International Journal Of Environmental Research And Public Health[JOURNAL]
Sun
200 papers
Organization and Integration of Care in the HIV-Non-Communicable Disease Syndemic: A Rapid Scoping Review.
Costa KTDS, Targino MFDCM, Ludugerio PIT … +3 more , de Medeiros GCBS, Piuvezam G, da Silva RAR
Int J Environ Res Public Health · 2026 May · PMID 42196733 · Full text
Advances in antiretroviral therapy have transformed infection with HIV into a manageable chronic disease, increasing the survival of people living with HIV, who are also undergoing a demographic aging process marked by t...
Advances in antiretroviral therapy have transformed infection with HIV into a manageable chronic disease, increasing the survival of people living with HIV, who are also undergoing a demographic aging process marked by the emergence of non-communicable chronic diseases. This study aims to map and analyze how the scientific literature addresses the organization and integration of care in the HIV-NCD syndemic, identifying implications for nursing and for health systems. This is a Rapid Scoping Review, using the databases PubMed, Scopus, CINAHL, and LILACS. Data synthesis was conducted using Microsoft Excel. The research was structured using the PCC framework: Population-people living with HIV (≥18 years); Concept-organization and integration of care in the HIV-NCD syndemic, including care models, care coordination, service integration, and the role of nursing; and Context-health services and systems. Twenty-three studies were included, most of which used qualitative methodology, were conducted in sub-Saharan Africa, and had predominantly female samples. This study demonstrated that the organization of care in the HIV-NCD syndemic remains predominantly characterized by fragmented models, which are insufficient to address the complexity of multimorbidity. Integrated care models emerge as a promising strategy; however, their effects remain limited in settings marked by health inequalities.
Comparative Analysis of Psychosocial Risks and Leadership in Municipal Government Agencies: A Study Based on NOM-035-STPS-2018 in Zacatecas, Mexico.
Villagrán Rueda S, Alvarado-Peña LJ, Vega Osuna LA … +5 more , Salaiza Lizárraga FC, Ruvalcaba Sánchez MLG, Santos-Hernández BL, Muñóz Castorena RV, Martínez WFR
Int J Environ Res Public Health · 2026 May · PMID 42196732 · Full text
The public sector constitutes a complex system of psycho-affective management, where leadership and autonomy are crucial for institutional efficacy. The objective of this study was to analyze the relationship between lea...
The public sector constitutes a complex system of psycho-affective management, where leadership and autonomy are crucial for institutional efficacy. The objective of this study was to analyze the relationship between leadership, autonomy (control over work), and other psychosocial risk factors across six departments of a government agency in Mexico, under the framework of NOM-035-STPS-2018. A quantitative, cross-sectional, and correlational design was utilized with 235 public servants, employing Reference Guide III of the official standard to identify psychosocial risk categories. The results, analyzed through Welch and Games-Howell tests, reveal significant differences based on the operational nature of each unit. Public Safety and Civil Protection present critical risks due to high demand and low control. The Municipal DIF (System for the Integral Development of the Family) stands out as a protective environment thanks to its positive leadership. A statistically significant association was identified between lower leadership quality and a decrease in work autonomy ( = 0.701), along with a consistently low perception of performance recognition across all evaluated departments ( = 0.056). It is concluded that management style influences the perception of psychosocial risk, suggesting the need for interventions centered on humanistic leadership to mitigate occupational stress.
Orthorexia Nervosa in Bodybuilders: Exploring a Critical Research Gap and the Role of Social Media and Self-Monitoring Applications.
D'Apolito F, Bulbarelli A, Lonati E … +2 more , Palestini P, Cazzaniga E
Int J Environ Res Public Health · 2026 May · PMID 42196731 · Full text
Bodybuilding aims to achieve a muscular physique through intensive resistance training and strict dietary control. Athletes in this sport could be at risk of disordered eating behaviors; however, limited evidence exists...
Bodybuilding aims to achieve a muscular physique through intensive resistance training and strict dietary control. Athletes in this sport could be at risk of disordered eating behaviors; however, limited evidence exists regarding its association with ON. Social media use and Weight-Related Self-Monitoring (WRSM) applications may contribute to ON symptoms by reinforcing rigid dietary behaviors. These aspects remain underexplored in the current literature, particularly within the sporting context. This narrative review aimed to synthesize current evidence on the potential association between bodybuilding and ON, and to examine the influence of social media and weight-related self-monitoring (WRSM) applications on its development. Literature searches included the terms "bodybuilding AND orthorexia nervosa", "bodybuilding AND eating disorders", "bodybuilding AND social media", "bodybuilding AND aesthetic pressure", "orthorexia nervosa", "orthorexia nervosa AND social media", "fitness influencers" and "orthorexia nervosa in sport". Available evidence suggests that bodybuilders may present risk factors for orthorexic tendencies, including dietary rigidity, body image centrality, perfectionism, and compulsive exercise. Social media may contribute by promoting unrealistic aesthetic standards, potentially reinforcing disordered eating patterns. Although direct data in bodybuilding are limited, findings indicate a plausible vulnerability profile. Monitoring and preventive strategies may be warranted to reduce the risk of onset or exacerbation of comorbid eating disorders.
Influence of Social Media on Self-Medication Behavior: A Study on Ozempic Use Among Emirati University Students.
Jeljeli R, Farhi F, El-Dahiyat F … +2 more , Alsbou M, Babar ZU
Int J Environ Res Public Health · 2026 May · PMID 42196730 · Full text
INTRODUCTION: Self-medication has become a growing concern, especially in the current era of digitalization. The ubiquitous access to social media platforms has been associated with this behaviour due to factors like bod...
INTRODUCTION: Self-medication has become a growing concern, especially in the current era of digitalization. The ubiquitous access to social media platforms has been associated with this behaviour due to factors like body image leading to weight loss obsession and seeking solutions to achieve the ideal body image and weight. AIMS: This research also examined the relationship between Social Media Usage and Self-Medication, Weight Loss Obsession, and further Intention to Use Ozempic (semaglutide) among university students in the United Arab Emirates. METHODS: The researchers used a cross-sectional design and gathered data from students enrolled at Al Ain University, United Arab Emirates. Data were analyzed using SPSS (Version 29) and SmartPLS software (Version 4). Descriptive statistics and Partial Least Squares Structural Equation Modelling (PLS-SEM) were employed to examine relationships among variables based on the Self-Medication Theory by Khantzian. RESULTS: It was found that Social Media Usage was significantly linked with Self-Medication behaviour among the students. Also, this usage makes individuals conscious about weight and body image as important concerns. Finally, Social Media Usage was also significantly linked with Intention to Use Ozempic for weight loss without medical prescriptions and doctor consultations. CONCLUSIONS: It is concluded that self-medication for weight loss disregards the significance of maintaining a well-balanced diet and regular exercise, leading to serious health risks, i.e., nutritional deficiencies, metabolic disorders, and negative effects on mental well-being. Educating and informing young individuals about the importance of adopting healthy and sustainable weight loss processes is important, underlining the need for professional guidance, nutrition education, and promoting a positive body image. This approach may help reduce the harmful outcomes associated with self-medication for weight loss.
Family-Based Preventive Interventions for Problematic Internet Use Among Children and Adolescents: Protocol for a Systematic Review and Meta-Analysis.
Moriyama S, Takahashi M, Hayashi A … +1 more , Harada T
Int J Environ Res Public Health · 2026 May · PMID 42196729 · Full text
Problematic internet use among children and adolescents is a major public health concern. In this protocol, it is defined as construct encompassing problematic gaming, social media use, smartphone use, and undifferentiat...
Problematic internet use among children and adolescents is a major public health concern. In this protocol, it is defined as construct encompassing problematic gaming, social media use, smartphone use, and undifferentiated use, characterized by impaired control, prioritization, and persistence despite harm. It is associated with academic, sleep, and psychosocial difficulties. However, preventive interventions-particularly family-based-remain underexplored despite evidence linking parenting and family functioning to risk. This protocol outlines systematic review and meta-analysis of family-based preventive interventions among children and adolescents (6-18 years). Randomized controlled, quasi-randomized, cluster-randomized, and quasi-experimental studies with parallel comparison groups will be included. Comparators defined as no intervention, waitlist, usual care, or non-family-based prevention. Searches will be conducted in CENTRAL, PubMed, PsycINFO, Web of Science, and CiNii Research, supplemented by reference screening. Risk-of-bias will be assessed using RoB 2 and ROBINS-I. Primary outcomes include changes in overall and subtype-specific severity; secondary outcomes include use time, family functioning, and parental involvement. Random-effects meta-analyses with Hartung-Knapp adjustment will be conducted when ≥3 homogeneous studies are available; otherwise, findings will be synthesized narratively following the Synthesis Without Meta-analysis guideline. This review will synthesize current evidence and clarify role of family-based prevention, informing research and public health strategies.
Nicotine Risk Education and Its Impact on Knowledge, Perceptions, and Behavioral Intentions: A Scoping Review of U.S. Studies.
Imran R, Patel A, Snell M
Int J Environ Res Public Health · 2026 May · PMID 42196728 · Full text
Smoking combustible cigarettes causes an enormous health and financial burden in the U.S. Across tobacco and nicotine products, cigarettes are ranked as the most toxic. Any harm reduction efforts rely on smokers understa...
Smoking combustible cigarettes causes an enormous health and financial burden in the U.S. Across tobacco and nicotine products, cigarettes are ranked as the most toxic. Any harm reduction efforts rely on smokers understanding nicotine's absolute and relative health risk potential, but many studies reveal widespread misperceptions. To inform policies focused on reducing the public health burden of smoking, it is essential to understand whether conveying accurate absolute and relative risk information about nicotine and its delivery methods may shift risk perceptions and impact use behaviors. To fill this gap, we conducted a systematic search, using PubMed, PsycINFO, and Google Scholar, for original U.S. studies investigating effects of exposure to educational messages about (1) nicotine's addictive and health risk properties or (2) relative risk information on participants' nicotine knowledge, perceptions, behavioral attentions, and/or use behaviors. Across studies of predominantly fair methodological quality, message exposure was consistently associated with improvements in knowledge and risk perceptions; however, findings were mixed regarding behavioral intentions, and the evidence base is limited by short-term experimental designs without longitudinal follow-up. Our results highlight the potential for educational interventions to increase nicotine knowledge more broadly and reveal important considerations for using education to try to shift behavior among individuals who smoke.
Association of Psychological Safety with PTSD Symptoms Among Regional Firefighters in South Korea: Moderating Roles of Occupational Identity and Peer Support.
Jung JY, Kim GG
Int J Environ Res Public Health · 2026 May · PMID 42196727 · Full text
Firefighters are repeatedly exposed to occupational trauma in high-risk work settings, and PTSD symptoms represent an important occupational and public health concern. This study examined the association between psycholo...
Firefighters are repeatedly exposed to occupational trauma in high-risk work settings, and PTSD symptoms represent an important occupational and public health concern. This study examined the association between psychological safety and PTSD symptoms among firefighters and tested whether this association is conditioned by occupational identity and peer support within an occupational health framework. A cross-sectional survey was conducted with 314 firefighters in Gyeongsangbuk-do, South Korea. PTSD symptoms were assessed using eight selected items adapted from the PCL-5 representing core symptom domains. Confirmatory factor analysis, correlation analysis, and regression analysis were performed, and moderation analyses were conducted using PROCESS Macro (Model 1). Results indicated that psychological safety was negatively associated with PTSD symptoms. Both occupational identity and peer support significantly conditioned this association. The negative association was consistently observed across all levels of occupational identity, whereas it was significant only at or above the mean level of peer support. These findings suggest that psychological safety may be understood as an organizational resource related to PTSD symptoms in high-risk occupational contexts, while occupational identity and peer support may function as individual and social resources that condition this association. The findings highlight the importance of understanding occupational mental health based on the integrated roles of organizational, individual, and social resources.
"Okay, So It's Not Me"-The of Formal and Informal Reporting of Sexual Harassment in Academia.
Binik O, Ginocchio D, Cricenti C … +6 more , Ferrari S, Addabbo T, Merzagora I, Giannini AM, Zara G, De Fazio GL
Int J Environ Res Public Health · 2026 May · PMID 42196726 · Full text
Sexual harassment (SH) in academia constitutes a pervasive form of gender-based violence that undermines individual well-being and academic equity. While existing research has largely investigated risk factors, less atte...
Sexual harassment (SH) in academia constitutes a pervasive form of gender-based violence that undermines individual well-being and academic equity. While existing research has largely investigated risk factors, less attention has been paid to protective factors, coping strategies, and the cumulative burden generated by the reporting process itself. This qualitative study explores how victims of SH in Italian universities mobilize resources when disclosing their experiences informally to peers and colleagues or formally through institutional channels and how this process generates : the cumulative cognitive, emotional, and practical labor victims have to perform as a direct consequence of inadequate institutional responses. Drawing on semi-structured interviews, we employed thematic and dialogical narrative analyses to examine cognitive, emotional, and behavioral coping dimensions. Findings highlight the central role of informal networks in enabling victims to recognize harassment, validate their narratives, and mobilize coping strategies. Trusted colleagues and supportive professors provided cognitive clarity, emotional relief, and practical protection. However, institutional responses were frequently perceived as inadequate or emotionally detached, reinforcing self-doubt and generating significant extra-fatigue to absorb largely alone or through informal support. Understanding extra-fatigue as structurally produced labor, rather than individual fragility, has implications for designing victim-centered institutional responses and structural reform in universities.
Public Knowledge and Attitudes Towards Clinical Trial Participation: A Mixed-Method Study in Bagamoyo District, Tanzania.
Mghanga S, Mtenga AE, Pasape L … +1 more , Olotu A
Int J Environ Res Public Health · 2026 May · PMID 42196725 · Full text
BACKGROUND: Clinical trials are important for advancing medical knowledge and improving healthcare delivery. However, participants' knowledge and attitudes towards clinical trials remain a key challenge affecting clinica...
BACKGROUND: Clinical trials are important for advancing medical knowledge and improving healthcare delivery. However, participants' knowledge and attitudes towards clinical trials remain a key challenge affecting clinical trial recruitment and participant retention. Therefore, this study aimed to assess the knowledge and attitudes of the Bagamoyo district towards participation in clinical trials. METHODS: A convergent parallel mixed-methods study was conducted among adults in the Bagamoyo district. Multistage stratified random sampling was used to select participants. Quantitative data were analysed descriptively and using logistic regression, while qualitative data were analysed thematically using NVivo. RESULTS: Among 394 recruited participants, 293 (74.4%) were female and 101 (25.6%) were male. Most participants had a primary-level education (266, 67.5%), while 128 (32.5%) had secondary or tertiary education. The majority were married (297, 75.4%) and 97 (24.6%) were either separated or unmarried. Regarding economic status, 244 participants (61.9%) earned less than TZS 50,000. General knowledge of clinical trials was low, with most participants scoring below 60%. However, we found a positive attitude towards participation in clinical trials. Logistic regression revealed that poor knowledge was significantly associated with being male (AOR, 22.95 (95% CI: 10.27-51.28, = 0.001)), age above 55 years (AOR of 2.43 (95% CI: 1.29-4.55, = 0.006)), and unemployment (AOR of 2.39 (95% CI: 1.27-4.53, = 0.007)). Positive attitudes towards clinical trial participation were significantly associated with being female (AOR) 7.61 (95% CI: 4.32-13.39, < 0.001), age 44 years and below, (AOR: 2.22 (95% CI: 1.27-3.86, = 0.005), and employment (AOR of 1.89 (95% CI: 1.08-3.32, = 0.03). CONCLUSIONS: Despite low levels of knowledge, the general population in the Bagamoyo district demonstrated a high willingness to participate in clinical trials. To address the knowledge gap, targeted educational interventions should focus on older adults and the unemployed. Furthermore, policies supporting community outreach and awareness campaigns may help strengthen public understanding and sustain positive attitudes toward clinical research.
Participation Mediates the Relationship Between Family Climate and Mental Well-Being Amongst Children with and Without Disability in a Cross-Sectional Swedish Registry-Based Study.
Homman L, Augustine L, Granlund M
Int J Environ Res Public Health · 2026 May · PMID 42196724 · Full text
Poor mental health (problems and well-being) among children, particularly those with disabilities, represents a significant individual and public health burden, with multifactorial origins including family environment an...
Poor mental health (problems and well-being) among children, particularly those with disabilities, represents a significant individual and public health burden, with multifactorial origins including family environment and participation limitations. Family climate also impacts participation, suggesting the three structures may be interlinked. Furthermore, children with disabilities face additional obstacles increasing their vulnerability to poor mental health, such as limitations to participation. Therefore, the present study aimed to (1) investigate whether participation mediated the relationship between family climate and mental health and (2) whether possible relationships differed by disabilities. The Swedish Statistics (SCB) register on the conditions of life for children (barnULF) was utilised. This interview-based registry study employs a repeated cross-sectional design, where children are recruited yearly and invited to participate in the study. The present study used data from 2013-2019, resulting in 3676 children aged 10-18, of whom 510 reported some type of disability. Structural Equation Models (SEMs) mediation analyses were conducted to assess the possible mediating role of participation between family climate and mental health (well-being and problems separately), including models with and without covariates (age and gender). Multigroup analyses were conducted to assess whether children with and without disability differed. Results showed that participation significantly mediated the relationship between family climate and mental well-being but not mental health problems, amongst all children. Models including covariates indicated mediating models for both well-being and problems, but only amongst children without disabilities. However, model fits were poor. Implications of the study direct preventative strategies to focus on family climate as a route to improve mental well-being and highlight the importance of earlier strategies amongst children with disabilities and in particular girls.
Feasibility and Acceptability of a School-Based Nutrition Education Toolkit: Findings from an Expert Review.
Sullivan A, Kubinsky B, McNamara J
Int J Environ Res Public Health · 2026 May · PMID 42196723 · Full text
Helping Early Adolescents Live Their Healthiest Youth (HEALTHY) is a theory-driven, school-based nutrition education program grounded in frozen-fruit smoothie taste tests that has been shown to improve fruit intake and p...
Helping Early Adolescents Live Their Healthiest Youth (HEALTHY) is a theory-driven, school-based nutrition education program grounded in frozen-fruit smoothie taste tests that has been shown to improve fruit intake and promote nutrition security among rural adolescents. To support broader dissemination, a comprehensive implementation toolkit and website were developed. This study conducted an expert review to evaluate the feasibility, clarity, and acceptability of the HEALTHY Toolkit. A survey collected quantitative (Likert-scale) and qualitative (open-ended) data, which were analyzed using descriptive statistics and content analysis. Experts ( = 15) primarily included Registered Dietitians (40%, = 6) and school nutrition professionals (33%, = 5). Experts reported high agreement that the HEALTHY Toolkit provided sufficient detail and guidance for implementation, indicating strong feasibility, clarity, and acceptability. Mean scores across Toolkit sections were high: Part I. Foundations (4.70 ± 0.26), Part II. Program Design and Implementation (4.64 ± 0.41), and Part III. Tools and Resources (4.14 ± 0.17). These findings support the use of formative evaluation approaches, such as expert review, to optimize implementation resources and strengthen readiness before dissemination. Overall, the HEALTHY Toolkit was perceived as a promising resource for supporting the implementation of the HEALTHY program.
What Drives Nutritional Supplement Use Among Academics? An Intention-Behavior Model of Motivation, Work Stress, and Digital Influences.
Önem Ş
Int J Environ Res Public Health · 2026 May · PMID 42196722 · Full text
Nutritional supplement use has emerged as an important health-related consumption behavior in digitalized environments, with implications for both public health and individual well-being. While prior research has largely...
Nutritional supplement use has emerged as an important health-related consumption behavior in digitalized environments, with implications for both public health and individual well-being. While prior research has largely focused on general populations, limited attention has been paid to how occupational pressures and digital information contexts jointly shape supplement-related decision-making among highly educated professionals. Addressing this gap, this study examines the behavioral determinants of nutritional supplement use among academics within an intention-behavior framework. Using survey data collected from academic professionals, the proposed model was tested through confirmatory factor analysis and structural equation modeling. The findings reveal that health motivation and academic work stress significantly predict supplement use intention, which, in turn, strongly influences actual consumption behavior. In contrast, digital health literacy and digital marketing exposure do not exert significant direct effects on usage intention. These results provide theoretical insight into the boundary conditions of informational determinants in consumer behavior models, suggesting that intrinsic motivation and contextual stressors may play a more dominant role than digital influences among highly educated consumers. From a practical perspective, the findings highlight the importance of addressing stress-related health coping mechanisms and motivation-driven behaviors in promoting informed supplement use.
Left Out and At Risk: Post-Pandemic Continuation of Organizational Service Reduction in Metropolitan New York City Coincides with Rise in Opiate Use and Mental Health Problems for Latinos.
Campbell RL, Dewan SE
Int J Environ Res Public Health · 2026 May · PMID 42196721 · Full text
Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New Y...
Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New York State (NYS). Guided by a Vulnerability Model and a framework of organizational enabling resources, this study used complementary longitudinal and cross-sectional designs. The longitudinal component examined changes in levels of organizational facilitators for Latino substance use disorder (SUD) help-seeking in Downstate NYS across three time periods, while the cross-sectional component compared post-pandemic facilitator levels across service types and regions. A convenience sample of 241 SUD clinicians participated in the longitudinal analysis. A sample of 150 clinicians whose practice information varied by location and service type participated in the post-pandemic cross-sectional comparisons. The findings revealed that the proportion of clinicians reporting organizational facilitation of Latino SUD help-seeking in Downstate NYS has diminished significantly from pre-pandemic levels, with little recovery. Cross-sectional analyses revealed no significant differences in clinician estimation of post-pandemic organizational resources by region or service type. The findings suggest that the organizational bulwarks against SUD and mental health problems are not sufficient to mitigate public health risk for NYS Latinos in the post-pandemic period. Recommendations informed by provider perspectives are discussed.
Spatio-Temporal COVID-19 Modeling: A Global Systematic Review of Data Integration, Equity, and Lessons for Pandemic Preparedness.
Norlund P, Arsanjani JJ, Paasch JM
Int J Environ Res Public Health · 2026 May · PMID 42196720 · Full text
The COVID-19 pandemic generated an unprecedented volume of spatially and temporally resolved data, enabling rapid development of spatio-temporal models for surveillance, forecasting, and policy support. However, the evol...
The COVID-19 pandemic generated an unprecedented volume of spatially and temporally resolved data, enabling rapid development of spatio-temporal models for surveillance, forecasting, and policy support. However, the evolution, geographic distribution, and equity implications of these models remain insufficiently synthesized. This study presents a global systematic review of 363 peer-reviewed studies published between January 2020 and August 2025 using publicly available data. Following PRISMA 2020 guidelines, studies were classified by geographic scale, modeling approach, data streams, and analytical purpose. The results indicate that Bayesian and compartmental models remained dominant throughout the pandemic, although methodological diversity increased over time with the growing use of machine learning and hybrid frameworks integrating mobility, environmental, and socio-demographic data. Data integration was more common than previously reported. Approximately 30% of studies relied on a single data stream, while 70% incorporated multiple sources, although most multi-source approaches combined only two data types and relatively few studies integrated three or more. Geographic coverage was uneven, with a strong concentration of studies in high-income regions and persistent underrepresentation of low- and middle-income contexts. Models incorporating finer spatial scales and socio-demographic variables more frequently supported geographically targeted interpretation of risk, vulnerability, testing access, and intervention needs. Overall, the findings highlight the importance of multi-source data integration, improved geographic representativeness, and transparent uncertainty communication, alongside the need for FAIR-aligned and equity-aware data infrastructures to strengthen future pandemic preparedness.
A Speech Analytics-Based Methodological Protocol for Monitoring Orthopedic Rehabilitation in the Brazilian Unified Health System.
Neto RB, Sablón VIB
Int J Environ Res Public Health · 2026 May · PMID 42196719 · Full text
The digital transformation of health systems and the increasing adoption of data-driven public health strategies have intensified the need for methods capable of capturing, structuring, and analyzing information derived...
The digital transformation of health systems and the increasing adoption of data-driven public health strategies have intensified the need for methods capable of capturing, structuring, and analyzing information derived from clinical interactions. In the Brazilian Unified Health System (SUS), orthopedic rehabilitation and therapeutic exercise prescription rely heavily on communication between healthcare professionals and patients, particularly with regard to understanding instructions, reporting symptoms, and identifying barriers to treatment continuity. However, much of this information remains embedded in unstructured spoken interactions, limiting its use for monitoring and evaluation purposes. This study presents a prospective methodological protocol for the future development and validation of a speech analytics architecture designed to analyze verbal interactions in orthopedic rehabilitation within the SUS. The proposed framework integrates automatic speech recognition, speaker diarization, semantic processing with large language models (LLMs), biomedical entity extraction, and retrieval-grounded analytical components to generate structured indicators from clinical speech. In addition, the manuscript includes an illustrative simulation based on administrative proxy data converted into synthetic narratives in order to exemplify the expected structure of downstream analytical outputs. This simulation does not constitute validation of the full audio-based pipeline, but rather serves to clarify the proposed analytical workflow. Overall, the protocol establishes a structured methodological basis for future empirical studies aimed at evaluating the technical performance, semantic validity, and potential public health utility of speech analytics in rehabilitation monitoring, under appropriate ethical, regulatory, and data protection safeguards.
Evolving Cancer Characteristics Among World Trade Center Survivors: An Updated Analysis from the WTC Environmental Health Center.
Durmus N, Wang Z, Arslan AA … +10 more , Goren E, Alptekin R, Lou Y, Shao A, Athar N, Ashebir YA, Shi Y, Wilson L, Reibman J, Shao Y
Int J Environ Res Public Health · 2026 May · PMID 42196718 · Full text
Local community populations ("survivors") exposed to the World Trade Center (WTC) disaster experienced complex exposures to mixtures of dust and combustion products with potential carcinogenic effects. Survivors with cer...
Local community populations ("survivors") exposed to the World Trade Center (WTC) disaster experienced complex exposures to mixtures of dust and combustion products with potential carcinogenic effects. Survivors with certifiable WTC-related conditions are eligible for inclusion in the federally funded WTC Health Program. We provide an updated description of cancers in the WTC Environmental Health Center (EHC), a program for WTC survivors, through 31 December 2024. Using data from the WTC EHC Pan Cancer Database, we summarized demographics, exposure history, and tumor characteristics among enrollees with pathologically confirmed primary cancers meeting WTC Health Program certification criteria. Among 17,449 members, 7274 had a certifiable cancer diagnosis; excluding non-melanoma skin cancers, 6588 patients with 7643 eligible cancers were analyzed. Women comprised 50.3% of the cohort and 47.5% of diagnoses. Solid tumors accounted for 87% of certifications, with breast (22%) and prostate (19%) cancers most frequent, followed by lung (8%), thyroid (6%), colorectal (6%), and melanoma (4.5%). Lymphoproliferative and hematopoietic malignancies represented 13% of cases. Fourteen percent developed multiple primary cancers, and median latency clustered around 14-16 years. Compared with our previous report in 2020, the enrolled number of cancers increased 2.5-fold. These findings support the need for sustained surveillance and additional epidemiologic studies to improve cancer prevention and survivorship in this uniquely exposed population.
Barriers to Antiretroviral Therapy Adherence Among Children in Ekurhuleni, South Africa: A Descriptive Study.
Sokazi P, van Rensburg ZJ, Jacobs W
Int J Environ Res Public Health · 2026 May · PMID 42196717 · Full text
This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenienc...
This study aimed to explore and describe the barriers to Antiretroviral Therapy (ART) adherence among children in Ekurhuleni, Gauteng. A quantitative, cross-sectional design using a survey method was employed. Convenience sampling was used to recruit 157 parents, guardians, and caregivers (PGCs) who consented to participate in the study. Data was collected using self-report questionnaires and analysed using descriptive statistics and frequency distributions. The study was not designed or statistically powered to formally test associations between variables; therefore, only descriptive statistical analyses were conducted. The reliability and validity of the instrument were ensured, and ethical clearance was obtained from the relevant authorities prior to data collection. The study was conducted in accordance with established ethical principles and in compliance with the Declaration of Helsinki. The findings revealed that there were multiple barriers to children's adherence to ART. Approximately one-third of PGCs reported being fully informed about the importance of ART adherence, while the majority indicated being only partially informed. Missed doses emerged as a significant challenge, with a substantial proportion reporting missed medication on one or more days, and only 31.2% administering ART consistently on time. Difficulties in understanding blood test results were also reported. In addition, a notable proportion of PGCs admitted to missing clinic appointments. These findings emphasize the need for strengthened caregiver education, ongoing support, and tailored interventions directed at primary health care nurses to promote consistent ART adherence among children.
A Precision Computational Framework for sLORETA Neurofeedback in Mild Cognitive Impairment: Integration of qEEG Biomarkers and Neuropsychological Metrics.
Dasilva V, Poli D, Pino O
Int J Environ Res Public Health · 2026 May · PMID 42196716 · Full text
This paper proposes a high-precision theoretical and computational neurorehabilitation framework for Mild Cognitive Impairment (MCI), connecting computational neuroscience and clinical practice through qEEG-guided neurof...
This paper proposes a high-precision theoretical and computational neurorehabilitation framework for Mild Cognitive Impairment (MCI), connecting computational neuroscience and clinical practice through qEEG-guided neurofeedback training (NFT). By employing sLORETA to identify putative pathological nodes within the Default Mode Network (DMN)-specifically the Precuneus and the Posterior Cingulate-the model utilizes spectral decomposition to isolate the aperiodic 1/f component, reducing background noise bias and allowing the calculation of a pure individual alpha frequency (IAF) to inform recalibration of Weber's Cognitive Threshold. The core architecture uses Bayesian algorithms and stochastic modeling to drive a Dynamic Weight Change mechanism. To support Long-Term Potentiation (LTP) and Hebbian learning, reward thresholds are modulated in real time to target a 70% success rate, as a strategic rationale to anticipate neural fatigue while maintaining the Reward Prediction Error required for synaptic strengthening. As a prospective validation pathway, future studies may assess clinical value through changes in MoCA and RAVLT scores, as well as by examining normalization of cortical coherence in the Default Mode Network (DMN). By merging computational neuroscience with biological models of synaptic plasticity, this work outlines how individual biology can be mapped into an explicit mathematical model. The proposed framework may inform an individualized protocol that provides an objective model-based measure of cognitive recovery, suggesting a replicable and robust strategy for neurorehabilitation during the prodromal phase of dementia, and providing a new approach to neuroscience-based cognitive rehabilitation. This work is intended as a theoretical and computational framework; no complete empirical dataset is reported in the present manuscript.
Area-Level Sociodemographic Differences Between Indian Health Service Purchased/Referred and Non-Purchased/Referred Care Delivery Areas.
Nash SH, Adcock R, Wang C … +7 more , Hebert-DeRouen MC, Joe NS, Pete D, Kratzer TB, Wiggins CL, Liu L, McDowell BD
Int J Environ Res Public Health · 2026 May · PMID 42196715 · Full text
PURPOSE: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassi...
PURPOSE: Purchased/Referred Care Delivery Area (PRCDA) counties are those where resident American Indian and Alaska Native (AIAN) people are eligible for Indian Health Service care. Due to concerns about racial misclassification, cancer statistics for AIAN people are often restricted to PRCDA counties. Differences in sociodemographic characteristics may exist between PRCDA and non-PRCDA counties, but have not been described; therefore, the potential selection bias associated with the restriction to PRCDA counties remains unknown. METHODS: We used data from the University of California, San Francisco Health Atlas to explore ecological differences in county-level demographic, socioeconomic, healthcare access, and health outcomes data between PRCDA and non-PRCDA counties (n = 3152 counties). We tested for statistical differences in mean levels of demographics between PRCDA and non-PRCDA counties using Pooled or Welch -tests. RESULTS: We observed small, but statistically significant differences between PRCDA and non-PRCDA counties in county-level demographic and socioeconomic characteristics (age, poverty, utility services threat, unemployment, educational attainment, computer access, and median income), neighborhood and environment characteristics (overcrowding, severe mortgage/rent burden), healthcare access and utilization (uninsured, annual checkup, annual dental visit, mammography, binge drinking, smoking, physical inactivity, social isolation), and health outcomes (poor mental health, arthritis, poor self-rated health, high blood pressure, diabetes, high cholesterol, and obesity). CONCLUSIONS: These results indicate variability in county-level measures between PRCDA and non-PRCDA counties. While these data do not speak specifically to AIAN peoples' experiences, they provide critical contextual information to understand how exclusion of AIAN people residing in non-PRCDA counties from cancer statistics may bias risk estimates.
Hypertension and Social Capital in Indonesia.
Kim Y, Radoias V
Int J Environ Res Public Health · 2026 May · PMID 42196714 · Full text
Hypertension is a serious public health concern in developing countries, where the lack of resources and the poor infrastructure often lead to a high incidence of disease and also to high rates of underdiagnosis. We stud...
Hypertension is a serious public health concern in developing countries, where the lack of resources and the poor infrastructure often lead to a high incidence of disease and also to high rates of underdiagnosis. We study the linkages between hypertension and social capital in Indonesia. Indonesia is a large developing economy, where social capital is encouraged and plays a significant role. We use participation in community programs as a proxy for social capital, specifically capturing the structural dimension of social networks. By engaging in these programs, individuals create the social ties that facilitate resource sharing and gain access to socially embedded resources. We find significant associations between participating in community programs and having lower blood pressure and lower likelihood of hypertension. These results underscore the public health significance of social capital as a potential non-clinical determinant of health. From a policy perspective, the findings suggest that strengthening community-based social infrastructure could offer an alternative strategy to mitigate hypertension in resource-constrained economies.
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