International Journal of Environmental Research and Public Health

14 pages, 939 KiB

Open AccessArticle

Substance Use Problems and Death of Despair in a 32-Year Follow-Up Study of Suicide Attempters Examined at a Medical Emergency Inpatient Unit

by Erik Niwhede, Jonas Berge, Agneta Öjehagen and Sara Lindström

Int. J. Environ. Res. Public Health 2025, 22(4), 575; https://doi.org/10.3390/ijerph22040575 (registering DOI) - 6 Apr 2025

Abstract

Deaths of despair (DoD), encompassing suicide, drug overdose, and alcohol-related mortality, are often linked to social and psychological distress. This study examined the long-term risk of DoD among individuals previously hospitalized for suicide attempts, with a focus on substance use problems and psychiatric [...] Read more.

Deaths of despair (DoD), encompassing suicide, drug overdose, and alcohol-related mortality, are often linked to social and psychological distress. This study examined the long-term risk of DoD among individuals previously hospitalized for suicide attempts, with a focus on substance use problems and psychiatric disorders as potential risk factors. A prospective cohort of 1044 individuals admitted to inpatient care following a suicide attempt between 1987 and 1998 was followed for up to 32 years using national registers. Cox proportional hazards regression models were used to assess associations between psychiatric diagnoses and mortality outcomes. The results showed that substance use problems, compared to no such problems, were associated with an increased risk of all-cause mortality but not DoD. In secondary analyses, dysthymia was linked to an increased risk of suicide but not non-suicidal DoD, suggesting distinct underlying mechanisms. Notably, aside from gender, no control variables were significantly associated with non-suicidal DoD, indicating that other factors may play a more prominent role in this high-risk population. These findings challenge the traditional DoD framework and highlight the need for tailored prevention efforts that consider the distinct risk profiles of suicide and non-suicidal DoD. Future research should incorporate socioeconomic and demographic factors to enhance understanding and prevention strategies. Full article

(This article belongs to the Special Issue Psychological Distress in Adolescents: Its Prevalence and Relation to Addictive Behaviors)

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16 pages, 703 KiB

Open AccessArticle

Barriers and Facilitators of Cardiac Rehabilitation in a Middle-Income Country: A Qualitative Study from China

by Ying Zou, Sarah Janus, Jiamin Du, Ning Qu, Karel Zuidema, Huibert Burger, Kees Ahaus, Zhigang Guo and Sytse Zuidema

Int. J. Environ. Res. Public Health 2025, 22(4), 574; https://doi.org/10.3390/ijerph22040574 (registering DOI) - 6 Apr 2025

Abstract

Background: Although effective and recommended by guidelines worldwide, Cardiac Rehabilitation (CR) remains scarce and underutilized. CR implementation has taken place in middle-income countries, but the progress is influenced by both positive and negative factors that remain underexplored. This study identified the barriers and [...] Read more.

Background: Although effective and recommended by guidelines worldwide, Cardiac Rehabilitation (CR) remains scarce and underutilized. CR implementation has taken place in middle-income countries, but the progress is influenced by both positive and negative factors that remain underexplored. This study identified the barriers and facilitators of CR in a middle-income country, specifically China. Methods: An exploratory qualitative study was conducted using semi-structured interviews. Results: Fifteen CR stakeholders were interviewed. According to the interviewees, the delivery of CR is impeded due to a lack of resources, a lack of CR professionals, and a lack of coordination between health institutions. The participation of CR is hindered by a lack of awareness, a lack of reimbursement, and a lack of access to CR. However, the interviewees also mentioned facilitating factors, namely, a positive attitude of stakeholders, high motivation of some patients, and policy support. Conclusions: More awareness regarding the effectiveness of CR is needed. Implementing CR in secondary and primary health institutions could overcome the barriers regarding travel distance and transportation to faraway hospitals. The CR reimbursement methods are needed to ease the financial burden on patients. Our findings reveal factors that need to be considered by policymakers to deliver CR on a wider scale in China. Full article

(This article belongs to the Section Health Care Sciences)

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13 pages, 1277 KiB

Open AccessArticle

Variations in Sleep, Fatigue, and Difficulty with Concentration Among Emergency Medical Services Clinicians During Shifts of Different Durations

by Paul D. Patterson, Sarah E. Martin, Sean A. MacAllister, Matthew D. Weaver and Charity G. Patterson

Int. J. Environ. Res. Public Health 2025, 22(4), 573; https://doi.org/10.3390/ijerph22040573 (registering DOI) - 6 Apr 2025

Abstract

We sought to characterize momentary changes in fatigue, sleepiness, and difficulty with concentration during short and long duration shifts worked by emergency medical services (EMS) and fire personnel across the United States. In addition, we tested for differences in pre-shift and on-shift sleep [...] Read more.

We sought to characterize momentary changes in fatigue, sleepiness, and difficulty with concentration during short and long duration shifts worked by emergency medical services (EMS) and fire personnel across the United States. In addition, we tested for differences in pre-shift and on-shift sleep stratified by shift duration. We examined real-time mobile-phone text message queries during scheduled shifts from the EMS Sleep Health Study, a nationwide, cluster-randomized trial (ClinicalTrials.gov Identifier: NCT04218279). Linear mixed effects models were used and Bonferroni p-values reported for multiple comparisons. In total, 388 EMS clinicians from 35 EMS/fire agencies documented 4573 shifts and responded to 64.6% of 161,888 text message queries. Most shifts (85.5%) were 12 or 24 h in duration. Mean sleep hours pre-shift was 6.2 (SD1.9) and mean sleep hours on shift was 3.4 (SD2.9) and varied by shift duration (p < 0.0001). The highest level of fatigue, sleepiness, and difficulty with concentration during any shift occurred during 24 h shifts and corresponded to the early morning hours at 03:00 or 04:00 a.m. The real-time assessments of sleep hours and fatigue in this study revealed deficits in sleep health for EMS and fire personnel and critical time points for intervention during shifts when the risk to safety is high. Full article

(This article belongs to the Topic New Research in Work-Related Diseases, Safety and Health)

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29 pages, 660 KiB

Open AccessReview

Methodology of Epidemic Risk Analysis in the Naval Military

by Laetitia Peultier-Celli, Alain Gérard, Franck Letourneur, Clara Inghels, Audrey Duclos and Philippe Perrin

Int. J. Environ. Res. Public Health 2025, 22(4), 572; https://doi.org/10.3390/ijerph22040572 (registering DOI) - 5 Apr 2025

Abstract

This review of the literature examines diseases and pathogen characteristics on military vessels, in order to improve the success of missions on a boat. Our aim is to understand the spread of disease, aiming to maximize biological resilience and hopefully eliminate outbreaks. Keyword [...] Read more.

This review of the literature examines diseases and pathogen characteristics on military vessels, in order to improve the success of missions on a boat. Our aim is to understand the spread of disease, aiming to maximize biological resilience and hopefully eliminate outbreaks. Keyword research was conducted from various sources of information, including scientific publications, theses, public health organization websites, and clinical trials. A synthesis of bacterial, viral, fungal, and parasitosis characteristics was established, and a risk prioritization index was defined, based on contagiousness (basic reproduction number (R0)) and clinical severity. For instance, COVID-19 was assessed as moderately contagious, with critical severity, and Influenza A H1N1 as having a minor level of contagiousness with critical severity, resulting in a level two out of three risk prioritization index. This approach demonstrates that while diseases have numerous characteristics, a method for classifying them by isolating specific criteria and prioritizing them could be proposed. In conclusion, further work is needed to analyze onboard operator activities and develop simulation models related to pathogen characteristics. Full article

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16 pages, 523 KiB

Open AccessArticle

Adolescents’ Knowledge on Climate Change: A Nationwide Study in Indonesia

by Evi Martha, Besral, Ulfi Hida Zainita, Naurah Assyifa Rilfi and Syifa Aulia Aminudin

Int. J. Environ. Res. Public Health 2025, 22(4), 571; https://doi.org/10.3390/ijerph22040571 (registering DOI) - 5 Apr 2025

Abstract

Adolescents’ knowledge about climate change is key to protecting the well-being of all generations and to promoting individuals’ rights and resilience. This study assesses the climate change literacy of Indonesian adolescents and its determinants. This nationwide study was conducted in 2023 in Sumatra, [...] Read more.

Adolescents’ knowledge about climate change is key to protecting the well-being of all generations and to promoting individuals’ rights and resilience. This study assesses the climate change literacy of Indonesian adolescents and its determinants. This nationwide study was conducted in 2023 in Sumatra, Java, Kalimantan, Sulawesi, and Eastern Indonesia. A total of 1126 adolescents aged 13–19 years were selected through multi-stage sampling. The data were analyzed using the chi-square test and multinomial logistic regression. This study found that 49.7% of adolescents had poor climate change literacy. In the multivariate analysis, the significantly related factors had an odds ratio of 1.66–4.75. Climate change literacy was higher in adolescents from the West and Central Regions, from public or religious schools, and those with educated parents, than in adolescents from the Eastern Region, from private or vocational schools, and those whose parents had low education, respectively. This study suggests the need to promote equality in climate change literacy among Indonesian adolescents through formal and informal education. High-quality formal education would necessitate well-trained teachers with expertise in climate change, as well as a structured, age-appropriate curriculum. Meanwhile, informal education through another information dissemination and social media-based movements can help broaden outreach among adolescents. Full article

(This article belongs to the Special Issue The Intersection of Nursing Education, Public Health and Climate Change)

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22 pages, 728 KiB

Open AccessArticle

Health Information Use and Trust: The Role of Health Literacy and Patient Activation in a Multilingual European Region

by Christian J. Wiedermann, Verena Barbieri, Stefano Lombardo, Timon Gärtner, Patrick Rina, Klaus Eisendle, Giuliano Piccoliori, Adolf Engl and Dietmar Ausserhofer

Int. J. Environ. Res. Public Health 2025, 22(4), 570; https://doi.org/10.3390/ijerph22040570 (registering DOI) - 5 Apr 2025

Abstract

The acquisition of reliable health information plays a pivotal role in shaping informed decision-making and health-related behaviours. This investigation examined the factors influencing health information use and trust in health sources among the adult population in South Tyrol, Italy, employing a population-based cross-sectional [...] Read more.

The acquisition of reliable health information plays a pivotal role in shaping informed decision-making and health-related behaviours. This investigation examined the factors influencing health information use and trust in health sources among the adult population in South Tyrol, Italy, employing a population-based cross-sectional survey (n = 2090). Descriptive analyses revealed sociodemographic disparities, with younger individuals and those with higher educational attainment demonstrating increased engagement with digital sources, while older adults and those with lower educational levels exhibited a greater reliance on traditional media and healthcare professionals. Correlation analyses showed that elevated health literacy (HLS-EU-Q16) was linked to enhanced engagement with structured and professional health sources, whereas higher patient activation (PAM-10) exhibited a negative correlation with a dependence on healthcare professionals, indicating that more activated individuals are less reliant on medical consultations for health information. Individuals reporting a better health status were less inclined to use health information sources, such as media, healthcare professionals, or the internet, as opposed to relying on personal knowledge or experience. Ordinal regression models further identified age, education, and linguistic background as crucial predictors of health information use and trust in sources. These findings highlight the influence of health literacy and patient activation on information engagement and trust and emphasise the need for tailored public health initiatives to ensure equitable access to reliable health information across diverse demographic groups. Full article

(This article belongs to the Special Issue Reducing Health Disparities: The Role of Health Literacy and Health Promotion)

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14 pages, 1404 KiB

Open AccessArticle

Relationship Between Darkness and Healing of Night Sky in Planetarium

by Midori Tanaka, Kenichi Otani and Takahiko Horiuchi

Int. J. Environ. Res. Public Health 2025, 22(4), 569; https://doi.org/10.3390/ijerph22040569 (registering DOI) - 5 Apr 2025

Abstract

This study aimed to address the unexplored relaxing effects of stargazing with different night sky darknesses in a planetarium by conducting an experiment to investigate the physiological effects of the relaxation/stress state on brain and autonomic nervous system activity, as well as the [...] Read more.

This study aimed to address the unexplored relaxing effects of stargazing with different night sky darknesses in a planetarium by conducting an experiment to investigate the physiological effects of the relaxation/stress state on brain and autonomic nervous system activity, as well as the psychological healing effects. Five healthy young women participated in our experiment. We conducted physiological measurements of oxygenated hemoglobin (OxyHb) concentration in the left and right prefrontal cortices by near-infrared spectroscopy, heart rate variability as a measure of the relaxation/stress state, and a psychological assessment of healing on an 11-point Likert scale. We used 9 types of stimuli: 6-star image stimuli that imitated dark star fields (low light pollution) to bright night sky (high light pollution), and movie stimuli that were viewed daily. The results showed that (1) visual stimulation with images of dark night sky significantly reduced the concentration of OxyHb in the right prefrontal cortex and (2) the psychological rating of healing was significantly higher compared to bright night sky. The results of this study will help solve the problems of the mental and physical effects of light pollution on astronomical observations and the reproduction of star images in planetariums. Full article

28 pages, 445 KiB

Open AccessArticle

The Emergence of AI in Public Health Is Calling for Operational Ethics to Foster Responsible Uses

by Gauthier Chassang, Jérôme Béranger and Emmanuelle Rial-Sebbag

Int. J. Environ. Res. Public Health 2025, 22(4), 568; https://doi.org/10.3390/ijerph22040568 (registering DOI) - 4 Apr 2025

Abstract

This paper discusses the responsible use of artificial intelligence (AI) in public health and in medicine, and questions the development of AI ethics in international guidelines from a public health perspective. How can a global ethics approach help conceive responsible AI development and [...] Read more.

This paper discusses the responsible use of artificial intelligence (AI) in public health and in medicine, and questions the development of AI ethics in international guidelines from a public health perspective. How can a global ethics approach help conceive responsible AI development and use for improving public health? By analysing key international guidelines in AI ethics (UNESCO, WHO, European High-Level Expert Group on AI) and the available literature, this paper advocates conceiving proper ethical and legal frameworks and implementation tools for AI in public health, based on a pragmatic risk-based approach. It highlights how ethical AI principles meet public health objectives and focuses on their value by addressing the meaning of human-centred innovations, transparency, accountability, diversity, equity, privacy protection, technical robustness, environmental protection, and post-marketing surveillance. It concludes that AI technology can reconcile individual and collective ethical approaches to public health, but requires specific legal frameworks and interdisciplinary efforts. Prospects include the development of supporting data infrastructures, of stakeholders’ involvement to ensure long-term commitment and trust, of the public’s and users’ education, and of international organisations’ capacity to coordinate and monitor AI developments. It formulates a proposal to reflect on an integrated transparent public health functionality in digital applications processing data. Full article

(This article belongs to the Special Issue Applications of Artificial Intelligence in Public Health and Medicine: From Targeted, Improved Technical Tools to a Wide, Deep Social Revolution)

15 pages, 426 KiB

Open AccessArticle

Reconfiguring Rehabilitation Services for Rural South Africans with Disabilities During a Health Emergency: A Qualitative Descriptive Study

by Litakazi Tekula, Madri Engelbrecht and Lieketseng Ned

Int. J. Environ. Res. Public Health 2025, 22(4), 567; https://doi.org/10.3390/ijerph22040567 (registering DOI) - 4 Apr 2025

Abstract

The COVID-19 pandemic and the subsequent hard lockdown in South Africa, implemented in March 2020, significantly disrupted disability and rehabilitation services. Persons with disabilities experienced limited access to essential Orthotic and Prosthetic services, particularly in rural provinces such as the Eastern Cape. This [...] Read more.

The COVID-19 pandemic and the subsequent hard lockdown in South Africa, implemented in March 2020, significantly disrupted disability and rehabilitation services. Persons with disabilities experienced limited access to essential Orthotic and Prosthetic services, particularly in rural provinces such as the Eastern Cape. This study aimed to explore how Medical Orthotists and Prosthetists reconfigured their services during and after the pandemic to inform disability-inclusive emergency responses. A descriptive qualitative study was conducted with 12 Medical Orthotists and Prosthetists practicing in the public sector in the Eastern Cape. Semi-structured interviews were conducted via MS Teams, and the data were analysed by using thematic analysis to identify key themes related to service disruptions and adaptations. Four main themes emerged: (1) disrupted access to Orthotic and Prosthetic services, (2) backlogs and limited services, (3) safety measures and adaptation control, and (4) lingering challenges and gaps. Service delivery was hindered by halted outreach clinics, limited access to materials, budget reallocations, and the deprioritisation of rehabilitation services. This study highlights the challenges faced by Medical Orthotists and Prosthetists in maintaining the functionality of Orthotic and Prosthetic services during the pandemic. These findings emphasise the need for disability-inclusive policies and strategies to ensure the continuity of rehabilitation services during emergencies. Full article

14 pages, 543 KiB

Open AccessArticle

Associations Between the Built Environment in GPS-Derived Activity Spaces and Sedentary Behavior, Light Physical Activity, and Moderate-to-Vigorous Physical Activity

by Dante G. Vittor, Jeffrey S. Wilson, Scott E. Crouter, Benjamin G. Ethier, Ling Shi, Sarah M. Camhi and Philip J. Troped

Int. J. Environ. Res. Public Health 2025, 22(4), 566; https://doi.org/10.3390/ijerph22040566 (registering DOI) - 4 Apr 2025

Abstract

Built environment and physical activity (PA) studies have predominantly used fixed or home-centric approaches to identify environmental exposures. In this study, GPS-derived daily activity spaces were used to examine the relationships between the built environment and sedentary behavior (SB), light PA (LPA), and [...] Read more.

Built environment and physical activity (PA) studies have predominantly used fixed or home-centric approaches to identify environmental exposures. In this study, GPS-derived daily activity spaces were used to examine the relationships between the built environment and sedentary behavior (SB), light PA (LPA), and moderate-to-vigorous PA (MVPA). Thirty-one adults were assessed with activity monitors and GPS units. Three types of activity spaces were created: 50 m buffered GPS tracks, minimum convex hulls (MCHs), and standard deviational ellipses (SDEs). The environmental variables included land use mix, greenness, and intersection, multi-use trail, bike infrastructure, and bike station densities. Repeated measures regression was used to test the associations for 141 person-days, controlling for age, gender, income, body mass index, crime, precipitation, and temperature. Greenness within MCH activity spaces was positively associated with LPA (p = 0.02). The bike infrastructure density within SDE spaces had a significant positive association with MVPA (p = 0.04). Multi-use trail, bike infrastructure, and bike station densities had significant negative associations with LPA (p ≤ 0.05). There were no significant adjusted associations with SB. The few significant associations in this study varied by outcome and type of activity space. Further studies are needed to determine optimal, yet flexible methods for activity spaces in built environment and PA research. Full article

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

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32 pages, 2077 KiB

Open AccessArticle

Telemedicine as an Approach to the Mental Health of Healthcare Workers in Angola

by Edmilson Serra and Teresa Magalhães

Int. J. Environ. Res. Public Health 2025, 22(4), 565; https://doi.org/10.3390/ijerph22040565 (registering DOI) - 4 Apr 2025

Abstract

Introduction: African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare. Objective: The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support [...] Read more.

Introduction: African healthcare professionals face significant mental health challenges; therefore, telemedicine can overcome geographical barriers and improve access to mental healthcare. Objective: The objective of this study was to identify the key factors influencing the adoption of telemedicine as a tool to support healthcare workers’ mental health in an Angolan healthcare network and develop a telemedicine model tailored to this context. Methodology: This mixed-method study collected quantitative data from a questionnaire applied to healthcare workers (n = 275), which were analyzed using descriptive statistics and logistic regressions. Qualitative data were obtained through structured interviews (n = 5) with psychologists and psychiatrists, and analyzed using thematic analysis in MAXQDA (Version 2022, VERBI Software, Germany), to identify recurring patterns and themes. The data were triangulated to ensure the rigor and consistency of the findings. Participation was anonymous and voluntary, and informed consent was obtained from all participants. Results: Previous experiences with mental health consultations, perceptions of teleconsultations, and doctor–patient relationship were significant in influencing telemedicine adoption by workers. The thematic analysis revealed four themes: perception and ease of telemedicine use, intention to use, and the perception of mental health in Angola. The key adoption factors for providers included project feasibility, management support, training, payment policies, and adherence to legal, ethical, and deontological standards. Conclusions: The adoption of telemedicine for occupational mental health requires culturally adapted interventions and compliance with technological and data protection standards. Hospital management must address infrastructure challenges and mental health perceptions, and implement sustainable strategies that promote occupational well-being within the organization. Full article

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

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16 pages, 288 KiB

Open AccessArticle

Pregnancy Termination Among Women of Reproductive Age: Evidence from the Indonesian Demographic and Health Survey

by Rosnani Rosnani, Rifky Octavia Pradipta, Bayu Satria Wiratama, Nelsensius Klau Fauk, Paul Russell Ward, Heri Kuswanto, Nikson Sitorus, Joni Haryanto and Hidayat Arifin

Int. J. Environ. Res. Public Health 2025, 22(4), 564; https://doi.org/10.3390/ijerph22040564 (registering DOI) - 4 Apr 2025

Abstract

The consequences associated with pregnancy termination have garnered attention from healthcare professionals, particularly in Indonesia. However, national-level evidence on the factors driving pregnancy termination in Indonesia remains limited. This research aimed to identify patterns and characteristics associated with pregnancy termination among reproductive-age women [...] Read more.

The consequences associated with pregnancy termination have garnered attention from healthcare professionals, particularly in Indonesia. However, national-level evidence on the factors driving pregnancy termination in Indonesia remains limited. This research aimed to identify patterns and characteristics associated with pregnancy termination among reproductive-age women in Indonesia. A cross-sectional study analyzed secondary data from the 2012 and 2017 Indonesian Demographic and Health Survey, involving women aged 15–49. The weighted sample included 42,269 individuals in 2012 and 47,001 in 2017. Binary logistic regression identified the correlates of pregnancy termination. Among 89,270 women of reproductive age, the prevalence of pregnancy termination was 12.68% in 2012 and 12.95% in 2017. Pregnancy termination was more frequently reported among women aged 44–49 years (adjusted odds ratio (AOR): 4.34, 95% confidence interval (CI): 3.54–5.33), those with secondary education (AOR: 1.29, 95% CI: 1.14–1.46), married women (AOR: 195.40, 95% CI: 114.70–332.90), employed women (AOR: 1.05, 95% CI: 1.00–1.09), individuals with health insurance (AOR: 1.07, 95% CI: 1.02–1.11), those who had experienced domestic violence (AOR: 1.07, 95% CI: 1.02–1.11), and regular television viewers (AOR: 1.10, 95% CI: 1.05–1.15). Conversely, pregnancy termination was less commonly reported among women with 1–2 living children (AOR: 0.80, 95% CI: 0.74–0.87), those who expressed no preference for having more children (AOR: 0.89, 95% CI: 0.84–0.94), and women using modern contraception (AOR: 0.76, 95% CI: 0.72–0.80). The findings revealed that the prevalence did not observe any changes in the incidence of pregnancy terminations between 2012 and 2017. Further evaluation by healthcare professionals is crucial to understanding the reasons behind pregnancy termination, especially among women of reproductive age. Insights into factors related to pregnancy termination, especially sociodemographic factors, can help mitigate the pregnancy termination in this population. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Global Perspective: Disease and Threats)

11 pages, 272 KiB

Open AccessBrief Report

Perceived Benefits of Nature in Diverse Populations

by Joy L. Hart, Kandi L. Walker, Cameron K. Stopforth, Anna Simpson, Aruni Bhatnagar and Rachel J. Keith

Int. J. Environ. Res. Public Health 2025, 22(4), 563; https://doi.org/10.3390/ijerph22040563 - 4 Apr 2025

Abstract

The relationship between socioeconomic and demographic characteristics and health effects of green spaces has been studied, suggesting that certain groups may reap more health benefits from exposure to nature. However, the link between the perceived benefits of nature and socioeconomic and demographic characteristics [...] Read more.

The relationship between socioeconomic and demographic characteristics and health effects of green spaces has been studied, suggesting that certain groups may reap more health benefits from exposure to nature. However, the link between the perceived benefits of nature and socioeconomic and demographic characteristics remains a gap in the literature. We used a subsample (n = 711, 2018–2019) from an environmental cardiovascular risk cohort to investigate the perceived benefits of nature. Participants completed an 11-item survey about their perceptions of the benefits of nature at in-person visits. Socioeconomic and demographic characteristics including income, education, race, biological sex at birth, and age, were self-reported. Generalized linear models were used to evaluate associations between the perceived benefits of nature and demographic and socioeconomic factors; odds ratios and 95% confidence intervals (CIs) are reported. Both unadjusted and fully adjusted models for race, age, sex, and education are reported. Our results suggest that participants who identified as male, a member of a minoritized population, and/or completing less education perceived nature as less beneficial. Although additional research is needed to better understand contributors to these perceptions, access to convenient, safe, and multi-use green spaces may be important in encouraging time in nature and shifting perceptions of the benefits of greenness. Full article

22 pages, 2191 KiB

Open AccessArticle

Predictive Modeling for Pandemic Forecasting: A COVID-19 Study in New Zealand and Partner Countries

by Oras Baker, Zahra Ziran, Massimo Mecella, Kasthuri Subaramaniam and Sellappan Palaniappan

Int. J. Environ. Res. Public Health 2025, 22(4), 562; https://doi.org/10.3390/ijerph22040562 - 4 Apr 2025

Abstract

This study proposes a data-driven approach to leveraging large-scale COVID-19 datasets to enhance the predictive modeling of disease spread in the early stages. We systematically evaluate three machine learning models—ARIMA, Prophet, and LSTM—using a comprehensive framework that incorporates time-series analysis, multivariate data integration, [...] Read more.

This study proposes a data-driven approach to leveraging large-scale COVID-19 datasets to enhance the predictive modeling of disease spread in the early stages. We systematically evaluate three machine learning models—ARIMA, Prophet, and LSTM—using a comprehensive framework that incorporates time-series analysis, multivariate data integration, and a Multi-Criteria Decision Making (MCDM) technique to assess model performance. The study focuses on key features such as daily confirmed cases, geographic variations, and temporal trends, while considering data constraints and adaptability across different scenarios. Our findings reveal that LSTM and ARIMA consistently outperform Prophet, with LSTM achieving the highest predictive accuracy in most cases, particularly when trained on 20-week datasets. ARIMA, however, demonstrates superior stability and reliability across varying time frames, making it a robust choice for short-term forecasting. A direct comparative analysis with existing approaches highlights the strengths and limitations of each model, emphasizing the importance of region-specific data characteristics and training periods. The proposed methodology not only identifies optimal predictive strategies but also establishes a foundation for automating predictive analysis, enabling timely and data-driven decision-making for disease control and prevention. This research is validated using data from New Zealand and its major trading partners—China, Australia, the United States, Japan, and Germany—demonstrating its applicability across diverse contexts. The results contribute to the development of adaptive forecasting frameworks that can empower public health authorities to respond proactively to emerging health threats. Full article

(This article belongs to the Special Issue 2nd Edition of Epidemiology and Global Health)

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30 pages, 2976 KiB

Open AccessArticle

Linking Household and Service Provisioning Assessments to Estimate a Metric of Effective Health Coverage: A Metric for Monitoring Universal Health Coverage

by Veenapani Rajeev Verma, Shyamkumar Sriram and Umakant Dash

Int. J. Environ. Res. Public Health 2025, 22(4), 561; https://doi.org/10.3390/ijerph22040561 - 3 Apr 2025

Abstract

Background: The framework of measuring effective coverage is conceptually straightforward, yet translation into a single metric is quite intractable. An estimation of a metric linking need, access, utilization, and service quality is imperative for measuring the progress towards Universal Health Coverage. A coverage [...] Read more.

Background: The framework of measuring effective coverage is conceptually straightforward, yet translation into a single metric is quite intractable. An estimation of a metric linking need, access, utilization, and service quality is imperative for measuring the progress towards Universal Health Coverage. A coverage metric obtained from a household survey alone is not succinct as it only captures the service contact which cannot be considered as actual service delivery as it ignores the comprehensive assessment of provider–client interaction. The study was thus conducted to estimate a one-composite metric of effective coverage by linking varied datasets. Methods: The study was conducted in a rural, remote, and fragile setting in India. Tools encompassing a household survey, health facility assessment, and patient exit survey were administered to ascertain measures of contact coverage and quality. A gamut of techniques linking the varied surveys were employed such as (a) exact match linking and (b) ecological linking using GIS approaches via administrative boundaries, Euclidean buffers, travel time grid, and Kernel density estimates. A composite metric of effective coverage was estimated using linked datasets, adjusting for structural and process quality estimates. Further, the horizontal inequities in effective coverage were computed using Erreygers’ concentration index. The concordance between linkage approaches were examined using Wald tests and Lin’s concordance correlation. Results: A significantly steep decline in measurement estimates was found from crude coverage to effective coverage for an entire slew of linking approaches. The drop was more exacerbated for structural-quality-adjusted measures vis-à-vis process-quality-adjusted measures. Overall, the estimates for effective coverage and inequity-adjusted effective coverage were 36.4% and 33.3%, respectively. The composite metric of effective coverage was lowest for postnatal care (10.1%) and highest for immunization care (78.7%). A significant absolute deflection ranging from −2.1 to −5.5 for structural quality and −1.9 to −8.9 for process quality was exhibited between exact match linking and ecological linking. Conclusions: Poor quality of care was divulged as a major factor of decline in coverage. Policy recommendations such as bolstering the quality via the effective implementation of government flagship programs along with initiatives such as integrated incentive schemes to attract and retain workforce and community-based monitoring are suggested. Full article

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

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24 pages, 4089 KiB

Open AccessArticle

Study of the Trace Element Composition of Drinking Water in Almaty City and Human Health Risk Assessment

by Marina Krasnopyorova, Igor Gorlachev, Pavel Kharkin, Mariya Severinenko and Dmitriy Zheltov

Int. J. Environ. Res. Public Health 2025, 22(4), 560; https://doi.org/10.3390/ijerph22040560 - 3 Apr 2025

Abstract

This research investigates the elemental composition of 78 drinking water samples collected during the summer, autumn, and winter of 2023 in different districts of Almaty city. Seasonal average concentrations and standard deviations were calculated for a range of chemical elements, including arsenic (As), [...] Read more.

This research investigates the elemental composition of 78 drinking water samples collected during the summer, autumn, and winter of 2023 in different districts of Almaty city. Seasonal average concentrations and standard deviations were calculated for a range of chemical elements, including arsenic (As), beryllium (Be), cobalt (Co), cadmium (Cd), copper (Cu), lithium (Li), molybdenum (Mo), nickel (Ni), lead (Pb), selenium (Se), uranium (U), mercury (Hg), aluminum (Al), barium (Ba), chromium (Cr), iron (Fe), manganese (Mn), strontium (Sr), vanadium (V), zinc (Zn), calcium (Ca), potassium (K), magnesium (Mg), and sodium (Na), across three distinct datasets. The sites of sampling represent various categories of drinking water sources. The quality of drinking water was assessed by comparing the obtained data with current national, international, and World Health Organization (WHO) standards. Drinking water contaminant indices for the heavy metal groups were calculated and the water quality compliance with the hygienic criteria adopted in the Republic of Kazakhstan was determined. With the exception of two sampling points, the levels of non-carcinogenic risk remained below the acceptable threshold. The predominant pathway for exposure for both adults and children was identified as the oral ingestion of hazardous elements. Carcinogenic risks linked to Ni, Pb, and Cr presence in the drinking water of Almaty were identified, with risk values at the majority of sampling sites categorically classified within the “high risk” designation. No substantial differences in carcinogenic risk levels were detected between adults and children. These results underscore the necessity for enhanced water purification methodologies and ongoing surveillance to protect public health. Full article

(This article belongs to the Section Environmental Sciences)

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31 pages, 2665 KiB

Open AccessCase Report

A Case Report on How BOAM Offers a Brief Family-Based Treatment by Integrating Psychoeducation and Self-Diagnostics

by Eva S. Potharst, Damiët Truijens, Francisca J. A. van Steensel, Steve Killick and Susan M. Bögels

Int. J. Environ. Res. Public Health 2025, 22(4), 559; https://doi.org/10.3390/ijerph22040559 - 3 Apr 2025

Abstract

BOAM is a family-based method in which children and parents together create an explanatory, personal and systemic diagnosis. Based on ten playful and visual models, the therapist provides universal psychoeducation to gain insight into the personal, relational and contextual causes of the child’s [...] Read more.

BOAM is a family-based method in which children and parents together create an explanatory, personal and systemic diagnosis. Based on ten playful and visual models, the therapist provides universal psychoeducation to gain insight into the personal, relational and contextual causes of the child’s problems for a shared understanding of how to approach them. This case report describes a seven-session BOAM trajectory in a family with a 6-year-old child with emotional and behavioural dysregulation, such as frequent temper tantrums, hitting her infant sister, and threatening with knives. In this case report, the course of the sessions is described, including the way the family applied the BOAM models within their (cultural) family values. The mother completed questionnaires on child psychopathology (Child Behaviour Checklist), executive functioning (Behaviour Rating Inventory of Executive Function), parenting stress (Parenting Stress Index) and partner relationship (Family Functioning Questionnaire) at baseline, pretest, post-test, and 3- and 5-month follow-up, and the father completed questionnaires on child psychopathology and parenting stress at baseline and 5-month follow-up. Parents reported clinically significant improvements, as calculated with reliable change indexes, in child externalising psychopathology, self-regulation, and parenting stress (post-test and 3- and 5-month follow-up). BOAM is a short and accessible method for psychoeducation, diagnostics and treatment. BOAM seems to be an effective intervention for this family; however, more research is necessary to demonstrate its effectiveness. This case report painted a vivid picture of how family conversations can be structured and targeted using the models. Full article

(This article belongs to the Special Issue Family-Based Treatment Approaches in Child and Adolescent Mental Health Services)

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38 pages, 1083 KiB

Open AccessArticle

A Qualitative Study Exploring How the Perspectives and Experiences of Cisgender Black Women Inform Their Readiness to Consider Pre-Exposure Prophylaxis for HIV Prevention

by Mandy J. Hill, Amber I. Sophus, Aaliyah Gray and Jaylen I. Wright

Int. J. Environ. Res. Public Health 2025, 22(4), 558; https://doi.org/10.3390/ijerph22040558 - 3 Apr 2025

Abstract

Attention to increasing pre-exposure prophylaxis (PrEP) use among cisgender Black women (CBW) in the southern United States (U.S.) is necessary to achieve national 2030 Ending the HIV Epidemic (EHE) goals. Qualitative exploration of CBW’s readiness to use PrEP is necessary to discern whether [...] Read more.

Attention to increasing pre-exposure prophylaxis (PrEP) use among cisgender Black women (CBW) in the southern United States (U.S.) is necessary to achieve national 2030 Ending the HIV Epidemic (EHE) goals. Qualitative exploration of CBW’s readiness to use PrEP is necessary to discern whether practical solutions to addressing PrEP uptake within this HIV-vulnerable population are feasible. Focus group discussions (n = 5) and key informant interviews (n = 3) in two EHE jurisdictions in Houston and Austin, Texas were used to explore how perspectives and lived experiences may serve as facilitators and/or barriers to PrEP readiness among 20 CBW. Codes highlighted facilitators and barriers to PrEP readiness. Facilitators involved positive experiences with the healthcare system, high perceived HIV vulnerability, and prioritizing PrEP as self-care. Barriers encompassed concerns with sexual relationship dynamics, mental health implications, and access to humane treatment within the healthcare system. High perceived vulnerability of HIV acquisition is related to an awareness that CBW may not know the entirety of their partner’s sexual activities. Findings indicate precursors of PrEP readiness and challenge the notion that CBW have low perceived vulnerability of acquiring HIV. Full article

(This article belongs to the Special Issue Promoting Women's Sexual and Reproductive Health)

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20 pages, 853 KiB

Open AccessReview

Assessment of Sport and Physical Recreation Participation for Children and Youth with Disabilities: A Systematic Review

by Georgina Leigh Clutterbuck, Eugeenia Wen and Sara Petroccitto

Int. J. Environ. Res. Public Health 2025, 22(4), 557; https://doi.org/10.3390/ijerph22040557 - 3 Apr 2025

Abstract

Accurate measurement of participation in sport/physical recreation for children with disabilities is important due to decreased physical activity in this population. This review examines the psychometric properties of relevant assessments. Four databases were searched for studies investigating assessments of participation in sport/physical recreation [...] Read more.

Accurate measurement of participation in sport/physical recreation for children with disabilities is important due to decreased physical activity in this population. This review examines the psychometric properties of relevant assessments. Four databases were searched for studies investigating assessments of participation in sport/physical recreation for children and youth with disabilities. The assessment content was analyzed by the proportion of items relevant to sport/physical recreation and the inclusion of participation elements (attendance or involvement). The evidence quality was evaluated using COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklists and summarized according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Nine assessments (46 papers) met criteria. Only the Children’s Assessment of Participation and Enjoyment measured attendance and involvement. Five assessments measured attendance (12–90% items related to sport/physical recreation) and three context-dependent assessments measured involvement. Only the Measure of Experiential Aspects of Participation and Self-reported Experiences of Activity Settings (involvement) were recommended by GRADE. No assessment adequately measured attendance and involvement in sport/physical recreation for children and youth with disabilities. While existing assessments may continue to be used to measure global participation, a comprehensive assessment of sport and physical recreation should be developed with and evaluated for children and youth with disabilities. Full article

(This article belongs to the Special Issue Health Intervention for Young Children with or at Risk for Disabilities)

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