International Journal of Environmental Research and Public Health

15 pages, 1754 KB

Open AccessArticle

Application of Computational Simulation for Occupational Safety Assessment in a Psychiatric Hospital

by Ruan Lucas, Carmen Riascos, Eugenio Merino and Jader Borges

Int. J. Environ. Res. Public Health 2025, 22(12), 1811; https://doi.org/10.3390/ijerph22121811 - 2 Dec 2025

Psychiatric hospitals present occupational hazards, with patients’ unexpected behaviors constituting a unique factor that makes the safety climate crucial for preventing injuries and ensuring a healthy work environment. In this context, this study analyzed occupational injuries and safety conditions in a psychiatric hospital [...] Read more.

Psychiatric hospitals present occupational hazards, with patients’ unexpected behaviors constituting a unique factor that makes the safety climate crucial for preventing injuries and ensuring a healthy work environment. In this context, this study analyzed occupational injuries and safety conditions in a psychiatric hospital in southern Brazil, employing system dynamics (SD)-based computational simulation as a decision-support tool. The study was carried out in five stages: definition of the case study; collection and descriptive analysis of injury data; development of safety indicators; SD modeling and simulation; and model validation through sensitivity analysis. The simulation results indicated that: (i) a 10% increase in personal protective equipment (PPE) usage reduced perceived risk to 76.48%; (ii) a 25% increase in patients’ unexpected behaviors resulted in six additional injuries; and (iii) standardizing 50% of activities could prevent seven injuries per year. The findings suggest that computational simulation enhances analytical capacity and demonstrate that the safety climate is directly influenced by mitigating occupational risks, implementing standardized internal procedures, training personnel, and establishing effective safety indicators. Full article

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

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16 pages, 305 KB

Open AccessArticle

Assessment of Quality of Life in the Early Postoperative Period in Patients with Lung Cancer

by Stana Pačarić, Tajana Turk, Ivan Erić, Marko Babić, Suzana Luketić, Nika Srb, Andrea Milostić Srb, Anamarija Petek Erić and Mario Duvnjak

Int. J. Environ. Res. Public Health 2025, 22(12), 1810; https://doi.org/10.3390/ijerph22121810 - 30 Nov 2025

Abstract

Measuring quality of life (QoL) in patients with early-stage lung cancer is an important aspect of treatment success. This study assessed QoL in the early postoperative period in patients with lung cancer, with regard to the type of cancer. This single-center study was [...] Read more.

Measuring quality of life (QoL) in patients with early-stage lung cancer is an important aspect of treatment success. This study assessed QoL in the early postoperative period in patients with lung cancer, with regard to the type of cancer. This single-center study was conducted on 64 patients who underwent surgery for non-small cell (NSCLC) and small cell (SCLC) lung cancer. Quality of life questionnaires (QLQs) of the European Organization for Research and Treatment of Cancer (EORTC) were used. The EORTC QLQ-C30 questionnaire assesses the quality of life of cancer patients, and the EORTC QLQ-LC13 questionnaire is a lung cancer module. In the group of patients with NSCLC, the general health status (p < 0.001), physical functioning (p = 0.004), emotional functioning (p = 0.005) and total functional scale (p = 0.01) were significantly better assessed, fatigue was less pronounced (p = 0.005), nausea/vomiting (p = 0.04), pain (p = 0.004), breathing difficulties were less pronounced (p = 0.03), loss of appetite was less pronounced (p = 0.005), and the symptom scale was significantly less pronounced (p = 0.002) compared to patients with SCLC. In the QLQ-LC13 symptom scale, SCLC patients had more cough (p = 0.02), dyspnea (p = 0.03), dysphagia (p = 0.005), peripheral neuropathy (p = 0.04), chest pain (p < 0.001), arm or shoulder pain (p < 0.001), and pain in other parts of the body (p = 0.005) compared to NSCLC patients. Patients with NSCLC evaluated the functioning scales better and had less pronounced symptoms on the symptom scale, while patients with SCLC evaluated the treatment symptoms worse on the symptom scale, especially the symptom of pain, which had an impact on the quality of life of the patients. The results of this study could contribute to raising public awareness about the quality of life of lung cancer patients. Full article

(This article belongs to the Special Issue Exploring Quality of Life in Nursing and Patient Care)

16 pages, 796 KB

Open AccessArticle

Adaptation and Validation of the Brazilian Portuguese Version of the Mental Health Knowledge Schedule (MAKS-BR) in the Context of Primary Health Care

by Larissa Moraes Moro, Vinícius Perinetto Pontel, Clarissa Pinto Pizarro de Freitas, Adriane Xavier Arteche and Kátia Bones Rocha

Int. J. Environ. Res. Public Health 2025, 22(12), 1809; https://doi.org/10.3390/ijerph22121809 - 30 Nov 2025

Abstract

This study aimed to translate the Mental Health Knowledge Schedule (MAKS) to Brazilian Portuguese, adapt it to the Brazilian primary health care context, and evaluate its psychometric properties. The adaptation process involved three stages: translation, back-translation, and peer-group evaluation. To achieve a valid [...] Read more.

This study aimed to translate the Mental Health Knowledge Schedule (MAKS) to Brazilian Portuguese, adapt it to the Brazilian primary health care context, and evaluate its psychometric properties. The adaptation process involved three stages: translation, back-translation, and peer-group evaluation. To achieve a valid and reliable instrument, the Brazilian Portuguese version of the questionnaire (MAKS-BR) was administered through an anonymous, online self-administered questionnaire to a convenience sample of 289 primary care professionals with a mean age of 39.6 years (SD = 9.6 years), 90% of whom were women. The instrument, in its final 11-item model, presented satisfactory fit and comparative indices with a two-factor model. The first factor aggregates items related to mental health knowledge, while the second included items related to recognition and familiarity with various mental health conditions. The network findings support the discriminant validity of the two dimensions, while also underscoring the integrative nature of mental health literacy, in which knowledge and recognition processes are interconnected yet functionally distinct. Our findings suggest that the MAKS is an adequate instrument for assessing mental health knowledge, considering the linguistic and cultural contexts of Brazil. 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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16 pages, 558 KB

Open AccessArticle

Maternal Coffee Consumption During Pregnancy and Attention-Deficit/Hyperactivity Disorder in Offspring: A Case–Control Study and Meta-Analysis

by Ahmed Arafa, Amira S. A. Said, Ehab Elkady, Tarig A. Y. Ali and Doaa Mahmoud Khalil

Int. J. Environ. Res. Public Health 2025, 22(12), 1808; https://doi.org/10.3390/ijerph22121808 - 30 Nov 2025

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Maternal diet can influence fetal neurodevelopment, and coffee is widely consumed during pregnancy and may have adverse effects on fetal development. This study aimed to investigate the association between maternal coffee consumption during pregnancy [...] Read more.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Maternal diet can influence fetal neurodevelopment, and coffee is widely consumed during pregnancy and may have adverse effects on fetal development. This study aimed to investigate the association between maternal coffee consumption during pregnancy and ADHD risk in offspring. Methods: First, we conducted a case–control study in Egypt, enrolling 176 mothers of children with ADHD and 504 mothers of typically developing children. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for ADHD associated with frequent maternal coffee consumption during pregnancy. Then, we combined the results of this case–control study with those from prior studies in a meta-analysis. Between-study heterogeneity was assessed using the I² statistic, and publication bias was evaluated by Egger’s regression test. Results: In the case–control study, frequent maternal coffee consumption during pregnancy was associated with a higher risk of ADHD in offspring (OR = 1.85; 95% CI: 1.17, 2.92). This association persisted after additional adjustments for antenatal, natal, and neonatal factors (OR = 1.82; 95% CI: 1.07, 3.09). Consistently, the meta-analysis showed a higher risk of ADHD associated with maternal coffee consumption during pregnancy (n = 7, OR = 1.33; 95% CI: 1.13, 1.57), with no between-study heterogeneity (I² = 8.89%, p = 0.36) or publication bias (z = 0.10, p = 0.92). Conclusions: Both our case–control study and meta-analysis suggest that higher maternal coffee consumption during pregnancy may increase the risk of ADHD in children. Still, prospective cohort studies with objective caffeine biomarkers are needed to clarify causality and determine safe exposure levels. Full article

(This article belongs to the Special Issue Nutritional Epidemiology and Public Health: Promoting Population Health and Diseases Prevention Through Dietary Research)

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31 pages, 881 KB

Open AccessReview

Global Health Governance and the WHO Pandemic Agreement: A Scoping Review of Challenges and Analysis of Reforms

by Kadria Ali Abdel-Motaal, Wafa Abu El Kheir-Mataria and Sungsoo Chun

Int. J. Environ. Res. Public Health 2025, 22(12), 1807; https://doi.org/10.3390/ijerph22121807 - 30 Nov 2025

Abstract

Background: The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. Objective: To identify key challenges in global [...] Read more.

Background: The COVID-19 pandemic exposed persistent weaknesses in global health governance, particularly in preparedness, equity, and accountability. The WHO Pandemic Agreement, adopted in May 2025, aims to address these systemic gaps through a binding international framework. Objective: To identify key challenges in global pandemic preparedness and health governance reported in the literature (2019–2024) through a systematic scoping review, and to evaluate how these challenges are addressed in the provisions of the WHO Pandemic Agreement via qualitative document analysis. Methods: Using Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we systematically identified and thematically analyzed 52 peer-reviewed studies published between 2020 and 2024. The thematic results informed a qualitative document analysis of the WHO Pandemic Agreement text to assess the extent to which its provisions address the identified challenges. Results: Persistent gaps in governance (limited enforceability, fragmented coordination), equity (inequitable access to medical countermeasures), capacity (technology transfer and financing), and accountability were identified. Health systems in low- and middle-income countries continue to face critical resource constraints and lack robust mechanisms to ensure accountability and continuous learning. Document analysis showed the WHO Pandemic Agreement addresses coordination and financing but offers limited advances in enforcement, technology transfer, and independent monitoring. Conclusion: The WHO Pandemic Agreement introduces important institutional and financing measures, but persistent gaps remain in enforcement, technology transfer, and inclusive implementation. Strengthening these domains is crucial to achieving equitable and resilient preparedness. By systematically linking evidence from the pandemic preparedness literature to Treaty provisions, this study offers a novel analytical framework for assessing how global health treaties respond to research-identified challenges. Full article

(This article belongs to the Section Global Health)

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25 pages, 819 KB

Open AccessArticle

Psychoactive Substance Use and Its Association with Mental Health Symptomatology Among Latvian Medical Students: A Cross-Sectional Study

by Warnakulasuriya S. A. V. Fernando, Aviad David, Nicolo Cianci, Anastasija Sevcenko, Jelena Vrublevska, Elmars Rancans and Lubova Renemane

Int. J. Environ. Res. Public Health 2025, 22(12), 1806; https://doi.org/10.3390/ijerph22121806 - 30 Nov 2025

Abstract

Medical students are at elevated risk for psychoactive substance use and mental health challenges due to academic pressures and environmental stressors. This study aimed to determine the prevalence and trends of psychoactive substance use among medical students at Riga Stradins University (RSU) and [...] Read more.

Medical students are at elevated risk for psychoactive substance use and mental health challenges due to academic pressures and environmental stressors. This study aimed to determine the prevalence and trends of psychoactive substance use among medical students at Riga Stradins University (RSU) and to examine associations with symptoms of anxiety, depression, and resilience to stress. A bilingual, anonymous cross-sectional study was conducted using a SurveyMonkey-hosted questionnaire. The survey included a socio-demographic questionnaire, the Generalized Anxiety Disorder Questionnaire-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Brief Resilience Scale (BRS), and the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST V3.1). A total of 559 RSU medical students participated (response rate: 31.8%). Lifetime substance use prevalence was highest for caffeine 98.7%, alcohol 93.9%, tobacco 68.4%, and cannabis 50.9%. High-risk use was noted for tobacco 6.8%, inhalants 4.2%, cocaine 3.6%, and alcohol 1.4%. Significant differences in total substance use were observed by gender (p = 0.006) and depression symptom severity by PHQ-9 (p < 0.001), which were predictors of the total involvement score. The findings suggest that further attention to mental health and substance use patterns among medical students may be beneficial for student well-being and professional development. Full article

(This article belongs to the Special Issue Substance Use Research Methods: Ethics, Culture, and Health Equity)

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17 pages, 1715 KB

Open AccessStudy Protocol

Greening Schoolyards to Improve Child Health: A Quasi-Experimental Study Protocol in Belgian and Dutch Primary Schools

by Bo H. W. van Engelen, Lore Verheyen, Bjorn Winkens, Michelle Plusquin, Robert Malina and Onno C. P. van Schayck

Int. J. Environ. Res. Public Health 2025, 22(12), 1805; https://doi.org/10.3390/ijerph22121805 - 29 Nov 2025

Abstract

Background: Childhood obesity and mental health problems are major public health concerns worldwide. Early-life exposure to green spaces has been shown to promote physical activity, reduce obesity risk, and improve cognitive and emotional development. Schoolyards offer a unique opportunity to promote health, as [...] Read more.

Background: Childhood obesity and mental health problems are major public health concerns worldwide. Early-life exposure to green spaces has been shown to promote physical activity, reduce obesity risk, and improve cognitive and emotional development. Schoolyards offer a unique opportunity to promote health, as children spend a large proportion of their time at school. Methods: This quasi-experimental protocol study investigates the effects of transforming gray schoolyards into biodiverse green spaces on children’s health and well-being. Four primary schools in Limburg (Belgium and The Netherlands) were recruited: two intervention schools and two control schools. Children aged 7–12 years were enrolled, with baseline data collected in November 2021 and follow-up measurements scheduled every six months until November 2023. Outcomes include body mass index (BMI) z-score (primary outcome), waist circumference, diet, cognitive performance, psychological well-being, biodiversity knowledge, and physical activity. Data will be analyzed using linear mixed models, and cost-effectiveness analyses will be performed. Expected Results: Improvements in BMI z-scores, cognitive functioning, dietary behavior, and psychological well-being are expected among children in green schoolyards compared to those in control schools. Increased biodiversity awareness and reduced exposure to black carbon are also anticipated. Conclusions: This study is designed to provide evidence on the health impacts of greener schoolyards and contribute to strategies for promoting child development through environmental interventions. Full article

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16 pages, 1423 KB

Open AccessArticle

Treatment Outcomes of Tuberculosis in the Eastern Cape: Clinical and Socio-Demographic Predictors from Two Rural Clinics

by Evidence L. Nxumalo, Ncomeka Sineke, Ntandazo Dlatu, Teke Apalata and Lindiwe Modest Faye

Int. J. Environ. Res. Public Health 2025, 22(12), 1804; https://doi.org/10.3390/ijerph22121804 - 29 Nov 2025

Abstract

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with South Africa among the highest-burden countries. The Eastern Cape is particularly affected due to poverty, HIV co-infection, and weak health systems. Understanding treatment outcomes and their determinants is required to [...] Read more.

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality, with South Africa among the highest-burden countries. The Eastern Cape is particularly affected due to poverty, HIV co-infection, and weak health systems. Understanding treatment outcomes and their determinants is required to achieve the WHO End TB Strategy targets. The objective of this study was to examine treatment outcomes for tuberculosis (TB) in both rural and urban clinics within the Eastern Cape Province. We aimed to identify the socio-demographic, clinical, and geographic factors that influence treatment success or failure. We included simple geographic visualisations comparing treatment outcomes between the two participating clinics to inform the development of targeted interventions aimed at enhancing TB control efforts. Methods: A retrospective cohort study of 385 TB patients treated at two public clinics in the Eastern Cape (2020–2024) was conducted. Socio-demographic, clinical, and geographical data were extracted from records. Outcomes were classified using WHO and South African National TB Programme guidelines. Logistic regression identified predictors of success, and spatial analysis mapped treatment outcomes. Results: The mean patient age was 40.6 years; 69.1% were HIV-positive, and 89.9% had pulmonary TB. The overall treatment success rate was 63.8%, below the WHO target of ≥85%. Pulmonary TB was independently associated with greater odds of success (aOR = 2.86, 95% CI: 1.23–6.65), while older age predicted poorer outcomes (aOR = 0.98, 95% CI: 0.963–0.998). HIV status and socioeconomic variables were not independently associated after adjustment, although poverty and unemployment were widespread. Spatial mapping showed clustering of poor outcomes in specific clinics, highlighting geographic and health system disparities. Conclusions: TB treatment outcomes in the Eastern Cape remain unsatisfactory. Older patients and those with extrapulmonary TB face higher risks of unfavourable outcomes, underscoring the need for closer monitoring and adherence support. Integrated TB/HIV care, social protection, and geographically targeted interventions are essential to strengthen health systems and reduce inequalities. Full article

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24 pages, 1580 KB

Open AccessArticle

Co-Creating Strategies and Recommendations to Enhance the Physical Activities of Undergraduate Students at a South African University: A Social Ecological Approach

by Chanté Johannes, Nicolette V. Roman, Sunday O. Onagbiye, Simone Titus and Lloyd Leach

Int. J. Environ. Res. Public Health 2025, 22(12), 1803; https://doi.org/10.3390/ijerph22121803 - 28 Nov 2025

Abstract

Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing [...] Read more.

Engagement in physical activity (PA) has been considered to be influenced by multiple psychosocial factors (such as mental health, motivation and social support). However, current interventions often neglect these complex interactions. The Social Ecological Model (SEM) highlights the need for context-specific strategies addressing individual, social, environmental, and public engagement domains to enhance student PA. Therefore, this study aimed to develop strategies and recommendations to enhance the PA levels of undergraduate university students by using a SEM Approach. A co-creative consensus workshop, held between July and August 2024, was employed. The stakeholder group (n = 25) comprised undergraduate university students, professors and academic doctors specialising in PA and health-related disciplines. Data generated from the workshop were uploaded into Atlas Ti. V8 and thematically analysed. The co-created strategies underscore the importance of a multi-level approach to enhancing PA participation among undergraduate students. A total of 32 strategies were developed, reflecting the interconnected influence of psychosocial factors across the levels of the SEM. These include strategies related to PA (9), mental health (7), motivation (9), and social support (7). By developing context-specific strategies and recommendations that address individual, social, physical, and public engagement levels, the research offers practical, student-centred solutions to enhance PA participation. The co-created strategies hold the potential to foster long-term behavioural change and promote active, healthier lifestyles within the South African university context. Full article

(This article belongs to the Special Issue Physical Activity, Physical Education, Exercise and Public Health)

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21 pages, 550 KB

Open AccessArticle

Maternal Expectations and Overinvolvement, and Child Emotion Regulation in Children with and Without Anxiety Disorders: An Experimental Observational Study

by Eva-Maria Fassot, Brunna Tuschen-Caffier, Vera Hauffe and Julia Asbrand

Int. J. Environ. Res. Public Health 2025, 22(12), 1802; https://doi.org/10.3390/ijerph22121802 - 28 Nov 2025

Abstract

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact [...] Read more.

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact of maternal expectations on overinvolvement and child distress. 65 children with ADs (ages 8–15) and 64 healthy controls (HCs) and their mothers participated in a tangram task, with manipulated maternal expectations. Mother–child interactions were observed for maternal involvement and child behavior (ER, distress), with children reporting their emotional reactivity. Against expectations, maternal involvement did not differ between groups and was not influenced by expectations. HC children had better ER abilities than those with ADs. Emotional reactivity moderated the relationship between overinvolvement and ER problems. Children with ADs exhibited more distress, unaffected by maternal expectations. Further research is needed to clarify the relationship between parental behavior and child behavior, particularly regarding emotional reactivity. Full article

(This article belongs to the Special Issue The Impact of Family Capabilities on the Wellbeing and Mental Health of Family Members)

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15 pages, 293 KB

Open AccessArticle

Predictors of Teenage Fatherhood Among Justice-Involved Adolescents

by Naomi McGoldrick, Colleen Sbeglia, Lauren Wyckoff, Paul J. Frick, Laurence Steinberg and Elizabeth Cauffman

Int. J. Environ. Res. Public Health 2025, 22(12), 1801; https://doi.org/10.3390/ijerph22121801 - 28 Nov 2025

Abstract

Justice-involved boys are more likely to become teenage fathers than their community peers. This is linked to numerous negative outcomes, including increased delinquent behavior. To help legal practitioners better identify which boys are at risk of becoming a teen parent, this study identifies [...] Read more.

Justice-involved boys are more likely to become teenage fathers than their community peers. This is linked to numerous negative outcomes, including increased delinquent behavior. To help legal practitioners better identify which boys are at risk of becoming a teen parent, this study identifies factors at the time of boys’ very first arrest that prospectively predict their odds of becoming a teen father. Data were drawn from a longitudinal study of 1216 adolescent boys at the time of their first arrest. Binary logistic regression models were used to predict the odds of becoming a teen father across three domains: individual factors, social and contextual factors, and risky behaviors. Approximately 15% of the total sample (n = 171) reported becoming a teen father after their first arrest. At the time of first arrest, poorer neighborhood conditions, increased peer delinquency, substance use, and self-reported offending history increased the odds that boys would become a teen father. Additional models indicated that substance use was the strongest driver of teen fatherhood. However, all factors failed to reached significance once condom use was included in this model. Practical implications for policymakers are discussed, along with suggestions for interventions to reduce teen pregnancy. Full article

(This article belongs to the Special Issue Understanding Health Risks and Protective Factors in Youth Delinquency)

23 pages, 837 KB

Open AccessArticle

Policy, Price, and Perception: A Phenomenological Qualitative Study of the Rural Food Environment Among Latina Households

by Natalia B. Santos, Thais F. Alves, TinaMaria Fernandez and Chad Abresch

Int. J. Environ. Res. Public Health 2025, 22(12), 1800; https://doi.org/10.3390/ijerph22121800 - 28 Nov 2025

Abstract

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with [...] Read more.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges. Full article

(This article belongs to the Special Issue System Approaches to Improving Latino Health)

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15 pages, 288 KB

Open AccessArticle

A Phenomenological Study of Primary Healthcare Nurses’ Experiences in Assessing and Managing Diabetic Foot Complications

by Simiso Ntuli

Int. J. Environ. Res. Public Health 2025, 22(12), 1799; https://doi.org/10.3390/ijerph22121799 - 28 Nov 2025

Abstract

Background: In South Africa, diabetic foot complications (DFC) often present for the first time at the primary healthcare (PHC) level, where nurses are central to diabetes management and prevention. Despite their key role, there are limited data on nurses’ experiences in managing DFC, [...] Read more.

Background: In South Africa, diabetic foot complications (DFC) often present for the first time at the primary healthcare (PHC) level, where nurses are central to diabetes management and prevention. Despite their key role, there are limited data on nurses’ experiences in managing DFC, particularly in resource-constrained primary healthcare (PHC) settings. This study’s objective was to explore and describe nurses’ experiences in managing DFC at the PHC level, with the aim of informing future interventions and policy development. Methods: A descriptive phenomenological study was conducted with 21 PHC nurses working in community healthcare centres to explore their experiences in managing DFC within PHC facilities. Results: Five key themes emerged: limited knowledge, time and workload constraints, lack of referral feedback, need for targeted training, and resource constraints. These reflect systemic and practical barriers that hinder effective care and contribute to inconsistent patient outcomes. Nurses are vital to early detection and intervention but face structural challenges that limit their capacity to deliver optimal care. Conclusions: Nurses encounter significant challenges when implementing routine diabetic foot screening at the primary healthcare level. These challenges include limited training, inadequate resources, and poor interprofessional collaboration. To overcome these barriers, targeted capacity-building initiatives, improved referral and communication pathways, and the provision of essential tools and support are needed. Additionally, integrating podiatrists into primary healthcare teams and establishing multidisciplinary foot care services are crucial steps to enhance care quality and reduce complications in resource-limited settings. Full article

(This article belongs to the Special Issue Primary Care: Nursing’s Contributions to Improving Access and Quality of Care)

16 pages, 559 KB

Open AccessArticle

Physical Activity Assessment—Self-Reported Versus Pedometer-Measured, and Associations with Health Markers Among University Students in South Africa

by Gareth Hewer, Francis Fabian Akpa-Inyang, Sizwe Vincent Mbona, Julian David Pillay and Firoza Haffejee

Int. J. Environ. Res. Public Health 2025, 22(12), 1798; https://doi.org/10.3390/ijerph22121798 - 27 Nov 2025

Abstract

Accurate measurement of physical activity is crucial for promoting health and preventing non-communicable diseases, particularly in Sub-Saharan Africa, where the dual burden of infectious and chronic diseases presents significant public health challenges. While self-reported tools are commonly used, they are often limited by [...] Read more.

Accurate measurement of physical activity is crucial for promoting health and preventing non-communicable diseases, particularly in Sub-Saharan Africa, where the dual burden of infectious and chronic diseases presents significant public health challenges. While self-reported tools are commonly used, they are often limited by recall and social desirability biases. This study aimed to compare self-reported physical activity with objectively measured pedometer data and explore their associations with fitness and anthropometric indicators among university students. A cross-sectional study was conducted among 60 full-time students at a South African university. The study was conducted in two phases: For phase 1, participants completed the International Physical Activity Questionnaire (IPAQ). For phase two, participants wore pedometers for seven consecutive days to measure total and aerobic step counts. Fitness was assessed using the Harvard Step Test to calculate the Physical Efficiency Index (PEI), and anthropometric data (BMI, waist-to-hip ratio, body fat percentage) were recorded. Statistical analyses included Spearman’s correlations, Mann–Whitney U test, Kruskal–Wallis H test, and multivariable linear regression. While 83.3% of participants self-reported high physical activity levels, pedometer data indicated that 61.7% accumulated fewer than 1500 aerobic steps per day and 53.3% recorded fewer than 5000 total steps. No significant association was found between self-reported activity and pedometer-measured steps (p-value = 0.748 and p-value = 0.835, respectively). Objective measures showed significant positive correlations between aerobic steps and PEI (r = 0.274, p-value = 0.034) and significant negative correlations with BMI (r = −0.489, p-value < 0.001) and body fat percentage (r = −0.255, p-value = 0.046). Older age and female gender were associated with lower step counts. This study reveals a significant overestimation of physical activity in self-reports compared to objective measures and stronger links between objectively measured steps and key health outcomes. The findings highlight the need to integrate objective monitoring tools into public health practice and youth-focused interventions in Sub-Saharan Africa. They underscore the importance of exploring context-specific factors influencing activity levels. Enhancing measurement accuracy is vital for advancing evidence-based strategies and achieving Sustainable Development Goal 3. Full article

(This article belongs to the Section Global Health)

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21 pages, 1010 KB

Open AccessArticle

Frequency, Correlates, and Symptom Severity of Eating Disorders Among College Students in Mexico

by María Alonso-Catalán, Silvia A. Tafoya, Rosalia Vazquez-Arevalo, María Luisa Ávila-Escalante, María Teresa Tusié-Luna, Lidia Moreno-Macías, Hortensia Moreno-Macías, Julián Corral-Aguilar, Mónica Aburto-Arciniega, Santiago Silva-Avalos, Diego Armando Coronel-Manzo, Benjamín Guerrero-López and Claudia Díaz-Olavarrieta

Int. J. Environ. Res. Public Health 2025, 22(12), 1797; https://doi.org/10.3390/ijerph22121797 - 27 Nov 2025

Abstract

The prevalence of eating disorders (ED) has grown in recent decades, associated with sociocultural pressures that partly stem from body stereotypes and increased stress in daily life. However, even though college constitutes a high-risk life stage, this group has received little attention, leaving [...] Read more.

The prevalence of eating disorders (ED) has grown in recent decades, associated with sociocultural pressures that partly stem from body stereotypes and increased stress in daily life. However, even though college constitutes a high-risk life stage, this group has received little attention, leaving a significant gap in prevention and early intervention. This cross-sectional and comparative study included 610 Mexican college students aged 18–30 enrolled in two public universities in Mexico: one sample comprised undergraduate students from Yucatan’s UADY (n = 457), and another one from Mexico City’s UNAM (n = 153). Screening tools included the EAT-26, BES, BSQ, DMS, HADS and AUDIT. We determined the frequency of ED symptomatology across both universities. Linear and multiple logistic regressions were conducted to identify factors associated with ED symptomatology. Overall, 19.8% of participants displayed significant ED symptomatology (UADY 15.5%, UNAM 32.7%). Significant ED symptomatology was more common among women (31.8%) than men (11.7%). Non-cisgender students (27.8%) showed a higher frequency than cisgender women (24.7%) and cisgender men (11.2%). High BD was the strongest predictor of significant ED symptomatology (OR = 13.35; 95% CI 6.79–26.26), followed by symptoms of anxiety (OR = 1.11, 95% CI 1.03–1.19). Our findings highlight the need for early screening and targeted interventions among college students in Mexico. Full article

(This article belongs to the Special Issue Health Behaviors and Mental Health Among College Students)

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18 pages, 332 KB

Open AccessArticle

Older Adults’ Perceptions of Health, Quality of Life, and Access to Health Promotion Initiatives for Active Aging: A Qualitative Approach

by José Antonio Bicca Ribeiro, Breno Berny Vasconcelos, Kamila Bierhals Fernandes, Inácio Crochemore-Silva and Cristine Lima Alberton

Int. J. Environ. Res. Public Health 2025, 22(12), 1796; https://doi.org/10.3390/ijerph22121796 - 27 Nov 2025

Abstract

(1) Background: Health promotion initiatives based on physical activity (PA) play a crucial role in fostering active aging. However, engagement in such initiatives is related to individual subjectivities that vary according to different social backgrounds among older adults. This study aims to explore [...] Read more.

(1) Background: Health promotion initiatives based on physical activity (PA) play a crucial role in fostering active aging. However, engagement in such initiatives is related to individual subjectivities that vary according to different social backgrounds among older adults. This study aims to explore older adults’ perceptions of their health and quality of life after participation in a PA program, as well as the factors influencing their access to health promotion services and initiatives. (2) Methods: This is a qualitative study based on two focus groups conducted in June 2025 at the University involving 14 older adults (11 women; mean age: 68 years), participating in a supervised PA program in a city in southern Brazil. (3) Results: The themes identified from the Thematic Analysis were Health, aging, and quality of life; Engagement with PA; and Perspectives on health promotion strategies. A positive perception of health and quality of life was identified as being related to participation/engagement in a PA program. Access to health services is facilitated; however, waiting times for care are long, especially for more specific diseases. (4) Conclusions: Although participation in a structured PA program influences the positive perception of health and quality of life, socioeconomic and structural barriers limit equitable access to these services, revealing the need for integrated public policies to address health inequalities and support active aging. Full article

(This article belongs to the Special Issue Addressing Healthcare Inequities for Older Adults: Challenges and Pathways to Equitable Healthcare Services)

13 pages, 284 KB

Open AccessArticle

Medicaid Expansion and Patient Safety Culture in USA Hospitals

by Jayson Forbes and Alejandro Arrieta

Int. J. Environ. Res. Public Health 2025, 22(12), 1795; https://doi.org/10.3390/ijerph22121795 - 27 Nov 2025

Abstract

Background: The Affordable Care Act (ACA) included provisions to improve access and patient safety. However, in some cases, improving access generated a rapid increase in demand, leading to a strain on the healthcare workforce, with potential impacts on patient safety. This study seeks [...] Read more.

Background: The Affordable Care Act (ACA) included provisions to improve access and patient safety. However, in some cases, improving access generated a rapid increase in demand, leading to a strain on the healthcare workforce, with potential impacts on patient safety. This study seeks to assess a potential trade-off between access and safety that could have resulted from Medicaid expansion, a key provision of ACA. To our knowledge, this is the first study that directly links Medicaid expansion to internal patient safety culture dynamics within hospitals. Methods: We used a panel data model with hospital fixed effects to assess how different dimensions of patient safety culture were affected in hospitals located in states that expanded Medicaid. We also clustered standard errors by hospital to account for dependence among responses within a single facility and correct for heteroskedasticity, thus achieving more precise and reliable estimates. Results: In small hospitals, Medicaid expansion is significantly associated with a reduced Teamwork Within Units dimension (−0.067, p < 0.01), a small but significant 1.7% decrease in a 1-to-5 Likert scale, while a negative association with Nonpunitive Response to Error dimension was observed in medium-sized hospitals (−0.045, p < 0.05) and in large hospitals (−0.064, p < 0.05). Conclusions: Public policies to improve healthcare access should plan around resources and capabilities to ensure patient safety. Small hospitals need additional support to manage the healthcare worker shortage that results from higher demand of healthcare services, while medium and large hospitals need to respond more in the areas of response to error. Full article

13 pages, 304 KB

Open AccessArticle

Prevalence, Screening Practices and Risk Stratification for Diabetic Foot Complications in Primary Healthcare Clinics: A Cross-Sectional Study in Gauteng Province, South Africa

by Simiso Ntuli

Int. J. Environ. Res. Public Health 2025, 22(12), 1794; https://doi.org/10.3390/ijerph22121794 - 27 Nov 2025

Abstract

Background/Objective: The incidence of diabetic foot complications has been increasing in South Africa. While foot screening at the primary healthcare level is crucial for preventing these complications, the growing number of cases in hospitals indicates that persons with diabetes are not undergoing [...] Read more.

Background/Objective: The incidence of diabetic foot complications has been increasing in South Africa. While foot screening at the primary healthcare level is crucial for preventing these complications, the growing number of cases in hospitals indicates that persons with diabetes are not undergoing routine screening in primary healthcare settings. Method: This cross-sectional descriptive observational study was conducted at five community healthcare centres, one in each municipality in Gauteng. Participants included persons with diabetes who presented at these facilities for their routine diabetes care. Data were collected, which included patient demographics, a history of screening, risk factors for diabetic foot, and an assessment of diabetic foot was conducted for each participant. Results: A total of 597 diabetic patients volunteered for this study. Only 10% (n = 60) had received a diabetic foot assessment. No patient had been risk-stratified; the results showed that 30% (n = 178) were very low risk and 17% (101) were at high risk. Active ulcers were recorded in 19% (116), and 18% (106) were in remission. Neuropathy was recorded in 33% (197), peripheral arterial disease in 22% (131), and a history of amputation was recorded in 17% (103). Conclusions: Implementing routine diabetic foot assessment and risk stratification at the PHC level could be key in preventing diabetic-related complications. Full article

11 pages, 551 KB

Open AccessArticle

Tooth Loss, Nutrition, and Oral Health-Related Quality of Life in Older Adults: Evidence from a Structural Equation Model

by Beatriz Della Terra Mouco Garrido, Patrícia Soares Silva Pereira, Kamilly Foloni, Heloisa Dalberto Pegoraro, Isabelle Roldão Souza, José Roberto Magalhães Bastos, Gerson Aparecido Foratori-Júnior, Monica Yamauti, Raquel Conceição Ferreira and Roosevelt Silva Bastos

Int. J. Environ. Res. Public Health 2025, 22(12), 1793; https://doi.org/10.3390/ijerph22121793 - 26 Nov 2025

Abstract

Background: Oral health problems, particularly tooth loss, may impair nutrition and reduce oral health-related quality of life (OHRQoL) in older adults. However, the pathways linking these conditions remain unclear. Methods: We analyzed data from 112 older adults (≥60 years). We measured OHRQoL using [...] Read more.

Background: Oral health problems, particularly tooth loss, may impair nutrition and reduce oral health-related quality of life (OHRQoL) in older adults. However, the pathways linking these conditions remain unclear. Methods: We analyzed data from 112 older adults (≥60 years). We measured OHRQoL using the Geriatric Oral Health Assessment Index (GOHAI) and nutritional status using the Mini Nutritional Assessment (MNA), and used tooth loss as a clinical indicator. Bivariate analyses used Spearman’s correlation, and structural equation modeling (SEM) with robust estimation was applied to assess direct and indirect pathways. Mediation was evaluated with bootstrap resampling. Results: The prevalence of impaired OHRQoL (GOHAI > 0) was 25.9% (95% CI: 18.6 to 34.9). Tooth loss correlated with worse nutrition (ρ = −0.32; 95% CI: −0.48 to −0.15), and poorer nutrition was associated with worse OHRQoL (ρ = −0.22; 95% CI: −0.40 to −0.03). SEM showed that tooth loss negatively affected nutrition (β = −0.21; 95% CI: −0.43 to 0.00) and that nutrition was directly associated with OHRQoL (β = −0.21; 95% CI: −0.34 to −0.08). Bootstrap analyses confirmed a direct effect of tooth loss on OHRQoL (β = 0.19; 95% CI: 0.02 to 0.36), while the indirect pathway through nutrition did not reach statistical significance. Conclusions: Tooth loss and poor nutrition independently reduce OHRQoL in older adults. Although mediation by nutrition was not statistically significant, the findings highlight the interdependence of oral and general health and support integrated public health strategies for aging populations. Full article

(This article belongs to the Special Issue Oral Health and Quality of Life in Older Adults)

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