International Journal of Environmental Research and Public Health

16 pages, 310 KB

Open AccessArticle

The Level of Knowledge, Attitude, Practice, and Adherence of Obstetricians and Gynecologists Towards the Triple Elimination Program (HIV, Syphilis, Hepatitis B) in Maternal Services at Government and Private Hospitals in Jakarta

by Yudianto Budi Saroyo, Baihaki, Mohammad Adya F. Dilmy, Lisa Novianti and Thalia Amila Elsiyana

Int. J. Environ. Res. Public Health 2026, 23(8), 1090; https://doi.org/10.3390/ijerph23081090 - 21 Aug 2026

Abstract

Background: Human Immunodeficiency Virus (HIV), Syphilis, and Hepatitis B significantly contribute to high morbidity and mortality rates associated with mother-to-child transmission (MTCT), particularly in developing nations. The study delves into the adherence levels of obstetricians and gynecologists to the Triple Elimination Program in [...] Read more.

Background: Human Immunodeficiency Virus (HIV), Syphilis, and Hepatitis B significantly contribute to high morbidity and mortality rates associated with mother-to-child transmission (MTCT), particularly in developing nations. The study delves into the adherence levels of obstetricians and gynecologists to the Triple Elimination Program in Jakarta. Methods: This study employed a descriptive cross-sectional design, conducted across government and private hospitals in Jakarta from January to December 2023. The study sample comprises obstetricians and gynecologists selected through consecutive sampling. Data collection involves questionnaires measuring knowledge, attitude, practice, and adherence, with validity and reliability assessed through pilot studies. Results: Out of the 106 respondents, 47.2% lacked adequate knowledge of the Triple Elimination Program, while 52.8% demonstrated higher knowledge. Insufficient attitude was observed in 50% of respondents, with the remaining 50% reporting a good attitude towards the program. Inadequate practice was noted in 49% of respondents and 51% perceived themselves as having fair practice. Most respondents demonstrated only fair adherence (74.5%), whereas only 25.5% achieved good adherence. Conclusions: The research findings highlight existing gaps in knowledge, attitude, practice, and adherence among healthcare providers, emphasizing the need for improvement in these areas. Full article

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

16 pages, 766 KB

Open AccessReview

Fragrance-Free Policies: A Scoping Review of Definitions, Implementation, and Gaps

by Sudipta Roy, John Molot, Robert Lattanzio, Jennifer Armstrong, Riina Bray, Adrianna Trifunovski and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(8), 1089; https://doi.org/10.3390/ijerph23081089 - 21 Aug 2026

Abstract

Background: Fragrance-free policies are increasingly adopted to improve indoor air quality and reduce fragrance exposure linked to adverse health outcomes and accessibility barriers. This scoping review mapped the evidence on fragrance-free policies across sectors. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, [...] Read more.

Background: Fragrance-free policies are increasingly adopted to improve indoor air quality and reduce fragrance exposure linked to adverse health outcomes and accessibility barriers. This scoping review mapped the evidence on fragrance-free policies across sectors. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched five peer-reviewed databases and grey literature sources. Documents describing formal scent-free or fragrance-free policies or guidance in workplaces, healthcare, educational, or public settings were included. Data were charted on policy characteristics, enforcement mechanisms, implementation supports, and governance features. Results: Sixty-three documents were included. Findings revealed substantial variability in terminology, scope, and enforcement. Many policies relied on voluntary compliance and awareness-based strategies, with limited integration of structural supports such as procurement controls, staff training, and evaluation frameworks. Enforcement mechanisms were predominantly reactive, responsibilities were inconsistently defined, and consequences for non-compliance were limited. Although many policies referenced multiple chemical sensitivity or fragrance sensitivity, accommodation pathways and accountability structures were frequently lacking. Four key themes indicate that many fragrance-free policies function as accommodation tools rather than integrated environmental health interventions. Conclusions: Strengthening definitional clarity, institutional accountability, and structural integration may enhance effectiveness and support more consistent, equitable, and evidence-informed approaches to reducing fragrance-related exposures in indoor environments. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

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29 pages, 789 KB

Open AccessArticle

Autoimmune Reporting Signals in FAERS Reports Listing COVID-19 Vaccines as Suspect Products: An Active-Comparator Disproportionality Analysis

by Assylzhan M. Messova, Makhmutbay Sanbayev, Sagira T. Abdrahmanova, Raikhan Temirkhanova, Nadiar M. Mussin and Amin Tamadon

Int. J. Environ. Res. Public Health 2026, 23(8), 1088; https://doi.org/10.3390/ijerph23081088 - 21 Aug 2026

Abstract

Background/Objectives: Autoimmune and immune-mediated adverse events coded in reports listing COVID-19 vaccines as suspect products are rare, heterogeneous, and difficult to evaluate in spontaneous reporting systems. We characterized autoimmune reporting signals using strict case definitions and an active-comparator disproportionality design. Methods: FAERS reports [...] Read more.

Background/Objectives: Autoimmune and immune-mediated adverse events coded in reports listing COVID-19 vaccines as suspect products are rare, heterogeneous, and difficult to evaluate in spontaneous reporting systems. We characterized autoimmune reporting signals using strict case definitions and an active-comparator disproportionality design. Methods: FAERS reports from 2021Q1 to 2023Q4 were deduplicated and harmonized by vaccine product, platform, sex, age group, and MedDRA Preferred Term (PT). COVID-19 vaccine reports recorded as primary or secondary suspect products were compared with traditional non-COVID vaccine reports. Strict autoimmune events were grouped into neurological, endocrine, rheumatological, hematological, dermatological, and cardiac categories. Reporting odds ratios (RORs), proportional reporting ratios (PRRs), PT-level rankings, masking audits, and sensitivity analyses were evaluated. Results: The primary analysis included 4191 COVID-19 vaccine reports, 2817 comparator reports, and 311 strict-autoimmune reports contributing 316 report-category observations. Positive category-level signals were identified for dermatological (ROR 10.49; 95% CI: 2.51–43.86), endocrine (ROR 5.39; 95% CI: 1.24–23.48), hematological (ROR 4.68; 95% CI: 2.32–9.44), and neurological events (ROR 1.63; 95% CI: 1.16–2.29). Rheumatological reporting was lower, strict cardiac events were absent, and hematological signals were most consistent across sensitivity analyses. Among five adjusted-positive finite PT signals, immune thrombocytopenia was more stable, multiple sclerosis intermediate, and acquired hemophilia, myasthenia gravis, and optic neuritis sparse/imprecise. A post hoc audit identified four potential clusters among 20 acquired-hemophilia reports; cluster collapse reduced the ROR to 2.70 (95% CI 0.30–24.18; p = 0.654). Conclusions: These findings are hypothesis-generating and do not establish incidence, absolute risk, or causality. Full article

(This article belongs to the Collection COVID-19 Research)

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16 pages, 643 KB

Open AccessArticle

Coaching the Caregivers: A Burnout Intervention for Military Physicians and Medical Students

by Lisa M. Foglia, Erin Keyser, Jason Massengill, Sorana Raiciulescu and Monica A. Lutgendorf

Int. J. Environ. Res. Public Health 2026, 23(8), 1087; https://doi.org/10.3390/ijerph23081087 - 21 Aug 2026

Abstract

Introduction: Burnout results from chronic stress, consisting of emotional exhaustion, depersonalization and decreased personal accomplishment. The objective of this study was to assess the effects of coaching on physician burnout in military obstetrician gynecologists (OB/GYNs). Methods: This was an IRB-approved observational study of [...] Read more.

Introduction: Burnout results from chronic stress, consisting of emotional exhaustion, depersonalization and decreased personal accomplishment. The objective of this study was to assess the effects of coaching on physician burnout in military obstetrician gynecologists (OB/GYNs). Methods: This was an IRB-approved observational study of coaching for military OB/GYN physicians and students. Physicians and medical students were assigned to attend six virtual group coaching sessions over three months with professional coaches. Coaching groups were organized by level of training. Participants completed surveys (Maslach Burnout Survey for Human Services Survey (MBI-HSS) with Areas of Worklife Survey (AWS)) at baseline and following coaching. A latent profile analysis (LPA) used MBI scores to identify burnout profiles in dimensions of depersonalization (DP), emotional exhaustion (EE), and personal accomplishment (PA). Statistical analysis included paired t-test, and chi squared analyses. Results: 59 participants completed coaching and surveys from August–October 2024. There were no significant differences in MBI scores pre- and post-coaching. LPA identified three profiles: (a) low DP, low EE, high PA, (b) low DP, moderate EE, high PA, (c) high DP, high EE, high PA. When analyzed on MBI definitions, those with a burnout profile (high DP and high EE) had significant improvements in workload, control, and fairness scores on the AWS following coaching (p < 0.05). Conclusions: A professional coaching intervention in military OB/GYN physicians with a burnout profile was associated with significant improvements in workload, control and fairness. Professional coaching may positively impact clinicians, particularly those experiencing burnout, and has the potential to improve retention of the workforce. Full article

(This article belongs to the Section Health Care Sciences)

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20 pages, 482 KB

Open AccessArticle

Facing Dementia in Primary Care: A Process Evaluation of a Multicomponent Practice Change Intervention to Improve Dementia Diagnosis in General Practice

by Mark Yates, Caroline Gibson, Constance Dimity Pond, Stephanie Daly, Jessica Jebramek, Sharon Daniel, Lyn Phillipson, Kate Laver, Meredith Gresham, Edwin Tan, Henry Brodaty, Jamie Swann, Shahana Ferdousi, Annica Barcenilla-Wong, Nora Wong and Lee-Fay Low

Int. J. Environ. Res. Public Health 2026, 23(8), 1086; https://doi.org/10.3390/ijerph23081086 - 20 Aug 2026

Abstract

Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention [...] Read more.

Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention to improve dementia diagnosis in Australian general practice. A mixed-methods process evaluation used the RE-AIM framework with the addition of Appropriateness. The intervention included Primary Health Network (PHN) engagement, GP education, clinical resources, audit and benchmarking reports, specialist support, and a dementia risk-alert tool. Data were collected through surveys, stakeholder interviews, website analytics and program documentation. Clinicians who participated reported increased confidence and changes in dementia-related clinical behaviours, while education, resources and benchmarking were perceived as valuable. However, overall reach was limited by competing clinical priorities, workforce pressures, lack of financial incentives, and PHN implementation challenges. The dementia risk-alert tool was feasible but achieved limited uptake because of software compatibility, usability concerns and incomplete electronic medical record data. Although the program was acceptable to participating clinicians, limited reach constrained its potential impact. These findings highlight organizational, workforce, digital infrastructure and policy factors that influenced implementation of multicomponent interventions in routine primary care. Full article

(This article belongs to the Special Issue Interventions to Improve the Care of People Living with Dementia)

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25 pages, 3215 KB

Open AccessReview

Updated Overview of the Geographical Prevalence of Polycystic Ovary Syndrome by Diagnostic Criteria, Phenotypes, Race, and Ethnicity

by Makenna J. O. Noland and Melissa D. Olfert

Int. J. Environ. Res. Public Health 2026, 23(8), 1085; https://doi.org/10.3390/ijerph23081085 - 20 Aug 2026

Abstract

Background: Newly named Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously Polycystic Ovary Syndrome (PCOS), affects women worldwide. The prevalence of PCOS is thought to range from 5 to 15% depending on the diagnostic criteria used. The 2023 International Evidence-Based Guidelines for the Assessment and [...] Read more.

Background: Newly named Polyendocrine Metabolic Ovarian Syndrome (PMOS), previously Polycystic Ovary Syndrome (PCOS), affects women worldwide. The prevalence of PCOS is thought to range from 5 to 15% depending on the diagnostic criteria used. The 2023 International Evidence-Based Guidelines for the Assessment and Management of PCOS recognize the 2003 Rotterdam criteria as the gold standard diagnostic tool. The objective was to examine the global prevalence of PCOS across diagnostic criteria, phenotypes, geographical locations, races, and ethnicities by reviewing current research. Methods: Researchers searched PubMed, PsycINFO, and Scopus. The study included 27 articles. Results: Prevalence varies globally, ranging from 1.6% to 28.5% in North America. In Brazil, the prevalence was 30.4%. Europe showed rates ranging from 5.9% to 19.9%. In Asia, the prevalence ranged from 4.21% in rural India to 35.3% in the Kashmir Valley. Oceania showed a prevalence of 6.8% among Samoan women and 12% in Australian women. The Middle East ranged from 1.6% in Dubai to 48.5% in Pakistan. In Africa, the prevalence was 32.5% in Sudan. Conclusions: The study’s findings highlight significant variations in the prevalence and phenotype distributions influenced by demographic factors and diagnostic criteria. Limitations include inconsistent diagnostic criteria, underrepresentation of geographical regions, and reliance on self-reported data, emphasizing the importance of using standardized diagnostic criteria and focused research. Full article

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21 pages, 6664 KB

Open AccessProject Report

The MAPme Project: Implementing a College-Based Study of Substance Use and Mental Wellness

by Whitney L. Barfield-Steward, Yijin Xiang, Dalora Najera, Jenipher Ober-Oluoch, Chelsie Benca-Bachman, Hope Derricott, Rameez Syed, Justine W. Welsh and Rohan H. C. Palmer

Int. J. Environ. Res. Public Health 2026, 23(8), 1084; https://doi.org/10.3390/ijerph23081084 - 20 Aug 2026

Abstract

Background: Transitional age youth aged 18–25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood [...] Read more.

Background: Transitional age youth aged 18–25 years are more likely to engage in risky behaviors, displaying significantly higher alcohol and illicit drug use levels than adolescents and older adults. College students are particularly vulnerable at this critical life juncture as transitioning to adulthood may impact emotional health and well-being, contributing to anxiety, depression, and feelings of hopelessness, all of which are linked to increased risk of substance use and disorders. Objective: This study characterizes the design and status of the MAPme Project, a prospective project centered on substance use and emotional wellness during and beyond college. Herein, we describe the 2018–2024 pilot cohort that was followed during the first two years of college, remotely during the COVID-19 pandemic, and upon the return to campus. We also describe our latest 2025+ cohort with ongoing data collection. Participants: The 2018–2024 cohort comprised 301 college freshmen who completed online assessments at baseline (Wave 1). The 2025+ cohort has currently enrolled 618 students and counting. Methods: We provide descriptive information on both cohorts, along with preliminary associations of pre- and early collegiate substance use outcomes, psychopathology, sleep patterns, and personality traits. Results: Approximately 64% of first-year students reported use of a substance in the 90 days leading up to college in 2018. Alcohol and cannabis were the most prevalent substances used in both cohorts with males consuming more alcohol than females. Females reported greater levels of daily stressors and mood symptoms. Other health and personality characteristics and observed associations between psychosocial risk and protective factors are described. Prior studies demonstrate the ability to test research hypotheses in the social, health, and clinical areas of psychology with robust statistical power. Conclusions: Substance use and emotional well-being vary considerably upon entry into college/university and at any particular moment in time. The MAPme Project encourages the engagement of students to address challenges associated with lack of awareness, inclusivity, and acceptance of scientific research. Overcoming barriers of inclusivity and empowering the community is key to the successful adoption and implementation of campus health and community-oriented research programs and systematically enhancing research training. Full article

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

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14 pages, 293 KB

Open AccessFeature PaperArticle

Assessing Discordance Between Self-Perceived HIV Risk and Laboratory-Confirmed HIV Status in South Africa: Insights from the 2022 National Population-Based Survey

by Sbonelo Chamane, Inbarani Naidoo, Musawenkosi Mabaso, Angeline Sibongile Ngcobo, Prudence Chambale, Tebogo Sole-Moloto, Lehlogonolo Makola, Sean Jooste, Lesiba Molopa, Thembelihle Ginyana, Sizulu Moyo, Nompumelelo Zungu and Khangelani Zuma

Int. J. Environ. Res. Public Health 2026, 23(8), 1083; https://doi.org/10.3390/ijerph23081083 - 20 Aug 2026

Abstract

Background: The discordance between individuals’ self-perceived risk of HIV infection and laboratory-confirmed risk has a significant impact on behaviours related to HIV prevention and timely initiation of treatment. Methods: Data was obtained from the sixth South African National HIV Prevalence, Incidence, and Behaviour [...] Read more.

Background: The discordance between individuals’ self-perceived risk of HIV infection and laboratory-confirmed risk has a significant impact on behaviours related to HIV prevention and timely initiation of treatment. Methods: Data was obtained from the sixth South African National HIV Prevalence, Incidence, and Behaviour Survey. Descriptive statistics were used to summarise the sample characteristics and provide the prevalence of discordance. A multivariable multinomial logistic regression was employed to investigate factors associated with discordant results. Results: Of 34,528 participants, 4.1% (95% Confidence Interval (CI): 3.7–4.5) were classified as HIV-positive with low perceived risk, while 11.5% (95% CI: 10.4–12.6) were classified as HIV-negative with high perceived risk and 1.0% (95% CI: 0.8–1.1) as self-misdiagnosed. Being HIV-positive with low perceived risk was significant among older ages (25–54 years) and lower among other races than Black Africans and those residing in rural informal areas. In contrast, being HIV-negative with high perceived risk of HIV risk was more common among participants aged 25–44 years, as well as those living in rural informal and rural formal areas, but lower among other races than Black Africans. The factor associated with self-misdiagnosis was being female. However, participants aged 15–24 years who were never married were less likely to self-misdiagnose. Conclusion: These findings highlight a significant discrepancy between perceived and laboratory-confirmed HIV risk, underscoring the importance of targeted interventions to improve risk perception accuracy. Enhancing individuals’ understanding of their true risk may lead to better engagement in preventive measures and the timely initiation of treatment. Full article

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

61 pages, 694 KB

Open AccessSystematic Review

Interventions to Support the Mental Health of Frontline Healthcare Workers During the COVID-19 Pandemic: A Systematic Review

by Rosechelle M. Ruggiero, Hetal J. Patel, Carol S. North and Traci N. Adams

Int. J. Environ. Res. Public Health 2026, 23(8), 1082; https://doi.org/10.3390/ijerph23081082 - 19 Aug 2026

Abstract

The COVID-19 pandemic led to distress and an increased prevalence of psychopathology among front-line (FL) healthcare workers (HCWs). A synthesis of the available data on the effectiveness of MH interventions among FL HCWs is essential to inform an MH plan for FL HCWs [...] Read more.

The COVID-19 pandemic led to distress and an increased prevalence of psychopathology among front-line (FL) healthcare workers (HCWs). A synthesis of the available data on the effectiveness of MH interventions among FL HCWs is essential to inform an MH plan for FL HCWs in future pandemics. The objective of this systematic review is to examine interventions used to support the MH of FL HCWs during the COVID-19 pandemic. All studies published between 1 January 2020 and 1 March 2026 that reported on MH interventions among FL HCWs during the COVID-19 pandemic were identified using PubMed, PsycINFO, Scopus, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Medline, and Web of Science. Studies published in peer-reviewed journals that reported data on interventions to support the MH of FL HCWs were included. The study was conducted using the approach by the PRISMA guidelines. The search generated 1450 records, of which 309 were reviewed at length, and 153 studies (N = 153) were included. Interventions in these studies included identification of risk for psychopathology and linkage to mental health care (n = 3), PE/PFA (n = 44), psychotherapy (n = 26), mindfulness programs (n = 58), medications (n = 5), and multiple/combined psychosocial support interventions (n = 17). The majority of studies found their interventions to be beneficial, largely based on user satisfaction scores and symptom screening scores. Importantly, symptoms in the vast majority of control arms also improved over time, though not to the degree that symptoms in intervention arms improved. This systematic review suggests that an established disaster MH response framework may be useful in directing the design of MH responses to FL HCWs in future pandemics, offering screening for psychopathology and connection with formal psychiatric services for full evaluation and provision of MH care, as well as supportive care with mindfulness interventions, crisis-oriented counseling, PE, and PFA. Full article

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

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13 pages, 638 KB

Open AccessArticle

Palliative Care Involvement in Hospitalized Amyotrophic Lateral Sclerosis Patients

by Sumeet Bhardwaj, Anita Chakraborty, Jillian Mead and Kalli Stilos

Int. J. Environ. Res. Public Health 2026, 23(8), 1081; https://doi.org/10.3390/ijerph23081081 - 19 Aug 2026

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with significant physical, psychological, and social distress. Given its terminal nature and high symptom burden, early integration of palliative care is essential. The inpatient Palliative Care Consult Team (PCCT) provides specialist palliative care [...] Read more.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with significant physical, psychological, and social distress. Given its terminal nature and high symptom burden, early integration of palliative care is essential. The inpatient Palliative Care Consult Team (PCCT) provides specialist palliative care to hospitalized patients with ALS. Hospitalizations are common throughout the ALS disease trajectory, particularly as patients experience progressive functional decline, respiratory compromise, and increasing care needs, making inpatient encounters important opportunities for specialist palliative care involvement. To extend palliative care beyond the inpatient setting and facilitate earlier involvement, an ALS ambulatory clinic was established in 2018. Despite the importance of palliative care, limited data describes its involvement among hospitalized ALS patients. This retrospective review examines the relationship between the PCCT and ALS patients admitted to a tertiary care facility between 2006–2019. Data collected included patient demographics, referral indications, clinical course, and disposition. Most patients referred to the PCCT had poor functional status and a guarded prognosis at initial consultation. Symptom management and support for complex decision-making were leading reasons for referral. Approximately half of patients died in the hospital within three months of referral. Most deaths occurred within one week, underscoring the importance of timely palliative care. Full article

(This article belongs to the Special Issue End-of-Life Care in Nursing Homes and Hospitals)

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32 pages, 407 KB

Open AccessArticle

Psychosocial Well-Being at Work: Large-Sample Structural Validation of the Multidimensional Psychosocial Work Experience Scale for Employed Persons (MPWES)

by Evija Nagle, Iluta Skrūzkalne, Maksims Zolovs, Jeļena Perevozčikova, Otto Andersen, Andrejs Ivanovs and Ieva Reine

Int. J. Environ. Res. Public Health 2026, 23(8), 1080; https://doi.org/10.3390/ijerph23081080 - 19 Aug 2026

Abstract

Psychosocial working conditions are important determinants of employee health, work ability, and organizational sustainability, yet existing instruments often assess job demands, job resources, psychosocial risks, or well-being outcomes separately. This study examined the structural validity of the Multidimensional Psychosocial Work Experience Scale for [...] Read more.

Psychosocial working conditions are important determinants of employee health, work ability, and organizational sustainability, yet existing instruments often assess job demands, job resources, psychosocial risks, or well-being outcomes separately. This study examined the structural validity of the Multidimensional Psychosocial Work Experience Scale for Employed Persons (MPWES), an instrument designed to assess a multidimensional occupational psychosocial profile comprising workplace conditions and demands, psychosocial resources, adverse exposures, health-related experiences, and subjective functioning. A cross-sectional validation study was conducted among 1631 employees from the pharmaceutical, energy, healthcare, and administrative sectors in Latvia. Confirmatory factor analysis with the robust WLSMV estimator was used to test the predefined measurement model. The refined eight-factor model demonstrated acceptable fit in the calibration subsample (N = 400; CFI = 0.930, TLI = 0.922, RMSEA = 0.066, SRMR = 0.078) and was replicated in the held-out validation subsample (N = 1231; CFI = 0.911, TLI = 0.901, RMSEA = 0.068, SRMR = 0.067). Reliability indices were acceptable for several domains, although some factors showed modest or borderline values. Discriminant validity was supported, with all HTMT values below 0.85, and measurement invariance testing supported configural, metric, scalar, and strict invariance across samples. The findings provide initial evidence of the MPWES’s structural validity and measurement stability in the present sample. However, further studies using external validity criteria, longitudinal designs, and culturally diverse samples are needed before the scale can be considered fully validated for broader occupational and public health applications. Full article

16 pages, 4143 KB

Open AccessArticle

An Integrated Decentralised–Centralised Oncology Care Model to Improve Cancer Screening, Access, and Continuity of Care in Rural Eastern Cape, South Africa: Implementation Study at Nelson Mandela Academic Hospital

by Zukiswa Jafta, Muamabangu Jean Paul Milambo, Eric Maimela, Constance Rufaro Sewani-Rusike and Wilson Wezile Chitha

Int. J. Environ. Res. Public Health 2026, 23(8), 1079; https://doi.org/10.3390/ijerph23081079 - 19 Aug 2026

Abstract

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced [...] Read more.

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

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

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19 pages, 1155 KB

Open AccessArticle

The Applicability of Forest Therapy for Socially Isolated Young Adults: Parallel Changes in Psychological Distress and Mindfulness

by Yeji Yang, Ji-Eun Pyo, Yongjun Lee, Beom Lee, Chang-Hyou Kim, Jeong-Ho Choi, Jina Yu, Jisoo Lee and Kee-Hong Choi

Int. J. Environ. Res. Public Health 2026, 23(8), 1078; https://doi.org/10.3390/ijerph23081078 - 19 Aug 2026

Abstract

This study examined the applicability of forest therapy in alleviating psychological distress among socially isolated young adults, with a particular focus on their associations with the mindfulness. A total of 159 socially isolated young adults were recruited from the community and participated in [...] Read more.

This study examined the applicability of forest therapy in alleviating psychological distress among socially isolated young adults, with a particular focus on their associations with the mindfulness. A total of 159 socially isolated young adults were recruited from the community and participated in a two-day, one-night forest therapy program. Psychological distress (depression, anxiety, loneliness, and stress) and mindfulness were assessed before and after the program. Multilevel analyses were conducted to examine changes in psychological distress and mindfulness following participation, as well as whether the five mindfulness subcomponents (nonreactivity, observing, acting with awareness, describing, and non-judging) were associated with individual differences in changes in these outcomes. The results indicated reductions in depression, anxiety, stress, and loneliness, along with an increase in overall mindfulness after the program. Among the mindfulness subcomponents, reductions in psychological distress over time occurred most closely in parallel with changes in nonreactivity, non-judging, and acting with awareness, whereas the parallel was weaker for describing and observing. These findings suggest that forest therapy may be a promising intervention for reducing psychological distress among socially isolated young adults, and that incorporating activities designed to cultivate mindfulness skills—particularly nonreactivity, non-judging, and awareness—could further enhance its mental health benefits. As this study did not include a control group, randomized controlled trials are needed to confirm these effects. 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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20 pages, 298 KB

Open AccessArticle

Fragrance-Free Policies in Practice: Identifying Perceived Implementation Gaps Through Lived Experience in a Qualitative-Dominant Mixed-Methods Study

by Sudipta Roy, Nene A. Diallo, John Molot, Robert Lattanzio, Riina Bray, Jennifer Armstrong and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(8), 1077; https://doi.org/10.3390/ijerph23081077 - 19 Aug 2026

Abstract

Background: Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with Multiple Chemical Sensitivity [...] Read more.

Background: Indoor air quality (IAQ) represents a key public health and accessibility concern. Improving IAQ through policies and practices that reduce exposure to fragranced products and other indoor air contaminants may enhance accessibility and support equitable participation for individuals with Multiple Chemical Sensitivity (MCS). Methods: Using a qualitative-dominant mixed-methods design, we examined IAQ accessibility barriers and explored perceived implementation and accessibility gaps in existing fragrance-free policies among sixty individuals with MCS and related IAQ exposures across ten focus groups. Qualitative and quantitative data were collected in parallel, with thematic analysis conducted in NVivo. A structured IAQ and policy survey was administered to quantify reported experiences and policy impacts. Results: Approximately 63.3% of focus group participants reported dissatisfaction with the indoor environments they encountered. Qualitative findings highlighted indoor environments as inaccessible, inadequately controlled, and associated with ongoing exposure to fragranced products as well as other indoor pollutants. These findings indicate that current approaches often fail to ensure accessibility, leaving individuals with MCS exposed and excluded from full participation in workplaces, healthcare settings, and other public spaces. Conclusions: Comprehensive fragrance-free policies incorporating source control, education, ventilation, and accountability mechanisms may reduce exposure while improving accessibility and inclusion across the built environment. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

18 pages, 310 KB

Open AccessArticle

When Disability Recognition Fails: Accommodation Refusals and Socioeconomic Challenges Among Canadians with Multiple Chemical Sensitivity

by Nene A. Diallo, John Molot, Riina Bray, Adrianna Trifunovski and Rohini Peris

Int. J. Environ. Res. Public Health 2026, 23(8), 1076; https://doi.org/10.3390/ijerph23081076 - 19 Aug 2026

Abstract

Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with [...] Read more.

Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. To our knowledge, this is the first national Canadian study to examine accommodation request outcomes across both employment and housing among adults with MCS, combining quantitative and qualitative data. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants’ experiences of disclosure, and accommodation outcomes. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). Findings should be interpreted in light of the cross-sectional design, self-reported data, and community-based recruitment, which may limit generalizability. The findings suggest that inconsistent institutional recognition of MCS can function as a barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires clarified guidance on the duty to accommodate multiple chemical sensitivity, proactive scent-free and lowest-emission policies in workplaces and housing, and improved healthcare provider education to support accommodation documentation. Full article

(This article belongs to the Special Issue Understanding Multiple Chemical Sensitivity (MCS): Interdisciplinary Insights into Science, Policy, and Lived Experience)

11 pages, 252 KB

Open AccessArticle

Training Frontline Providers in Basic Obstetric Ultrasound to Promote Healthy Pregnancy in Zimbabwe: Trainer and Trainee Experiences from a Qualitative Phenomenological Study

by Cladious Verenga, Shalote Chipamaunga-Bamu, Farai D. Madzimbamuto and Sunanda C. Ray

Int. J. Environ. Res. Public Health 2026, 23(8), 1075; https://doi.org/10.3390/ijerph23081075 - 19 Aug 2026

Abstract

Background: Limited access to trained providers remains a barrier to basic obstetric ultrasound use in low-resource antenatal care settings. This study aimed to explore trainer and trainee experiences of Zimbabwe’s six-week Basic Obstetric Ultrasound Short Course (BOUSC) and its perceived relevance to promoting [...] Read more.

Background: Limited access to trained providers remains a barrier to basic obstetric ultrasound use in low-resource antenatal care settings. This study aimed to explore trainer and trainee experiences of Zimbabwe’s six-week Basic Obstetric Ultrasound Short Course (BOUSC) and its perceived relevance to promoting healthy pregnancy through antenatal risk recognition and referral readiness. Methods: A qualitative study using transcendental phenomenology was conducted in the Fetal Medicine Units of Sally Mugabe Central Hospital and Parirenyatwa Group of Hospitals. Sixteen semi-structured interviews were conducted between September and October 2023 with eight trainers and eight trainees purposively selected from course records. Interviews were audio-recorded, transcribed verbatim, and analysed using Moustakas’ approach, including bracketing, horizontalisation, clustering of significant statements, and theme synthesis. Results: Thematic saturation was achieved. Four themes emerged: interactive and clinically situated teaching; confidence and basic skill development through supervised scanning; interprofessional learning that reduced hierarchy; and sustainability concerns related to equipment, mentorship, refresher training, and post-training practice. The most salient finding was that midwives trained as advanced obstetric sonographers were perceived as credible trainers for doctors and other cadres when operating within a supervised fetal medicine governance structure. Conclusions: Participants perceived the BOUSC as a practical and collaborative training model for basic obstetric ultrasound. The study does not demonstrate clinical outcome effects, but suggests that supervised basic ultrasound training may help promote healthy pregnancy when embedded within clear competency limits, quality assurance, and referral pathways. Full article

(This article belongs to the Special Issue Promoting Healthy Pregnancy)

28 pages, 9485 KB

Open AccessArticle

Extreme Heat and Emergency Health Impacts in the US (2018–2025)

by Tyler Hecht, Baoyuan Zhou, Abhi Thanvi and Lelys Bravo de Guenni

Int. J. Environ. Res. Public Health 2026, 23(8), 1074; https://doi.org/10.3390/ijerph23081074 - 18 Aug 2026

Abstract

Future climate projections suggest an increase in heat-related mortality and a decrease in cold-related deaths under warming scenarios. Understanding the health impacts of extreme heat, and their implications for healthcare demand is essential for assessing the future burden of climate-related illnesses. In this [...] Read more.

Future climate projections suggest an increase in heat-related mortality and a decrease in cold-related deaths under warming scenarios. Understanding the health impacts of extreme heat, and their implications for healthcare demand is essential for assessing the future burden of climate-related illnesses. In this study, we examined the relationship between extreme heat events and Emergency Department Visits (EDV) for heat-related illnesses (HRIs) across the United States from 2018 to 2025. Using data from the Centers for Disease Control and Prevention (CDC) Heat and Health Tracker and other relevant sources, we analyzed EDV rates standardized to 100,000 population. We aggregated daily into the 10 U.S. Health and Human Services (HHS) Regions. We used 0.5° × 0.5° gridded maximum daily temperature data (aggregated to HHS regions with proportional area weighting) and daily maximum heat index extracted from the CDC data portal (estimated using the US National Weather Service methodology and aggregated to HHS regions using total population weighting) to characterize seasonal patterns and regional variability. The association between peak heat events and EDV time series was explored using log-linear mixed-effects models, which accounted for seasonal trends, climate variables, and their regional variability. Random effects were used to capture regional heterogeneity in predictor-response relationships, accommodating variation in associations across regions. Model performance was evaluated using prediction error metrics and goodness-of-fit assessments. Maximum temperature and heat index were both significant predictors, with the heat index offering a slightly better fit. Associations were largely contemporaneous, with peak correlations at lag zero, underscoring the need for real-time response. EDV increased several days before peak environmental conditions, consistent with early exposure effects. While temperature-EDV relationships varied regionally, heat index associations were more stable. This work underscores the urgent need for regionally adaptive public health strategies in the face of intensifying climate extremes and outlines future directions for research and policy to strengthen health systems’ preparedness in a warming world. Full article

(This article belongs to the Special Issue Leveraging AI-Powered Tools and Big Data for Global Health Surveillance)

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36 pages, 759 KB

Open AccessReview

Integrated Education Models for Addressing Substance Use Among Schoolchildren: A Scoping Review of School-Based Educational Interventions

by Deeksha Bajpai Tewari, Upma Gautam, Vaishnavi Jaiswal, Pooja, Ankita Mishra and Priya Das

Int. J. Environ. Res. Public Health 2026, 23(8), 1073; https://doi.org/10.3390/ijerph23081073 - 18 Aug 2026

Abstract

Background: Early and comprehensive interventions are crucial for preventing substance use in adolescents. In school settings, such interventions can be easily integrated into the curricular and co-curricular activities with the active involvement of school administration, teachers, trained staff, parents, and community members. This [...] Read more.

Background: Early and comprehensive interventions are crucial for preventing substance use in adolescents. In school settings, such interventions can be easily integrated into the curricular and co-curricular activities with the active involvement of school administration, teachers, trained staff, parents, and community members. This review aimed to comprehensively examine preventive, protective, and corrective school-based intervention models for substance use to suggest an evidence-based and effective educational model for preventing substance use in children. Methods: In this scoping review, online databases, including SCOPUS and Web of Science, were searched to identify and collect articles evaluating the effectiveness of school-based prevention models. The PRISMA approach for scoping review (PRISMA-ScR) was employed to assess the scope of relevant literature and synthesise existing school-based intervention models. Two independent reviewers independently screened records (κ = 0.75). Due to heterogeneity, findings were synthesised narratively using a socio-ecological framework. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies, mostly from the United States, were included in the review. All school-based interventions examined were preventive or protective in their approaches. There was no school-based intervention model that was corrective in its approach. Increased knowledge, negative attitudes towards substance use, and reduced substance use in the intervention groups were key outcomes. Effective interventions involved a multi-pronged approach wherein teacher training, student education, and the involvement of parents, senior citizens, police officials, experts, and the community were key components. Additionally, culturally tailored interventions have shown promising results. Conclusions: Among school children, tobacco and alcohol use are most prevalent, and schools can play a crucial role in addressing this issue. Apart from preventive and protective intervention models, the focus needs to shift towards developing integrated school-based corrective models to address the concerns of substance use among school students. Full article

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

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13 pages, 531 KB

Open AccessArticle

Examining Community Engagement Strategies Used in the Climate Impact on Lung Cancer via Exposure to Radon (CLOVER) Study

by Mary Srivastava, Andrea Thoumi, Yadurshini Raveendran, Phillip Gibson, Jules Iradukunda, Ashwini Joshi, Suur D. Ayangeakaa, Jeffrey M. Clarke, Amie Koch, Junfeng (Jim) Zhang and Tomi Akinyemiju

Int. J. Environ. Res. Public Health 2026, 23(8), 1072; https://doi.org/10.3390/ijerph23081072 - 18 Aug 2026

Abstract

Background: Residential radon exposure is a leading risk factor for lung cancer, and climate change may exacerbate this risk by increasing radon entry into homes. In North Carolina (NC), disparities in lung cancer outcomes and low radon awareness disproportionately affect racially and ethnically [...] Read more.

Background: Residential radon exposure is a leading risk factor for lung cancer, and climate change may exacerbate this risk by increasing radon entry into homes. In North Carolina (NC), disparities in lung cancer outcomes and low radon awareness disproportionately affect racially and ethnically diverse and low-income populations. However, little is known about how use of conventional address-based sampling (ABS) compares with community-engaged recruitment strategies for enrolling historically underrepresented populations into such research. Community-engaged approaches are used to improve participation in environmental health research, yet few studies compare their effectiveness with traditional approaches in NC. This manuscript compares recruitment outcomes between ABS and community-engaged approaches within the CLOVER study to address this gap. Materials and Methods: The Climate Impact on Lung Cancer via Exposure to Radon (CLOVER) study is a cross-sectional study examining climate-impacted radon exposure and lung cancer risk in NC. Participants were recruited using either ABS through a commercial address database or targeted community-engaged approaches implemented through partnerships with community organizations and culturally responsive, in-person outreach events. After providing informed consent, participants completed a household survey and a 7-day home radon test. Recruitment outcomes—consent, survey completion, and radon test return—were stratified by race and ethnicity and compared across strategies. Results: Of 236 consented participants, community-engaged recruitment enrolled a higher proportion of Non-Hispanic (NH) Black, Hispanic/Latino, and American Indian participants than ABS (57.3% vs. 41.9%). Community-engaged recruitment also had a higher consent rate than ABS (10.2% vs. 1.3%). Of the 145 participants who completed the survey, ABS participants completed surveys at a higher rate than community-engaged participants (73.3% vs. 54.7%), while of the 86 who returned the radon test kits, community-engaged participants did so at twice the rate of ABS participants (44.7% vs. 22.1%). Conclusions: Community-engaged recruitment enrolled a more racially and ethnically diverse sample and achieved higher consent and return rates than ABS, though ABS participants completed surveys at a higher rate. These findings highlight the importance of community partnerships and in-person recruitment strategies to improve participation of historically underrepresented populations in environmental health research and support equitable approaches to radon mitigation and lung cancer prevention. Full article

(This article belongs to the Section Environmental Health)

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