International Journal Of Environmental Research And Public Health[JOURNAL]
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200 papers
Stigma and Barriers to Mental Health and Substance Use Care for Hispanic/Latine Individuals Living with HIV or at Risk for HIV in Texas, United States.
Guzman R, Castellanos D, Salinas Escamilla E … +3 more , Malik S, Bessaha M, Muñoz-Laboy M
Int J Environ Res Public Health · 2026 May · PMID 42354251 · Full text
OBJECTIVES: To describe levels of barriers to mental health and substance use services and to examine the associations, if any, between these barriers and substance use and mental health stigma among Hispanic/Latine adul...
OBJECTIVES: To describe levels of barriers to mental health and substance use services and to examine the associations, if any, between these barriers and substance use and mental health stigma among Hispanic/Latine adults receiving services for HIV prevention or HIV treatment. METHODS: We conducted a cross-sectional survey as part of a mixed-method, community-based statewide study among Hispanic/Latine individuals served by HIV service delivery organizations in Texas, United States, between September 2022 and May 2023 (n = 300). Participants completed a computer-based survey at collaborating organizations. Analyses included descriptive statistics and linear regression modeling. RESULTS: Demographic and background characteristics were significantly associated with differences in reported barriers to mental health and substance use services. Mental health-related stigma was significantly associated with barriers to mental health services. CONCLUSIONS: Strategies to reduce barriers, tailored to specific demographic subgroups, and interventions to address mental health-related stigma should be prioritized by HIV service delivery organizations serving Hispanic/Latine communities.
"When the Worlds Change and We Get Old": Indigenous Older Adults Reflecting on Dementia and Aging.
Ginossar T, Partridge EL, Adair JC … +7 more , Ghahate DM, Quam MM, Prestopnik JL, Knoefel JA, Ryman SG, Rosenberg GA, Shah VO
Int J Environ Res Public Health · 2026 May · PMID 42354250 · Full text
BACKGROUND: Understanding the perspectives of Indigenous older adults about aging and dementia in different Indigenous communities can inform the provision of culturally grounded services and advance equity. However, the...
BACKGROUND: Understanding the perspectives of Indigenous older adults about aging and dementia in different Indigenous communities can inform the provision of culturally grounded services and advance equity. However, the experiences and perspectives of Southwestern Pueblo communities are under-researched. METHODS: Approved by the Zuni Tribal Government and IRB, this community-engaged, qualitative research explored Zuni older adults' perceptions, experiences, and support needs. Two co-authors who are community members co-led four focus groups and transcribed them. RESULTS: Twenty participants in four focus groups shared holistic perceptions of dementia. Whereas they often described dementia as a part of aging, they also expressed a strong desire for specialized dementia care and information. They expressed a strong commitment to caregiving as a cultural value, along with challenges and the need for resources to support caregiving as part of specialized dementia healthcare. The challenges experienced by community members were exacerbated by the devastating impact of the COVID-19 pandemic, including the loss of loved ones, long-term COVID-19, disruption of gatherings, loneliness and social isolation. CONCLUSIONS: The need for culturally grounded services is inseparable from Zuni participants' requests for specialized dementia services (including prevention, screening, and caregiving). As the first study to report on the impact of the COVID-19 pandemic on Zuni aging, it highlights the importance of re-building social services and gatherings in planning of service provision.
Linking Perceived Hospital-Generated Content to Psychological Well-Being Through Integrated Cognitive and Emotional Resilience Mechanisms Among Emerging Adults.
Hamdoyo A, Antonio F, Tengor JRS
Int J Environ Res Public Health · 2026 May · PMID 42354249 · Full text
BACKGROUND: Hospital-generated digital health content (HGC) represents an emerging psychosocial influence on young adults' internalizing trajectories. This study examined how perceived HGC variables may associate with ps...
BACKGROUND: Hospital-generated digital health content (HGC) represents an emerging psychosocial influence on young adults' internalizing trajectories. This study examined how perceived HGC variables may associate with psychological well-being (PWB) through cognitive-behavioral and affective mediators, with neuroticism (NEU) moderating these associations. METHODS: In a cross-sectional online survey, 248 Indonesian respondents (born 1997-2012) who regularly consumed HGC completed validated and adapted instruments. The data were analyzed using PLS-SEM. RESULTS: Perceptions of HGC function as key social-cognitive correlates of PWB in emerging adults. Perceived scientific reliability (PSR) and peace of mind (PEM) are positively associated with digital health literacy (DHL), cyberchondria resilience (CYR), and emotional regulation strategies (ERS). Conversely, humanizing value (HMV) is linked with a potential "comfort-without-competence" trajectory. The CYR construct emerged as the primary mediating mechanism for PWB, whereas NEU was found to weaken the positive association between DHL and PWB. CONCLUSION: These results suggest that HGC is associated with enhanced PWB by facilitating information competence, reducing compulsive health-seeking, and supporting emotional regulation, though emotionally warm formats may be linked with lower literacy development. The personality trait NEU selectively moderates cognitive pathways while leaving affective and behavioral pathways intact, suggesting a need for risk-stratified approaches. By providing clinically screened content that integrates cognitive-behavioral scaffolding, healthcare institutions can support early psychological prevention and self-regulation.
Estrogen Status and Temporomandibular Disorders: A Systematic Review.
Mazareanu A, Grigorov C, Pandea A … +4 more , Iacob M, Balaiasa DG, Greenbaum T, Konecny P
Int J Environ Res Public Health · 2026 May · PMID 42354248 · Full text
BACKGROUND: Temporomandibular disorders (TMDs) exhibit a marked female predominance, suggesting a potential role for estrogen in their pathophysiology. However, evidence linking estrogen status to TMD remains inconsisten...
BACKGROUND: Temporomandibular disorders (TMDs) exhibit a marked female predominance, suggesting a potential role for estrogen in their pathophysiology. However, evidence linking estrogen status to TMD remains inconsistent. OBJECTIVE: To systematically review the association between estrogen-related factors and TMD prevalence and clinical presentation in women. METHODS: PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched through September 2025. Observational studies evaluating hormonal contraceptive use, menopausal status, menstrual cycle variation, pregnancy, or estrogen receptor polymorphisms in women with TMD were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Newcastle-Ottawa Scale. Due to substantial heterogeneity, a narrative synthesis was conducted. RESULTS: Seven studies met the inclusion criteria, including six clinical studies involving 2735 participants and one mechanistic supportive study. Moderate-certainty evidence suggested associations between hormonal contraceptive use, menopausal/climacteric status, and increased TMD risk or symptom severity. Additional low-certainty evidence supported associations involving menstrual cycle variation, pregnancy, and estrogen receptor polymorphisms. CONCLUSIONS: Current evidence suggests that hormonal factors may influence TMD risk and symptom presentation in women. However, heterogeneity in definitions of hormonal exposure and diagnostic criteria limits definitive conclusions. Further prospective studies using standardized diagnostic protocols and real-time biochemically validated hormonal assessments correlated with clinical symptoms are needed.
Sitting by the Fire: Dene Perspectives on Indigenous Traditional Ecological Knowledges, Land Stewardship, and Community Wellbeing.
Carroll D, Vandermeer J, Nakehk'o D … +3 more , Zoe JB, Mackenzie Vukson C, Redvers N
Int J Environ Res Public Health · 2026 May · PMID 42354247 · Full text
Indigenous Peoples continue to steward their Lands through their traditional ecological knowledge (TEK), their Laws, and their kinship-driven processes as they have for millennia. There are various factors, including cli...
Indigenous Peoples continue to steward their Lands through their traditional ecological knowledge (TEK), their Laws, and their kinship-driven processes as they have for millennia. There are various factors, including climate change, that threaten Indigenous TEK, Lands, and other processes including intergenerational knowledge transfer. Our team carried out a qualitative research study with Indigenous community members to increase understanding of Dene Peoples' connections with Land, community TEK protection and stewardship, as well as changes in local environments. Semi-structured interviews were conducted with ten participants from the Northwest Territories (NWT), Canada, from December 2024 to February 2025. Coding and reflexive thematic analysis were carried out using qualitative software. Six themes were characterized from the interview data including: (1) intergenerational TEK are central to our ways of life; (2) despite various factors, our communities continue to share TEK across generations; (3) our collective health and healing are tied to our TEK as well as our values; (4) climate change-related threats and damages are impacting our People and the Land; (5) protecting and governing our own data is crucial for preserving our stories and knowledge; and (6) we need to protect Mother Earth for future generations. This study further demonstrates that the protection of Indigenous TEK is deeply important for the overall health and wellbeing of Indigenous Peoples. Additionally, the honouring of Indigenous sovereignty and Land rights is essential to transform current climate change approaches.
Characterising Occupational Solar UVA Exposure Intensity and Self-Reported Health Outcomes Among Outdoor Military Workers in Lohatla, South Africa.
Galawe SD, Rathebe PC, Lebelo K
Int J Environ Res Public Health · 2026 May · PMID 42354246 · Full text
This study aimed to assess the risks associated with ultraviolet radiation (UVR) exposure among military outdoor workers at Lohatla Military Base, South Africa, and to inform targeted risk reduction strategies. A quantit...
This study aimed to assess the risks associated with ultraviolet radiation (UVR) exposure among military outdoor workers at Lohatla Military Base, South Africa, and to inform targeted risk reduction strategies. A quantitative, cross-sectional design was employed, using a questionnaire survey with 161 participants (81% completion rate; 58.39% male; the largest age group was 19-25 years) and five days of objective environmental monitoring. Environmental data confirmed the presence of elevated solar ultraviolet radiation conditions, with peak irradiance levels recorded between 12:00 PM and 1:00 PM, while temperature highs frequently exceeded 35 °C (peaking at 39 °C). Statistical analysis using Spearman's rank-order correlation revealed strong positive associations among sun protection behaviours, including wearing protective clothing, hat use, sunscreen use, and avoidance of peak sun exposure hours (ρ values up to 0.764, < 0.001), indicating the clustered and interdependent nature of effective sun safety practices. Furthermore, engagement in protective behaviours was significantly associated with improved health outcomes, including a lower incidence of sunburn (ρ = 0.407, < 0.001) and reduced hyperpigmentation (ρ = 0.438, < 0.001). These findings indicate that combined protective strategies are associated with reduced self-reported dermatological outcomes. Despite the benefits of individual behaviours, military personnel remain exposed to high levels of environmental ultraviolet radiation, underscoring the need for institutional, evidence-based policy interventions to mitigate occupational exposure risks. The study concludes that military organisations should implement mandatory administrative controls (e.g., schedule adjustments), standardise high-ultraviolet-protection-factor protective gear, and enhance targeted health literacy training to mitigate long-term UV-related health risks and improve the operational effectiveness of their workers.
The Modifying Effect of Individual-Level Neighborhood Perceptions on the Relationship Between Census-Level Neighborhood Social Vulnerability and Cognition in Older Latinos.
Lamar M, Parson CV, Glover CM … +6 more , Capuano AW, Estrella ML, Morris EP, Barnes LL, Bennett DA, Marquez DX
Int J Environ Res Public Health · 2026 May · PMID 42354245 · Full text
Residents of vulnerable neighborhoods show lower levels of, and faster longitudinal declines in cognition across most, but not all studies. Mixed results may exist, in part, because residents' self-reported (individual-l...
Residents of vulnerable neighborhoods show lower levels of, and faster longitudinal declines in cognition across most, but not all studies. Mixed results may exist, in part, because residents' self-reported (individual-level) perceptions of their neighborhood do not always reflect Census-level measurements. We investigated both types of neighborhood characteristics to reexamine previously reported null associations between neighborhood vulnerability and cognition within an interactive socio-environmental framework. Self-identified Latinos ( = 224; x¯age = 70.4) without dementia completed a modified Perception of Neighborhood Environment Scale (mPNES; higher scores = more positive perceptions of total and domain-specific community cohesiveness, health opportunities, and ambience), annual cognitive assessments, and had baseline addresses geocoded to a Census-derived Social Vulnerability Index (SVI; higher scores = higher vulnerability). Separate mixed effects regression models adjusted for relevant confounders tested relationships between mPNES and cognitive composite z-scores, and modifying effects of mPNES on the SVI-cognition associations. Higher total mPNES scores were associated with higher baseline global cognition and working memory (driven by community cohesiveness). Higher domain-specific health opportunities associated with slower rates of global cognitive decline. mPNES modified relationships between SVI and cognition, particularly baseline global cognition and episodic memory. Results demonstrate the importance of incorporating individual-level neighborhood perceptions when examining relationships between Census-level measures of neighborhood health and cognition.
Barriers and Enablers in Implementing Technology-Enabled Care for Older Adults in Rural and Remote Settings: A Scoping Review.
Krahe MA, Baker S, Anderson E … +2 more , Strivens E, Larkins SL
Int J Environ Res Public Health · 2026 May · PMID 42354244 · Full text
Existing reviews of technology-enabled care for older adults have primarily focused on technology usability, patient acceptance, and clinical outcomes. However, there remains limited synthesis of the organizational and s...
Existing reviews of technology-enabled care for older adults have primarily focused on technology usability, patient acceptance, and clinical outcomes. However, there remains limited synthesis of the organizational and system-level factors influencing the implementation of technology-enabled care in rural, regional, and remote contexts. This review addresses this gap by mapping barriers and facilitators using the Consolidated Framework for Implementation Research. Using technology to enable or enhance healthcare, rehabilitation, and self-management offers significant potential to improve access, outcomes, and equity for older adults; however, adoption and sustained use in rural, regional, and remote (RRR) settings remain limited. This scoping review aimed to identify factors influencing the implementation of technology-enabled care interventions for community-dwelling older adults in RRR contexts. Searches were conducted in PubMed, MEDLINE, CINAHL, Web of Science, and Scopus for empirical studies published from 2014 onwards. Barriers and enablers were mapped to the Consolidated Framework for Implementation Research (CFIR) and synthesized narratively. The search identified 807 records, of which 433 remained after duplicate removal and 105 proceeded to full-text assessment. Five studies met the inclusion criteria, examining telehealth, telerehabilitation, remote monitoring, and mobile health applications. Across the included studies, 71 implementation factors were identified, comprising 39 barriers and 32 enablers mapped across five CFIR domains and 20 constructs. The most frequently reported barriers related to innovation recipients' capability, innovation design, innovation complexity, and outer setting local conditions. The most frequently reported enablers related to innovation adaptability, innovation complexity, and innovation recipients' motivation. Findings suggest that implementation in RRR settings depends less on technological sophistication than on aligning design and delivery with user capability and local system capacity, reducing cognitive and technical burden, and embedding relational and contextual support.
Indoor Radon Exposure Among Schoolchildren: A Systematic Review of Risk Factors.
Yusuf RA, Mbonane TP, Rathebe PC
Int J Environ Res Public Health · 2026 May · PMID 42354243 · Full text
Radon (222Rn) is a naturally occurring radioactive gas. It is colourless, odourless, and tasteless, produced through the spontaneous decay of uranium in soil and rocks. Among school-aged children, exposure to radon is a...
Radon (222Rn) is a naturally occurring radioactive gas. It is colourless, odourless, and tasteless, produced through the spontaneous decay of uranium in soil and rocks. Among school-aged children, exposure to radon is a major public health concern because, during school hours, learners spend an average of 6-8 h daily inside school buildings, often on the ground floor or in basement classrooms, where radon levels tend to be highest. This study aims to contextualize radon exposure among children in educational settings, with a focus on the associated risk factors. A systematic review of the literature on radon exposure in classrooms among schoolchildren was conducted, analysing associated risk factors and methods of radon measurement. A literature search was performed across reputable databases to ensure compliance with systematic review standards. The quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. A total of 32 studies met the inclusion criteria and were analyzed. Radon levels measured in classrooms exhibit variability based on geographic location. Certain classrooms in Continental Europe and North America exceed the WHO reference limit of 100 Bq/m, as well as regional thresholds, including the European Union limit of 300 Bq/m and the United States Environmental Protection Agency (EPA) limit of 148 Bq/m. Indoor radon exposure in classrooms is a worldwide concern because children are particularly vulnerable during their formative years. Those attending daycare centers and kindergartens are at greater risk due to their nascent respiratory systems.
Capacity Planning for Small Hospitals and Departments Illustrated Using Maternity and Paediatrics Departments: Roles for Weighted Population Density, Seasonality and Size, Myths Around Length of Stay and Factors Influencing Costs and Funding.
Jones RP
Int J Environ Res Public Health · 2026 May · PMID 42354242 · Full text
The Erlang B equation is directly applicable to smaller hospital departments such as maternity and paediatrics departments. The bed occupancy margin is directly linked to size and not 'efficiency'. A figure of 0.1% turn-...
The Erlang B equation is directly applicable to smaller hospital departments such as maternity and paediatrics departments. The bed occupancy margin is directly linked to size and not 'efficiency'. A figure of 0.1% turn-away has been recommended as a planning target, i.e., only 1 in a thousand admissions suffer a delay before a bed can be found. Two bed calculators are provided which can be used for paediatric, obstetric, maternity, midwife-led, birthing wards and neonatal/paediatric critical care capacity. The negative effects of turn-away are likely to be context specific, hence, critical care > theatres > birthing unit > maternity unit. The uncertainty regarding future births is discussed along with the variable nature of seasonality in births. For paediatrics, much of bed demand is also influenced by the trend in births. Weighted population density (WPD) is associated with the size distribution of hospitals/units within countries and regions. This influences the average cost per birth/admission. The USA has a low WPD and a significant problem with small hospitals/departments. Only 10% of countries have WPD higher than England. Some countries choose to operate with even more hospitals than needed and this acts to elevate costs. Suggestions are made for a pragmatic approach to bed planning, especially where a dispersed population dictates a need for small hospitals, and hence, issues regarding size and costs. For maternity/paediatrics admissions (and other relatively short-stay admissions) the majority of overhead/indirect costs and most staffing costs should be apportioned based on admissions, and not LOS. Apportionment based on LOS creates the spurious illusion that LOS is the major cost driver and that reducing LOS will immediately save costs. Below 20 beds, Poisson statistical variation plus environment-induced randomness in daily arrivals imply that staff costs may become increasingly fixed irrespective of LOS. Around >30 beds, it looks possible to save costs by reducing LOS. Allocating total organizational costs to individual units and then to patients is less precise than realized and can be done in different ways, which all heavily rely on the steady-state assumption. When bed availability is the bottleneck, then reducing LOS may increase throughput per bed and increase income; however, is this for the benefit of the patient or for the benefit of the organization, and does it lead to higher unanticipated total costs including patient harm? The older economy-of-scale literature has been demonstrated to be flawed, with a recent focus on economy of scale at the department level being entirely consistent with the application of the Erlang B equation. A list of nine catastrophic pitfalls is given for doctors to identify dubious capacity advice from managers and external experts.
Assessing the Influence of Socio-Demographic and Personal Traits (Knowledge, Attitude) on Practices Among Silica-Dust Exposed Mineworkers in the SADC Region.
Khoza NN, Moyo D, Rathebe PC … +2 more , Masekameni MD, Mbonane TP
Int J Environ Res Public Health · 2026 May · PMID 42354241 · Full text
BACKGROUND: Exposure to respirable crystalline silica dust remains a significant occupational health challenge in the Southern African Development Community region, leading to high incidences of silicosis and pulmonary t...
BACKGROUND: Exposure to respirable crystalline silica dust remains a significant occupational health challenge in the Southern African Development Community region, leading to high incidences of silicosis and pulmonary tuberculosis, particularly among mining workers. This study evaluated the knowledge, attitudes, and practices (KAP) of mineworkers regarding silica dust risks across Lesotho, Malawi, Mozambique, and Zambia. METHODS: A cross-sectional analytical study was conducted involving 1440 mineworkers exposed to silica dust in mines across four SADC countries. Data were collected using structured questionnaires covering socio-demographic traits and knowledge, attitude, and practices. Data analysis was conducted using Stata version 18. RESULTS: While 91% of participants exhibited adequate knowledge and 88% demonstrated acceptable practices, 51% maintained negative safety attitudes. Knowledge scores were positively correlated with company training ( = 0.386). However, a "Training Paradox" emerged in the regression model: compulsory company training was significantly associated with a 1.20-unit decrease in practice scores, whereas external training and higher education levels (+2.98 units) predicted improved compliance. Technicians and younger workers were identified as higher-risk cohorts. CONCLUSIONS: The findings suggest that top-down mandatory training may trigger psychological reactance, undermining behavioural safety. To mitigate silica-related diseases, industry stakeholders should transition toward participatory, role-specific safety interventions that prioritize worker autonomy and cognitive engagement over administrative compliance.
Spirometric Lung Function Among Smokers and Non-Smokers: A Cross-Sectional Study in University Students.
Tabbah K, Abufanas AS, Kanawati AJ … +6 more , Elawaddlly SHS, Hamza DN, Madarati MMM, Dakak AIG, Abdelhafiz DF, Al Ammour MT
Int J Environ Res Public Health · 2026 May · PMID 42354240 · Full text
BACKGROUND: With the increasing use of cigarettes and electronic nicotine delivery systems (ENDS) in young adults, growing concern exists regarding lung health among university students. While the adverse respiratory eff...
BACKGROUND: With the increasing use of cigarettes and electronic nicotine delivery systems (ENDS) in young adults, growing concern exists regarding lung health among university students. While the adverse respiratory effects of smoking are well established in older populations, early functional changes among young adults remain less well studied. Identifying such changes in this vulnerable population is crucial due to the risk of detrimental long-term health effects and the role of implementing early preventive measures. This study aims to compare the effects of nicotine use, sex, and body mass index (BMI) on the spirometric lung function parameters, including FEV, FVC, and FEV/FVC ratio, of smokers (including cigarette, ENDS, shisha, and midwakh users) and non-smokers in a university population. METHODS: This cross-sectional study was conducted at Ajman University, United Arab Emirates. A convenience sample of 652 smokers and non-smokers students was initially recruited voluntarily, of whom 630 participants met the spirometry acceptability criteria and were included in the final analysis. Lung function was assessed using spirometry performed according to the guidelines of the American Thoracic Society and European Respiratory Society. Forced expiratory volume in one second (FEV), forced vital capacity (FVC), and the FEV/FVC ratio were recorded and expressed as percentages of predicted values based on Global Lung Function Initiative reference equations. Lung function parameters were compared according to smoking status, sex, and BMI. RESULTS: A total of 630 students were included (60.5% males; the majority aged 20-22 years). The prevalence of smoking was 28.9% and was significantly higher among males than females (38.6% vs. 14.1%; OR = 3.86, < 0.001). Smokers demonstrated a significantly lower FEV/FVC ratio compared with non-smokers (0.84 ± 0.07 vs. 0.86 ± 0.07, < 0.001), despite slightly higher predicted FEV and FVC values. Males exhibited higher predicted lung volumes than females, whereas females had higher FEV/FVC ratios ( < 0.001). Lung function varied significantly across BMI categories ( < 0.001), with increasing BMI associated with higher predicted lung volumes but lower FEV/FVC ratios. Stratified analysis showed that male smokers had the lowest FEV/FVC ratios, while female non-smokers had the highest. CONCLUSIONS: Smoking, sex, and BMI significantly influenced lung function in this cohort. Smokers demonstrated reduced FEV/FVC ratios, indicating early airflow limitation. Males were more likely to smoke and had higher lung volumes, while females showed higher FEV/FVC ratios. Increasing BMI was associated with higher lung volumes but lower FEV/FVC ratios. These findings suggest that early pulmonary changes may occur in young adults, highlighting the importance of early screening, careful interpretation of spirometry, and the implementation of targeted public health interventions to reduce nicotine use, promote smoking cessation, and support lung health among university students.
Approach-Avoidance Motivation and Goal Adaptation in Chronic Pain: Predicting Pain Intensity and Interference.
Eshraghi P, Drake D, Iddon J … +1 more , Dickson JM
Int J Environ Res Public Health · 2026 May · PMID 42354239 · Full text
Chronic pain is a major public health concern associated with disability, reduced functioning and psychological distress. Compared with biological studies, relatively little research has studied chronic pain from a psych...
Chronic pain is a major public health concern associated with disability, reduced functioning and psychological distress. Compared with biological studies, relatively little research has studied chronic pain from a psychological perspective, specifically motivation. Yet, motivation is considered fundamental to human functioning and drives human behaviour. The present study aimed to investigate whether distinct motivational and adaptive goal processes are implicated in chronic pain. The sample comprised 190 adult community participants who reported chronic pain for 3 months or more. Participants completed self-report measures of approach and avoidance motivation, adaptive goal processes, pain intensity, and interference. As hypothesised, avoidance motivation (but not approach motivation) was positively and significantly associated with increased pain intensity and interference. Further, increased goal disengagement was negatively and significantly related to reduced pain intensity and interference, as predicted. Contrary to expectation, goal re-engagement was positively related to increased pain interference. As predicted, solving pain was significantly and positively associated with pain intensity and interference. As predicted, meaningfulness of life was related to lower pain interference but not pain intensity. Counter to prediction, acceptance of the insolubility of pain was significantly and positively related to both pain intensity and pain interference. Our findings highlight significant associations between motivational orientation, adaptive goal regulation processes, and chronic pain intensity and interference and underscore the importance of understanding chronic pain from a motivational perspective.
Critical Factors Influencing the Uptake of Breastfeeding Support Interventions in Neonatal Intensive Care Units: A Scoping Review.
Hirani SAA, Awojobi ON
Int J Environ Res Public Health · 2026 May · PMID 42354238 · Full text
Breastfeeding is considered the optimal source of nutrition for infants admitted to Neonatal Intensive Care Units (NICUs). Despite these well-documented benefits, establishing and sustaining breastfeeding in NICU setting...
Breastfeeding is considered the optimal source of nutrition for infants admitted to Neonatal Intensive Care Units (NICUs). Despite these well-documented benefits, establishing and sustaining breastfeeding in NICU settings remains challenging due to inadequate uptake of breastfeeding support measures. This scoping review aimed to examine the evidence on factors influencing the uptake of breastfeeding support practices in NICUs. The search was undertaken across four electronic databases: PubMed, MEDLINE, CINAHL, and the Cochrane Library. Primary studies published in English between 1994 and 2025 were included. Eligible studies focused on factors influencing breastfeeding support, implementation, or uptake of breastfeeding-related interventions in NICU settings. Exclusion criteria included studies not involving NICU populations, studies not addressing breastfeeding outcomes or support, secondary literature, and non-English publications. A total of 30 peer-reviewed studies met the inclusion criteria. Data were charted and synthesized using thematic analysis. A total of 30 studies met the inclusion criteria. Four major themes influencing breastfeeding support uptake in NICUs were identified: (1) institutional commitment to the Neonatal Baby-Friendly Hospital Initiative (Neo-BFHI), (2) NICU breastfeeding protocols and care practices, (3) breastfeeding training for NICU staff and mothers, and (4) parental breastfeeding motivation and family support. Across studies, breastfeeding support was strengthened by organizational breastfeeding policies, staff education, lactation support services, family-centred care practices, and parental involvement. However, variations in NICU resources, institutional practices, and staff support contributed to inconsistencies in breastfeeding implementation and continuation. Breastfeeding support in NICUs is influenced by interconnected organizational, clinical, educational, and psychosocial factors. The findings highlight the importance of integrated breastfeeding-supportive approaches that combine institutional commitment, standardized NICU practices, healthcare provider education, and family-centred care to improve breastfeeding support for vulnerable infants in NICU settings.
The Master's Tools-Anti-Bullying and Harassment Policy in Higher Education Institutions.
Hodgins M, Ballantine C, Mannix McNamara P
Int J Environ Res Public Health · 2026 May · PMID 42354237 · Full text
The persistently high prevalence of gender-based violence and harassment (GBVH) in higher education institutions is a well established phenomenon, as is the inadequacy of institutional responses and the silencing of thos...
The persistently high prevalence of gender-based violence and harassment (GBVH) in higher education institutions is a well established phenomenon, as is the inadequacy of institutional responses and the silencing of those who aim or attempt to report it. Drawing on Ahmed's concept of 'non-performativity', 'institutional speech acts that do not bring into effect what they name', this paper argues that the non-performativity of anti-bullying and harassment policy is an exercise of power, consistent with Agócs concept of institutionalised resistance. Reporting misconduct is intentionally transformational, but seen as a threat to powerful organisational actors, who exercise institutional power to enact procedures in such a way that victim-survivors are unvoiced and tricked into 'reluctant acquiescence' with adverse consequences on their personal and occupational health. We employ documentary analysis to critique policies and procedures for GBVH in Irish universities, and specifically how institutional power is exercised through policy documents. The analysis is based on ten pseudonymised universities, rendering a sample size of 23 documents, pertaining to GBVH for staff. We find that the tone and language employed in policies, and the way in which the informal and formal approaches in anti-bullying and harassment policies frame the problem, serve the interests of the institution. Confidentiality clauses, the framing of the problem as an individualistic, incident-based problem, to be resolved case-by-case, and quasi-legal processes facilitate non-performativity, preserving institutional power and the status quo. From a public health perspective such inertia undermines efforts to prevent harm and promote workplace wellbeing. Meaningful reform will require that HEIs employ alternative tools capable of unsettling these entrenched institutional arrangements and to adopt alternative, proactive tools that prioritise accountability, transparency, prevention and health gain. We suggest new tools in the form of victim-centred, trauma-informed, remediation- and restorative-based approaches.
Social Determinants of Health/Health Equity and Hypertension Prevalence Among Mississippi Adults.
Mendy VL, Jones-Lee L, Tsegay NW … +2 more , Rowell-Cunsolo T, Enkhmaa B
Int J Environ Res Public Health · 2026 May · PMID 42354236 · Full text
More than one million adults in Mississippi have hypertension. We examined the association between a summary measure of social determinants of health (SDOH) and health equity (SDOH/HE) and hypertension prevalence among M...
More than one million adults in Mississippi have hypertension. We examined the association between a summary measure of social determinants of health (SDOH) and health equity (SDOH/HE) and hypertension prevalence among Mississippi adults. Using data from 3867 respondents to the 2023 Mississippi Behavioral Risk Factor Surveillance System SDOH/HE Module, we performed multivariable logistic regression analyses to examine the association between hypertension prevalence and a summary SDOH/HE measure. The SDOH/HE summary measure score was created using responses to 10 questions assessing employment/economic and housing stability, receipt of food assistance, access to quality food and transportation, utilities security, social isolation, social and emotional support, life satisfaction, and mental well-being of the participants. The likelihood of experiencing 0, 1, 2, 3, or 4 or more SDOH/HE risk factors was 38.6, 22.9%, 13.7%, 7.9%, and 16.8%, respectively. Mississippi adults experiencing one (adjusted odds ratio, AOR, 1.47) and four or more (AOR, 2.62) of SDOH/HE risk factors had higher odds of hypertension compared to those experiencing no SDOH/HE risk factors. Associations between presence of two or three SDOH/HE risk factors and hypertension were not significant. Mississippi adults with one and at least four SDOH/HE risk factors had significantly higher odds of hypertension risk than those with no SDOH/HE risk factors. These findings highlight an association between SDOH/HE factors and the burden of hypertension and underscore the need for targeted inventions among Mississippi adults with multiple SDOH/HE risk factors.
Exploring Nurses' Perceptions on Clinical Governance at Grey Hospital, Eastern Cape Province, South Africa.
Dike P, Mnyaka OR
Int J Environ Res Public Health · 2026 May · PMID 42354235 · Full text
Clinical governance is a systematic approach to maintaining and improving the quality of patient care within health systems. This research assessed nurses' perceptions of the availability of clinical governance protocols...
Clinical governance is a systematic approach to maintaining and improving the quality of patient care within health systems. This research assessed nurses' perceptions of the availability of clinical governance protocols and quality improvement activities at Grey Hospital, a district hospital in the Eastern Cape Province of South Africa. A descriptive cross-sectional study was used to collect quantitative data from doctors and nurses across various disciplines using a structured questionnaire. Data were captured using Microsoft Excel and analysed using STATA. Of the 105 participants who consented to participate, the majority were female (66.4%) and aged between 37 and 47 years (48.6%), with a mean age of 43.9 years. Most participants were professional nurses (59.8%), with enrolled nurses (20.6%) and enrolled nursing assistants (17.8%) comprising the remainder of the sample. The findings show that nurses perceived most clinical governance protocols to be present at Grey Hospital. However, only 54.3% reported occurrence of regular morbidity and mortality (M&M) meetings. These results suggest that while nurses perceive clinical governance protocols to be available at Grey Hospital, the gap in regular M&M meetings indicates that perceived availability does not automatically translate to effective implementation. Strengthening accountability mechanisms, ensuring adequate resources, and establishing systematic monitoring are essential to translate protocols into sustained quality improvement.
Digital Physical Activity Interventions for Mental Health Promotion of and Reduction in Addictive Behaviors: Integrative Comprehensive Review with a Focus on Personalization and Implementation.
Morouço P, Ramadas E
Int J Environ Res Public Health · 2026 May · PMID 42354234 · Full text
Digital interventions can increase the reach and continuity of physical activity promotion, but evidence remains fragmented across mental health and addictive behaviors. We conducted a comprehensive integrative review su...
Digital interventions can increase the reach and continuity of physical activity promotion, but evidence remains fragmented across mental health and addictive behaviors. We conducted a comprehensive integrative review supported by structured searches (2015-2026) in biomedical, psychological, multidisciplinary and technology-oriented databases, complemented by backward/forward snowballing. Eligible studies included digital interventions in which physical activity (or sedentary reduction) was a core component and those that reported mental health outcomes (e.g., depression, anxiety, stress, and well-being) and/or addiction-related outcomes (e.g., craving, consumption, lapses/relapse, and treatment retention). We synthesized findings thematically by intervention typology (apps, wearables, hybrid models with human support, and adaptive approaches) and by key active ingredients (goal setting, self-monitoring, feedback, reinforcement, planning, and engagement strategies). Overall, most studies targeted mental health outcomes and used app-based multicomponent programs, sometimes complemented by wearables, with generally short follow-up and heterogeneous engagement metrics. Evidence in addictions was more context-specific and concentrated in alcohol treatment and opioid agonist therapy settings, supporting feasibility and a plausible role for physical activity as a coping strategy. Advanced personalization frameworks (EMA/EMI/JITAI) provide a clear implementation pathway but are less consistently operationalized when physical activity is the central therapeutic component. This review highlights practical design recommendations and research priorities for scalable, safe, and equity-oriented digital physical activity interventions in mental health promotion and relapse prevention.
Nurse-Led Mobile Clinics to Improve Rural Health Access and Disaster Preparedness: A Mixed-Methods Evaluation of a Texas Program.
Kroll NP, Dormire SL, Wilson KL
Int J Environ Res Public Health · 2026 May · PMID 42354233 · Full text
BACKGROUND: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may...
BACKGROUND: Rural communities face persistent healthcare barriers related to workforce shortages, geographic isolation, transportation limitations and constrained emergency response capacity. Nurse-led mobile clinics may support healthcare access, continuity of care, and disaster preparedness in underserved settings. This study examined the Texas A&M University (TAMU) nurse-led mobile clinic model with respect to rural service delivery, health equity, operational considerations, and disaster preparedness. METHODS: A mixed-methods descriptive program evaluation was conducted using programmatic operational data, survey responses, and preparedness-planning records. The TAMU mobile clinic serves six rural counties through primary, preventive, and behavioral healthcare delivery using in-person care, telehealth, and home visits. Disaster preparedness activities were integrated through the annual Disaster Day interprofessional simulation involving approximately 600-700 learners. A 2025 Central Texas flooding event served as a case study to evaluate operational preparedness and system readiness. RESULTS: Mobile clinic operations supported healthcare access, continuity of care, and community engagement in rural settings. Interprofessional education simulation findings demonstrated perceived gains in teamwork, triage, communication, and rapid decision-making. During the 2025 flooding event, activation protocols were initiated; however, deployment was not authorized, highlighting system-level constraints related to administrative approval pathways despite operational readiness and workforce preparedness. CONCLUSIONS: Nurse-led mobile clinics may serve as an adaptable infrastructure for improving rural healthcare access, supporting continuity of care, and strengthening disaster preparedness. Findings further emphasize that clinical preparedness alone is insufficient without coordinated administrative processes, interoperable systems, and governance structures capable of supporting rapid emergency deployment.
Systematic Worldwide Review on the Performance of Non-Invasive Exhalation-Based Methods for the Diagnosis of Liver Fibrosis.
Moya-Salazar J, Liviapoma-Rojas GS, Aliaga-Refulio C … +4 more , Goicochea-Palomino EA, Moya-Salazar MJ, Morales-Martinez ME, Espinoza-Morriberrón D
Int J Environ Res Public Health · 2026 May · PMID 42354232 · Full text
Liver fibrosis is a chronic disease diagnosed through invasive methods that can worsen patients' health. Moreover, this disease is diagnosed in terminal stages, when the damage is already widespread and irreversible, whi...
Liver fibrosis is a chronic disease diagnosed through invasive methods that can worsen patients' health. Moreover, this disease is diagnosed in terminal stages, when the damage is already widespread and irreversible, which makes it necessary to have minimally invasive diagnostic methods with high performance. The aim was to compare research on non-invasive methods, respiratory footprint, and volatile organic compounds for the diagnosis of liver fibrosis through patient exhalation. Following the PRISMA guidelines, systematic searches were conducted in 13 databases. We could identify 17,454 documents between 2009 and 2022. Inclusion criteria comprised original investigations using Gas Chromatography-Mass Spectrometry (GC-MS), Ion Mobility-Mass Spectrometer (IMR-MS), and e-nose for liver fibrosis diagnosis. We considered the precision, specificity, and sensitivity of each test and the methodological quality of each study according to the PEDro guideline. Seven investigations were included. Four (57%) studies used GC-MS, and two (28.6%) used e-nose. The most commonly used gold standard was liver biopsy, and all studies were of European origin, with only adult populations. Three (42%) studies had a specificity >90%, and five (71.4%) had a sensitivity between 85 and 100%. Isoprene is the most significant and distinguishable biomarker for liver fibrosis diagnosis. Five (71.4%) studies had high methodological quality. GC-MS is the most used technique for detecting liver fibrosis, and isoprene is the most frequent volatile organic compound (VOC) found in the exhalation of patients with liver fibrosis. More studies are needed in areas with high risk and prevalence of hepatic fibrosis.
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