International Journal of Environmental Research and Public Health

20 pages, 353 KiB

Open AccessArticle

Bridging Gaps: Provider Perspectives on Integrating Systems for Health Equity

by Brittany R. Schuler, Stacey L. Shipe, Astrid Uhl, Samantha Smith, LaShanta Majeed, Nicole O’Reilly, Cheri Carter and Bradley N. Collins

Int. J. Environ. Res. Public Health 2025, 22(4), 550; https://doi.org/10.3390/ijerph22040550 (registering DOI) - 2 Apr 2025

Abstract

Health equity is shaped by multiple factors intersecting with service delivery in community-based organizations (CBOs). Providers in under-resourced areas are often the first point of contact for families seeking child development, mental health, and behavioral support. However, system-level barriers hinder service delivery and [...] Read more.

Health equity is shaped by multiple factors intersecting with service delivery in community-based organizations (CBOs). Providers in under-resourced areas are often the first point of contact for families seeking child development, mental health, and behavioral support. However, system-level barriers hinder service delivery and access. This study explores provider perspectives to identify barriers and inform system-level changes that promote equity in child and family health. Using a narrative qualitative design, in-depth interviews were conducted with 21 health and mental health professionals from child- and family-serving CBOs. Guided by ecological and strengths-based frameworks, interviews examined provider insights on challenges, strengths, and supports affecting service delivery. Key themes emerged across macro (rights-based policies, racism/oppression), community (environmental impacts, social cohesion), organizational (secondary stress, system fragmentation, provider supports), and family levels (basic needs, parenting support, service access). Findings highlight the need for a multilevel approach that prioritizes rights-based policies, strengthens community cohesion, and improves system integration. Enhancing CBO capacity to address these determinants could advance equity-oriented service delivery and mitigate structural barriers that perpetuate health disparities. Full article

(This article belongs to the Special Issue Improving Healthcare Quality)

20 pages, 2918 KiB

Open AccessArticle

The Relationship Between Food Insecurity and Mental Health Among Syrians and Syrian Refugees Working in Agriculture During COVID-19

by Clara Calia, Afnan El-Gayar, Ann-Christin Zuntz, Shaher Abdullateef, Esraa Almashhor, Liz Grant and Lisa Boden

Int. J. Environ. Res. Public Health 2025, 22(4), 549; https://doi.org/10.3390/ijerph22040549 (registering DOI) - 2 Apr 2025

Abstract

The COVID-19 pandemic has disproportionately impacted vulnerable populations, such as internally displaced Syrians and Syrian refugees (SSRs) in Middle Eastern host countries, through a syndemic interplay of health, social, and economic challenges. Movement restrictions disrupted their livelihoods resulting in increased food insecurity. A [...] Read more.

The COVID-19 pandemic has disproportionately impacted vulnerable populations, such as internally displaced Syrians and Syrian refugees (SSRs) in Middle Eastern host countries, through a syndemic interplay of health, social, and economic challenges. Movement restrictions disrupted their livelihoods resulting in increased food insecurity. A mixed-methods approach was used to address the research question: “What is the relationship between Food Insecurity (FI), Mental Health (MH), and COVID-19 among displaced SSRs working in agriculture”? One hundred SSR participants working in agriculture were recruited from northern Syria and neighbouring countries to participate in a Household Survey. The survey data were analysed using correlation and regression analysis. Additionally, interviews with Household Survey researchers were conducted and thematically analysed. Increasing food insecurity was significantly correlated with worse mental health outcomes among SSR participants (r_s = −0.24, p = 0.018). No moderation effects were found with COVID-19 measures or household responses to the pandemic. However, smaller food portions and storing food were positively correlated with poor mental health and food insecurity. The COVID-19 pandemic exacerbated food insecurity and mental health challenges among displaced Syrians and refugees, particularly during Ramadan in 2020, highlighting the compounded effects of overlapping crises and the need for further research into resilience strategies. Full article

(This article belongs to the Special Issue Refugee Health and Well-Being: Psychological, Behavioral and Biochemical Insights)

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15 pages, 878 KiB

Open AccessArticle

A Stress Management and Health Coaching Intervention to Empower Office Employees to Better Control Daily Stressors and Adopt Healthy Routines

by Despoina Ziaka, Xanthi Tigani, Christina Kanaka-Gantenbein and Evangelos C. Alexopoulos

Int. J. Environ. Res. Public Health 2025, 22(4), 548; https://doi.org/10.3390/ijerph22040548 (registering DOI) - 2 Apr 2025

Abstract

The present pilot randomized control study examined the effectiveness of an 8-week stress management and health coaching intervention on perceived stress, healthy routines, sleep quality, self-efficacy, self-esteem and happiness. A total of 38 office employees were randomly assigned to the intervention group (IG, [...] Read more.

The present pilot randomized control study examined the effectiveness of an 8-week stress management and health coaching intervention on perceived stress, healthy routines, sleep quality, self-efficacy, self-esteem and happiness. A total of 38 office employees were randomly assigned to the intervention group (IG, n = 20) or the control group (CG, n = 18) and validated tools were used to assess outcomes. Statistically significant differences in the IG after the 8 weeks were observed in perceived stress (i.e., a decrease in PSS-14 score, p = 0.043), in “Daily Routine”, i.e., an increase in control over the consistent timing of meals and sleep (p = 0.001) and in “Social and Mental Balance”, i.e., an increase in inclination to socialize, balance leisure and personal time and adopt positive thinking or cognitive control over stressors (p = 0.003). These improvements were reflected in an increase in total healthy lifestyle and personal control score (HLPCQ, p = 0.048). Short time and stress management and coaching interventions at workplaces can empower employees to increase control over stressors and to take the first step in adopting healthy behaviors by recognizing bad habits. Furthermore, in building sustainable employment, an empowered employee would participate at an organizational level more actively. Our preliminary results strongly support the idea that primary health care professionals should be educated in health coaching and relaxation techniques. Full article

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20 pages, 603 KiB

Open AccessPerspective

The Intersection of Sarcopenia and Musculoskeletal Pain: Addressing Interconnected Challenges in Aging Care

by Yacov Grosman and Leonid Kalichman

Int. J. Environ. Res. Public Health 2025, 22(4), 547; https://doi.org/10.3390/ijerph22040547 (registering DOI) - 2 Apr 2025

Abstract

The global aging population faces a growing prevalence of sarcopenia and musculoskeletal (MSK) pain, two interrelated conditions that diminish physical function, quality of life, and independence in older adults. Sarcopenia, characterized by the loss of muscle strength, mass, and function, often coexists with [...] Read more.

The global aging population faces a growing prevalence of sarcopenia and musculoskeletal (MSK) pain, two interrelated conditions that diminish physical function, quality of life, and independence in older adults. Sarcopenia, characterized by the loss of muscle strength, mass, and function, often coexists with MSK pain, with emerging evidence suggesting that each condition may contribute to the progression of the other. This perspective explores the bidirectional relationship between sarcopenia and MSK pain, highlighting shared mechanisms, including inactivity, cellular aging, chronic inflammation, gender-related hormonal changes, and psychosocial factors such as depression and social isolation, which underlie the mutual exacerbation between conditions. Through a multidisciplinary framework, the article emphasizes integrating care across specialties to address these interconnected conditions. Practical approaches, including comprehensive screening protocols, tailored resistance exercise, and nutritional support, are discussed alongside innovative hybrid care models combining in-person and telemedicine systems to enhance accessibility and continuity of care. A call to action is presented for clinicians, policymakers, and researchers to adopt collaborative strategies, prioritize investment in integrated healthcare, and bridge critical knowledge gaps. By reframing care delivery and advancing multidisciplinary efforts, this perspective aims to effectively address the complex challenges posed by the intersection of sarcopenia and MSK pain in older adults. Full article

(This article belongs to the Special Issue Perspectives in Health Care Sciences)

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11 pages, 251 KiB

Open AccessCommentary

Rapid-Acting Treatments for Perinatal Depression: Clinical Landscapes and Future Horizons

by Emily M. Beydler, Amanda Koire, Elizabeth Steuber, Joseph J. Taylor and Reid J. Mergler

Int. J. Environ. Res. Public Health 2025, 22(4), 546; https://doi.org/10.3390/ijerph22040546 (registering DOI) - 2 Apr 2025

Abstract

Perinatal depression affects approximately 1 in 5 women and is the leading cause of maternal mortality in the United States. In addition to evidence-based treatment with antidepressant medications, there has been a push to identify rapid-acting options for pregnant and postpartum individuals. This [...] Read more.

Perinatal depression affects approximately 1 in 5 women and is the leading cause of maternal mortality in the United States. In addition to evidence-based treatment with antidepressant medications, there has been a push to identify rapid-acting options for pregnant and postpartum individuals. This paper reviews the evidence behind new pharmacological agents (neurosteroids and ketamine) and non-pharmacological approaches (transcranial magnetic stimulation). The paper also highlights the risks and benefits of electroconvulsive therapy and selective serotonin reuptake inhibitors. Based on recent studies and research, the paper provides considerations when prescribing these modalities including: timing of symptom onset, severity of presentation, breastfeeding priorities, prior treatment response and treatment availability and cost. Full article

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

13 pages, 2502 KiB

Open AccessArticle

Spatial Analysis of Tuberculosis, COVID-19, and Tuberculosis/COVID-19 Coinfection in Recife, PE, Brazil

by Alene Bezerra Araújo Silva, Wayner Vieira de Souza, José Constantino Silveira Júnior, Juliana Silva de Santana and Ricardo Arraes de Alencar Ximenes

Int. J. Environ. Res. Public Health 2025, 22(4), 545; https://doi.org/10.3390/ijerph22040545 (registering DOI) - 2 Apr 2025

Abstract

Tuberculosis (TB) remains a public health problem, which the COVID-19 pandemic may have exacerbated. Scaling TB, COVID-19, and coinfection in area and socioeconomic contexts is an important way to detect more vulnerable groups. Objective: To verify, through the spatial distribution of cases of [...] Read more.

Tuberculosis (TB) remains a public health problem, which the COVID-19 pandemic may have exacerbated. Scaling TB, COVID-19, and coinfection in area and socioeconomic contexts is an important way to detect more vulnerable groups. Objective: To verify, through the spatial distribution of cases of tuberculosis, COVID-19, and coinfection, the existence of an association between the risk of illness and income. Methods: An analytical ecological study was carried out in Recife, whose unit of analysis was the neighborhood, in the year 2020. The data were collected from the SINAN-TB, NOTIFICA-PE, and IBGE Information Systems. Neighborhoods were grouped into strata according to income through K-means analysis. Incidence rates were calculated. Marshall’s Local Empirical Bayesian Smoothing Method was used. Risk ratios were calculated to estimate the magnitude of association between income strata and incidence rates. Results: A heterogeneous pattern of spatial distribution was verified for the three events addressed, compatible with the inequality of income distribution existing in Recife. For COVID-19, the highest incidence rates occurred in the strata of better-income neighborhoods. There was an association with a gradual increase in the incidence rate as income decreased for tuberculosis. Coinfection did not show a gradual increase in the incidence rate as income decreased, but a lower incidence rate was observed in the stratum of better economic conditions. Conclusions: Studies must be carried out to verify the spatial distribution of COVID-19 and its possible association with socioeconomic factors in subsequent years. There was a positive association between low income and the risk of becoming ill from tuberculosis. The lower incidence rate of coinfection in the stratum of the higher-income population suggests that the pre-existence of TB contributes to illness by COVID-19 in the low-income population. Full article

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14 pages, 1712 KiB

Open AccessArticle

Improving Access to Radiotherapy Services in Gauteng: Quantitative Analysis of Key Time Intervals from Diagnosis to Treatment

by Portia N. Ramashia, Pauline B. Nkosi and Thokozani P. Mbonane

Int. J. Environ. Res. Public Health 2025, 22(4), 544; https://doi.org/10.3390/ijerph22040544 (registering DOI) - 2 Apr 2025

Abstract

Background: Timely access to radiotherapy is crucial for optimal cancer treatment outcomes, as delays in receiving treatment can lead to disease progression and decreased chances of survival. Healthcare systems need to prioritise efficient scheduling and coordination of radiotherapy services to ensure patients receive [...] Read more.

Background: Timely access to radiotherapy is crucial for optimal cancer treatment outcomes, as delays in receiving treatment can lead to disease progression and decreased chances of survival. Healthcare systems need to prioritise efficient scheduling and coordination of radiotherapy services to ensure patients receive timely care. This study aims to quantitatively analyse the key time intervals in the cancer care continuum, specifically from diagnosis to the start of radiotherapy treatment in Gauteng. Methods: Data from 800 patients treated between January and December 2023 were analysed using a retrospective analysis of patient records from the two public radiotherapy centres in Gauteng Province, one in Johannesburg and the other in Pretoria, focusing on key time intervals in the cancer care continuum. The durations from diagnosis to the commencement of radiotherapy were analysed. Results: The mean duration of the first consultation was 8.32 months, highlighting significant delays in accessing specialised care. This finding is further supported by the average time until a Computed Tomography (CT) simulation, which was 13.38 months, highlighting a considerable delay in treatment planning. Conclusion: This study highlights systemic delays in the Gauteng radiotherapy pathway, highlighting the need for optimisation of referral processes, resource constraints, and strategies to improve cancer care. Full article

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

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9 pages, 516 KiB

Open AccessBrief Report

Gain-Framed Text Messages and Nicotine Replacement Therapy for Smoking Cessation Among Lung Cancer Screening Patients: A Brief Report of a Pilot Randomized Controlled Trial

by Kinsey Pebley, Benjamin A. Toll, Matthew J. Carpenter, Gerard Silvestri and Alana M. Rojewski

Int. J. Environ. Res. Public Health 2025, 22(4), 543; https://doi.org/10.3390/ijerph22040543 (registering DOI) - 2 Apr 2025

Abstract

People who undergo lung cancer screening (LCS) and continue to smoke are at risk for negative clinical outcomes and lowered survival and need effective smoking cessation interventions. This pilot study tested an 8-week intervention for smoking cessation after LCS. The participants (N [...] Read more.

People who undergo lung cancer screening (LCS) and continue to smoke are at risk for negative clinical outcomes and lowered survival and need effective smoking cessation interventions. This pilot study tested an 8-week intervention for smoking cessation after LCS. The participants (N = 40) were randomized to the intervention group (combination nicotine replacement therapy [NRT] plus gain-framed text messaging for 8 weeks) or the control group (standard cessation counseling) after LCS. Assessments were completed at 8-week and 3-month follow-ups, including self-reported 7-day point prevalence abstinence. The mean age was 64.4 years old (SD = 6.2); 32.5% were Black or African American; and 55% were female. At Week 8, 14.3% (3/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group (p > 0.05). At 3-month follow-up, 4.8% (1/21) of the participants in the intervention group were abstinent versus 0% (0/19) in the control group. Among the intervention group participants, up to 52.4% used the provided patches and up to 61.9% used the provided lozenges during the study period. This study demonstrated modest quit rates for LCS patients receiving gain-framed text messages and NRT. The results highlight the need for more effective smoking cessation interventions for this priority population. Full article

(This article belongs to the Special Issue Advancing Health Services and Systems for Vulnerable Populations including People with Chronic Conditions)

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16 pages, 326 KiB

Open AccessArticle

Differences Between Health- and Skill-Related Physical Fitness Profiles of Kenyan Children from Urban and Rural Areas: The Kenya-LINX Project

by Stanley Kagunda Kinuthia, Gareth Stratton, Lucy Joy Wachira, Victor Okoth, George Evans Owino, Sophie Ochola, Amie Bethan Richards, Festus Kiplamai, Vincent Onywera and Nils Swindell

Int. J. Environ. Res. Public Health 2025, 22(4), 542; https://doi.org/10.3390/ijerph22040542 (registering DOI) - 2 Apr 2025

Abstract

Physical fitness is a key indicator of children’s health, yet amidst rising inactivity and obesity, data on Kenyan children are scarce. This study assessed health- and skill-related fitness differences between rural and urban Kenyan children while examining demographic influences. Cardiorespiratory fitness (CRF), BMI, [...] Read more.

Physical fitness is a key indicator of children’s health, yet amidst rising inactivity and obesity, data on Kenyan children are scarce. This study assessed health- and skill-related fitness differences between rural and urban Kenyan children while examining demographic influences. Cardiorespiratory fitness (CRF), BMI, strength, flexibility, speed, agility, and coordination were assessed in 1131 children aged 11.07 ± 0.9 years (52.7% girls) recruited using stratified cluster random sampling. Significant rural–urban disparities were observed. In urban areas, 16.6% were overweight and 2.8% obese, compared to 4% and 0.6% in rural areas (p < 0.001). Conversely, 44.5% of the rural cohort were underweight versus 13.7% urban cohort (p < 0.001). Multivariable regression revealed that rural children demonstrated superior CRF (β = −4.68 laps, p < 0.001) and lower back flexibility (β = −2.77 cm, p < 0.001), while urban children excelled in speed and coordination (β = 3.68 bounces, p < 0.001) and grip strength (β = 2.16 kg, p < 0.001). Boys outperformed girls in explosive leg power (β = −6.75 cm, p < 0.001) and CRF (β = −6.92 laps, p < 0.001). These findings highlight fitness inequities among Kenyan children, emphasising the need for equitable, targeted, and inclusive physical activity opportunities. Full article

16 pages, 752 KiB

Open AccessArticle

Enhancing Communication Among Patients with Cancer, Caregivers, and Extended Family: Development of a Communication Module

by Stephanie D. Torres-Marrero, Carled Argüelles-Berrios, Ninoshka Rivera-Torres, Lianel Rosario-Ramos, Alondra De Lahongrais-Lamboy and Normarie Torres-Blasco

Int. J. Environ. Res. Public Health 2025, 22(4), 541; https://doi.org/10.3390/ijerph22040541 (registering DOI) - 1 Apr 2025

Abstract

(1) Background: Coping with a cancer diagnosis can be a challenging process, in which patients and caregivers often require family support. For an adequate support network, there must be clear communication among patients, caregivers, and family members. However, the literature has not adequately [...] Read more.

(1) Background: Coping with a cancer diagnosis can be a challenging process, in which patients and caregivers often require family support. For an adequate support network, there must be clear communication among patients, caregivers, and family members. However, the literature has not adequately discussed communication interventions with extended family members. Our research team identified the need to incorporate communication strategies among patients, caregivers, and extended family. For this reason, we aimed to develop a communication module for patients with cancer, caregivers, and extended family members. (2) Methods: We conducted two steps to address the study’s objective: (a) a narrative literature review to identify communication strategies or interventions and (b) a data triangulation with the narrative literature review findings, the primary study findings, and the cultural expert expertise. (3) Results: The module content included learning what to say and improving general communication. Within the content were communication strategies such as prompt lists, priority lists, methods of telling others, delegating, seeking support, and others. (4) Conclusions: Enhancing the communication among patients with cancer, caregivers, and extended family promotes adequate family support. Nevertheless, future studies should explore the acceptability and implementation strategies of protocols focused on communication. Full article

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

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21 pages, 1228 KiB

Open AccessStudy Protocol

Internet-Based Psycho-Physical Exercise Intervention Program in Mild-to-Moderate Depression: The Study Protocol of the SONRIE Randomized Controlled Trial

by Juan Manuel Escudier-Vázquez, Manuel Ruiz-Muñoz, Inmaculada Garrido-Palomino, Sonia Ortega-Gómez, Eulalio Juan Valmisa Gómez de Lara, María del Mar Espinosa Nogales, Alicia Viglerio Montero, Miguel Ángel Rosety-Rodríguez, David Jiménez-Pavón, Ana Carbonell-Baeza and Vanesa España-Romero

Int. J. Environ. Res. Public Health 2025, 22(4), 540; https://doi.org/10.3390/ijerph22040540 (registering DOI) - 1 Apr 2025

Abstract

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive–behavioral therapy on depressive symptoms in adults [...] Read more.

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive–behavioral therapy on depressive symptoms in adults with mild-to-moderate depression. This randomized controlled trial involved 80 adults aged 25–65 years diagnosed with depression according to the ICD-10 criteria. Participants were randomized to an experimental group receiving the combined online intervention or to a control group receiving standard care. The primary outcome was the change in depression severity, assessed by the Beck Depression Inventory, with outcomes measured at baseline, immediately post-intervention, and after an 8-week follow-up phase. Statistical analyses include analysis of covariance to compare group changes over time, with effect sizes quantifying the intervention’s impact. The SONRIE study demonstrates a promising online approach for treating depression, with potential implications for clinical practice and public health strategies. Full article

(This article belongs to the Special Issue Effectiveness of Physical Exercise for People with Chronic Diseases)

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16 pages, 3370 KiB

Open AccessSystematic Review

Prevalence of CVD Among Indian Adult Population: Systematic Review and Meta-Analysis

by Mohd Shannawaz, Isha Rathi, Nikita Shah, Shazina Saeed, Amrish Chandra and Harpreet Singh

Int. J. Environ. Res. Public Health 2025, 22(4), 539; https://doi.org/10.3390/ijerph22040539 (registering DOI) - 1 Apr 2025

Abstract

Cardiovascular disease is among the leading causes of mortality and morbidity globally. Over three-quarters of CVD-related deaths now occur in low- and middle-income countries (LMICs); India accounts for one-fifth of global CVD-related deaths, especially among the younger population. The objective of this study [...] Read more.

Cardiovascular disease is among the leading causes of mortality and morbidity globally. Over three-quarters of CVD-related deaths now occur in low- and middle-income countries (LMICs); India accounts for one-fifth of global CVD-related deaths, especially among the younger population. The objective of this study was to evaluate the prevalence of CVD among the Indian adult population. We systematically searched Scopus and PubMed from January 2000 to December 2024 to identify relevant articles and pooled the prevalence of CVD using random-effects meta-analysis. Among the 14,647 records screened, 501 full-text articles were assessed for eligibility and 15 studies were included in the final analysis. The pooled prevalence of CVD was 11% (95% CI: 0.09–0.17). Subgroup analysis showed prevalence rates of 12% among males and 14% among females. Urban areas had a higher prevalence (12%) compared to rural areas (6%), with a significant difference. Our study shows the significant prevalence of cardiovascular disease (CVD) in India, particularly in urban areas, with slightly higher rates among females. Focused public health strategies are required to mitigate the growing burden of CVD, along with preventive measures, to reduce further increases in disease prevalence and related fatalities. Full article

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13 pages, 1008 KiB

Open AccessArticle

Convergent Validity of the Lower Quarter Y Balance Test Against Two-Step and Timed Up and Go Tests in Thai Older Adults with and Without Locomotive Syndrome

by Chadapa Rungruangbaiyok, Charupa Lektip, Jiraphat Nawarat, Eiji Miyake, Keiichiro Aoki, Hiroyuki Ohtsuka, Yasuko Inaba, Yoshinori Kagaya and Weeranan Yaemrattanakul

Int. J. Environ. Res. Public Health 2025, 22(4), 538; https://doi.org/10.3390/ijerph22040538 (registering DOI) - 1 Apr 2025

Abstract

Locomotive syndrome (LS) predisposes older adults to falls and functional dependency. In older adults with LS, the validity of the Lower Quarter Y Balance Test (YBT-LQ)—a dynamic balance assessment tool—remains unclear. This cross-sectional study aimed to assess the convergent validity of the YBT-LQ [...] Read more.

Locomotive syndrome (LS) predisposes older adults to falls and functional dependency. In older adults with LS, the validity of the Lower Quarter Y Balance Test (YBT-LQ)—a dynamic balance assessment tool—remains unclear. This cross-sectional study aimed to assess the convergent validity of the YBT-LQ with the Two-Step and Timed Up and Go (TUG) tests and compare YBT-LQ performance between individuals with and without LS. Sixty Thai community-dwelling older adults (≥60 years) were equally divided into LS and non-LS groups and performed the YBT-LQ, Two-Step test, and TUG test. Correlation analyses and independent t-tests assessed relationships and between-group comparisons, respectively. The YBT-LQ exhibited moderate positive correlations with the Two-Step test (r = 0.366, p = 0.004) and moderate negative correlations with the TUG test (r = −0.412, p = 0.001). The LS group exhibited significantly lower YBT-LQ scores across all reach directions than the non-LS group (p < 0.05), highlighting impaired balance in individuals with LS. The YBT-LQ is a valid and reliable tool for assessing dynamic balance and postural control, as well as identifying multidirectional stability deficits in older adults, particularly those with LS. Implementing the YBT-LQ in routine geriatric evaluations could enhance early detection and targeted interventions to reduce fall risk and improve mobility in aging populations. Full article

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23 pages, 2794 KiB

Open AccessArticle

Precarity in the Modes of Living: Proposing an Index for Studying Health Inequities at the Ecological Level in Colombia

by Hugo-Alejandro Santa Ramírez, Andrés-Felipe Ramírez-Giraldo, Hugo Pilkington, Carme Borrell and Gabriel-Jaime Otálvaro-Castro

Int. J. Environ. Res. Public Health 2025, 22(4), 537; https://doi.org/10.3390/ijerph22040537 (registering DOI) - 1 Apr 2025

Abstract

Deprivation indices are used to monitor health inequities. However, their theoretical underpinnings have been based on the context of Western industrialized countries, which have distinct social and historical backgrounds compared to Latin America and the Caribbean and countries in the Global South. Following [...] Read more.

Deprivation indices are used to monitor health inequities. However, their theoretical underpinnings have been based on the context of Western industrialized countries, which have distinct social and historical backgrounds compared to Latin America and the Caribbean and countries in the Global South. Following the Latin American Social Determination of Health perspective, particularly the category Modes of Living supported by the construct of precarity, we aimed to develop an index of precarity in the modes of living at the department level in Colombia and assess its geographical distribution and potential value for public health. We conducted an ecological cross-sectional study with national administrative records. We developed a precarity index through Principal Component Analysis and performed spatial autocorrelation analyses and regression models with child mortality indicators. Our final index comprised twenty indicators representing four dimensions of the modes of living and power relations. We found precarity not to distribute randomly in Colombia, with a center-periphery divide and higher precarity observed in the country’s margin. We also found an association of our index with under-five mortality (SMR = 1.19; 95%CI 1.08–1.31) and infant mortality (SMR = 1.13; 95%CI 1.00–1.26). Our index highlights the relevance of considering the modes of living when devising deprivation indices or similar measures from Colombia or Latin America. This approach may provide different perspectives on the health-disease process and potential value for public health planning. Full article

(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)

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16 pages, 1221 KiB

Open AccessArticle

Physical Activity Friendliness of Neighborhoods: Do Subjective and Objective Measures Correspond Within a Mid-Sized Dutch Town?

by Thomas G. Kuijpers, H. Susan J. Picavet, Jeroen Lakerveld, Johannes Mark Noordzij, G.C. Wanda Wendel-Vos and Barbara A. M. Snoeker

Int. J. Environ. Res. Public Health 2025, 22(4), 536; https://doi.org/10.3390/ijerph22040536 (registering DOI) - 1 Apr 2025

Abstract

One potential strategy to promote physical activity (PA) involves changing the neighborhood environment. The PA-friendliness of neighborhood environments is often calculated using geospatial data. However, the association with perceived PA-friendliness seems to be low. Therefore, we examined the relationship between two Dutch geospatial [...] Read more.

One potential strategy to promote physical activity (PA) involves changing the neighborhood environment. The PA-friendliness of neighborhood environments is often calculated using geospatial data. However, the association with perceived PA-friendliness seems to be low. Therefore, we examined the relationship between two Dutch geospatial measures and residents’ perceptions regarding the PA-friendliness of their neighborhoods. Data from 3438 respondents aged 40–80 years from the Doetinchem Cohort Study were linked to individual geospatial data. In addition to respondents’ self-reports, we used the following two geospatial measures: the Dutch walkability index and the Dutch indicator for PA-friendly environments (KBO-indicator). We performed logistic regression analyses to assess associations between perceived PA-friendliness and two objective geospatial measures, including interactions for age, sex, education, work status, and physical functioning. The majority of respondents (83%) evaluated their neighborhood as PA-friendly. The logistic analyses revealed no associations between the geospatial measures of walkability and PA-friendliness and the individuals’ perception measures. Similarly, a comparison of residents from high versus low walkable or PA-friendly neighborhoods demonstrated no significant differences in their perception of PA-friendliness. Additionally, no significant interaction effects were observed with sex, age, education, employment status, or physical functioning, indicating that even among subgroups there was no correspondence between objective and subjective measures. The lack of correspondence between both objective and subjective measures for PA-friendliness in the neighborhood suggests that these are distinct constructs. Future research should focus on qualitative methods to bridge the gap between objective and subjective measures and test whether the perceived PA-friendliness is similar to the objective measures. Full article

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26 pages, 7476 KiB

Open AccessArticle

Exploring the Restorative Effects of Natural Environments in Virtual Reality

by Silvia Marocco, Valeria Vitale, Elena Grossi, Fabio Presaghi, Marino Bonaiuto and Alessandra Talamo

Int. J. Environ. Res. Public Health 2025, 22(4), 535; https://doi.org/10.3390/ijerph22040535 (registering DOI) - 1 Apr 2025

Abstract

Natural environments are known to foster positive emotions and well-being, while Virtual Reality (VR) represents a powerful tool to explore such effects. This study investigates the restorative potential of virtual natural environments for emotional recovery, combining self-report and physiological measures. Fifty-two participants were [...] Read more.

Natural environments are known to foster positive emotions and well-being, while Virtual Reality (VR) represents a powerful tool to explore such effects. This study investigates the restorative potential of virtual natural environments for emotional recovery, combining self-report and physiological measures. Fifty-two participants were divided into three Natural groups—formed spontaneously based on their preferred natural scenarios—and a Neutral group—exposed to a neutral scenario. The results reveal that virtual natural scenarios effectively restored positive emotions (valence) after exposure to arousing stimuli. Both neutral and natural scenarios reduced arousal, but the physiological data show higher activation in Natural groups. Interestingly, this activation was positively appraised, supporting emotional recovery. These findings confirm the restorative potential of VR nature, with nuanced arousal effects. Full article

(This article belongs to the Section Environmental Health)

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11 pages, 276 KiB

Open AccessArticle

Attitudes of Community Health Nurses Towards Postnatal Home Visitation: A Study in the Ashanti Region of Ghana

by Yvonne Agyeman-Duah and Million Bimerew

Int. J. Environ. Res. Public Health 2025, 22(4), 534; https://doi.org/10.3390/ijerph22040534 (registering DOI) - 1 Apr 2025

Abstract

Enhancing maternal and newborn care is a key priority for governments worldwide. World leaders have taken deliberate steps to improve these essential services, with an emphasis on postnatal care, including home visits for mothers and their newborns. However, in the Ashanti Region and [...] Read more.

Enhancing maternal and newborn care is a key priority for governments worldwide. World leaders have taken deliberate steps to improve these essential services, with an emphasis on postnatal care, including home visits for mothers and their newborns. However, in the Ashanti Region and across Ghana, challenges surrounding the delivery and effectiveness of postnatal home visits remain a significant concern. This study aimed to assess the attitudes of Community Health Nurses towards postnatal home visitation in selected districts of the Ashanti Region. A quantitative survey approach was used to gather data from 100 CHNs randomly selected from 10 regional districts. Structured questionnaires were used to gather quantitative data from CHNs. Findings from the study were analysed using descriptive and inferential tests. The study results indicated that most of the CHNs were young adults, 35 years of age (79%), with the majority having 3–5 years of work experience. The respondents generally demonstrated a negative attitude towards PNHV as they believed it was an extra workload, time-consuming, and unnecessary. A Pearson chi-square test indicated strong significant association between CHNs’ attitude towards the components of the attitude scale and years of experience as well as their age. In conclusion, the study revealed that even though CHNs are expected, as part of their job description, to embark on home visitation activities, most of them have a negative attitude towards this professional duty. There should be conscientious, novel ways to ignite the interest of these essential service providers to help improve infant and maternal health. Full article

(This article belongs to the Special Issue The 20th Anniversary of IJERPH)

39 pages, 2838 KiB

Open AccessReview

The Interplay Between Sleep and Safety Outcomes in the Workplace: A Scoping Review and Bibliographic Analysis of the Literature

by Janet Mayowa Nwaogu, Albert P. C. Chan, John A. Naslund and Shahnawaz Anwer

Int. J. Environ. Res. Public Health 2025, 22(4), 533; https://doi.org/10.3390/ijerph22040533 (registering DOI) - 31 Mar 2025

Abstract

Occupational incidents comprising injuries and accidents remain a serious concern globally. With sleep deprivation and fatigue representing key drivers of many workplace incidents, one strategy to reduce occupational incidents is implementing effective sleep management systems. Yet, to date, there are complaints about the [...] Read more.

Occupational incidents comprising injuries and accidents remain a serious concern globally. With sleep deprivation and fatigue representing key drivers of many workplace incidents, one strategy to reduce occupational incidents is implementing effective sleep management systems. Yet, to date, there are complaints about the methodological approach in sleep–safety studies. The extent of work carried out with respect to the impact of sleep on safety outcomes needs to be reviewed to highlight the state of the art in the face of increasing technological advancement and changing lifestyle attitudes. A systematic search of the Scopus and PubMed databases retrieved 63 journal articles published up to 2023. The units of analysis included article performance and thematic analysis. It was deduced that workers in healthcare and construction have been the focus of most studies, pointing to the prevalence of safety issues in both these sectors. Most of the studies adopted a quantitative methodology employing validated sleep questionnaires, especially the Pittsburgh Sleep Quality Index. Using thematic analysis, the research focus was mapped into six areas, including sleep disorders, cognition and performance, and injury and accident prevention in the construction sector. In objective studies, alertness and cognitive performance were considered a proxy for sleep deprivation and safety performance. Harmonising sleep questionnaires is necessary to prevent excessive paperwork and ineffective safety systems. This study has the potential to provide occupational health and safety researchers outside of the medicine and psychology disciplines with knowledge on baseline information that could advance efforts to address sleep deprivation and the resulting safety concerns in the workplace. Full article

(This article belongs to the Special Issue Promoting Health and Safety in the Workplace)

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21 pages, 961 KiB

Open AccessConference Report

Rehabilitation Engineering Research Center on Mobile Rehabilitation: State of the Science Conference Report—Future Directions for mRehab for People with Disabilities

by John Morris, Mike Jones, Frank DeRuyter, Amanda Rabinowitz and David J. Reinkensmeyer

Int. J. Environ. Res. Public Health 2025, 22(4), 532; https://doi.org/10.3390/ijerph22040532 (registering DOI) - 31 Mar 2025

Abstract

This article summarizes proceedings of the State of the Science (SOS) Conference on Information and Communication Technology (ICT) Access for Mobile Rehabilitation, convened by the Rehabilitation Engineering Research Center on Mobile Rehabilitation (mRehab RERC), which is funded by the U.S. National Institute on [...] Read more.

This article summarizes proceedings of the State of the Science (SOS) Conference on Information and Communication Technology (ICT) Access for Mobile Rehabilitation, convened by the Rehabilitation Engineering Research Center on Mobile Rehabilitation (mRehab RERC), which is funded by the U.S. National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). The conference sought to assess the current state of the field and identify future research and development priorities for the field of mobile rehabilitation. The conference comprised four sessions addressing the following broad areas: (1) adherence to and effectiveness of home therapeutic exercise programs (HEPs); (2) technology for remote monitoring to support rehabilitation in the home and community (mRehab); (3) analytic techniques for using “big data” generated by remote monitoring to customize home exercise; and (4) barriers and facilitators to adoption of mRehab technology. Priorities for further research and development were identified using a three-stage process of gathering and refining expert opinions informed by the Delphi method for identifying future states in specific fields of inquiry. Results: Eight research and six technology development priorities were identified in the third and last stage of refinement of the initial set of priorities identified during the SOS Conference. Full article

(This article belongs to the Special Issue Mobile Health and Mobile Rehabilitation for People with Disabilities: 2nd Edition)

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