International Journal of Environmental Research and Public Health

16 pages, 312 KB

Open AccessArticle

Assessment of Occupational Health and Safety Hazards in Mosquito Control Personnel in North Carolina and Virginia, USA

by Naina Sharma Bastakoti, Stephanie L. Richards, Avian White and Jo Anne Balanay

Int. J. Environ. Res. Public Health 2026, 23(6), 819; https://doi.org/10.3390/ijerph23060819 (registering DOI) - 19 Jun 2026

Abstract

Mosquito control personnel work within health departments, public works, private companies, and other agencies. These essential outdoor workers have highly specialized training and are faced with a variety of potential health and safety hazards (e.g., arthropod bites and stings, exposure to insecticides and [...] Read more.

Mosquito control personnel work within health departments, public works, private companies, and other agencies. These essential outdoor workers have highly specialized training and are faced with a variety of potential health and safety hazards (e.g., arthropod bites and stings, exposure to insecticides and other chemicals, working with heavy equipment, noise, heat, solar ultraviolet radiation, slips, trips, and/or falls). Mosquito control personnel undergo employer-provided and other types of training on a variety of topics from regulatory updates to new surveillance and control techniques that are required for safety purposes and to maintain their applicator license. Here, an exploratory baseline survey was conducted among members of the North Carolina Mosquito and Vector Control Association (NCMVCA) and the Virginia Mosquito Control Association (VMCA). There was a 28% response rate so results should be interpreted with caution in this pilot study. Most respondents reported utilizing ultra-low volume insecticide application equipment for controlling adult mosquitoes. Backpack sprayers were utilized by less than half of respondents. Those who reported using respirators showed higher concern about insecticide-related health effects than those who did not use respirators. Outdoor workers encounter various potential hazards and utilize several forms of personal protective equipment to reduce risks. This baseline work can be considered a starting point for implementing and strengthening occupational safety and health awareness and preventive measures for mosquito control workers. Knowledge of health and safety hazards can reduce workplace risk. Full article

16 pages, 339 KB

Open AccessArticle

Association Between Dysfunctional Parenting Practices and Suspected Gaming Disorder Among Japanese Male Junior High School Students: A Cross-Sectional Study of Parental Assessment

by Daisuke Takahara, Misuzu Takahara, Noudéhouénou Credo Adelphe Ahissou and Daisuke Nonaka

Int. J. Environ. Res. Public Health 2026, 23(6), 818; https://doi.org/10.3390/ijerph23060818 (registering DOI) - 19 Jun 2026

Abstract

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD [...] Read more.

The growing prevalence of gaming disorder (GD) in adolescents is a global concern. Despite parents’ critical role in addressing GD, how dysfunctional parenting practices are associated with adolescent GD remains understudied. This study assessed the association between dysfunctional parenting practices and adolescent GD among Japanese male junior high school students. Data were collected in 2024 via web-based, self-administered questionnaires from 300 parents (183 fathers and 117 mothers), each reporting on one male junior high school student. Suspected GD was assessed using a validated parent report measure (i.e., the Gaming Disorder Scale for Parents). Dysfunctional parenting practices were measured using the Parenting Scale, comprising two dimensions: Overreactivity and Laxness. Mean factor scores of Overreactivity and Laxness were compared between the suspected and non-suspected GD groups using a t-test. Logistic regression models assessed the association of Overreactivity and Laxness with suspected GD, controlling for covariates. The mean score of Overreactivity was significantly higher in the suspected GD group than in the non-suspected group, whereas that of Laxness was not. After adjustment, overreactive parenting was significantly associated with suspected GD (adjusted odds ratio: 1.89, 95% CI [1.31, 2.74]). This study showed that overreactive parenting was independently and significantly associated with increased odds of suspected GD. Full article

(This article belongs to the Special Issue Psychological Wellbeing, Mental Health and Problematic Internet Use Among Adolescents)

17 pages, 988 KB

Open AccessProject Report

A National Virtual Peer Support Group for Women Veterans Living with Breast Cancer: Lessons from the Field

by Jenny K. Cohen, Kara Zamora-Rogoski, Caitlin L. McLean, Mariam E. Jacob, Evana Mack, Haley Moss and Aimee Kroll-Desrosiers

Int. J. Environ. Res. Public Health 2026, 23(6), 817; https://doi.org/10.3390/ijerph23060817 (registering DOI) - 19 Jun 2026

Abstract

Within the Veteran’s Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in mental health and behavioral health settings. PSS-facilitated cancer support groups are less common and underused in this setting. The purpose of this study was to understand the acceptability, feasibility, [...] Read more.

Within the Veteran’s Health Administration (VHA), peer support specialists (PSSs) have traditionally worked in mental health and behavioral health settings. PSS-facilitated cancer support groups are less common and underused in this setting. The purpose of this study was to understand the acceptability, feasibility, and perceived benefits of a PSS-facilitated peer support group for women veterans with breast cancer. Semi-structured interviews were conducted among veteran participants and health system leaders (HSLs) and were recorded, transcribed, and analyzed using rapid qualitative analysis. Key findings from interviews with veterans and HSLs emerged across several domains: The value of shared experiences, peer status and “matching”, virtual aspect, group structure, beneficial topics, and desired outcomes. Veteran participants greatly valued the ability to share experiences and connect with other women veterans with breast cancer and shared a desire for the facilitator to be a peer with an overlapping shared lived experience as they described benefits from peer interactions including supportive coping and instrumental coping. Veterans also reflected on the acceptability of the group being virtual, and uncovered attitudes and preferences regarding group structure, beneficial topics, and desired outcomes. HSLs noted that target outcomes might be linked to feeling connected with community and having an increased feeling of support. Findings suggest that cancer support groups, unlike more traditional mental health support groups at the VHA, may require greater specificity regarding programmatic content and PSS-cancer-experience-matching for group experience to feel authentic and meaningful. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research—2nd Edition)

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16 pages, 951 KB

Open AccessArticle

Faecal Pathogen Survival and Risks of Use of Ecological Sanitation By-Products in Burera District, Rwanda: A Quantitative Microbial Risks Assessment

by Celestin Banamwana, David Musoke, Theoneste Ntakirutimana, Esther Buregyeya, John Ssempebwa, Gakenia Wamuyu Maina, Charles Drago Kato, Lordrick Alinaitwe, Patrick Albert Ipola and Nazarius Mbona Tumwesigye

Int. J. Environ. Res. Public Health 2026, 23(6), 816; https://doi.org/10.3390/ijerph23060816 (registering DOI) - 19 Jun 2026

Abstract

Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as “faecal by-products” are being used to sustain soil nutrients and improve on-site sanitation, the concern remains [...] Read more.

Reuse of human excreta and derivatives is becoming a common practice in areas with agricultural predominance. While in situ treated faeces through ecological sanitation (Ecosan), known as “faecal by-products” are being used to sustain soil nutrients and improve on-site sanitation, the concern remains about the health risks related to the survival of pathogens in these by-products in the community of farmers. This study assessed the survival of faecal pathogens and estimated microbial risks associated with the use of Ecosan faecal by-products in agriculture. The quantitative microbial risks assessment (QMRA) framework was used to estimate the risks posed by each faecal pathogen in solid and semi-solid faecal by-products under the probabilistic model of Monte Carlo simulation. Ascaris lumbricoides (6.5 eggs/gr), Taenia species (0.3 egg/gr), Schistosoma species (9.3 cercariae/gr), Entamoeba species (4.4 cysts/gr), and Escherichia coli (451 Cfu/gr) were detected in semi-solid faecal products. Exposure scenarios were observed throughout four critical points: vault faecal by-products removal/unloading, transport, collection, and application of faecal by-products in the gardens. Due to the presence of eggs and cysts, an estimated annual risk of infections was found in semi-solid faecal by-products with Schistosoma species (88%) and Ascaris lumbricoides (90%). Both concentrations were above World Health organisation (WHO) standards of associated infective risks of 0–10% of helminths in faecal sludge applied in the gardens. The users of faecal by-products, particularly farmers are exposed not only to high concentrations of helminth eggs but also to protozoa and bacteria with infective risks of Entamoeba species (99%) and E. coli species (62%). A stepwise implementation of faecal pathogens die-off during treatment of faecal by-products in compliance with the WHO’s 2018 guidelines can prevent the use of unsanitary faecal by-products. According to these findings, the proper control of intestinal protozoa and soil-transmitted helminths (STHs) should be enforced through personal protective measures in Burera district, Rwanda. Full article

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19 pages, 427 KB

Open AccessArticle

Association Between Nutritional Biomarkers and Low Muscle Mass, Obesity, and Low Muscle Mass with Obesity Across Physical Activity Levels Among U.S. Adults: Finding from the National Health and Nutrition Examination Survey 2015–2018

by Uraiporn Booranasuksakul, Mario Siervo, Alongkote Singhato, Narisa Rueangsri, Tepparit Samrit, Wichukorn Suriyawongpaisal and Piyapong Prasertsri

Int. J. Environ. Res. Public Health 2026, 23(6), 815; https://doi.org/10.3390/ijerph23060815 (registering DOI) - 19 Jun 2026

Abstract

Background: Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, [...] Read more.

Background: Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, obesity, and low muscle mass with obesity and nutritional biomarkers across physical activity levels among U.S. adults across physical activity levels. Methods: This cross-sectional study analyzed data from adults aged 20–59 years from the 2015–2018 cycles of the National Health and Nutrition Examination Survey (NHANES) 2015–2018. Low muscle mass was defined by low appendicular lean mass relative to body weight (LALM/W). Obesity was classified using body mass index (BMI¹), waist circumference (WC²), and body fat percentage (FM%³), and low muscle mass with obesity was defined using three coexisting phenotypes (LALM/W-O1, LALM/W-O2, LALM/W-O3). Nutritional biomarkers included serum albumin, vitamin D, triglyceride, cholesterol, LDL cholesterol, iron, insulin resistance (HOMA IR), and high-sensitivity C-reactive protein (hs-CRP). Physical activity was categorized as inactive, insufficiently active, or sufficiently active based on MET minutes per week. Multivariable regression models accounted for the complex survey design and relevant covariates. Results: After adjustment, LALM/W was significantly associated with low serum albumin, low vitamin D, high triglyceride, high HOMA-IR, and high CRP. Obesity was significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O in all phenotypes were significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O phenotypes demonstrated the strongest associations, particularly with high HOMA-IR and hs-CRP. Although the associations varied by physical activity level, sufficiently active group was associated with lower odds of adverse nutritional biomarkers compared with insufficient activity. Conclusions: Nutritional biomarkers are associated with LALM/W and obesity. Sufficient physical activity was associated with fewer adverse outcomes. This suggests that adequate physical activity may be associated with better nutritional status and body composition. Full article

(This article belongs to the Special Issue Exercise and Active Living in Diverse Environments for Health Promotion)

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15 pages, 998 KB

Open AccessArticle

Perceived Exertion Is Associated with Cardiovascular Strain but Not Glycemic Response to Gym-Based Exercise in Adults with Type 1 Diabetes: An Exploratory Randomized Crossover Trial

by José Adevalton Feitosa Gomes, Anthony Rodrigues de Vasconcelos, José Roberto Andrade do Nascimento Júnior, Ysadora Verena Ribeiro de Souza, Fabiana Oliveira dos Santos Camatari, Bruno Bavaresco Gambassi, Manoel da Cunha Costa, Paulo Adriano Schwingel and Jorge Luiz de Brito Gomes

Int. J. Environ. Res. Public Health 2026, 23(6), 814; https://doi.org/10.3390/ijerph23060814 (registering DOI) - 19 Jun 2026

Abstract

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may [...] Read more.

Adults with type 1 diabetes mellitus (T1DM) face elevated cardiovascular risk, and regular exercise is a key non-pharmacological mitigation strategy. However, safe prescription requires cardiovascular and glycemic monitoring, often unfeasible in real-world gyms. Low-cost psychophysiological tools (ratings of perceived exertion—RPE and enjoyment) may offer practical alternatives. This exploratory randomized crossover trial examined whether post-session RPE and enjoyment are associated with acute heart rate (HR) and capillary blood glucose (BG) responses to gym-based aerobic and resistance training. Twelve adults with T1DM (29.8 ± 7.8 years; HbA1c 7.7 ± 1.6%; LDL-c 119.5 ± 24.4 mg/dL) completed three ~30 min sessions: aerobic interval training (AE) and two resistance protocols (STA, STB). HR and BG were measured pre-, immediately post-, and 20 min post-exercise; RPE and enjoyment, post-session. Multiple linear regression, controlling for exercise session type, examined associations of RPE and enjoyment with resting HR, BG, and percentage of heart rate reserve (%HR). RPE was higher after STA and STB than AE (p < 0.001; η²p = 0.529), while enjoyment and %HR were similar across sessions. Neither variable was associated with resting HR or BG (all adjusted R² < 0; all p > 0.05). Controlling for exercise session type, RPE was a significant positive predictor of %HR (β = 0.44, p = 0.044), whereas enjoyment was not (β = −0.06, p = 0.719); however, the overall %HR model did not reach statistical significance (adjusted R² =0.119; F(4,31) = 2.183; p = 0.094). These exploratory findings suggest that RPE, but not enjoyment, may serve as a low-cost adjunct intensity marker to inform exercise prescription in adults with T1DM at elevated cardiovascular risk; however, replication in larger samples is needed before clinical recommendations can be drawn. Direct BG monitoring remains essential for safety. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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20 pages, 553 KB

Open AccessArticle

A Qualitative Phenomenological Study of Treatment Options for Patients with SCD and Chronic Pain: Buprenorphine–Naloxone or Full-Agonist Therapy

by Najibah Galadanci, Calia Torres, Terrika Johnson and Julie Kanter

Int. J. Environ. Res. Public Health 2026, 23(6), 813; https://doi.org/10.3390/ijerph23060813 - 18 Jun 2026

Abstract

Data in sickle cell disease (SCD) shows that 30–50% of adults have chronic pain. Chronic pain is a life-shaping condition that is often inadequately managed with chronic opioid therapy (COT). Buprenorphine–naloxone (bup-nal) is an alternative (to COT), yet patient perspectives on its use [...] Read more.

Data in sickle cell disease (SCD) shows that 30–50% of adults have chronic pain. Chronic pain is a life-shaping condition that is often inadequately managed with chronic opioid therapy (COT). Buprenorphine–naloxone (bup-nal) is an alternative (to COT), yet patient perspectives on its use remain limited. This is a phenomenological qualitative study exploring how adults with SCD experience chronic pain and consider treatment options including COT and bup-nal. Semi-structured interviews were conducted with 26 adults with SCD and chronic pain who were offered pain management with bup-nal, including individuals who declined or discontinued treatment. Participants described pain as a constant, embodied experience around which they structured their daily functioning, relationships, well-being, and treatment. Those receiving bup-nal consistently reported improved daily functioning, greater independence, enhanced mood, and reduced healthcare utilization. In contrast, participants not receiving bup-nal described ongoing pain interference, reduced daily functioning, and continued reliance on acute care services. Importantly, participants emphasized functional improvement and stability, rather than pain elimination, as the most meaningful outcomes. These findings suggest that buprenorphine–naloxone may shift pain from a dominant, disabling experience to a more manageable condition that improves participation in work, relationships, and daily activities. To optimize management of chronic pain in SCD, it is necessary to align treatment with patient priorities. Full article

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14 pages, 600 KB

Open AccessArticle

Changes in Bone Parameters and Serum Zinc Levels Following Oral Zinc Supplementation in Duchenne Muscular Dystrophy: A Quasi-Experimental Study

by Thaís Borges, Evellyn Grilo, Thais Alves Cunha, Luana Lima, Karina Vermeulen-Serpa, Mário Dourado-Júnior, Marília Lopes, Núbia Torres, Breno Bezerra, José Brandão-Neto and Sancha Vale

Int. J. Environ. Res. Public Health 2026, 23(6), 812; https://doi.org/10.3390/ijerph23060812 - 18 Jun 2026

Abstract

Individuals with Duchenne muscular dystrophy (DMD) are prone to nutritional imbalances, and zinc deficiency may contribute to impaired bone health. This study evaluated serum zinc status and the effects of oral supplementation on bone parameters in DMD. In this quasi-experimental before-and-after study, 34 [...] Read more.

Individuals with Duchenne muscular dystrophy (DMD) are prone to nutritional imbalances, and zinc deficiency may contribute to impaired bone health. This study evaluated serum zinc status and the effects of oral supplementation on bone parameters in DMD. In this quasi-experimental before-and-after study, 34 patients were assessed at three time points over eight months. Eligible participants who met the inclusion criteria and agreed to participate received the proposed interventions during routine follow-up at the Neurology outpatient clinic. Anthropometry, dietary intake, bone mineral density (BMD), bone mineral content (BMC), and serum zinc were measured; supplementation (5–15 mg/day) was provided for four months. Baseline zinc deficiency was observed in 36.7% of participants. No significant overall changes were detected. Stratified analyses revealed a modest increase in total body BMD among individuals with adequate baseline BMD (p = 0.02). As this finding emerged from a subgroup analysis, it should be interpreted cautiously, and the potential contribution of physiological growth to the observed change cannot be excluded. In addition, zinc-deficient participants showed a significant rise in serum zinc levels (p = 0.008). These findings suggest that the response to zinc supplementation may vary according to baseline nutritional and skeletal status and underscore the relevance of micronutrient monitoring in individuals with DMD. Trial registration: The trial was also registered in the Brazilian Registry of Clinical Trials under the code RBR-7cfdxm, approved on 14 June 2018. Full article

(This article belongs to the Special Issue Healthcare Delivery and Nutritional Support in Rare Diseases)

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18 pages, 1481 KB

Open AccessArticle

Risk of Diabetes Mellitus and Its Association with Cardiorespiratory Endurance in Zenú Indigenous People in Momil, Córdoba, Colombia

by Leily Montoya-Alvarez, Edgar Rodriguez-Sepúlveda, Claudia Galeano-Páez, Osnamir Elias Bru-Cordero and Noelba Alcala-Tafur

Int. J. Environ. Res. Public Health 2026, 23(6), 811; https://doi.org/10.3390/ijerph23060811 - 18 Jun 2026

Abstract

Type 2 diabetes mellitus (T2DM) represents a growing public health concern in Indigenous populations, where early risk identification remains limited. This study aimed to analyze the association between estimated T2DM risk and cardiorespiratory endurance in a Zenú Indigenous community in northern Colombia. A [...] Read more.

Type 2 diabetes mellitus (T2DM) represents a growing public health concern in Indigenous populations, where early risk identification remains limited. This study aimed to analyze the association between estimated T2DM risk and cardiorespiratory endurance in a Zenú Indigenous community in northern Colombia. A cross-sectional study was conducted among adults aged 18–70 years belonging to the Momil Urban Minor Indigenous Cabildo (Córdoba, Colombia). T2DM risk was assessed using the Finnish Diabetes Risk Score (FINDRISC), and cardiorespiratory endurance was evaluated through the Ruffier index. Associations were examined using a multivariable ordinal logistic regression model, and discriminative performance was evaluated using receiver operating characteristic (ROC) curve analysis. A total of 95 participants were included, most of whom were classified as low risk according to FINDRISC, while cardiorespiratory endurance assessed by the Ruffier index was predominantly classified as moderate to good. Age was significantly associated with higher risk categories in the adjusted model, whereas cardiorespiratory endurance was not significantly associated with estimated T2DM risk. The model demonstrated excellent discriminative capacity (AUC = 0.912; 95% CI: 0.850–0.973). In this population, age and family history were key determinants of estimated T2DM risk. Findings regarding cardiorespiratory endurance should be interpreted cautiously given sample size limitations. Full article

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

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22 pages, 1710 KB

Open AccessArticle

First-Mile Walking to Transit and Physical Activity: A Cross-Sectional Study of the MRT Pink Line Corridor in Bangkok, Thailand

by Sigit D. Arifwidodo, Nattanon Ubontip, Natsiporn Sangyuan, Orana Chandrasiri, Panitat Ratanawichit and Putthipanya Rueangsom

Int. J. Environ. Res. Public Health 2026, 23(6), 810; https://doi.org/10.3390/ijerph23060810 - 18 Jun 2026

Abstract

Background. First-mile walking to mass rapid transit (MRT) has two methodological problems. Composite walkability scores blur which features drive walking. And because walking to transit is itself transport physical activity (PA), linking it to total PA is circular. Both issues are sharper in [...] Read more.

Background. First-mile walking to mass rapid transit (MRT) has two methodological problems. Composite walkability scores blur which features drive walking. And because walking to transit is itself transport physical activity (PA), linking it to total PA is circular. Both issues are sharper in tropical Asian cities. Methods. We surveyed 378 adults within a 1 km network distance of 20 stations on Bangkok’s Pink Line MRT. Walkability was measured with NEWS-A (aggregate and eight subscales); PA with the GPAQ. Binary logistic regression with station-cluster-robust standard errors tested which NEWS-A subscales predict first-mile walking and whether walkers meet the WHO PA guideline (≥150 min/week MVPA). A tautology sensitivity test removed transport PA from the outcome. Results. Walkers were 71.7% of the sample. Disaggregating NEWS-A improved fit; two subscales were the dominant predictors: pedestrian infrastructure and traffic safety. Walkers were 30.6 percentage points more likely to meet the overall PA guideline; with transport PA removed, the gap was 17.5 points and still significant. The pedestrian infrastructure effect was strongest 201–1000 m from a station, not at the immediate frontage. Conclusions. Perceived pedestrian infrastructure quality and perceived traffic safety drive first-mile walking in suburban Bangkok. The walking–PA link is not entirely a measurement artefact. The 201–1000 m ring is a plausible priority for pedestrian investment. Full article

(This article belongs to the Special Issue Building Healthy Cities: Influences of the Urban Environment on Active Mobility and Human Health)

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11 pages, 578 KB

Open AccessBrief Report

Comparison of Heart Rate Variability Between Sexes: Impact of a Physically Active Lifestyle

by Reberth Magalhães Da Silva, Ariane Viana, Fernanda Monma, Fernando Alves Santa Rosa, José Robertto Zaffalon, Jr. and Kátia De Angelis

Int. J. Environ. Res. Public Health 2026, 23(6), 809; https://doi.org/10.3390/ijerph23060809 - 18 Jun 2026

Abstract

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels [...] Read more.

Sex differences and lifestyle factors such as physical activity play an important role in cardiovascular autonomic regulation. Heart rate variability (HRV) is a widely used marker of cardiac autonomic modulation and cardiovascular health. However, the combined influence of sex and physical activity levels on HRV in young, healthy adults has not been sufficiently explored. Therefore, this study investigated the effects of sex and a physically active lifestyle on HRV in men and women. A cross-sectional study was conducted on a cohort of young, healthy adults aged 18–30 and categorized into four groups based on: physically active men (AM; n = 37), sedentary men (SM; n = 44), and physically active women (AW; n = 31) and sedentary women (SW; n = 40). Regarding the impact of lifestyle, the AM group exhibited 41% higher total variance (VAR-RR) and 34% higher RMSSD (a parasympathetic index) than the SM group. The AW exhibited 74% and 78% higher VAR-RR and RMSSD, respectively, compared to the SW. Furthermore, the physically active groups (AM and AW) displayed a 75% and 50% lower LF/HF ratio, respectively, compared to their sedentary counterparts. Interestingly, the LF/HF ratio was 66% higher, and the RMSSD was 20% lower in the AM group than in the AW group. HRV indices demonstrated large to very large effect sizes. In conclusion, these findings demonstrate significantly advantage in cardiac autonomic modulation among physically active individuals and women. Together, these results reinforce the roles of female sex and an active lifestyle as important protective factors for cardiovascular health. Full article

(This article belongs to the Special Issue Health Effects of Physical Activity and Exercise in People at Risk for Cardiovascular Diseases)

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20 pages, 1212 KB

Open AccessArticle

Knowledge, Attitudes, and Perceptions Towards Male Circumcision Among Men Aged 20–40 Years in Otjiwarongo, Otjozondjupa Region, Namibia

by Masilu Daniel Masekameni, Joinet Sitapata, Phoka Caphus Rathebe and Themba Titus Sigudu

Int. J. Environ. Res. Public Health 2026, 23(6), 808; https://doi.org/10.3390/ijerph23060808 - 18 Jun 2026

Abstract

Male circumcision (MC) has been shown in studies from South Africa, Kenya, and Uganda to reduce heterosexual Human Immunodeficiency Virus (HIV) transmission among men by approximately 50–60%. Despite Namibia’s adoption of voluntary medical male circumcision (VMMC) as part of national HIV prevention strategies, [...] Read more.

Male circumcision (MC) has been shown in studies from South Africa, Kenya, and Uganda to reduce heterosexual Human Immunodeficiency Virus (HIV) transmission among men by approximately 50–60%. Despite Namibia’s adoption of voluntary medical male circumcision (VMMC) as part of national HIV prevention strategies, uptake remains suboptimal in some communities. This study assessed the knowledge, attitudes, and perceptions (KAP) of male circumcision among men aged 20–40 years in Otjiwarongo, Namibia, and examined socio-demographic factors associated with these outcomes. A community-based cross-sectional survey was conducted between March and May 2024, involving 359 participants selected through multistage sampling. Data were collected using structured, pre-tested questionnaires and analysed using STATA version 19. Descriptive statistics, chi-square tests, and binary logistic regression were used to summarise data and identify predictors of favourable KAP outcomes. Overall, 69.1% of respondents demonstrated good knowledge of male circumcision, 72.7% had positive attitudes, and 69.9% reported positive perceptions. Awareness of male circumcision was high (91.9%); however, only 69.4% of participants recognised its role in reducing HIV infection risk, and notable misconceptions persisted regarding its protective effects and procedural aspects. Multivariable analysis showed that urban residence (AOR = 1.58; 95% CI: 1.03–2.42; p = 0.035) and higher education (AOR = 4.12; 95% CI: 1.21–14.02; p = 0.024) were significant predictors of favourable KAP outcomes. In addition, good knowledge was strongly associated with positive attitudes (AOR = 3.25; 95% CI: 2.01–5.26; p < 0.001) and perceptions (AOR = 2.87; 95% CI: 1.79–4.60; p < 0.001). In conclusion, while knowledge, attitudes, and perceptions towards male circumcision were generally favourable, important gaps and misconceptions remain. Targeted, culturally appropriate health education interventions are needed, particularly among rural and less-educated populations, to improve understanding and acceptance of VMMC as part of comprehensive HIV prevention strategies. Full article

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

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11 pages, 478 KB

Open AccessArticle

A National Overview of Nutritional Care in Diet-Treated Inborn Errors of Metabolism in Brazil

by Soraia Poloni, Laura de Azevedo Pesce, Viviane de Cássia Kanufre, Lilia Ramos Farret, Camila Pugliese, José Araújo de Oliveira Silva, Monique Poubel, Maria Efigênia de Queiroz Leite and Renata Bernardes de Oliveira

Int. J. Environ. Res. Public Health 2026, 23(6), 807; https://doi.org/10.3390/ijerph23060807 - 17 Jun 2026

Abstract

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = [...] Read more.

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = 37) and to patients and caregivers (n = 278), addressing professional training, workload, access to resources, treatment adherence, and socioeconomic factors. Results: Healthcare professionals from 20 out of the 26 Brazilian states participated, most of them female (81%) and dietitians (81%). Although more than half had over 10 years of experience, 59% considered their training insufficient to work with IEM. Only 19% reported exclusive dedication to the field, and 54% were the sole professional responsible for dietary prescriptions at their center. Weekly workload dedicated to IEM varied widely. Among the patients and families, phenylketonuria (60.4%) and glycogen storage disease (25.9%) were the most frequent conditions. Higher educational level and longer time since diagnosis were associated with a better understanding of dietary management (p < 0.05). Among patients on protein-restricted diets, most reported regular use of protein substitutes, although 92% reported poor palatability and 36% reported supply problems. Access to special low-protein foods was limited, and over half of the families reported some level of food insecurity. Conclusions: Significant systemic, logistical, and socioeconomic barriers to optimal dietary management of IEM persist in Brazil, highlighting the need for strengthened public policies, professional training, and equitable access to dietary resources. Full article

(This article belongs to the Special Issue Healthcare Delivery and Nutritional Support in Rare Diseases)

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13 pages, 627 KB

Open AccessArticle

Association Between Physical Activity, Body Mass Index, and Aerobic Capacity in Periurban Adolescents

by Fabian Sepúlveda, Ana Peñata-Taborda, Osnamir Bru-Cordero, Leily Montoya-Álvarez and Alicia Humanez-Álvarez

Int. J. Environ. Res. Public Health 2026, 23(6), 806; https://doi.org/10.3390/ijerph23060806 - 17 Jun 2026

Abstract

Adolescence is a critical window for health behavior consolidation, yet the combined influence of physical activity level (PAL) and the body mass index (BMI) on aerobic capacity remains understudied, especially in transitioning periurban environments. This study examined the association between PAL, BMI, and [...] Read more.

Adolescence is a critical window for health behavior consolidation, yet the combined influence of physical activity level (PAL) and the body mass index (BMI) on aerobic capacity remains understudied, especially in transitioning periurban environments. This study examined the association between PAL, BMI, and aerobic capacity in adolescents from Montería, Colombia. A cross-sectional study was conducted among 112 adolescents (aged 12–17 years). Aerobic capacity was assessed using the 20 m shuttle run test (Course Navette), and PAL was measured via the validated Assessment of Physical Activity Levels Questionnaire (APALQ), following standard fitness assessment protocols. Multivariable linear regression models were utilized to estimate independent associations, adjusting for age and sex. The multivariable model was significant (F = 8.45; p < 0.001), explaining 21% of the variance in aerobic capacity (adjusted R² = 0.21). PAL was positively and independently associated with aerobic capacity (B = 0.22; 95% CI: 0.05–0.38; p = 0.010), regardless of BMI. While age showed a positive association (B = 0.09; p = 0.032) and sex was inversely associated (B = −0.39; p < 0.001), BMI did not emerge as an independent predictor in the adjusted model (B = −0.04; p = 0.080). Aerobic capacity in adolescents is more consistently explained by behavioral factors (what they “do”) than by anthropometric status (what they “weigh”). These findings support a paradigm shift in pediatric public health, prioritizing high-intensity movement overweight control to improve cardiorespiratory fitness in transitioning urban territories. Full article

(This article belongs to the Special Issue Healthy Child, Healthy Adult—Children’s Nutrition and Physical Activity as a Public Health Concern)

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18 pages, 945 KB

Open AccessArticle

Occupational Exposure Profiles and Respiratory Health Outcomes Among Surface and Underground Miners: A Comparative Epidemiological Analysis

by Masilu Daniel Masekameni, Thokozane Patrick Mbonane, Khathutshelo Vincent Mphaga, Themba Titus Sigudu and Phoka Caiphus Rathebe

Int. J. Environ. Res. Public Health 2026, 23(6), 805; https://doi.org/10.3390/ijerph23060805 - 17 Jun 2026

Abstract

Occupational lung diseases remain a significant public health concern in mining populations, particularly in high-exposure environments. This study examined occupational exposure profiles and respiratory health outcomes among surface and underground miners in Mpumalanga Province. A cross-sectional analytical design was employed among 239 mine [...] Read more.

Occupational lung diseases remain a significant public health concern in mining populations, particularly in high-exposure environments. This study examined occupational exposure profiles and respiratory health outcomes among surface and underground miners in Mpumalanga Province. A cross-sectional analytical design was employed among 239 mine workers. Data on socio-demographic characteristics, occupational exposures, behavioural factors, and respiratory outcomes were analysed using descriptive statistics, chi-square tests, and logistic regression models. Underground miners were significantly more likely to report high dust exposure (44.9% vs. 24.1%), poor ventilation (60.6% vs. 39.3%), and longer working hours (>8 h: 68.5% vs. 50.0%) compared to surface miners. They also reported a higher prevalence of respiratory symptoms, including chronic cough (45.7% vs. 25.9%), shortness of breath (41.7% vs. 23.2%), wheezing (34.6% vs. 18.8%), and diagnosed lung disease (23.6% vs. 9.8%). Multivariable analysis showed that underground mining (AOR = 1.92; 95% CI: 1.08–3.41), smoking (AOR = 1.78; 95% CI: 1.02–3.11), and high dust exposure (AOR = 2.89; 95% CI: 1.45–5.76) were independent predictors of chronic cough. A significant interaction between smoking and underground mining (AOR = 2.74; 95% CI: 1.32–5.68) further amplified respiratory risk. Additionally, underground miners demonstrated lower levels of knowledge (48.8% vs. 66.1%) and poorer preventive practices (44.1% vs. 64.3%). These findings highlight the combined influence of occupational and behavioural factors on respiratory health and highlight the need for integrated interventions to reduce the burden of occupational lung diseases. Full article

(This article belongs to the Special Issue Modern Epidemiology of Occupational Lung Diseases)

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16 pages, 1075 KB

Open AccessSystematic Review

Preoperative Treatment Expectations and Their Association with Postoperative Quality of Life and Patient Satisfaction in Non-Orthopedic Surgery: A Systematic Review

by Nanna W. Christiansen, Thora G. Thomsen, Elizabeth E. Rosted, Marianne Krogsgaard, Marian C. Petersen and Anja Geisler

Int. J. Environ. Res. Public Health 2026, 23(6), 804; https://doi.org/10.3390/ijerph23060804 - 16 Jun 2026

Abstract

Background: Patients’ preoperative expectations may influence postoperative quality of life and satisfaction. Aim: To provide an overview of the evidence regarding the association between patients’ preoperative expectations and postoperative quality of life as the primary outcome, with postoperative satisfaction included as a secondary [...] Read more.

Background: Patients’ preoperative expectations may influence postoperative quality of life and satisfaction. Aim: To provide an overview of the evidence regarding the association between patients’ preoperative expectations and postoperative quality of life as the primary outcome, with postoperative satisfaction included as a secondary outcome. Methods: A systematic review was conducted in accordance with the PRISMA guidelines and Cochrane Handbook of Systematic Reviews guidelines. A comprehensive search was conducted across five databases for all study types. Results: Ten cohort studies met the inclusion criteria, encompassing 1013 patients undergoing various surgical procedures. Most studies exhibited a high risk of bias, and several employed unvalidated instruments to assess preoperative expectations. Only one study found a significant association between preoperative expectations and quality of life. One study reported significantly better perceived health among patients with high preoperative expectations, and four studies identified a significant relationship between preoperative expectations and post-operative satisfaction. Overall, the findings were inconsistent, and the included studies demonstrated substantial methodological heterogeneity. Conclusions: Only individual studies identified significant associations with quality of life, perceived health, or postoperative satisfaction; overall, the findings were inconsistent. The evidence is limited by high risk of bias, heterogeneous methodologies, and use of non-validated measurement tools. Further research is needed to clarify the role preoperative expectations have in postoperative outcomes. Full article

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Graphical abstract

1 pages, 177 KB

Open AccessCorrection

Correction: Grewal et al. Diversity and Representation in Cardiovascular Research: Evidence Gaps, Emerging Models, and Policy Implications. Int. J. Environ. Res. Public Health 2026, 23, 241

by Simran Grewal, James Wildish, Catherine Chalmers, Christine Dedding, Jeanine Suurmond, Charles Agyemang and Nimrat Grewal

Int. J. Environ. Res. Public Health 2026, 23(6), 803; https://doi.org/10.3390/ijerph23060803 - 16 Jun 2026

Abstract

Missing Conflict of Interest [...] Full article

(This article belongs to the Special Issue Inequities in Health and Well-Being)

14 pages, 1229 KB

Open AccessArticle

Persistence of Asbestos-Containing Friction Materials in the Hungarian Waste Stream Twenty Years After the European Union Ban

by Áron Szandi, Zsombor Balog, Krisztián Sándor Zaka and Gergely Zoltán Macher

Int. J. Environ. Res. Public Health 2026, 23(6), 802; https://doi.org/10.3390/ijerph23060802 - 16 Jun 2026

Abstract

Although asbestos has been banned in the European Union since 2005, asbestos-containing materials, such as brake pads and clutch linings, may still occur in waste streams due to the long service life of vehicles, legacy equipment, and international trade in spare parts. The [...] Read more.

Although asbestos has been banned in the European Union since 2005, asbestos-containing materials, such as brake pads and clutch linings, may still occur in waste streams due to the long service life of vehicles, legacy equipment, and international trade in spare parts. The persistence of these materials raises environmental and occupational health concerns, particularly in waste management systems. This study aims to assess the presence, temporal trends, and sectoral distribution of asbestos-containing friction materials in the Hungarian waste management system two decades after the EU ban, and to evaluate the associated regulatory and occupational risk implications. The analysis is based on national hazardous waste datasets classified under EWC code 16 01 11* (asbestos-containing brake pads), with a specific focus on this waste category rather than on the full range of asbestos-related waste streams recorded in the national database. The results indicate that asbestos-containing friction materials are still present in the waste stream, with measurable quantities recorded annually. Despite regulatory control, identification challenges and potential misclassification may contribute to underreporting. The continued occurrence of asbestos-containing materials highlights the persistence of legacy hazardous materials within circular economy systems. Strengthened monitoring, improved identification protocols, and enhanced occupational safety measures are necessary to mitigate residual exposure risks. The findings underline that asbestos is not merely a historical issue but remains a contemporary environmental and public health challenge. Full article

(This article belongs to the Section Environmental Health)

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15 pages, 448 KB

Open AccessArticle

Association Between Food Environment Characteristics and Overweight and Anemia in Socially Vulnerable Children Living in Favelas

by Luiz Gonzaga Ribeiro Silva-Neto, Risia Cristina Egito de Menezes, Vanessa Sá Leal, Thays Lane Ferreira dos Santos and Telma Maria de Menezes Toledo Florêncio

Int. J. Environ. Res. Public Health 2026, 23(6), 801; https://doi.org/10.3390/ijerph23060801 - 15 Jun 2026

Abstract

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the [...] Read more.

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the association between the availability of fruits, vegetables, and ultra-processed beverages in the food environment and the occurrence of overweight and anemia in children living in socially vulnerable areas. Methods: This is a cross-sectional study with an ecological component, conducted between 2020 and 2021, involving 665 children residing in 40 favelas and urban communities in Maceió, Alagoas, Brazil. Socioeconomic, anthropometric, and hematological data were collected, along with a characterization of the food environment in 624 establishments using the AUDITNOVA tool, focusing on the availability of fruits, vegetables, and ultra-processed beverages. The outcomes investigated were overweight (BMI-for-age z-score > +2) and anemia (hemoglobin < 11 g/dL). Multilevel models were used to assess the associations between the food environment and the outcomes of interest. Results: The prevalence of overweight was 19.7%, while anemia affected 50.4% of the children assessed. Greater availability of fruits and vegetables was associated with a lower chance of being overweight (OR: 0.82; 95% CI: 0.79–0.98). In contrast, high availability of ultra-processed beverages was associated with a higher chance of being overweight (OR: 1.35; 95% CI: 1.07–1.84) and anemia (OR: 1.53; 95% CI: 1.04–2.29). Conclusion: Food environments characterized by widespread availability of ultra-processed beverages were associated with a higher prevalence of overweight and anemia among children. In comparison, greater availability of fresh or minimally processed foods was associated with a lower prevalence of overweight. These findings highlight the importance of public policies that promote healthier food environments in socially vulnerable areas. Full article

(This article belongs to the Special Issue The Role of the Food Environment in the Health of Children and Adolescents)

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