International Journal of Environmental Research and Public Health

14 pages, 531 KB

Open AccessArticle

Feasibility and Acceptability of Assessing Personal Care Product Use and Exposure to Endocrine-Disrupting Chemicals Among Black and Hispanic Breast Cancer Survivors: A Pilot Study

by Erin Speiser, Peggy-ita Obeng-Nyarkoh, Wanting Zhai, Adana A. M. Llanos, Jennifer Hicks, Chiranjeev Dash, Lucile L. Adams-Campbell, Gail E. Starr and Traci N. Bethea

Int. J. Environ. Res. Public Health 2025, 22(10), 1579; https://doi.org/10.3390/ijerph22101579 - 16 Oct 2025

Abstract

This pilot study explored the feasibility and acceptability of utilizing silicone wristbands to assess exposure to endocrine-disrupting chemicals (EDCs) among 25 Black and Hispanic breast cancer survivors recruited in Washington, DC, and Hackensack, NJ. Over half of participants (58%) were diagnosed with Stage [...] Read more.

This pilot study explored the feasibility and acceptability of utilizing silicone wristbands to assess exposure to endocrine-disrupting chemicals (EDCs) among 25 Black and Hispanic breast cancer survivors recruited in Washington, DC, and Hackensack, NJ. Over half of participants (58%) were diagnosed with Stage I breast cancer and the mean age was 58 ± 9 years. Most of the 24 survey respondents (95.83%) reported that the wristband did not interfere with daily activities and few (4) removed the wristband during the 7-day data collection period, demonstrating feasibility of use. Acceptability of passive sampling via silicone wristband was high with 73.91% of survivors reporting being “very satisfied” and 21.74% reporting being “satisfied” with their experience. The wristbands were analyzed via gas chromatography mass spectrometry for approximately 1500 semi-volatile organic compounds. This untargeted approach detected sixty distinct chemicals with an average of 21.8 per wristband. Personal care product, flame retardant, commercial product, and pesticide chemical classifications were detected in every wristband and frequently detected chemicals included biologically active compounds with potential genotoxic or endocrine-disrupting effects. This study demonstrates the feasibility of use and technical feasibility, as well as the acceptability, of utilizing silicone wristbands to assess exposure to semi-volatile organic compounds, including EDCs, among Black and Hispanic breast cancer survivors and lays the foundation towards engaging diverse cancer survivors in environmental health research. Full article

(This article belongs to the Special Issue Breast Health and Cancer Awareness: Addressing Breast Cancer Disparities from Etiology to Survivorship)

23 pages, 531 KB

Open AccessSystematic Review

Promoting Mental Health Literacy of 13–16-Year-Old Students: A Systematic Review

by Aino Asplund, Maika Kummel, Camilla Laaksonen, Karmen Erjavec, Evanthia Sakellari, Elina Santala and Joonas Korhonen

Int. J. Environ. Res. Public Health 2025, 22(10), 1578; https://doi.org/10.3390/ijerph22101578 - 16 Oct 2025

Abstract

Purpose: The global rise in mental health challenges among adolescents has led to the development of targeted interventions, including those designed to promote young people’s understanding and awareness of mental health. This systematic review aims to identify and evaluate interventions implemented among secondary [...] Read more.

Purpose: The global rise in mental health challenges among adolescents has led to the development of targeted interventions, including those designed to promote young people’s understanding and awareness of mental health. This systematic review aims to identify and evaluate interventions implemented among secondary school students with the goal of enhancing mental health literacy, and to assess their effectiveness in achieving this outcome. Methods: This review was partially aligned with the PRISMA 2020 guidelines. Studies were retrieved from four electronic databases—CINAHL Complete, PubMed, Academic Search Elite, and ERIC—and supplemented by a limited number of relevant studies identified outside the systematic search. The analysis focused on the content, delivery, design, evaluation methods, and outcomes of mental health literacy (MHL) interventions conducted in secondary schools internationally. Results: A total of 16 articles met the inclusion criteria. The articles described a variety of different MHL interventions (n = 12). The findings indicate that school-based MHL interventions have a positive impact on students’ knowledge and understanding of mental health, but stigma reduction demonstrated less consistent effects. Study population, country, intervention content, delivery, methods, outcome measures, sample sizes and participants’ age range varied notably across the studies. Conclusions: Based on the evidence synthesized in this review, school-based MHL interventions appear to be effective and may serve as a valuable component in broader efforts to promote mental health in adolescence. These findings reinforce existing evidence and provide a foundation for practical implications, but future research is highly recommended for a more solid base of evidence. Full article

(This article belongs to the Special Issue Students’ Education and Mental Health)

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13 pages, 262 KB

Open AccessArticle

Assessing Zoonotic Disease Exposure and Occupational Health and Safety Practices Among Veterinary Services Fieldworkers in North West Province, South Africa

by Sboniso Mhlongo, Nisha Naicker and Tanusha Singh

Int. J. Environ. Res. Public Health 2025, 22(10), 1577; https://doi.org/10.3390/ijerph22101577 - 16 Oct 2025

Abstract

Background: Veterinary fieldworkers play an important role in managing animal and public health risks, yet they face significant occupational hazards, particularly from zoonotic diseases. In South Africa’s North West Province, the occupational health and safety (OHS) of this workforce remains understudied. This study [...] Read more.

Background: Veterinary fieldworkers play an important role in managing animal and public health risks, yet they face significant occupational hazards, particularly from zoonotic diseases. In South Africa’s North West Province, the occupational health and safety (OHS) of this workforce remains understudied. This study aimed to describe and characterize the OHS practices, zoonotic disease risk exposures, and contributing factors affecting veterinary services fieldworkers in the North West Province. Methods: A cross-sectional descriptive study was conducted among 137 veterinary fieldworkers, including animal health technicians, state veterinarians, and veterinary public health officers. Data were collected using a structured, self-administered questionnaire focusing on sociodemographics, knowledge of zoonoses, exposure history, and OHS practices. Descriptive statistics were applied using SPSS version 27. Results: Fieldworkers frequently reported contact with animals, animal waste, and body fluids without consistent access to adequate personal protective equipment (PPE) or comprehensive training. While most were aware of common zoonoses such as rabies and brucellosis, less than half received regular OHS training or vaccinations. Significant associations were found between occupational category and reported PPE use, as well as between knowledge levels and years of experience. Conclusions: This study highlights critical gaps in knowledge of zoonotic disease, inconsistent implementation of safety protocols, and inadequate PPE provision and/or use among veterinary fieldworkers. These findings highlight the urgent need to strengthen occupational health frameworks, standardize training, and improve access to protective resources to safeguard both workers and broader public health. Full article

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

23 pages, 376 KB

Open AccessArticle

Differences in Cannabis and Cannabidiol Attitudes, Perceptions, and Behaviors Between US Adolescents Receiving Mood Disorder Treatment and Their Parents Across Legal Contexts

by Christopher J. Hammond, Mary A. Fristad, Yoon Ji Moon, Melissa M. Batt, Richard Dopp, Neera Ghaziuddin, Leslie Hulvershorn, Jarrod M. Leffler, Manpreet K. Singh, Aimee E. Sullivan, Sally Weinstein and Leslie Miller

Int. J. Environ. Res. Public Health 2025, 22(10), 1576; https://doi.org/10.3390/ijerph22101576 - 16 Oct 2025

Abstract

Dramatic shifts in state-level cannabis laws (CLs) and federal hemp regulations have resulted in increased availability and use of cannabis and cannabidiol (CBD) products throughout the US, with unknown implications for the youth. Youth with mood disorders represent a vulnerable population that is [...] Read more.

Dramatic shifts in state-level cannabis laws (CLs) and federal hemp regulations have resulted in increased availability and use of cannabis and cannabidiol (CBD) products throughout the US, with unknown implications for the youth. Youth with mood disorders represent a vulnerable population that is more likely to use cannabis and CBD and is at elevated risk for experiencing cannabis-related adverse health outcomes. This multisite study characterized attitudes, health perceptions, and behaviors related to cannabis and CBD use among US youth receiving mood disorder treatment and their parents, and assessed whether attitudinal differences varied as a function of respondent group and state-level CL status. Anonymous surveys were completed by 84 youths and 66 parents recruited from six child mood clinics providing care to patients living in eleven US states with variable CLs. Covariate-adjusted regressions were run using respondent group and state-level CL status as between-subject factors. Most youths (76% and 74%) and parents (65% and 68%) endorsed believing that cannabis and CBD, respectively, are safe and effective treatments for mental health conditions, and that regular use of these products reduces depression, anxiety, and suicidal behaviors. Intergenerational differences in cannabis-related attitudes and health perceptions were observed, with some associations varying as a function of state-level CL. Among the youth, male sex and positive cannabis expectancies and attitudes were associated with higher cannabis use intentions. Findings can inform prevention and public health messaging efforts. Full article

(This article belongs to the Special Issue Identifying Environmental and Biopsychosocial Risk and Protective Factors for Adolescent Cannabis Use in a Changing Global Context)

16 pages, 413 KB

Open AccessArticle

Challenges and Opportunities of Male Partner Involvement in Cervical Cancer Prevention and Control in Central Kenya: A Qualitative Analysis

by John H. Mwangi, Pretty N. Mbeje and Gloria N. Mtshali

Int. J. Environ. Res. Public Health 2025, 22(10), 1575; https://doi.org/10.3390/ijerph22101575 - 15 Oct 2025

Abstract

Background: Cervical cancer remains a significant public health concern in Kenya, with male partner involvement increasingly recognized as a key factor in effective prevention and control. However, limited research has explored the specific barriers and enablers to such involvement in the Kenyan context. [...] Read more.

Background: Cervical cancer remains a significant public health concern in Kenya, with male partner involvement increasingly recognized as a key factor in effective prevention and control. However, limited research has explored the specific barriers and enablers to such involvement in the Kenyan context. This study aimed to examine the challenges and opportunities associated with male partner involvement in cervical cancer prevention in Central Kenya. Methods: A qualitative descriptive design was employed. Purposive sampling was used to select 73 participants, including 20 couples (40 individuals), 20 nurses, 2 clinical officers, 2 gynecologists, 6 community health workers, and 3 county health directors. Data were collected through interviews and focus group discussions and analyzed thematically to identify key patterns and insights. Results: The mean age of male partners was 36.9 years, and 30.5 years for female partners. Most couples (70%, n = 28) had attained secondary education. The average duration of professional experience for nurses and clinical officers was 13 years. Key challenges included knowledge gaps, financial and logistical barriers, limited moral support, time constraints, sociocultural beliefs, stigma, and inadequate facility infrastructure. Identified opportunities included community education, shifting norms, improved couple communication, practical support from men, and integration of services. Conclusions: This study identifies key challenges and practical opportunities for increasing male involvement in cervical cancer prevention. Clarifying and promoting specific male roles such as support for screening and vaccination can enhance the effectiveness of cervical cancer prevention strategies in Central Kenya. Full article

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18 pages, 319 KB

Open AccessPerspective

Mental Health of Young People in the Post-Pandemic Era: Perspective Based on Positive Psychology and Resilience

by Daniel T. L. Shek

Int. J. Environ. Res. Public Health 2025, 22(10), 1574; https://doi.org/10.3390/ijerph22101574 - 15 Oct 2025

Abstract

With the gradual decline in COVID-19 cases, there is a need to re-visit the mental health of adolescents and emerging adults in the post-pandemic period. Several observations can be highlighted from the scientific literature. First, while some studies suggest that mental health of [...] Read more.

With the gradual decline in COVID-19 cases, there is a need to re-visit the mental health of adolescents and emerging adults in the post-pandemic period. Several observations can be highlighted from the scientific literature. First, while some studies suggest that mental health of young people has worsened in the post-pandemic period, there are inconsistent and conflicting findings. Second, there are more studies on psychological morbidity than on positive psychological attributes. Third, compared with the West, there are relatively fewer Chinese studies. Fourth, compared with adolescents, there are relatively fewer studies on emerging adults. Based on these observations of the existing literature, I have detailed several reflections on the mental health of young people, including enhancing positive psychological attributes in young people through positive youth development (PYD) programs, building up the individual resilience of young people, strengthening family resilience, adopting multidisciplinary, interdisciplinary and transdisciplinary approaches in understanding the mental health of young people, building more well-articulated theoretical models, charting future research directions, and developing intervention strategies in the post-pandemic period. Full article

(This article belongs to the Special Issue Perspectives in Behavioral and Mental Health)

19 pages, 418 KB

Open AccessArticle

Knowledge Connects Our Hearts and Lands: A Qualitative Research Study on Stewarding Indigenous Traditional Ecological Knowledges for Community Well-Being

by Danya Carroll, Desiree J. Edwards, Ramon Riley and Nicole Redvers

Int. J. Environ. Res. Public Health 2025, 22(10), 1573; https://doi.org/10.3390/ijerph22101573 - 15 Oct 2025

Abstract

Indigenous Peoples have developed and stewarded complex knowledge systems that have contributed to thriving societies. With continued threats to Indigenous lifeways, there is increasing need to further protect traditional ecological knowledges (TEK). We carried out a qualitative study to explore Indigenous community perspectives [...] Read more.

Indigenous Peoples have developed and stewarded complex knowledge systems that have contributed to thriving societies. With continued threats to Indigenous lifeways, there is increasing need to further protect traditional ecological knowledges (TEK). We carried out a qualitative study to explore Indigenous community perspectives on stewarding and protecting TEK while identifying gaps in community-level protections of TEK. We conducted ten semi-structured interviews in December 2024 and one focus group in January 2025 with Indigenous Peoples in the southwestern United States. Reflexive thematic analysis through open coding was carried out using qualitative software. Six overarching themes were characterized in the interviews, which overlapped with findings from the focus group, including the following: (1) Historical and current barriers impact the sharing of TEK; (2) Preserving our language is necessary for intergenerational transmission of our TEK; (3) Our TEK reveals changes to our Lands; (4) Protecting our Lands and medicines is vital to our health; (5) We must take the time to learn our TEK for future generations; and (6) We need to protect our TEK. Our research highlights the importance of supporting Indigenous communities’ capacities to protect their TEK for personal, community, and environmental well-being. Full article

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20 pages, 1027 KB

Open AccessReview

Intersectoral Strategies for Type 2 Diabetes Prevention and Management in Emerging Countries: A Narrative Review of Food Sovereignty, Digital Health, and Syndemic Dynamics

by Tatiana Palotta Minari

Int. J. Environ. Res. Public Health 2025, 22(10), 1572; https://doi.org/10.3390/ijerph22101572 - 15 Oct 2025

Abstract

Background: Type 2 diabetes (T2D) is no longer a standalone clinical condition—it has become a syndemic shaped by food insecurity, social inequality, and digital marginalization in emerging economies. This convergence calls for a reimagining of public health through intersectoral, digitally enabled, and culturally [...] Read more.

Background: Type 2 diabetes (T2D) is no longer a standalone clinical condition—it has become a syndemic shaped by food insecurity, social inequality, and digital marginalization in emerging economies. This convergence calls for a reimagining of public health through intersectoral, digitally enabled, and culturally grounded approaches. This study explores how intersectoral strategies, supported by digital innovation and rooted in food sovereignty, can help prevent and manage T2D in emerging countries. Methods: A narrative review was conducted using the PubMed, Scopus, and Web of Science databases. Studies published between 2014 and 2025 were included if they addressed T2D and food security in emerging contexts, focusing on intersectoral or multisectoral strategies. Studies on T1D, non-human subjects, and high-income settings were excluded from the study. Thirty-nine studies were critically synthesized. Results: Food insecurity acts as both a biological stressor and a sociopolitical condition that worsens poor glycemic control. Promising but underutilized intersectoral strategies include agroecological food systems, school-based nutrition programs, and community health worker networks. Digital tools, such as AI-driven diagnostics, blockchain food traceability, and mobile health platforms, offer scalable solutions but face challenges in infrastructure, digital literacy, and ethical governance. Conclusions: A digitally inclusive, ethically reflexive intersectoral paradigm is needed that recognizes food and digital access as human rights. Full article

(This article belongs to the Special Issue Nutrition and Diabetes: Advances in Prevention and Management)

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17 pages, 1519 KB

Open AccessArticle

Biophilic Design and Restorative Effects: A Neuropsychological Study of Healthy Indoor Workspaces in Urban Contexts

by ChoHye Youn, Minji Kang and Juyoung Lee

Int. J. Environ. Res. Public Health 2025, 22(10), 1571; https://doi.org/10.3390/ijerph22101571 - 15 Oct 2025

Abstract

The rapid increases in urbanization and time spent in built indoor environments have sparked significant concerns about their impact on human health and well-being. People who spend long hours in enclosed and highly artificial settings, such as hospital workers, are especially vulnerable to [...] Read more.

The rapid increases in urbanization and time spent in built indoor environments have sparked significant concerns about their impact on human health and well-being. People who spend long hours in enclosed and highly artificial settings, such as hospital workers, are especially vulnerable to environmental stressors. This study examined whether applying biophilic (i.e., human tendency to connect with nature and other lifeforms) spatial design within hospital spaces could provide restorative benefits for nurses working in high-stress environments. Twenty-one nurses participated in this study, staying under two different conditions for 10 min: a control room with plain white walls and a biophilic space where the walls were entirely covered with vegetation. During the sessions, functional near-infrared spectroscopy was used to measure hemodynamic responses in the dorsolateral prefrontal cortex (DLPFC). Additionally, standardized self-report questionnaires were used to analyze the level of perceived restorativeness, affective states, mood, and anxiety. Results showed that exposure to the biophilic space significantly reduced oxyhemoglobin (oxy-Hb) concentrations in the DLPFC, reflecting relief from cognitive–emotional overload and enhanced neural stabilization. Psychological measures further indicated decreases in fatigue, depression, and anxiety, alongside increases in vigor, attentiveness, and perceived restorativeness in biophilic space. These findings demonstrate that even brief exposure to a biophilically designed indoor environment can produce neuropsychologically restorative effects, suggesting biophilic interventions as sustainable, effective strategies for healthier workplaces and urban environments. Full article

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15 pages, 274 KB

Open AccessArticle

Providers’ Perceptions of Respectful Maternity Care and Enabling Conditions in a Regional Hospital: A Qualitative Study

by Sthembile P. Zwane and Lawrence Chauke

Int. J. Environ. Res. Public Health 2025, 22(10), 1570; https://doi.org/10.3390/ijerph22101570 - 15 Oct 2025

Abstract

Globally, women continue to die from pregnancy-related conditions that could be prevented through ensuring timely access to emergency obstetric care and facility-based deliveries supervised by skilled birth attendants. However, many women are reluctant to deliver in maternity healthcare facilities due to the widespread [...] Read more.

Globally, women continue to die from pregnancy-related conditions that could be prevented through ensuring timely access to emergency obstetric care and facility-based deliveries supervised by skilled birth attendants. However, many women are reluctant to deliver in maternity healthcare facilities due to the widespread disrespect and abuse that patients have reportedly received. Respectful maternity care has been identified amongst the possible solutions. This study explored perceptions of respectful maternity care and the enabling conditions of a multidisciplinary group of maternity healthcare providers working at a busy, specialised public mother and child regional hospital in Gauteng, South Africa. An explorative, descriptive, and contextual study design with a phenomenological perspective was adopted. Semi-structured interviews were conducted with each of the 30 purposefully selected study participants. The interviews were digitally recorded, professionally transcribed, and analysed using Tesch’s Constant Comparison method. Two main categories, namely (1) healthcare providers’ perceptions of respectful maternity care and (2) enabling conditions for its practice emerged, encompassing seven themes: women-centred care, provision of high-quality care, preservation and promotion of women’s rights, creating an enabling environment for the practice of RMC, in-service training, accountability of healthcare providers for their actions, and community involvement. The perceptions of the study participants regarding respectful maternity care align with global standards; however, successful implementation requires the establishment of enabling conditions. Full article

(This article belongs to the Special Issue Improving the Quality of Maternity Care)

24 pages, 559 KB

Open AccessReview

Prevention of Alcohol, Tobacco, and Illicit Drug Use Among Youth: A Scoping Review of European School-Based Programs with Insights on Mental Health

by Ahmed Abdelrahman, Luz Bernad, Fiona Harris, Elodie Rezzonico, Antoine Flahault and Jennifer Hasselgard-Rowe

Int. J. Environ. Res. Public Health 2025, 22(10), 1569; https://doi.org/10.3390/ijerph22101569 - 15 Oct 2025

Abstract

Alcohol, tobacco, and drug misuse continue to rise globally, with adolescents at particular risk. In response, school-based prevention programs have been widely implemented, yet their efficacy and long-term impact remain under-discussed. This scoping review synthesised evidence on the effectiveness of three commonly used [...] Read more.

Alcohol, tobacco, and drug misuse continue to rise globally, with adolescents at particular risk. In response, school-based prevention programs have been widely implemented, yet their efficacy and long-term impact remain under-discussed. This scoping review synthesised evidence on the effectiveness of three commonly used programs (Preventure, Unplugged, and IPSYcare) in Europe. A search of four databases (PubMed, Embase, PsycInfo, and Web of Science) identified 21 peer-reviewed articles published between 2008 and 2023, spanning 12 European countries. Unplugged was most frequently evaluated (10 studies), followed by Preventure (6 studies) and IPSYcare (5 studies). Findings showed that Preventure yielded mixed outcomes, delaying binge drinking and reducing substance use among high-risk groups but with limited generalisability. Unplugged was associated with reductions in cannabis use and heavy drinking at 15 months post-intervention. IPSYcare demonstrated longer-term benefits, including improved school connectedness and reductions in alcohol and tobacco use. Results suggest that while standardised programs such as Unplugged enable scalability, contextual adaptations may enhance effectiveness, and tailored approaches are valuable for high-risk populations. Overall, the programs show potential, but variability indicate the need for further longitudinal and qualitative research in order to improve program delivery and sustain long-term impacts. Full article

(This article belongs to the Special Issue Risk Reduction for Health Prevention)

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16 pages, 314 KB

Open AccessArticle

The Implementation of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: A Process Evaluation Pilot Study

by Bianca DeSilva, Anna Sui, Sam Liu and Patti-Jean (PJ) Naylor

Int. J. Environ. Res. Public Health 2025, 22(10), 1568; https://doi.org/10.3390/ijerph22101568 - 15 Oct 2025

Abstract

Background: The Early Intervention Program (EIP) was a 10-week family-based healthy living intervention for children with a BMI-for-age ≥85th percentile. The effectiveness of the EIP has been previously demonstrated; however, its implementation has not been fully described. Process evaluations provide valuable insight into [...] Read more.

Background: The Early Intervention Program (EIP) was a 10-week family-based healthy living intervention for children with a BMI-for-age ≥85th percentile. The effectiveness of the EIP has been previously demonstrated; however, its implementation has not been fully described. Process evaluations provide valuable insight into implementation and improve ongoing intervention delivery. Objective: The aim was to evaluate recruitment, intervention content, delivery, and implementation for quality improvement and to inform potential scale-up. Methods: A mixed-methods process evaluation design was used and represented one component of a Type I hybrid effectiveness trial. Results: The EIP reached diverse ethnic, educational, and socioeconomic backgrounds (n = 47). Participation barriers were transportation, scheduling, and illness. Participation facilitators were the free cost and family recreation pass, sibling inclusion, and location. Program acceptability/satisfaction was rated over 4/5 for all measures. Implementation barriers were recruitment, small group size, attendance, and limited time to deliver material. Implementation facilitators were high compatibility and feasibility, as well as the provided resources. Staff interviews showed high acceptability/satisfaction across all sites. Conclusion: The EIP was highly acceptable and feasible for families and delivery partners, but recruitment, attendance, and online engagement were implementation challenges. Program adjustments are recommended prior to scale-up. These strengths and limitations can help to inform other multi-site childhood healthy living interventions. Full article

8 pages, 562 KB

Open AccessArticle

Assessing Compliance with Evolving Exposure Standards: Respirable Crystalline Silica (RCS) Exposure in Western Australian Mining

by Adelle Liebenberg, Kiam Padamsey, Kerry Staples, Matthew Oosthuizen, Marcus Cattani, Andy McCarthy and Jacques Oosthuizen

Int. J. Environ. Res. Public Health 2025, 22(10), 1567; https://doi.org/10.3390/ijerph22101567 - 15 Oct 2025

Abstract

The link between occupational exposure to Respirable Crystalline Silica (RCS) and silicosis, a potentially fatal respiratory disease, has been well-established, leading to global reductions in RCS Exposure Standards (ES). In Western Australia (WA), RCS data have been collected by the Department of Energy, [...] Read more.

The link between occupational exposure to Respirable Crystalline Silica (RCS) and silicosis, a potentially fatal respiratory disease, has been well-established, leading to global reductions in RCS Exposure Standards (ES). In Western Australia (WA), RCS data have been collected by the Department of Energy, Mining, Industry Regulation and Safety (DEMIRS) from 1986 to 2024 (n = 144,141). These results were analysed to assess the impacts of recent changes to the ES on compliance. Findings suggest that the WA mining sector, regardless of commodity type, is compliant with RCS exposures as assessed against the 0.05 mg/m³ ES (2019). Laboratory technicians, exploratory drilling, miscellaneous trades/utilities, trades assistant, sample preparation, and sampler/sample operator are SEGS that had the highest RCS exposures. Exposure assessment did not account for the protection provided by respiratory protective equipment (RPE). In the WA mining sector, a robust respiratory protection regime is enforced that includes respirator fit testing, and this is most likely the case throughout Australia. On the balance of epidemiological evidence, industry compliance over decades, reducing exposure profiles, and robust RPE programmes, it could be argued that further reductions to the RCS exposure standard are not justified. Regulators need to consider the protection provided by respirators in exposure assessment. Full article

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11 pages, 263 KB

Open AccessArticle

Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients

by Julio Quispe-Alcocer, Antonio Biroli and Fabricio González-Andrade

Int. J. Environ. Res. Public Health 2025, 22(10), 1566; https://doi.org/10.3390/ijerph22101566 - 15 Oct 2025

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Abstract

Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates [...] Read more.

Traumatic brain injury (TBI) remains a critical public health issue worldwide, with significant morbidity, mortality, and long-term disability. Timely transfer to a specialized trauma unit is crucial to improving outcomes, yet in resource-limited settings, delays often exceed recommended time frames. This study evaluates the impact of arrival time on mortality, disability, and clinical outcomes in Ecuadorian patients with TBI. A cross-sectional and observational study was conducted, analyzing 383 adult patients diagnosed with TBI. Patients were categorized into two cohorts: those who arrived at a specialized trauma unit within five hours post-injury and those who arrived between five and 24 h. Demographic, clinical, and radiological characteristics were analyzed, including Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Marshall Scale classification, and presence of subarachnoid hemorrhage (SAH). Logistic regression models were used to identify predictors of mortality and disability. Longer transfer times were associated with increased mortality (3.34 times higher for ≥5 h, p < 0.05) and disability (2.92 times higher for ≥5 h, p < 0.05). Patients with Marshall Diffuse Injury III and IV had an 8.80- and 9.05-fold increased risk of mortality, respectively. SAH was an independent predictor of mortality (4.53 times higher), and GCS between 9–13 increased the likelihood of death by 6.49 times. Delayed transfers were associated with lower GCS at admission, longer ICU stays, and increased surgical complications. Although some survivors experienced improvement over time, disability in TBI can persist for many years or even lifelong, underscoring the burden of delayed trauma care. Despite delays, overall survival remained higher than reported in high-income countries, suggesting compensatory factors in hospital-based management. Delayed hospital arrival in TBI patients significantly increases mortality and disability. Early transfer within five hours is essential to reduce secondary brain injury and improve functional outcomes. Findings suggest that in resource-limited settings, optimizing pre-hospital care and transport efficiency is crucial to minimizing long-term disability. Full article

(This article belongs to the Section Health Care Sciences)

13 pages, 2336 KB

Open AccessArticle

The Impact of Research Results Feedback on the Lived Experiences of Elderly Participants in the DIMAMO Health Demographic Site: A Case of AWI-Gen Participants

by Reneilwe G. Mashaba, Cairo B. Ntimana, Precious Makoti, Katlego Mothapo, Joseph Tlouyamma and Kagiso P. Seakamela

Int. J. Environ. Res. Public Health 2025, 22(10), 1565; https://doi.org/10.3390/ijerph22101565 - 15 Oct 2025

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Abstract

The concept of engaging the community in the results of research or returning individual results to the respective participants seems more of an afterthought than an integral part of research processes. The study aims to assess the impact of research results feedback among [...] Read more.

The concept of engaging the community in the results of research or returning individual results to the respective participants seems more of an afterthought than an integral part of research processes. The study aims to assess the impact of research results feedback among study participants from a rural black community of low socio-economic status. The study was qualitative. The interview data was analyzed using a deductive content analysis method to develop themes. The present study included about 31 individuals, of which 79% were women and 29% were men. The study used deductive content analysis to identify themes. These themes included health and lifestyle awareness, perceived benefits of research participation, community perception of health research, economic and social motivations, and challenges and concerns. The present study shed light on the importance of returning individual results for participants in health research. Providing feedback was found to improve participants’ health awareness, lifestyle behavior and contribute to early disease detection, especially for conditions that are not routinely tested in clinics. The themes that were generated showed that participants altered their lives and health-seeking behavior because of the information they received from participating in research, a situation that would not have happened if they did not have the results back. The findings of the present study indicate that it is important to return feedback results post conducting a research study. Returning results not only improves the livelihood of participants at the community level but also has the potential to foster strong researcher–community partnerships to enhance research participation and health outcomes, especially in disadvantaged populations. Full article

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8 pages, 977 KB

Open AccessArticle

The Effects of Eye Exercises on Eye-Hand Coordination, Cognitive Functions and Balance Ability of the Elderly: A Randomized Controlled Trial

by Onchuma Mueangson, Wanchai Keawmai, Radamanee Pabbumnan, Aisada Chukaithai, Ploynapas Thongdonmuean and Parinya Vongvaivanichakul

Int. J. Environ. Res. Public Health 2025, 22(10), 1564; https://doi.org/10.3390/ijerph22101564 - 14 Oct 2025

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Abstract

This study investigated the effects of eye exercises on eye-hand coordination, cognitive function, and balance in sixty elderly participants aged 60–70 years who were randomly assigned to an experimental or control group. The experimental group performed Gaze Stability Exercises (GSE) for 50 min [...] Read more.

This study investigated the effects of eye exercises on eye-hand coordination, cognitive function, and balance in sixty elderly participants aged 60–70 years who were randomly assigned to an experimental or control group. The experimental group performed Gaze Stability Exercises (GSE) for 50 min per session, while the control group performed eyeball exercises for 10 min. Both groups trained twice a week for four weeks. Assessments of eye-hand coordination, cognitive function, and balance were conducted before and after the intervention. An Analysis of Covariance (ANCOVA), adjusting for baseline scores and gender, was used for between-group comparisons. ANCOVA revealed that the GSE group showed significantly greater improvements in cognitive function and dynamic balance compared to the control group (p < 0.05). However, no significant difference was found between the groups for eye-hand coordination. Within-group comparisons showed that both groups improved in eye-hand coordination and cognitive function (p < 0.05). These findings suggest that eye exercises, including GSEs and eyeball exercises, can enhance eye-hand coordination and cognitive function in elderly individuals. The dynamic balance improvements observed only in the experimental group highlight the potential of GSEs in balance training. Preliminary findings indicate that consistent eye exercise help improve motor and cognitive skills in the elderly, which requires further study. Full article

(This article belongs to the Section Exercise and Health-Related Quality of Life)

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19 pages, 479 KB

Open AccessArticle

Exploring How Intent of Self-Harm Affects Trainee Healthcare Practitioners’ Views, Attitudes and Clinical Decision-Making in Northwest England: A Qualitative Study

by Destiny Priya Kumari, Kathryn Jane Gardner and Peter Taylor

Int. J. Environ. Res. Public Health 2025, 22(10), 1563; https://doi.org/10.3390/ijerph22101563 - 14 Oct 2025

Viewed by 92

Abstract

Self-harm is often stigmatised by healthcare professionals. Little is known about how certain characteristics of the behaviour, like the degree of suicidal intent, affect clinicians’ judgements and responses. This study explored how intent of self-harm (suicidal or non-suicidal) affects trainee practitioners’ views and [...] Read more.

Self-harm is often stigmatised by healthcare professionals. Little is known about how certain characteristics of the behaviour, like the degree of suicidal intent, affect clinicians’ judgements and responses. This study explored how intent of self-harm (suicidal or non-suicidal) affects trainee practitioners’ views and attitudes towards behaviour and clinical decision-making. A qualitative study using semi-structured online interviews was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a reflexive thematic analysis. Fifteen trainee healthcare practitioners (psychological wellbeing practitioners, clinical/counselling psychologists, nurses, and medics) were interviewed. Three themes were identified: (1) interpreting intent in self-harm: clinical utility and challenges, (2) the perceived responsibility of self-harm, (3) trainees’ struggle for equal care in a hierarchical system. Participants observed staff expressing pejorative views towards both forms of self-harm but did not share them. Across most clinical decisions, intent informed trainees’ judgements and beliefs. Clients presenting with suicidal-related self-harm received more urgent care but fewer therapeutic interventions. Trainees felt ambivalent about distinguishing intent. Nevertheless, this distinction was evident across treatment, risk and care decisions. A consistent approach towards suicidal and non-suicidal self-harm is important. Trainees should be supported in addressing difficult emotions arising from this work, helping to shift the blame culture and promoting a more empathic approach. Full article

(This article belongs to the Special Issue Research on Suicide Assessment, Prevention and Management)

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7 pages, 230 KB

Open AccessArticle

Relationship Between Urban Year-Round Green Exercise and Perceived Health, Well-Being, and Reasons for Engagement

by Konrad Reuß and Christopher Huth

Int. J. Environ. Res. Public Health 2025, 22(10), 1562; https://doi.org/10.3390/ijerph22101562 - 14 Oct 2025

Viewed by 197

Abstract

Urban year-round green exercise (YRGE)—defined as moderate to vigorous physical activity performed regularly in natural urban settings throughout all seasons and weather conditions—has the potential to promote health, well-being, and social connectedness. This study investigates the relationship between YRGE and individuals’ perceived health [...] Read more.

Urban year-round green exercise (YRGE)—defined as moderate to vigorous physical activity performed regularly in natural urban settings throughout all seasons and weather conditions—has the potential to promote health, well-being, and social connectedness. This study investigates the relationship between YRGE and individuals’ perceived health status, psychological well-being, and reasons for engagement. A cross-sectional online survey was conducted with 408 adult participants engaged in urban green exercise. The findings indicate that physical activity in adverse meteorological conditions, such as rain, cold, and wind, is positively associated with perceived current health, health over the past 12 months, and well-being. Social connectedness is particularly influenced by environmental factors like sun exposure and heat. The study also reveals key motivational factors for YRGE participation, including improving health and fitness, disconnecting from everyday life, enjoying nature, and experiencing tranquility, with significant variation depending on age and individual nature connectedness. These results suggest that YRGE serves as an accessible and inclusive public health intervention with consistent benefits across socio-demographic groups. Urban planning and health promotion initiatives should prioritize the maintenance and accessibility of urban green spaces and offer guided YRGE programs to encourage sustainable participation across the population. Full article

(This article belongs to the Special Issue Exercise in Living Environments: A Healthy Lifestyle)

11 pages, 645 KB

Open AccessPerspective

Applying Race and Ethnicity in Health Disparities Research

by Keith C. Norris, Matthew F. Hudson, M. Roy Wilson, Genevieve L. Wojcik, Elizabeth O. Ofili and Jerris R. Hedges

Int. J. Environ. Res. Public Health 2025, 22(10), 1561; https://doi.org/10.3390/ijerph22101561 - 14 Oct 2025

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Abstract

Health professionals commonly reference race and ethnicity to inform health care and administrative decisions. However, health researchers (and, arguably, society at large) misapply race and ethnicity when assuming an inherent relationship of these concepts with biological and health outcomes of interest. Misapplication of [...] Read more.

Health professionals commonly reference race and ethnicity to inform health care and administrative decisions. However, health researchers (and, arguably, society at large) misapply race and ethnicity when assuming an inherent relationship of these concepts with biological and health outcomes of interest. Misapplication of race potentially results from socially embedded identification predicated upon race essentialism, the belief that people within a racial group share “inherent” biological traits that define them as distinct from other racial groups. This false belief is often associated with implied racial hierarchies obscuring authentic causal disease relationships. Similarly, ethnicity is a socially and politically constructed group descriptor for people from a similar national or regional background who may share common cultural, historical, and social experiences. Thus, as for race, no inherent biological information is contained within such group definitions. This article summarizes the Research Centers for Minority Institutions (RCMI) 2025 Annual Grantee Meeting keynote session on Race and Ethnicity in Medicine. The session described how society originated and subsequently applied/misapplied race and ethnicity in various domains of policy and public health. The keynote session also considered the use of race and ethnicity in describing and envisioning biomedical research, clinical trials, clinical practice, and health services research. The authors summarize a more tenable use of race and ethnicity to advance biomedical research and health by focusing upon social and environmental drivers of health, population representation in clinical trials, and other factors. Associated recommendations from the keynote session are provided. Full article

(This article belongs to the Special Issue Proceedings of the 2024 and 2025 Research Centers in Minority Institutions (RCMI) Consortium National Conferences)

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13 pages, 998 KB

Open AccessArticle

eHealth Literacy and Knowledge of Social Health Financing Among Undergraduate Healthcare Students in Kenya

by Elham Aldousari, Maha Alhajeri and Dennis Kithinji

Int. J. Environ. Res. Public Health 2025, 22(10), 1560; https://doi.org/10.3390/ijerph22101560 - 13 Oct 2025

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Abstract

Low rates of actively contributing to the Social Health Insurance Fund (SHIF) under the Social Health Authority (SHA) could be due to health insurance knowledge inadequacies, possibly because of poor electronic health (eHealth) literacy. This study assesses whether eHealth literacy is associated with [...] Read more.

Low rates of actively contributing to the Social Health Insurance Fund (SHIF) under the Social Health Authority (SHA) could be due to health insurance knowledge inadequacies, possibly because of poor electronic health (eHealth) literacy. This study assesses whether eHealth literacy is associated with SHA/SHIF knowledge among undergraduate healthcare students in Kenya. An analytical cross-sectional study was conducted using the eHealth Literacy Scale (eHEALS) and an adapted Kaiser Family Foundation quiz. A total of 207 students in mainly six health-related academic programs in 21 institutions of higher learning in Kenya responded to the online survey. Only 54% and 21.7% of the participants had high (median ≥ 4 out of 5) levels of eHealth literacy and knowledge of SHA/SHIF, respectively. About 9.2% of the students had never heard of SHA/SHIF. Only high eHealth literacy compared to low eHealth literacy (OR = 6.2, p < 0.0001) and pursuing nursing, public health, and other programs compared to pursuing Bachelor of Medicine and Bachelor of Surgery (MBChB) (OR = 4.9–5.1, p = 0.01–0.03) significantly predicted SHA/SHIF knowledge. Thus, eHealth literacy levels and SHA/SHIF knowledge require improvement among undergraduate healthcare students in Kenya to prepare them as SHA ambassadors in their communities. Full article

(This article belongs to the Special Issue Health Equity and Universal Health Coverage)

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16 pages, 334 KB

Open AccessArticle

Quantitative Assessment of Surge Capacity in Rwandan Trauma Hospitals: A Survey Using the 4S Framework

by Lotta Velin, Menelas Nkeshimana, Eric Twizeyimana, Didier Nsanzimfura, Andreas Wladis and Laura Pompermaier

Int. J. Environ. Res. Public Health 2025, 22(10), 1559; https://doi.org/10.3390/ijerph22101559 - 13 Oct 2025

Viewed by 484

Abstract

Surge capacity is the ability to manage sudden patient influxes beyond routine levels and can be evaluated using the 4S Framework: staff, stuff, system, and space. While low-resource settings like Rwanda face frequent mass casualty incidents (MCIs), most surge capacity research comes from [...] Read more.

Surge capacity is the ability to manage sudden patient influxes beyond routine levels and can be evaluated using the 4S Framework: staff, stuff, system, and space. While low-resource settings like Rwanda face frequent mass casualty incidents (MCIs), most surge capacity research comes from high-resource settings and lacks generalisability. This study assessed Rwanda’s hospital surge capacity using a cross-sectional survey of emergency and surgical departments in all referral hospitals. Descriptive statistics, t-tests, Fisher’s exact test, ANOVA, and linear mixed-model regression were used to analyze responses. Of the 39 invited participants, 32 (82%) responded. On average, respondents believed that they could manage 13 MCI patients (95% CI: 10–16) while maintaining routine care, with significant differences between tertiary and secondary hospitals (11 vs. 22; p = 0.016). The intra-class correlation was poor for most variables except for CT availability and ICU beds. Surge capacity perception did not vary significantly by professional category, though less senior staff reported higher capacity. Significantly higher capacity was reported by those with continuous access to imaging (p < 0.01). Despite limited resources, Rwandan hospitals appear able to manage small to moderate MCIs. For larger incidents, patient distribution across facilities is recommended, with critical cases prioritized for tertiary hospitals. Full article

(This article belongs to the Section Global Health)

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11 pages, 621 KB

Open AccessArticle

Using Conversations, Listening and Leadership to Support Staff Wellness: The CALM Framework

by Usman Iqbal, Natalie Wilson, Robyn Taylor, Louise Smith and Friedbert Kohler

Int. J. Environ. Res. Public Health 2025, 22(10), 1558; https://doi.org/10.3390/ijerph22101558 - 13 Oct 2025

Viewed by 175

Abstract

Healthcare workers’ (HCWs) wellness is a critical concern, particularly following the COVID-19 pandemic. Staff Wellness Rounding (SWR) has emerged as a leadership-driven strategy to support HCWs but research on its effectiveness remains limited. This study examines the impact of SWR within a large [...] Read more.

Healthcare workers’ (HCWs) wellness is a critical concern, particularly following the COVID-19 pandemic. Staff Wellness Rounding (SWR) has emerged as a leadership-driven strategy to support HCWs but research on its effectiveness remains limited. This study examines the impact of SWR within a large healthcare organisation in Australia and introduces the CALM (Conversation, Active Listening, Leadership Engagement, Mechanism for Feedback) Framework to enhance leadership-driven wellness initiatives. SWR was implemented across six acute hospitals and 14 community health centres in New South Wales, Australia (July to October 2021). A sequential mixed-methods design was used to evaluate SWR effectiveness, leadership engagement, and key components for a structured wellness approach. Phase One included a survey of 169 HCWs to capture their experiences, and Phase Two and Three comprised semi-structured interviews with SWR leaders, participants of SWR and analysis of 342 SWR records. Findings showed that informal conversations foster trust, active listening supports emotional well-being, and leadership engagement facilitates issue escalation. However, feedback mechanisms require improvement: 77.5% of HCWs felt able to escalate concerns but only 32.5% believed feedback was effectively addressed. These insights directly informed the development of the CALM Framework with implications for leadership training and digital wellness integration in healthcare settings. Full article

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16 pages, 320 KB

Open AccessArticle

A Multi-Site Observational Evaluation of the Equine Assisted Growth and Learning Association Model of Equine-Assisted Psychotherapy for Veteran Trauma Survivors

by Halina Kowalski, Hannah Van Buiten, Patricia Hopkins, Connie Baldwin, Elena Nazarenko and William R. Marchand

Int. J. Environ. Res. Public Health 2025, 22(10), 1557; https://doi.org/10.3390/ijerph22101557 - 13 Oct 2025

Viewed by 211

Abstract

The primary aim of this study was to evaluate the feasibility, safety, and preliminary outcomes of the Equine Assisted Growth and Learning Association (Eagala) model of equine-assisted psychotherapy for active-duty military and veteran trauma survivors. This was a retrospective multi-site observational study. Study [...] Read more.

The primary aim of this study was to evaluate the feasibility, safety, and preliminary outcomes of the Equine Assisted Growth and Learning Association (Eagala) model of equine-assisted psychotherapy for active-duty military and veteran trauma survivors. This was a retrospective multi-site observational study. Study participants completed four psychological instruments pre- and post-intervention. These were the PTSD Checklist for DSM-5, the Patient Health Questionnaire, the Satisfaction with Life Scale and the Sheehan Disability Scale. The Client Satisfaction Questionnaire-8 was also completed post-intervention. Paired-sample t-tests were conducted to assess for changes in the primary outcome variables pre- and post-intervention. The RAPID qualitative approach was used to analyze the qualitative data and develop subthemes. Subjects were 107 participants at 12 sites. Participants ranged in age from 22 to 78 and were predominately male. Findings revealed that the Eagala model intervention can be implemented for this population across multiple sites. Further, treatment engagement may be better than found with conventional psychotherapy interventions for this population. Pre-to-post-intervention changes in scores on the psychological instruments revealed significant decreases in PTSD symptoms, depression, and disability as well as increases in satisfaction with life. Future randomized controlled trails of this intervention are warranted. Full article

24 pages, 1316 KB

Open AccessArticle

When Pedestrian Crossings Become Danger Zones: Trauma and Mortality Risks in Elderly Pedestrians

by Peter Pavol, Vasileios Topalis, Sofia-Chrysovalantou Zagalioti, Olha Kuzyo, Martin Müller, Aristomenis K. Exadaktylos, Mairi Ziaka and Jolanta Klukowska-Rötzler

Int. J. Environ. Res. Public Health 2025, 22(10), 1556; https://doi.org/10.3390/ijerph22101556 - 13 Oct 2025

Viewed by 209

Abstract

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study [...] Read more.

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. Methods: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and ≥65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). Results: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. Conclusion: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients. Full article

(This article belongs to the Special Issue Road Traffic Risk Assessment: Control and Prevention of Collisions)

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19 pages, 312 KB

Open AccessArticle

Violence, Inequity, and Their Impact on Health and Access to Healthcare Services Among the Elderly Population of Bogotá

by Carlos Alberto Cano-Gutiérrez, Diego Andrés Chavarro-Carvajal and Julián Andrés Sucerquia-Quintero

Int. J. Environ. Res. Public Health 2025, 22(10), 1555; https://doi.org/10.3390/ijerph22101555 - 13 Oct 2025

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Abstract

Objective: This study explores the prevalence of violence and forced displacement as indicators of inequity among Bogotá’s elderly population, with a particular focus on how these factors affect their health and access to healthcare services. Methods: This is a subsidiary analysis of the [...] Read more.

Objective: This study explores the prevalence of violence and forced displacement as indicators of inequity among Bogotá’s elderly population, with a particular focus on how these factors affect their health and access to healthcare services. Methods: This is a subsidiary analysis of the SABE-Bogotá survey. The design was a probabilistic cluster sample of 2000 people aged 60 and over. The study was carried out by the Pontificia Universidad Javeriana’s Institute on Aging and cosponsored by Colciencias. The variables of interest were displacement and experiences of violence, assessed through self-reporting. A descriptive analysis of all variables was performed, calculating simple frequency distributions. Subsequently, dependency and association analyses were performed using Chi-square, T-tests, and multivariate logistic regressions, depending on each case. Results: 43.32% of the subjects were victims of some type of violence in the last year, among which offensive language was one of the most frequent. Individuals with severe depression (OR 2.10 [1.21–3.65]) and those who had been victims of displacement (OR 2.55, CI 95% [1.65–3.95]) had the highest risk of violence. The results reveal a direct correlation between these experiences and pre-existing health conditions. For instance, severe depression and a history of displacement were associated with a higher risk of experiencing violence, while the risk of displacement was higher among individuals with diabetes, severe depression, and, crucially, those who lacked access to health insurance. Conclusion: A high percentage of the elderly population in the city of Bogotá has been victims of different types of violence, including ones related to armed conflict and forced displacement, which is a particular and exclusive form of violence suffered by this group of people. These findings suggest that violence and displacement are social determinants of health that exacerbate inequities, underscoring the need for more inclusive health policies and improved access to medical care for this vulnerable population. Full article

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

12 pages, 268 KB

Open AccessArticle

The Relationship Between Artificial Sweetener Intake from Soft Drinks and Internet Addiction Among Students: An Analytical and Cross-Sectional Study

by Nika Lovrincevic Pavlovic, Ivan Miskulin, Ivana Kotromanovic Simic, Marija Drmic, Marina Markovic, Ivana Milovanovic, Stela Jokic, Lana Radaus, Barbara Simatic and Maja Miskulin

Int. J. Environ. Res. Public Health 2025, 22(10), 1554; https://doi.org/10.3390/ijerph22101554 - 13 Oct 2025

Viewed by 195

Abstract

The increasing consumption of artificially sweetened beverages among young people, coupled with prevalent digital technology use, presents growing public health concerns regarding potential effects on health and behavior. This study aimed to determine the concentrations of three commonly used artificial sweeteners—acesulfame K, saccharin, [...] Read more.

The increasing consumption of artificially sweetened beverages among young people, coupled with prevalent digital technology use, presents growing public health concerns regarding potential effects on health and behavior. This study aimed to determine the concentrations of three commonly used artificial sweeteners—acesulfame K, saccharin, and aspartame—in soft drinks available on the market in Osijek, Croatia, to assess their compliance with European Union regulations, and to investigate the consumption patterns and possible associations with internet addiction among university students. Laboratory analysis of 43 beverages was performed using high-performance liquid chromatography with diode array detection, while a cross-sectional survey of 792 students collected data on sociodemographic characteristics, beverage consumption, and internet use. Acesulfame K was the most frequently detected sweetener, followed by aspartame and saccharin, with mean concentrations of 50.1 mg/L, 22.7 mg/L, and 19.76 mg/L, respectively. Overall, 85.7% of the students stated that they consumed artificially sweetened drinks, with an average consumption of 0.2 L/day. Internet addiction was found in 39.8% of the participants, but no significant correlation was found between beverage consumption and internet addiction (p = 0.177). All measured concentrations of sweeteners were below the legal limits. These results suggest that while exposure to artificial sweeteners in beverages is within safe limits, further research is needed to assess cumulative intake and its potential impact on behavioral health in young adults. Full article

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13 pages, 814 KB

Open AccessArticle

The Influence of Rehabilitation Programs on the Mental State and Quality of Life in Patients with Fibromyalgia: A Comparative Cohort Study from Romania

by Theodora Florica Borze (Ursu), Annamaria Pallag, Doriana Ioana Ciobanu, Klara Kalman, Anca Paula Ciurba, Ramona Nicoleta Suciu, Mariana Mureșan and Carmen Delia Nistor-Cseppento

Int. J. Environ. Res. Public Health 2025, 22(10), 1553; https://doi.org/10.3390/ijerph22101553 - 12 Oct 2025

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Abstract

Fibromyalgia (FM) affects millions of people around the world, causing widespread physical pain, exhaustion, and psychological disorders. Through this study, we aim to observe the effectiveness of two different rehabilitation programs in reducing the impact of FM on daily functioning and psychological factors. [...] Read more.

Fibromyalgia (FM) affects millions of people around the world, causing widespread physical pain, exhaustion, and psychological disorders. Through this study, we aim to observe the effectiveness of two different rehabilitation programs in reducing the impact of FM on daily functioning and psychological factors. Specifically, we compare a complex conservative program that combines physical therapy and hydrokinetotherapy in a hospital setting with a therapy focused on intrinsic relaxation. Methods: This comparative study involved 63 patients aged between 19 and 69 years diagnosed with FM, divided into two groups: the study group (SG, 32 participants) and the control group (CG, 31 participants). Over 90% of participants are female, 30 in the study group and 28 in the control group. SG followed a conservative physiotherapy combined with thermal water therapy, and CG followed a recovery program through intrinsic relaxation. Participants were evaluated on the first and last day of the rehabilitation program using the Revised Fibromyalgia Impact Questionnaire (FIQR) and the Hamilton Anxiety Rating Scale (Ham—A). The rehabilitation program consisted of 10 sessions conducted over a period of two weeks. Results: After the two-week recovery period, the results showed a significant improvement in both FIQR and Ham—A scores in the study group (p < 0.001). In the control group, there were no significant changes in FIQR variables (p > 0.05), while a significant improvement was observed on the anxiety scale (p < 0.001). Conclusions: The combination of hydrokineto-therapy and physical therapy is more effective in improving the overall condition of patients with FM compared to relaxation. Full article

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

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14 pages, 393 KB

Open AccessArticle

Eyeing ID: Access to Identification as a Barrier to Banking and Other Social Determinants of Health

by Katie Bonner, Natalia Fana, Sarah Lunney, Sarah Campbell, Deanna Merriam, Cristian Estrella Almonte and Sarah Gander

Int. J. Environ. Res. Public Health 2025, 22(10), 1552; https://doi.org/10.3390/ijerph22101552 - 12 Oct 2025

Viewed by 190

Abstract

Personal identification (ID) is a prerequisite to many financial and social services; however, many vulnerable residents do not have ID and lack the resources to acquire it. To assess the impact of ID inaccessibility in a local context, a study was conducted throughout [...] Read more.

Personal identification (ID) is a prerequisite to many financial and social services; however, many vulnerable residents do not have ID and lack the resources to acquire it. To assess the impact of ID inaccessibility in a local context, a study was conducted throughout New Brunswick, Canada. The study objective was to understand the implications of ID requirements and the barriers to acquiring it through the lens of consumers. This mixed-methods, observational study included surveys and interviews. The survey collected demographics, socioeconomic status (SES), financial behaviors and experiences, and barriers to accessing ID. The semi-structured interviews explored individual experiences. In order to address disparities in health and social outcomes, ID requirements and barriers to access need to be acknowledged and mitigated. A total of 142 surveys were completed. Many respondents reported difficulty obtaining or replacing a driver’s license (30.8%), a provincial photo ID (47.7%), or their birth certificate (39.4%), identifying cost (34.4%) and required documentation (28.1%) as the main barriers. Thematic analysis identified three main themes: the difficulty of living without ID, barriers to obtaining or replacing an ID, and an exploration of solutions. Current ID policies restrict access to community services such as banking, housing, and employment, which are intended to support individuals to improve their situation and gain autonomy. Policies and services are required to address this urgent issue. Full article

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23 pages, 2027 KB

Open AccessArticle

Bayesian Network Modeling of Environmental, Social, and Behavioral Determinants of Cardiovascular Disease Risk

by Hope Nyavor and Emmanuel Obeng-Gyasi

Int. J. Environ. Res. Public Health 2025, 22(10), 1551; https://doi.org/10.3390/ijerph22101551 - 12 Oct 2025

Viewed by 337

Abstract

Background: Cardiovascular disease (CVD) is the leading global cause of death and is shaped by interacting biological, environmental, lifestyle, and social factors. Traditional models often treat risk factors in isolation and may miss dependencies among exposures and biomarkers. Objective: To map interdependencies among [...] Read more.

Background: Cardiovascular disease (CVD) is the leading global cause of death and is shaped by interacting biological, environmental, lifestyle, and social factors. Traditional models often treat risk factors in isolation and may miss dependencies among exposures and biomarkers. Objective: To map interdependencies among environmental, social, behavioral, and biological predictors of CVD risk using Bayesian network models. Methods: A cross-sectional analysis was conducted using NHANES 2017–2018 data. After complete-case procedures, the analytic sample included 601 adults and 22 variables: outcomes (systolic/diastolic blood pressure, total/LDL/HDL cholesterol, triglycerides) and predictors (BMI, C-reactive protein (CRP), allostatic load, Dietary Inflammatory Index, income, education, age, gender, race, smoking, alcohol, and serum lead, cadmium, mercury, and PFOA). Spearman’s correlations summarized pairwise associations. Bayesian networks were learned with two approaches: Grow–Shrink (constraint-based) and Hill-Climbing (score-based, Bayesian Gaussian equivalent score). Network size metrics included number of nodes, directed edges, average neighborhood size, and Markov blanket size. Results: Correlation screening reproduced expected patterns, including very high systolic–diastolic concordance (p ≈ 1.00), strong LDL–total cholesterol correlation (p = 0.90), inverse HDL–triglycerides association, and positive BMI–CRP association. The final Hill-Climbing network contained 22 nodes and 44 directed edges, with an average neighborhood size of ~4 and an average Markov blanket size of ~6.1, indicating multiple indirect dependencies. Across both learning algorithms, BMI, CRP, and allostatic load emerged as central nodes. Environmental toxicants (lead, cadmium, mercury, PFOS, PFOA) showed connections to sociodemographic variables (income, education, race) and to inflammatory and lipid markers, suggesting patterned exposure linked to socioeconomic position. Diet and stress measures were positioned upstream of blood pressure and triglycerides in the score-based model, consistent with stress-inflammation–metabolic pathways. Agreement across algorithms on key hubs (BMI, CRP, allostatic load) supported network robustness for central structures. Conclusions: Bayesian network modeling identified interconnected pathways linking obesity, systemic inflammation, chronic stress, and environmental toxicant burden with cardiovascular risk indicators. Findings are consistent with the view that biological dysregulation is linked with CVD and environmental or social stresses. Full article

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23 pages, 1203 KB

Open AccessArticle

Improving Peer Relationships Through Positive Deviance Practices and the HOPE (Healthy Outcomes from Positive Experiences) Framework

by Laura Gallant, Catalina Borges, Alisha De Lorenzo, Curt Lindberg and Dina Burstein

Int. J. Environ. Res. Public Health 2025, 22(10), 1550; https://doi.org/10.3390/ijerph22101550 - 12 Oct 2025

Viewed by 252

Abstract

Positive Childhood Experiences (PCEs), including supportive peer relationships, are crucial for optimal adult health and socioeconomic outcomes. As part of a broader initiative to address trauma in youth, we conducted a quality improvement project using a Positive Deviance (PD) approach. We aimed to [...] Read more.

Positive Childhood Experiences (PCEs), including supportive peer relationships, are crucial for optimal adult health and socioeconomic outcomes. As part of a broader initiative to address trauma in youth, we conducted a quality improvement project using a Positive Deviance (PD) approach. We aimed to improve peer relationships among members of the Asbury Park Boy & Girls Club and evaluate the feasibility of using a PD approach in a community-based setting. Using PD methodology, we identified practices used by staff to improve members’ experiences. Pre-intervention focus groups with staff and youth, discovery and action dialogues and staff observations identified positive deviants (PDs) and PD practices. PD practices were further defined during staff observations and developed into staff training. Post-intervention focus groups assessed perceived changes. Qualitative data was analyzed using deductive thematic analysis through the HOPE (Healthy Outcomes from Positive Experiences) framework domains of PCEs: Relationships, Environment, Engagement and Emotional Growth. In vivo coding generated subthemes, preserving participant language. Post-intervention focus group analysis suggested improvements in peer-to-peer relationships with club members referring to their peers as “nice” and “kind”, a contrast from pre-intervention findings. Findings were supported by club staff during member checking. These results suggest that the PD approach is a promising strategy for improving peer relationships and increasing access to PCEs in a community-based setting. Full article

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Int. J. Environ. Res. Public Health, Volume 22, Issue 10 (October 2025) – 116 articles

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