldwina Olirk, Simon Mamuya, Idda Mosha, Bente Elisabeth Moen and Aiwerasia Ngowi

Int. J. Environ. Res. Public Health 2025, 22(10), 1529; https://doi.org/10.3390/ijerph22101529 - 6 Oct 2025

Abstract

Over the past decades, women’s participation in horticulture has become increasingly apparent across Africa. Women perform physically demanding agricultural work on family farms, as hired laborers, or as paid workers on other farms. To increase yield and protect crops, pesticides are used, yet [...] Read more.

Over the past decades, women’s participation in horticulture has become increasingly apparent across Africa. Women perform physically demanding agricultural work on family farms, as hired laborers, or as paid workers on other farms. To increase yield and protect crops, pesticides are used, yet the health risks faced by these women remain under-researched. This qualitative exploratory case study conducted in 2023, in four villages in northern Tanzania, explored pesticide exposure risks, gender roles, and awareness among women working on horticultural farms. Data were collected through four focus group discussions with 46 women (mean age, 39 years; mean work experience, 10 years). Data was transcribed and thematically analyzed. Six themes emerged: gender division of labor, limited training and awareness, adverse health effects, unsafe storage and disposal practices, inadequate protective measures, and resilience. Although pesticide spraying was typically performed by men, poor or unmarried women also undertook this task. Women had limited access to training on safe pesticide handling, and protective gear was rarely used. Despite awareness of potential health risks, economic necessity and prevailing gender norms compelled continued exposure. Gender-sensitive interventions including targeted occupational health education and promotion of safer agricultural practices are urgently needed to reduce pesticide-related health effects among women. Full article

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14 pages, 314 KB

Open AccessArticle

Effects of Challenge Initiative’s Community Health Volunteers (CHVs) on Public Sector Service Provision of Family Planning Services in Urban Sindh, Pakistan

by Junaid-ur-Rehman Siddiqui, Mansoor Ahmed Veesar, Kashif Manzoor, Irum Imran, Amir Saeed, Faisal Mahar, Saqib Ali Shaikh, Zafar Ali Dehraj, Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab and Victor Igharo

Int. J. Environ. Res. Public Health 2025, 22(10), 1528; https://doi.org/10.3390/ijerph22101528 - 5 Oct 2025

Abstract

To counter the high unmet need for family planning in urban areas of Sindh province, Pakistan, Greenstar Social Marketing began implementation of The Challenge Initiative (TCI) in collaboration with the government departments of Population Welfare and Health in eight urban districts of Sindh [...] Read more.

To counter the high unmet need for family planning in urban areas of Sindh province, Pakistan, Greenstar Social Marketing began implementation of The Challenge Initiative (TCI) in collaboration with the government departments of Population Welfare and Health in eight urban districts of Sindh province. This study aimed to assess the effectiveness of TCI’s Community Health Volunteers (CHVs) on public sector service provision of family planning services in eight urban districts of Sindh province, Pakistan. The Contraceptive Logistics Management Information System (cLMIS) and District Health Information System 2 (DHIS2) were used to obtain monthly contraceptive data from June 2022 to December 2024. CHVs began implementation at different time points in each district, starting from January 2023 to October 2023, when CHVs became operational in all eight districts. Descriptive statistics and two-sample t-tests were used for data analysis. CHVs significantly improved family planning service provision, particularly for short- and long-acting methods at the facility level, with greater change observed in Department of Health facilities. This study provides preliminary evidence of the effectiveness of CHVs in increasing public sector service provision of contraceptives, particularly for Department of Health facilities. CHVs bridge the gap between the community and the facility, particularly in areas uncovered by the government’s existing mobilization staff. Full article

(This article belongs to the Section Health Care Sciences)

9 pages, 493 KB

Open AccessTechnical Note

Rapid Agrichemical Inventory via Video Documentation and Large Language Model Identification

by Michael Anastario, Cynthia Armendáriz-Arnez, Lillian Shakespeare Largo, Talia Gordon and Elizabeth F. S. Roberts

Int. J. Environ. Res. Public Health 2025, 22(10), 1527; https://doi.org/10.3390/ijerph22101527 - 5 Oct 2025

Abstract

Background: This technical note presents a methodological approach to agrichemical inventory documentation. It complements exposure assessments in field settings with time-restricted observational periods. Conducted in Michoacán, Mexico, this method leverages large language model (LLM) capabilities for categorizing agrichemicals from brief video footage. Method: [...] Read more.

Background: This technical note presents a methodological approach to agrichemical inventory documentation. It complements exposure assessments in field settings with time-restricted observational periods. Conducted in Michoacán, Mexico, this method leverages large language model (LLM) capabilities for categorizing agrichemicals from brief video footage. Method: Given time-limited access to a storage shed housing various agrichemicals, a short video was recorded and processed into 31 screenshots. Using OpenAI’s ChatGPT (model: GPT-4o^®), agrichemicals in each image were identified and categorized as fertilizers, herbicides, insecticides, fungicides, or other substances. Results: Human validation revealed that the LLM accurately identified 75% of agrichemicals, with human verification correcting entries. Conclusions: This rapid identification method builds upon behavioral methods of exposure assessment, facilitating initial data collection in contexts where researcher access to hazardous materials may be time limited and would benefit from the efficiency and cross-validation offered by this method. Further refinement of this LLM-assisted approach could optimize accuracy in the identification of agrichemical products and expand its application to complement exposure assessments in field-based research, particularly as LLM technologies rapidly evolve. Most importantly, this Technical Note illustrates how field researchers can strategically harness LLMs under real-world time constraints, opening new possibilities for rapid observational approaches to exposure assessment. Full article

(This article belongs to the Special Issue Artificial Intelligence and Sustainable Food Systems for Public Health Promotion)

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34 pages, 4943 KB

Open AccessReview

Microbial and Chemical Water Quality Assessments Across the Rural and Urban Areas of Nepal: A Scoping Review

by Suhana Chattopadhyay, Alex Choiniere, Nedelina Tchangalova, Yunika Acharya, Amy R. Sapkota and Leena Malayil

Int. J. Environ. Res. Public Health 2025, 22(10), 1526; https://doi.org/10.3390/ijerph22101526 - 5 Oct 2025

Abstract

Nepal is currently facing critical water quality challenges due to urbanization, water management and governance issues, as well as natural disasters. This has resulted in the presence of harmful contaminants (e.g., pathogens, nitrates, arsenic) across multiple water sources, subsequently leading to waterborne disease [...] Read more.

Nepal is currently facing critical water quality challenges due to urbanization, water management and governance issues, as well as natural disasters. This has resulted in the presence of harmful contaminants (e.g., pathogens, nitrates, arsenic) across multiple water sources, subsequently leading to waterborne disease risks (e.g., cholera and typhoid). In response to these environmental and public health concerns, we conducted a scoping review to assess microbial and chemical contaminants in drinking and irrigation water in Nepal, as well as their potential impacts on public health. Following the JBI Manual for Evidence Synthesis and the PRISMA-SCR guidelines, we systematically searched for peer-reviewed literature on Nepal’s water quality in seven databases. Of 3666 unique records screened using predefined inclusion criteria, 140 met our criteria. The studies encompassed a variety of methodological designs, with the majority focusing on water sources in the Bagmati province. Bacteria and arsenic emerged as the most prevalent contaminants. Additionally, diseases such as arsenicosis and typhoid remain widespread and may be linked to contaminated water sources. The review identified key gaps in Nepal’s water quality management, including limited geographic research coverage, inconsistent testing protocols, weak regulatory enforcement, and a lack of integration of water quality with public health planning. Our findings underscore the urgent need for effective surveillance systems and a robust regulatory framework to promptly respond to water contamination events in Nepal. Full article

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21 pages, 1509 KB

Open AccessArticle

From Trust to Choice: A Cross-Sectional Survey of How Patient Trust in Pharmacists Shapes Willingness and Vaccination Decision Control Preferences

by Oluchukwu M. Ezeala, Nicholas P. McCormick, Lotanna Ezeja, Sara K. Jaradat, Spencer H. Durham and Salisa C. Westrick

Int. J. Environ. Res. Public Health 2025, 22(10), 1525; https://doi.org/10.3390/ijerph22101525 - 5 Oct 2025

Abstract

Background/Objectives: The U.S. Centers for Disease Control and Prevention recommends some vaccinations using shared clinical decision-making (SCDM). SCDM recommendations are made when not every individual within a given age or risk group would benefit from vaccination, requiring collaborative discussions between patients and providers [...] Read more.

Background/Objectives: The U.S. Centers for Disease Control and Prevention recommends some vaccinations using shared clinical decision-making (SCDM). SCDM recommendations are made when not every individual within a given age or risk group would benefit from vaccination, requiring collaborative discussions between patients and providers to assess risks and benefits. Pharmacists play a key role in implementing this recommendation and have frequent opportunities to engage with patients who may be eligible for SCDM-based vaccines. Because SCDM requires provider discussions to assess each patient’s eligibility for the vaccines under SCDM, trust may play a central role in the process. Trust has been suggested to affect patient’s participation in their care and their decision making preferences; however, the nature of this relationship in the context of SCDM vaccines and willingness to engage with pharmacists has yet to be investigated. As the CDC continues to expand the SCDM vaccine category, there is need to assess these. This study aimed to examine relationships between patient characteristics, trust in pharmacists, willingness to engage in SCDM, and vaccination decision control preference. Methods: Using quota sampling, cross-sectional data were collected from Alabama residents aged 18+ between February and March 2024 via a validated online questionnaire. Bivariate and multivariable logistic regression analyses were used to determine the association between trust, patient characteristics and willingness. Structural equation modeling was used to assess the direct and indirect relationships between trust, willingness and vaccination decision control preference. Statistical significance was set at p < 0.05. Results: A substantial portion (45.8%) of participants were unaware that certain vaccinations were based on SCDM. Multivariable logistic regression showed that race (Black vs. White, p = 0.001), age (25–34 vs. 18–24, p = 0.029), highest degree obtained (high school diploma or graduate equivalency degree vs. less than high school, p = 0.001; associate degree or vocational certificate vs. less than high school, p = 0.000; bachelor’s degree or higher vs. less than high school, p = 0.001), political affiliation (Democrat vs. Republican, p = 0.002), confidence in understanding health-related information (high vs. low, p =.029); moderate vs. low, p = 0.002), and patients’ trust in community pharmacists’ communication skills (p = 0.045) and benevolence (p = 0.001) towards their patients were significantly associated with patients’ willingness to engage in SCDM. Trust had a significant direct (p = 0.001) and indirect relationship (p = 0.000) with decision control preference through the willingness variable. Conclusions: Educational interventions are recommended to improve awareness and knowledge of SCDM vaccines among patients. Given their trusted role, pharmacists should actively build and maintain trust with patients, as this may help foster collaborative environments for discussion, encourage patient engagement in SCDM, and support more informed vaccination choices. Full article

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15 pages, 764 KB

Open AccessArticle

The Combined Effect of Acute Interval and Cognitive Training on Visual-Spatial Abilities in Women: Preliminary Insights for Health Promotion

by Christel Galvani, Sabrina Demarie, Ester Tommasini, Alessandro Antonietti, Thomas Zandonai and Paolo Bruseghini

Int. J. Environ. Res. Public Health 2025, 22(10), 1524; https://doi.org/10.3390/ijerph22101524 - 5 Oct 2025

Abstract

Different sports require elevated visual-spatial and related cognitive abilities, which are increasingly recognized as crucial not only for athletic performance but also for broader public health implications. Sex-related differences in these abilities have often been explained through both biological and sociocultural factors, with [...] Read more.

Different sports require elevated visual-spatial and related cognitive abilities, which are increasingly recognized as crucial not only for athletic performance but also for broader public health implications. Sex-related differences in these abilities have often been explained through both biological and sociocultural factors, with males traditionally described as having superior visual-spatial skills. However, fewer studies have investigated how targeted physical training can enhance these abilities in women. This study aimed to analyze the influence of two different cycling interval training exercises on visual-spatial ability in women. Seventy-two healthy, active, and young women engaged in (1) a High-Intensity Interval Training (HIIT) session followed by a cognitive training (CT); or (2) a Low-Volume Interval Training (LVIT) session followed by a CT; or (3) a cognitive (COG) session, consisting of listening to music followed by a CT; or (4) a control (CTRL) session, consisting of solely listening to music. Cognitive performance was assessed at baseline and after the training sessions using the Metzler and Shepard Test (MS), the Paper Folding and Cutting Test (PFC), and the Mental Rotation Test (MRT). No significant between-group differences were observed. However, in all groups the time to complete the PFC and MRT tests was significantly lower and the number of errors was significantly smaller for the PFC test in the post-test compared with the pre-test. These findings expand the current literature by demonstrating that interval training, whether high intensity or low volume, when combined with cognitive training, may improve certain aspects of visual-spatial cognitive performance in healthy, active, young women. These findings highlight the potential of combining structured exercise with cognitive challenges. Such interventions may promote cognitive health in women and contribute to long-term public health outcomes. Full article

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20 pages, 3734 KB

Open AccessSystematic Review

One Health in Coastal and Marine Contexts: A Critical Bibliometric Analysis Across Environmental, Animal, and Human Health Dimensions

by Alexandra Ioannou, Evmorfia Bataka, Nikolaos Kokosis, Charalambos Billinis and Chrysi Laspidou

Int. J. Environ. Res. Public Health 2025, 22(10), 1523; https://doi.org/10.3390/ijerph22101523 - 4 Oct 2025

Abstract

Coastal ecosystems sustain biodiversity, food resources, and human livelihoods, yet are increasingly exposed to climate change, pollution, and anthropogenic stressors. These pressures affect not only ecosystem integrity but also human health, highlighting the urgency of adopting the One Health framework. While One Health [...] Read more.

Coastal ecosystems sustain biodiversity, food resources, and human livelihoods, yet are increasingly exposed to climate change, pollution, and anthropogenic stressors. These pressures affect not only ecosystem integrity but also human health, highlighting the urgency of adopting the One Health framework. While One Health has gained global prominence, its systematic application in coastal and marine governance remains limited. This study provides the first bibliometric review of One Health research in coastal and marine contexts, analyzing 154 publications from Scopus (2003–2025) using Bibliometrix under PRISMA-S guidelines. Scientific output was minimal until 2015 but accelerated after 2020, peaking at 37 publications in 2024. Less than 20% of studies explicitly integrated all three One Health dimensions. Research has largely centered on environmental monitoring and aquaculture health, with antimicrobial resistance, climate–health linkages, and integrated coastal indicators underexplored. Keyword mapping revealed two distinct yet connected clusters: a biomedical cluster emphasizing antibiotics, resistance, and microbiology, and an environmental cluster focusing on pollution, ecosystems, and zoonotic risks. Outputs are geographically concentrated in high-income countries, particularly the USA, Brazil, and the UK, while contributions from low- and middle-income coastal regions remain scarce. These findings confirm both the rapid growth and the fragmentation of One Health scholarship in coastal contexts. By identifying gaps, trends, and collaboration patterns, this study builds an evidence base for embedding One Health in coastal monitoring, climate adaptation, and governance, advancing multiple United Nations’s Sustainable Development Goals. Full article

(This article belongs to the Special Issue Implications of Climate Change and One Health Approach)

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9 pages, 236 KB

Open AccessArticle

A Service Evaluation of Migrants’ Experiences of Accessing Healthcare in an Infectious Diseases Clinic in Ireland

by Fergal Howley, Cassandra Barrett, Eoghan de Barra, Samuel McConkey, Cora McNally and Peter Coakley

Int. J. Environ. Res. Public Health 2025, 22(10), 1522; https://doi.org/10.3390/ijerph22101522 - 4 Oct 2025

Abstract

The healthcare needs of refugees and people seeking asylum are often broad and complex, with a higher burden of communicable diseases. There are limited data describing migrants’ experiences of accessing healthcare in Ireland. This cross-sectional study describes the experiences of migrants accessing healthcare [...] Read more.

The healthcare needs of refugees and people seeking asylum are often broad and complex, with a higher burden of communicable diseases. There are limited data describing migrants’ experiences of accessing healthcare in Ireland. This cross-sectional study describes the experiences of migrants accessing healthcare services through an Irish Infectious Diseases clinic. Individuals attending the infectious diseases services in our hospital who had migrated to Ireland were included. Data were collected via a questionnaire, focusing on factors that may limit access to care, including communication, accessibility, cost, and stigmatisation. Seventy-six patients participated in this study. N = 20 (26%) of patients reported a commuting time of more than two hours to attend our clinic. N = 11 (15%) had experienced being unable to access healthcare in Ireland due to cost. Trust in healthcare providers was high (88%), and patient-reported satisfaction with communication was high (>90%). Persons living in direct provision services were more likely to report issues around privacy and less likely to have registered with a general practitioner. Accessibility and privacy were among the biggest challenges faced by migrants attending infectious diseases services at our centre, while communication and trust in healthcare providers were identified as areas of strength. Considering the burden of infectious diseases in migrant populations, and the challenges that certain migrant populations face in accessing healthcare, it is important to identify potential barriers to accessing care in order to ensure equitable, effective care. This study seeks to identify and describe the challenges that migrants face when accessing care through an Irish infectious diseases clinic. The results can help inform service provision and allocation of resources at a local level, while also identifying an area for further research regarding the barriers to accessing care faced by migrant communities in Ireland. Full article

(This article belongs to the Special Issue Migrant Health Challenges in Infectious and Non-Communicable Disease Epidemiology)

13 pages, 12323 KB

Open AccessArticle

Spatial Modeling of the Potential Distribution of Dengue in the City of Manta, Ecuador

by Karina Lalangui-Vivanco, Emmanuelle Quentin, Marco Sánchez-Murillo, Max Cotera-Mantilla, Luis Loor, Milton Espinoza, Johanna Mabel Sánchez-Rodríguez, Mauricio Espinel, Patricio Ponce and Varsovia Cevallos

Int. J. Environ. Res. Public Health 2025, 22(10), 1521; https://doi.org/10.3390/ijerph22101521 - 4 Oct 2025

Abstract

In Ecuador, the transmission of dengue has steadily increased in recent decades, particularly in coastal cities like Manta, where the conditions are favorable for the proliferation of the Aedes aegypti mosquito. The objective of this study was to model the spatial distribution of [...] Read more.

In Ecuador, the transmission of dengue has steadily increased in recent decades, particularly in coastal cities like Manta, where the conditions are favorable for the proliferation of the Aedes aegypti mosquito. The objective of this study was to model the spatial distribution of dengue transmission risk in Manta, a coastal city in Ecuador with consistently high incidence rates. A total of 148 georeferenced dengue cases from 2018 to 2021 were collected, and environmental and socioeconomic variables were incorporated into a maximum entropy model (MaxEnt). Additionally, climate and social zoning were performed using a multi-criteria model in TerrSet. The MaxEnt model demonstrated excellent predictive ability (training AUC = 0.916; test AUC = 0.876) and identified population density, sewer system access, and distance to rivers as the primary predictors. Three high-risk clusters were identified in the southern, northwestern, and northeastern parts of the city, while the coastal strip showed lower suitability due to low rainfall and vegetation. These findings reveal the strong spatial heterogeneity of dengue risk at the neighborhood level and provide operational information for targeted interventions. This approach can support more efficient surveillance, resource allocation, and community action in coastal urban areas affected by vector-borne diseases. Full article

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10 pages, 437 KB

Open AccessArticle

Effects of a Hypocaloric Diet and Physical Training on Ventilatory Efficiency in Women with Metabolic Syndrome: A Prospective Interventional Study

by Caroline Simões Teixeira, Débora Dias Ferraretto Moura Rocco, Raphael de Souza Pinto, Alexandre Galvão da Silva and Alessandra Medeiros

Int. J. Environ. Res. Public Health 2025, 22(10), 1520; https://doi.org/10.3390/ijerph22101520 - 3 Oct 2025

Abstract

Metabolic syndrome (MetS) is a multifactorial clinical condition characterized by the co-occurrence of abdominal obesity, impaired glucose metabolism, high blood pressure, and dyslipidemia. Non-pharmacological strategies, such as hypocaloric diets (HD) and structured physical training (PT), have shown promise in improving metabolic and functional [...] Read more.

Metabolic syndrome (MetS) is a multifactorial clinical condition characterized by the co-occurrence of abdominal obesity, impaired glucose metabolism, high blood pressure, and dyslipidemia. Non-pharmacological strategies, such as hypocaloric diets (HD) and structured physical training (PT), have shown promise in improving metabolic and functional outcomes in this population. The aim of this prospective interventional study was to evaluate the effects of a 16-week program combining HD with PT on ventilatory efficiency and cardiometabolic risk markers in women with MetS. Forty-one sedentary women (aged 45–55 years) with clinically diagnosed MetS underwent anthropometric, metabolic, nutritional, and cardiopulmonary assessments before and after the intervention. Participants engaged in 60 min exercise sessions three times per week and followed a personalized hypocaloric diet targeting 5–10% weight loss. Post-intervention analyses revealed significant reductions (p ≤ 0.05) in body weight (from 86.6 kg ± 3.3 kg to 78.2 kg ± 3.3 kg), body fat percentage (40.1% ± 0.6% to 33.4% ± 1.6%), and waist circumference (105.1 cm ± 1.2 cm to 95.7 cm ± 1.9 cm). Improvements were also observed in fasting glucose (from 117.1 mg/dL to 95.1 mg/dL) and triglycerides (158.8 mg/dL ± 9.1 mg/dL to 111.8 mg/dL ± 9.1 mg/dL), and in lean mass percentage (59.9% ± 6.5% to 66.6% ± 1.7%). Cardiopulmonary variables showed enhanced ventilatory function, with increased VO₂peak (1.59 L/min ± 0.1 L/min to 1.74 ± 0.1 L/min), improved oxygen uptake efficiency slope (OUES), and a steeper VO₂/workload relationship. Resting heart rate and blood pressure declined significantly (69.9 bpm ± 2.0 bpm to 64.9 ± 1.8 bpm; 145.4 mmHg ± 3.9/80.2 ± 3.0 mmHg to 140.1 mmHg ± 2.7/75.2 ± 1.6 mmHg). In conclusion, the 16-week intervention combining HD with PT proved effective for reducing cardiometabolic risk factors and enhancing ventilatory efficiency, suggesting improved integration of oxygen uptake, transport, and utilization in the women with MetS assessed. Full article

(This article belongs to the Special Issue The Healthcare of Metabolic Diseases and Chronic Diseases)

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