International Journal of Environmental Research and Public Health

12 pages, 270 KiB

Open AccessProtocol

The Effectiveness of Indoor Residual Spraying for Malaria Control in Sub-Saharan Africa: A Systematic Protocol Review and Meta-Analysis

by Moses Ocan, Kevin Ouma Ojiambo, Loyce Nakalembe, Geofrey Kinalwa, Alison A. Kinengyere, Sam Nsobya, Emmanuel Arinaitwe and Henry Mawejje

Int. J. Environ. Res. Public Health 2025, 22(6), 822; https://doi.org/10.3390/ijerph22060822 - 23 May 2025

Abstract

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of [...] Read more.

Background: Indoor residual spraying (IRS) is a core insecticide-based vector control tool employed in most malaria-affected settings globally. However, mosquito vectors have developed resistance to nearly all of the insecticides currently used in IRS. This has necessitated a transition to new classes of insecticides, from mostly using dichlorodiphenyltrichloroethane (DDT) and pyrethroids from 1997 to 2010 to carbamates in 2011 and organophosphates in 2013. In addition, other vector control measures, like the use of long-lasting insecticide-treated bed nets (LLINs), have also been employed for malaria control. Despite the implementation of these mosquito vector control interventions, malaria remains a disease of public health concern, especially in sub-Saharan Africa, which bears over 90% of the disease burden. This review will thus collate evidence on the effectiveness of IRS for malaria control in sub-Saharan Africa. Methods and analysis: The systematic review will be conducted following a priori criteria developed using the PRISMA guidelines. Articles will be obtained through a search of the Web of Science, Google Scholar, Medline via PubMed, Scopus and Embase databases. Mesh terms and Boolean operators (“AND”, “OR”) will be used in the article search. Additionally, websites of malaria research institutions will be searched. The article search will be conducted by two independent librarians (AAK and RS). All identified articles will be transferred to EPPI-reviewer v6.15.1.0 software. Article screening and data abstraction will be performed in duplicate by four reviewers (KOO, LN, GK and MO), and any further disagreements will be resolved through discussion and consensus. We shall extract data on the country, region, study design, insecticide combination, season, susceptibility procedure used, vector control interventions, population, mosquito species, malaria incidence or prevalence, insecticide efficacy, susceptibility, genotypic resistance, vector mortality and knockdown effect. Data analysis will be performed using STATA v17.0. Effect sizes will be statistically pooled using inverse-variance-weighted random-effects meta-analysis. Heterogeneity and publication bias in the articles will be assessed using the I² statistic and a funnel plot, respectively. For the studies that will not be included in the meta-analysis, a narrative synthesis will be written following the Cochrane Consumer and Communication Review Group format. Results: The findings of this review will help generate evidence on the effectiveness of indoor residual spraying using WHO pre-qualified insecticides in malaria control in sub-Saharan Africa. This protocol was registered in PROSPERO, registration number CRD42024517119. Full article

(This article belongs to the Section Infectious Diseases, Chronic Diseases, and Disease Prevention)

11 pages, 469 KiB

Open AccessArticle

Medically Attended Outpatient Parainfluenza Virus Infections in Young Children from a Single Site in Machala, Ecuador

by Manika Suryadevara, Dongliang Wang, Freddy Pizarro Fajardo, Jorge Luis Carrillo Aponte, Froilan Heras, Cinthya Cueva Aponte, Irene Torres and Joseph Domachowske

Int. J. Environ. Res. Public Health 2025, 22(6), 821; https://doi.org/10.3390/ijerph22060821 - 23 May 2025

Abstract

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 [...] Read more.

Parainfluenza virus (PIV) infections contribute to the overall childhood morbidity from acute respiratory illness, yet virus-specific epidemiologic data are lacking across many regions globally. Here, we describe the clinical manifestations, seasonality, and meteorologic associations with PIV infections in Ecuadorian children. Between July 2018 and July 2023, we documented demographic and clinical information from children younger than 5 years seen in a single public health clinic with signs and symptoms consistent with an acute respiratory infection. Nasopharyngeal swabs collected at study enrollment underwent multiplex polymerase chain reaction-based diagnostic testing (Biofire FilmArray v. 1.7™). Regional meteorological data from the same period were provided by Ecuador’s Instituto Nacional de Meteorologia e Hidrologia. Parainfluenza viruses were detected in 9% of the 1251 enrolled subjects. PIVs were most frequently detected between March and July, with no change in seasonality following SARS-CoV-2 pandemic onset. Clinical manifestations of PIV infections included non-specific upper respiratory illness (82%), laryngotracheitis (3%), and bronchiolitis (11%). Events of PIV detection were negatively associated with ambient temperature and rainfall. Our findings highlight the contribution that PIVs play in the morbidity associated with pediatric medically attended outpatient respiratory tract infection and provide new insights into the seasonal epidemiology of PIV infections in coastal Ecuador. Full article

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30 pages, 436 KiB

Open AccessReview

Antecedents of Workplace Psychological Safety in Public Safety and Frontline Healthcare: A Scoping Review

by Emily Ip, Rani Srivastava, Liana Lentz, Sandra Jasinoski and Gregory S. Anderson

Int. J. Environ. Res. Public Health 2025, 22(6), 820; https://doi.org/10.3390/ijerph22060820 - 23 May 2025

Abstract

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces [...] Read more.

Workplace psychological safety (PS) has been recognized as crucial in mitigating organizational stressors and enhancing positive workplace outcomes, particularly in high-risk occupations such as healthcare and public safety. This scoping review aims to synthesize the existing literature on psychological safety in high-risk workplaces to identify key antecedents, workplace enhancements, and research gaps. A systematic search of studies published between 2010 and January 2025 was conducted across multiple databases, including CINAHL, Medline, ERIC, JSTOR, PsycInfo, Business Source Ultimate, and Sociological Abstract. Inclusion criteria focused on adult workers in high-risk workplace environments. Following screening and eligibility assessments, 16 studies from six countries were selected for analysis. Data were extracted and thematically analyzed based on leadership styles, organizational structures, and workplace culture related to psychological safety. The review identified three primary antecedents of psychological safety in high-risk workplaces: (1) inclusive and transformational leadership styles, (2) hierarchical structures and power dynamics, and (3) workplace climate and communication culture. Studies consistently found that inclusive leadership, ethical integrity, and transformational leadership were strongly associated with higher psychological safety levels. While hierarchical structures provided the necessary organization, overly rigid hierarchies often suppressed employee voice and innovation. A workplace culture characterized by trust, transparency, and open communication fosters greater psychological safety and improved teamwork and well-being. Full article

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12 pages, 316 KiB

Open AccessArticle

Exploring Vaccine Hesitancy in the Philippines: A Content Analysis of Comments on National TV Channel YouTube Videos

by Daniel Fritz Silvallana, Carlos Elias and Daniel Catalan-Matamoros

Int. J. Environ. Res. Public Health 2025, 22(6), 819; https://doi.org/10.3390/ijerph22060819 - 22 May 2025

Abstract

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze [...] Read more.

Examining public attitudes towards COVID-19 vaccination is crucial for understanding the global effort to combat the ongoing pandemic. Social media platforms such as YouTube play a significant role in the dissemination of information and misinformation about the vaccine, making it imperative to analyze user comments to gain insights into vaccine perceptions. Analyzing the Philippines case is particularly significant as it provides insights into the attitudes towards COVID-19 vaccination in a country that has been heavily impacted by the pandemic. The current study investigates the discourse surrounding vaccine hesitancy in comments on YouTube videos announcing the COVID-19 vaccination campaign by the Philippines national TV channels and its impact on engagement levels. A total of 741 YouTube comments were analyzed, with 80% exhibiting vaccine-hesitant related discourse. The results indicate that those with negative attitudes towards COVID-19 vaccination exhibit higher engagement levels than those supporting vaccination (p < 0.05). Additionally, the most commonly used themes in vaccine-hesitant posts were “ingredients”, “health department control”, “pharmaceutical interest”, and “adverse effects”. Moreover, 134 sources were identified among the posts, with vaccine-hesitant posts utilizing more sources than supportive vaccine posts (p < 0.001). The most significant information sources utilized in the posts were related to other YouTube users, politicians, clinicians, and scientific papers. Finally, a total of 890 discourses were coded, with the most frequently used discourse types among vaccine-hesitant posts being negationist, institutional, preventive, political, and pharmaceutical. These findings offer valuable insights into the nature and prevalence of vaccine hesitancy discourse on social media platforms and its impact on public engagement. This study highlights the importance of targeted communication strategies and the provision of accurate information from reliable sources in addressing vaccine hesitancy. Full article

(This article belongs to the Special Issue Evolving Role of Social Media in Health Communication)

12 pages, 283 KiB

Open AccessReview

A Call to Integrate Measures of Environmental Context into Research on Maternal Brain Health

by Sofia I. Cárdenas and Bridget L. Callaghan

Int. J. Environ. Res. Public Health 2025, 22(6), 818; https://doi.org/10.3390/ijerph22060818 - 22 May 2025

Abstract

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a [...] Read more.

Environmental factors—especially those related to interpersonal relationships and physical resources—profoundly impact women’s neurobiology and mental health. Despite this, environmental factors, including socioeconomic status, early life adversity, and neighborhood resources, are less explored within the maternal brain literature. This literature highlights pregnancy as a developmental phase in adult women’s lifespans marked by neurobiological shifts supporting fetal development and optimizing caregiving behaviors. While neurobiological shifts during this period are well-documented, pregnancy is also associated with a heightened risk for mental health challenges. This narrative review, focusing on the last 10 years, examines the research that underscores the importance of integrating environmental factors into research frameworks to comprehensively understand their effects on maternal neurobiology and mental health throughout pregnancy. Building on this research, authors discuss future research methodologies that will support a more comprehensive understanding of the intersection between environmental contexts, maternal neurobiology, and mental health. Full article

(This article belongs to the Special Issue How Reproductive Life Events Influence Women's Mental Health)

12 pages, 247 KiB

Open AccessArticle

Equitable Healthcare Access for Type 2 Diabetes Patients Under a Low-Income Group Health Care Scheme: A Sustainable Development Goal Perspective

by Sin Wei Tey, Kingston Rajiah, Mari Kannan Maharajan, Norasila Binti Zakaria and Nor Haslinda Binti Ishak

Int. J. Environ. Res. Public Health 2025, 22(6), 817; https://doi.org/10.3390/ijerph22060817 - 22 May 2025

Abstract

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key [...] Read more.

Objective: The purpose of this study is to explore the factors influencing access to healthcare services among Type 2 Diabetes Mellitus (T2DM) patients enrolled in the PEKA B40 programme at a public health clinic in Melaka, Malaysia. It aims to examine how key dimensions—availability, accessibility, accommodation, and acceptance—affect patients’ experiences and the utilisation of diabetes-related healthcare services. This study also seeks to identify gaps and challenges within the current healthcare delivery system, particularly for low-income populations, to inform strategies for improving equitable and sustainable access to care. Methods: This study was conducted in a public health clinic in Melaka, Malaysia. Purposive sampling was used among T2DM patients under the “Health Care Scheme for Group B40” programme in a public health clinic in Melaka, Malaysia. The study included participants with at least a 6-month history of T2DM to ensure substantial experience in accessing healthcare services. Results: Fifteen patients participated in this study. Elderly individuals, retirees, and those with average incomes demonstrated higher healthcare service utilisation. Ethnic diversity was crucial, revealing its impact on health behaviours and healthcare-seeking patterns. Primary or secondary education levels among participants highlighted the necessity for targeted health literacy efforts. Conclusions: This study highlighted notable awareness and satisfaction among patients concerning the availability, accessibility, and accommodation of services, particularly emphasising the importance of geographical proximity in healthcare services. However, challenges faced by elderly individuals in accessing social support are also highlighted. The potential of enhancing the amenities of healthcare facilities to improve patient experiences is also reflected in our results. These insights provide evidence for the effectiveness of the Malaysian healthcare system in catering to a diverse demographic and can also be helpful in refining healthcare strategies and further optimising patient-centred care in Malaysia. Full article

(This article belongs to the Special Issue Access to Public Health Services and Challenges to Healthcare Management)

21 pages, 1019 KiB

Open AccessReview

Health Knowledge About Early Diagnosis of Autism Spectrum Disorders: A Case for Soft Transdiagnostic Approaches to Better Represent the Clinical and Scientific Reality of ASD

by Mirah Dow and Ting Wang

Int. J. Environ. Res. Public Health 2025, 22(6), 816; https://doi.org/10.3390/ijerph22060816 (registering DOI) - 22 May 2025

Abstract

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature [...] Read more.

Objective: This study explores the current state of science regarding DSM-5 diagnostic criteria for Autism Spectrum Disorder (ASD) in young children. It examines the effectiveness of existing diagnostic methods and evaluates the potential of transdiagnostic approaches for early intervention. Method: A systematic literature review was conducted using MEDLINE, PsycINFO, and the Psychology and Behavioral Sciences Collection, focusing on peer-reviewed studies published between 2020 and 2023. The search followed PRISMA guidelines, selecting articles investigating ASD diagnosis in toddlers and preschoolers using DSM-5 criteria, behavioral assessments, and emerging diagnostic tools. Results: Findings indicate that DSM-5 provides a structured framework for ASD diagnosis, but it has limitations in early identification. It is necessary to integrate multiple assessment tools. Recent research highlights transdiagnostic models, which move beyond rigid diagnostic categories to capture the complexities of ASD presentation in young children. Conclusion: The literature supports a shift towards a transdiagnostic approach that combines behavioral, biological, and environmental assessments. This study underscores the need for interdisciplinary collaboration to refine ASD diagnostic frameworks to ensure more accurate and timely diagnoses that better serve affected children and their families. Full article

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

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9 pages, 244 KiB

Open AccessEditorial

Integrating Exposome into Lifecourse Understanding of Cognitive Ageing and Dementia: Current Evidence, Methodological Challenges, and Future Directions

by Jessica Gong and Paola Zaninotto

Int. J. Environ. Res. Public Health 2025, 22(6), 815; https://doi.org/10.3390/ijerph22060815 - 22 May 2025

Abstract

Cognitive decline and dementia represent some of the most pressing challenges to global public health, especially amid rapidly ageing populations worldwide [...] Full article

(This article belongs to the Special Issue Exposomic Approach to Dementia and Cognitive Ageing)

12 pages, 273 KiB

Open AccessArticle

The Roles of Dissociation and Depression in PTSD Among Soldiers Exposed to Combat

by Leah Shelef, Nir Spira, Uzi Bechor, Jacob Rotschield and Eran Shadach

Int. J. Environ. Res. Public Health 2025, 22(6), 814; https://doi.org/10.3390/ijerph22060814 - 22 May 2025

Abstract

Exposure to severe combat situations significantly raises the risk of depression and post-traumatic stress disorder (PTSD). Trauma survivors may use dissociation as a defense mechanism, increasing the likelihood of PTSD. This study aims to explore the roles of dissociation and depression in PTSD [...] Read more.

Exposure to severe combat situations significantly raises the risk of depression and post-traumatic stress disorder (PTSD). Trauma survivors may use dissociation as a defense mechanism, increasing the likelihood of PTSD. This study aims to explore the roles of dissociation and depression in PTSD among soldiers exposed to combat who sought help from the Israel Combat Stress Reaction Unit. Method: This cross-sectional study involved 927 individuals who participated in a particular military operation in 2014 [98.5% male (n = 906); mean age = 27.08 (SD = 5.93)]. Participants completed three questionnaires: the Dissociative Experiences Scale (DES), the Beck Depression Inventory (BDI), and the Post-Traumatic Stress Symptom Checklist (PCL-5) for PTSD. Results: Our results showed that severe PTSD (PCL score ≥ 33) was found in 30.4% of participants, and 76.6% showed dissociative symptoms (DES score ≥ 30). Additionally, 23.5% experienced moderate depression, while 19.1% reported severe depressive symptoms. A Generalized Linear Model revealed that both depression and dissociation significantly contribute to PTSD. Individuals with depression were three times more likely to experience post-traumatic symptoms compared to 1.23 times for those with dissociative symptoms. Conclusions: Life-threatening situations significantly predicted higher PTSD symptoms, serving as a risk factor for depression and dissociation, which play important roles in PTSD, with depression having notably greater impact. Full article

(This article belongs to the Special Issue Mental Health and Psychological Resilience: The Mental Health Burden of Terrorism, Epidemiology, Risk Factors and Global Disparities)

17 pages, 316 KiB

Open AccessArticle

Exploring Sedentary and Nutritional Behaviour Patterns in Relation to Overweight and Obesity Among Youth from Different Demographic Backgrounds in Saudi Arabia

by Anwar Al-Nuaim and Ayazullah Safi

Int. J. Environ. Res. Public Health 2025, 22(5), 813; https://doi.org/10.3390/ijerph22050813 - 21 May 2025

Abstract

Background: The prevalence of overweight and obesity has increased over the last three decades, becoming a major public health concern. This issue is particularly pressing in terms of the impact it has on the population of the Kingdom of Saudi Arabia (KSA). Thus, [...] Read more.

Background: The prevalence of overweight and obesity has increased over the last three decades, becoming a major public health concern. This issue is particularly pressing in terms of the impact it has on the population of the Kingdom of Saudi Arabia (KSA). Thus, the aim of this research was to explore the nutritional and lifestyle habits of youth in the Al-Ahsa region of the KSA. Methods: This cross-sectional study included a total of 1270 secondary-school boys and girls (15–19 years) from all five of the Al-Ahsa Governorate districts. BMI and waist circumference measurements were recorded using anthropometric measurements, and the lifestyle–Arab Teens Lifestyle Survey (ATLS) was used to measure sedentary and eating habits. Results: Chi-square analysis revealed that a higher proportion of females (90.68%) than males (79.18%) exceeded two hours of daily sedentary time. Frequent sugary drink consumption (>3 times per week) was similar in males (67.40%) and females (66.11%). Students from different geographical locations showed significant differences in exceeding cut-off scores for fast food (χ² = 24.503, p < 0.001), cakes/doughnuts (χ² = 8.414, p = 0.015), sweets/candy (χ² = 19.613, p < 0.001), and energy drinks (χ² = 21.650, p < 0.001). Conclusions: Al-Ahsa is the largest governorate in the KSA. It has some of the largest health risks regarding obesity and poor lifestyle habits. This study highlights the major need for future research and policy interventions. Full article

26 pages, 3068 KiB

Open AccessReview

Impact of Climate Change on Schistosomiasis Transmission and Distribution—Scoping Review

by Kwame Kumi Asare, Muhi-Deen Wonwana Mohammed, Yussif Owusu Aboagye, Kathrin Arndts and Manuel Ritter

Int. J. Environ. Res. Public Health 2025, 22(5), 812; https://doi.org/10.3390/ijerph22050812 - 21 May 2025

Abstract

Schistosomiasis, a neglected tropical disease caused by parasitic worms of the genus Schistosoma and transmitted through freshwater snails, affects over 200 million people worldwide. Climate change, through rising temperatures, altered rainfall patterns, and extreme weather events, is influencing the distribution and transmission dynamics [...] Read more.

Schistosomiasis, a neglected tropical disease caused by parasitic worms of the genus Schistosoma and transmitted through freshwater snails, affects over 200 million people worldwide. Climate change, through rising temperatures, altered rainfall patterns, and extreme weather events, is influencing the distribution and transmission dynamics of schistosomiasis. This scoping review examines the impact of climate change on schistosomiasis transmission and its implications for disease control. This review aims to synthesize current knowledge on the influence of climate variables (temperature, rainfall, water bodies) on snail populations, transmission dynamics, and the shifting geographic range of schistosomiasis. It also explores the potential effects of climate adaptation policies on disease control. The review follows the Arksey and O’Malley framework and PRISMA-ScR guidelines, including studies published from 2000 to 2024. Eligible studies were selected based on empirical data on climate change, schistosomiasis transmission, and snail dynamics. A two-stage study selection process was followed: title/abstract screening and full-text review. Data were extracted on environmental factors, snail population dynamics, transmission patterns, and climate adaptation strategies. Climate change is expected to increase schistosomiasis transmission in endemic regions like Sub-Saharan Africa, Southeast Asia, and South America, while some areas, such as parts of West Africa, may see reduced risk. Emerging hotspots were identified in regions not currently endemic. Climate adaptation policies, such as improved water management and early warning systems, were found effective in reducing transmission. Integrating climate adaptation strategies into schistosomiasis control programs is critical to mitigating the disease’s spread, particularly in emerging hotspots and shifting endemic areas. Full article

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26 pages, 1764 KiB

Open AccessReview

A Horizon Scan of Neurotechnology Innovations

by Shona Haston, Sean Gill, Katie Twentyman, Elizabeth Green, Opeyemi Agbeleye, Claire Eastaugh, Dawn Craig, Sonia Garcia Gonzalez-Moral and Andrew Mkwashi

Int. J. Environ. Res. Public Health 2025, 22(5), 811; https://doi.org/10.3390/ijerph22050811 - 21 May 2025

Abstract

Neurotechnology is a rapidly emerging field with vast potential within healthcare, but also has inherent concerns. There is, therefore, a need to ensure the responsible and ethical development and regulation of these technologies. This horizon scan aimed to provide an overview of neurotechnologies [...] Read more.

Neurotechnology is a rapidly emerging field with vast potential within healthcare, but also has inherent concerns. There is, therefore, a need to ensure the responsible and ethical development and regulation of these technologies. This horizon scan aimed to provide an overview of neurotechnologies in development and those approved by the FDA as of June 2024 for a range of conditions relating to mental health, healthy ageing, and physical disability. Searches of clinical trials, conferences, journals, and news were performed in March 2024. Relevant technologies were identified through a process of screening, data extraction and synthesis. A total of 81 unique neurotechnologies were identified, with 23 relating to mental health, 31 to healthy ageing, and 42 to physical disability. A total of 79% percent did not yet have FDA approval and 77.4% were at earlier stages of development (pilot/feasibility studies), with 22.6% at pivotal or post-market stages. Digital elements were common features of the technologies, including software, apps, and connectivity to other devices; however, there were only three technologies with an identifiable AI component. A complex regulatory landscape and unique ethical and safety concerns associated with neurotechnology could pose challenges to innovators, though the emerging nature of the field also provides an opportunity to pre-emptively address potential issues. Full article

(This article belongs to the Special Issue Digital Innovations for Health Promotion)

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16 pages, 2076 KiB

Open AccessArticle

Hearing Impairment Among Drug-Resistant Tuberculosis Patients in Rural Eastern Cape: A Retrospective Analysis of Audiometric Findings

by Lindiwe Modest Faye, Mojisola Clara Hosu, Ntandazo Dlatu, Vatiswa Henge-Daweti and Teke Apalata

Int. J. Environ. Res. Public Health 2025, 22(5), 810; https://doi.org/10.3390/ijerph22050810 - 21 May 2025

Abstract

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This [...] Read more.

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This study aimed to assess the prevalence and predictors of hearing impairment among DR-TB patients in rural Eastern Cape, South Africa. A retrospective analysis was conducted on 438 DR-TB patients treated between 2018 and 2020, using pure tone audiometry (PTA) to assess hearing status post-treatment. Demographic, clinical, and lifestyle data were extracted from patient records and analyzed using logistic regression. The overall prevalence of hearing loss was 37.2%. Risk was significantly associated with an older age, a male gender, DR-TB classification (MDR, pre-XDR, and XDR), unsuccessful treatment outcomes, and substance use. Prevalence of HL increased notably in patients aged 70 and older. Lifestyle factors, particularly combined use of tobacco, alcohol, and drugs, were linked to higher odds of HL. These findings underscore the need for routine audiometric screening and personalized treatment monitoring in DR-TB care, especially for high-risk populations. Early identification of ototoxicity risk factors can inform safer treatment regimens and improve patient outcomes in resource-limited settings. Full article

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18 pages, 846 KiB

Open AccessSystematic Review

Economic Evaluation of Proactive PTSI Mitigation Programs for Public Safety Personnel and Frontline Healthcare Professionals: A Systematic Review and Meta-Analysis

by Hadiseh Azadehyaei, Yue Zhang, Yan Song, Tania Gottschalk and Gregory S. Anderson

Int. J. Environ. Res. Public Health 2025, 22(5), 809; https://doi.org/10.3390/ijerph22050809 - 21 May 2025

Abstract

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTEs) and developing post-traumatic stress injuries (PTSIs, e.g., depression, anxiety) by the nature of their work. PTSI is also connected to increased absenteeism, suicidality, and [...] Read more.

Public safety personnel and frontline healthcare professionals are at increased risk of exposure to potentially psychologically traumatic events (PPTEs) and developing post-traumatic stress injuries (PTSIs, e.g., depression, anxiety) by the nature of their work. PTSI is also connected to increased absenteeism, suicidality, and performance decrements, which compromise occupational and public health and safety in trauma-exposed workers. There is limited evidence on the cost effectiveness of proactive “prevention” programs aimed at reducing the risk of PTSIs. The purpose of this meta-analysis is to measure the economic effectiveness of proactive PTSI mitigation programs among occupational groups exposed to frequent occupational PPTEs, focusing on the outcomes related to PTSI symptoms, absenteeism, and psychological wellness. Findings from 15 included studies demonstrate that proactive interventions can yield substantial economic and health benefits, with Return On Investment (ROI) values ranging widely from −20% to 3560%. Shorter interventions (≤6 months) often produced higher returns, while longer interventions (>12 months) showed more moderate or negative returns. Notably, the level at which an intervention is targeted significantly affects outcomes—programs aimed at managers, such as the 4 h RESPECT training course, demonstrated a high ROI and broad organizational impact by enhancing leadership support for employee mental health. Sensitivity analyses highlighted significant variability based on the organizational context, program design, and participant characteristics. The majority of proactive interventions successfully reduced psychological distress and enhanced workplace outcomes, although thoughtful consideration of program design and implementation context is essential. Full article

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19 pages, 342 KiB

Open AccessArticle

EAT-Lancet Diet Components Acquisition According to Food Insecurity and Poverty Status in Brazil: An Analysis of National Household Budget Survey 2017–2018

by Eduardo De Carli, Mariana Alves Ferreira, Lucas de Almeida Moura, Valéria Troncoso Baltar and Dirce Maria Lobo Marchioni

Int. J. Environ. Res. Public Health 2025, 22(5), 808; https://doi.org/10.3390/ijerph22050808 - 21 May 2025

Abstract

The EAT-Lancet diet outlines target consumption for specific food components but overlooks accessibility and cost issues, which may hinder adherence among vulnerable populations. This study examines the acquisition profile of EAT-Lancet diet components by food security and poverty status, using data from 57,920 [...] Read more.

The EAT-Lancet diet outlines target consumption for specific food components but overlooks accessibility and cost issues, which may hinder adherence among vulnerable populations. This study examines the acquisition profile of EAT-Lancet diet components by food security and poverty status, using data from 57,920 households in the 2017–2018 Brazilian Household Budget Survey. Poverty and food insecurity were defined according to the World Bank per capita income cutoffs and the Brazilian Food Insecurity Scale, respectively. Food acquisition was classified into 15 EAT-Lancet diet components and expressed as per capita daily averages (g, % of total available energy, and % of food expenditure), by food security and poverty strata. Brazilian households were 37.9% food-insecure and 12% poor. Compared to more privileged counterparts, these households prioritized the acquisition of staples like refined cereals and legumes over most EAT-Lancet diet adequacy components, such as fruits, vegetables, whole grains, nuts, and peanuts. While lower energy shares from moderation components were only slightly evident for red meat and dairy among food-insecure households, pronounced reductions in added sugars and vegetable oils were seen among the poor. These findings suggest that public policies should synergically address particularities of different deprivation contexts to promote sustainable diets in Brazil. Full article

(This article belongs to the Section Global Health)

15 pages, 692 KiB

Open AccessArticle

Moving Towards a South African NHI System of Excellence: Recommendations Based on the Insider Perspectives of CHWs as Key Role-Players

by Corlia Janse van Vuuren, Zanette Lowe and Karen Bodenstein

Int. J. Environ. Res. Public Health 2025, 22(5), 807; https://doi.org/10.3390/ijerph22050807 - 21 May 2025

Abstract

Aligned with the worldwide shift towards promotional and preventative health care, the South African government has introduced a re-engineered primary health care plan, facilitated through a National Health Insurance (NHI) platform. Community health workers (CHWs) are key role-players in most universal health care [...] Read more.

Aligned with the worldwide shift towards promotional and preventative health care, the South African government has introduced a re-engineered primary health care plan, facilitated through a National Health Insurance (NHI) platform. Community health workers (CHWs) are key role-players in most universal health care systems. This article shares insider perspectives from 31 CHWs in one of the South African NHI pilot districts. Based on their perspectives, the authors share recommendations to strengthen the NHI plan. Recommendations comprise of the inclusion of a dedicated CHW team leader and reporting nurse, ongoing CHW education and training with an accompanying portfolio of evidence, and awareness campaigns on the role of CHWs within the South African re-engineered primary health care plan and NHI platform. Full article

(This article belongs to the Special Issue Universal Health Coverage—for a Globally Accessible and Affordable Health Care Service)

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14 pages, 1453 KiB

Open AccessSystematic Review

Neurodegenerative Disease and Association Football (NDAF): Systematic Review and Meta-Analysis

by Nathan E. Howarth, Chen Ji, John Batten, Alan J. Pearce, Helen Dawes, Adam J. White, Gabriele DeLuca, Samantha Bureau, Christopher J. Nowinski and Michelle A. Miller

Int. J. Environ. Res. Public Health 2025, 22(5), 806; https://doi.org/10.3390/ijerph22050806 - 21 May 2025

Abstract

There is increasing concern that head injuries in Association Football (or soccer) may lead to adverse health outcomes. The aim of this study was to determine whether head impacts or injuries are associated with an increased risk of neurodegenerative disease. We performed a [...] Read more.

There is increasing concern that head injuries in Association Football (or soccer) may lead to adverse health outcomes. The aim of this study was to determine whether head impacts or injuries are associated with an increased risk of neurodegenerative disease. We performed a systematic search using PubMed, Embase, and Ovid (up to April 2025). Studies included investigated neurodegenerative diseases in football in comparison to control athletic and general populations. Data were extracted according to PRISMA guidelines. Studies with an odds ratio (OR) were included in the meta-analysis. A total of ten studies were included in this review, of which nine were suitable for meta-analysis from eight cohorts. The risk for developing any neurodegeneration was 1.69 OR (95%CI 1.11 to 2.59; p = 0.01); for Dementia, it was 2.16 OR (95%CI 1.60 to 2.93; p < 0.01; for Motor Neurone Disease (MND), it was 1.39 OR (95%CI 0.67 to 2.53; p = 0.21); for Parkinson’s Disease (PD), it was 1.14 OR (95%CI 0.55 to 2.89; p = 0.79). Heterogeneity was reduced following the removal of two studies and the revised risk scores for any neurodegenerative disease; Dementia increased, with that for MND reaching significance, 1.81 OR (95%CI 1.22 to 2.30; p = 0.01), but there remained no association with PD. Evidence suggests that professional football significantly increases the odds of neurodegenerative disease. Full article

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18 pages, 3694 KiB

Open AccessArticle

Relationship Between Brazilian Dietary Patterns and the Global Syndemic: Data from the CUME Study

by Jéssica Bevenuto Mattar, Marcos Heil Costa, Ana Luiza Gomes Domingos, Helen Hermana Miranda Hermsdorff, Adriano Marçal Pimenta and Josefina Bressan

Int. J. Environ. Res. Public Health 2025, 22(5), 805; https://doi.org/10.3390/ijerph22050805 - 21 May 2025

Abstract

Global food systems are contributing to a shift toward unhealthy diets, which is linked to the three components of the global syndemic. This cross-sectional study evaluates how dietary patterns in Brazil are associated with the components of the global syndemic. Anthropometric and food [...] Read more.

Global food systems are contributing to a shift toward unhealthy diets, which is linked to the three components of the global syndemic. This cross-sectional study evaluates how dietary patterns in Brazil are associated with the components of the global syndemic. Anthropometric and food intake data were obtained from the CUME Study—a prospective cohort conducted with a sample of Brazilian university graduates. BMI was used to assess obesity. Insufficient intake of micronutrients was considered undernutrition. Carbon, water, and ecological footprints were used to assess the environmental impact of dietary patterns. Dietary patterns were identified through principal components analysis. Linear regression models were used to evaluate associations between dietary patterns and the components of the global syndemic. The Unhealthy Dietary Pattern was positively associated with BMI and had the highest environmental impact. The Brazilian Dietary Pattern was also positively associated with BMI but had the lowest environmental impact. The Healthy Dietary Pattern was the most protective against micronutrient inadequacy. Diet affected the environment and people’s health in this sample. The dietary patterns identified here as contributing to poor health and environmental damage can help the government develop policies that incorporate the costs of these effects into the prices of food. Full article

(This article belongs to the Special Issue The Role of Food Consumption in the Global Syndemic)

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15 pages, 457 KiB

Open AccessArticle

Level of Patient Satisfaction with Quality of Primary Healthcare in Almaty During COVID-19 Pandemic

by Dinara Shaki, Gulshara Aimbetova, Venera Baysugurova, Marina Kanushina, Aigerim Chegebayeva, Muratkhan Arailym, Erkebulan Merkibekov and Indira Karibayeva

Int. J. Environ. Res. Public Health 2025, 22(5), 804; https://doi.org/10.3390/ijerph22050804 - 21 May 2025

Abstract

Background: This study aimed to assess patient satisfaction with the quality of healthcare services at selected public primary healthcare facilities in Almaty during the COVID-19 pandemic and to identify associated demographic and facility-related factors. Methods: A cross-sectional, quantitative study was conducted over a [...] Read more.

Background: This study aimed to assess patient satisfaction with the quality of healthcare services at selected public primary healthcare facilities in Almaty during the COVID-19 pandemic and to identify associated demographic and facility-related factors. Methods: A cross-sectional, quantitative study was conducted over a period of 6 months, from 30 June to 31 December 2021, through a web-based survey. An adapted questionnaire was employed to survey the respondents. In total, 1035 respondents participated in the study. To examine the relationship between demographic and facility characteristics and patient satisfaction, we utilized the proportional odds model for ordinal logistic regression. Results: A total of eight primary healthcare organizations from the public sector in Almaty participated in the survey. The analysis identified significant demographic predictors of patient satisfaction, such as marital status, social status, self-perceived health, and the use of online consultations. Among the facility-related factors, only the availability of a cross-ventilation system emerged as a significant predictor. Conclusions: This study provides evidence for the factors influencing patient satisfaction with primary healthcare services in Almaty during the COVID-19 pandemic. Both demographic characteristics and facility-level attributes were found to significantly affect satisfaction levels. These findings underscore the need for targeted structural and organizational improvements in primary healthcare settings, especially during public health emergencies. Addressing these gaps through infrastructural upgrades, enhanced preparedness, and the integration of patient-centered care models can help to bolster trust and resilience within Kazakhstan’s healthcare system. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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International Journal of Environmental Research and Public Health

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