International Journal of Environmental Research and Public Health最新文献

{"title":"Young Adults with Chronic Conditions During the COVID-19 Pandemic: Comparison with Healthy Peers, Risk and Resilience Factors.","authors":"Ann-Katrin Job, Heike Saßmann","doi":"10.3390/ijerph22091431","DOIUrl":"10.3390/ijerph22091431","url":null,"abstract":"<p><p>The COVID-19 pandemic led to psychological impacts for young adults worldwide. Young adults with chronic medical conditions (YACCs) generally experience a higher risk of psychological impairment. This study examined the differences regarding the impact of the pandemic on YACCs compared with healthy peers and aimed to identify risk and buffering factors. A longitudinal survey with <i>n</i> = 272 (51% female) young adults was conducted at three time-points during the COVID-19 pandemic. Symptoms of depression and anxiety, positive mental health, life satisfaction, loneliness, and suicidal ideation were assessed, together with sociodemographic variables. The factors contributing to resilient mental health trajectories during the pandemic were examined. A chronic medical condition was reported by 36.8% (<i>n</i> = 100) of the participants. Female YACCs, but not male YACCs, experienced significantly more symptoms of anxiety and clinically relevant symptoms of depression more often, and both female and male YACCs reported a significantly lower life satisfaction compared with healthy peers. The corresponding effect sizes were small. YACCs had somewhat higher odds (OR = 1.69) of non-resilient trajectories during the COVID-19 pandemic compared with healthy young adults, although the prediction model explained little variance. The same was true for female compared with male young adults (OR = 1.86). YACCs and female young adults appear to be at higher risk for psychological impairment during pandemic situations. The early detection of those with psychological problems is recommended. Further research is needed to examine the disease-specific influences on resilient trajectories and their interaction with gender and other potentially relevant risk and protective factors.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating a Research Training Program in Environmental Health and Noncommunicable Diseases in Georgia.","authors":"Carla J Berg, Lela Sturua, Amiran Gamkrelidze, Tina Beruchashvili, Tinatin Manjavidze, Givi Javashvili, Nino Kiladze, Levan Baramidze, W Michael Caudle","doi":"10.3390/ijerph22091433","DOIUrl":"10.3390/ijerph22091433","url":null,"abstract":"<p><p>The Clean Air Research and Education (CARE) program, launched in 2020, aims to enhance environmental health (EH) and noncommunicable disease (NCD) research capacity in the Republic of Georgia. This paper evaluates the first 4.5 years of CARE, summarizing fellows' activities and achievements to date and fellow and faculty reactions to CARE. In February 2025, CARE leadership anonymously surveyed fellows (100% response rate: <i>n</i> = 23/23; 4 Master's of Public Health [MPH], 19 PhD) and faculty (66.7%: <i>n</i> = 10/15; 6 Georgia-based, 4 US-based). Thesis/dissertation topics included tobacco (43.5%), air pollution and respiratory outcomes (each 21.7%), lead exposure and cancer-related and cardiovascular outcomes (each 13.0%), and others. Fellows leveraged CARE's financial support for research execution (78.3%), scientific conferences (34.8%), specific training (21.7%, <i>n</i> = 5/23), and/or publication fees (26.1%). Fellows indicated that the most valuable program aspects were opportunities for (1) building/expanding professional networks; (2) exposure to experts and training; and (3) instrumental support to pursue their PhD and conduct research. Fellows and faculty prioritized sustaining the following: structured mentor-mentee relationships; involvement of US-based mentors; support identifying research funding and preparing publications; and training in methods/data analysis. This study provides a model for evaluating other research training programs and highlights the important role such programs may play in developing the capacity to conduct relevant public health research in low- and middle-income countries.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traditional Knowledge Holders and Practitioners: First Responders in Native Nations During the COVID-19 Pandemic.","authors":"Nicolette I Teufel-Shone, Amanda Hunter, Carol Goldtooth-Begay, Manley A Begay, Andria B Begay, Darold H Joseph, Melinda S Smith, Julie A Baldwin","doi":"10.3390/ijerph22091432","DOIUrl":"10.3390/ijerph22091432","url":null,"abstract":"<p><p>Native Americans in the US experienced disproportionate risks of COVID-19 infection and mortality. Despite these adversities, Native Americans relied on the world view and lessons of their cultural teachings, as strategies to find personal solace and social harmony amid the crisis. Traditional Knowledge Holders and Practitioners (TKHPs) reinforced these survival strategies and were essentially first responders. In 2021, 22 TKHPs from three Arizona Native nations were interviewed about their personal reflections and practice during the pandemic. A cross-Native nation analysis of the narratives revealed three determinants shaped the health of Native peoples in these communities: (1) relationships with all living beings and the natural environment, (2) the intersection of non-Indigenous and Indigenous health care systems, and (3) cultural continuity. TKHPs' contributions to their communities' physical, social, cultural, and spiritual health during the COVID-19 crisis elucidates the need to ensure their inclusion in public health emergency response plans. Their knowledge and practice are foundational assets in Native American communities, offering invaluable lessons to promote mental wellness and resilience. TKHPs' approach to addressing pandemic-related challenges extended beyond the typical Western approaches to medicine, making them vital providers for current and future efforts in improving the health status of Native Americans.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Health Technologies for Diabetic Foot Ulcers: A Systematic Review of Clinical Evidence, Access Inequities, and Public Health Integration.","authors":"Tatiana Cristina Dias de Oliveira, Alana Ferreira de Oliveira, Laila de Castro Araújo, Maria Pantoja Moreira de Sena, Valéria de Castro Fagundes, Phelipe Augusto Rabelo Paixão, Stefani Gisele Bastos Dornas, Clarisse Andrade Sales, Ana Paula Simões Castro, Patricia Alves de Mendonça Cavalcante, Luann Wendel Pereira de Sena","doi":"10.3390/ijerph22091430","DOIUrl":"10.3390/ijerph22091430","url":null,"abstract":"<p><p>Diabetic foot ulcers are among the most severe complications of diabetes mellitus, disproportionately affecting populations in low- and middle-income countries. Digital health technologies have emerged as promising tools for prevention, diagnosis, and management; however, their effectiveness, usability, and applicability within public health systems remain insufficiently defined. This systematic review aimed to critically synthesize the clinical effectiveness, perceived usability, and methodological quality of digital interventions for the care of individuals with diabetes-related foot ulcers. A comprehensive search was performed in PubMed, Scopus, Web of Science, Embase, and Google Scholar for studies published between 2012 and 2024. Eighteen studies met the inclusion criteria, encompassing mobile health applications, wearable sensor devices, artificial intelligence-based tools, and telehealth platforms. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Artificial intelligence-driven approaches demonstrated high diagnostic accuracy, with sensitivity and specificity above 90% for ulcer detection and classification. Mobile applications showed positive effects on self-efficacy, glycemic control, and adherence to preventive foot care, while usability scores were consistently high. Wearable sensor devices demonstrated potential for reducing ulcer recurrence, though supporting evidence remains limited. Across studies, recurrent methodological limitations included small sample sizes, absence of control groups, lack of economic evaluations, and barriers related to digital literacy and interoperability between systems. Most investigations were conducted in high-income countries, with limited consideration of public health contexts such as the Brazilian Unified Health System. In conclusion, digital health technologies show promise in improving the care of individuals with diabetes-related foot complications but face significant challenges regarding scalability, equity of access, and integration into public healthcare systems. Future research should prioritize context-adapted designs, robust clinical trials, and economic evaluations to inform health policies and support the rational adoption of these tools within universal health coverage frameworks. PROSPERO registration number: CRD420251023152.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Transportation Barriers to Maternal Care for Black Women in Los Angeles County.","authors":"Rebecca O Usigbe, Zanobia R Ibrahim-Watkins, Astrid Williams, Sylvie Wilson, Zoe Cunliffe, Gabrielle Brown, Tianna Shaw-Wakeman, Regan F Patterson","doi":"10.3390/ijerph22091429","DOIUrl":"10.3390/ijerph22091429","url":null,"abstract":"<p><p>The United States ranks among the worst high-income countries for maternal health outcomes, with Black women experiencing disproportionately high and alarming rates of maternal mortality and morbidity. In Los Angeles County, Black women are four times more likely to die from pregnancy-related causes than women of other racial and ethnic groups. These disparities may partially be attributed to social determinants of health, including transportation access. Lack of transportation can hinder access to healthcare, with significant consequences for reproductive health. This study investigates how transportation barriers affect Black birthing people's access to maternal healthcare in Los Angeles. In partnership with Black Women for Wellness, we conducted a descriptive, observational study using an online survey completed by 235 respondents, all of whom self-identified as women. Findings reveal that Black women in Los Angeles face substantial transportation barriers when seeking maternal healthcare, including limited public transportation, lack of personal vehicles, and challenges in securing rides. Many participants reported that these issues caused delayed or missed prenatal appointments. These results underscore the urgent need for policy interventions and systems-level solutions to improve transportation access. Addressing these barriers is essential for reducing maternal health disparities and improving outcomes for Black women.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thriving from Work Questionnaire: Validation of a Measure of Worker Wellbeing Among Older U.S. Workers.","authors":"Maren Wright Voss, Cal J Halvorsen, Kanchan Yadav, Stephanie M Neidlinger, Gregory R Wagner, Susan E Peters","doi":"10.3390/ijerph22091428","DOIUrl":"10.3390/ijerph22091428","url":null,"abstract":"<p><p>As life expectancy and retirement ages rise globally, understanding how older workers thrive in the workplace is an increasingly vital measurement and wellbeing priority. In this study, we validated the Thriving from Work Questionnaire (TfWQ) for workers aged ≥50. A U.S. online panel yielded 617 older workers and 372 younger counterparts for comparison. Using item response theory alongside model-fit evaluation and correlational tests with job/life satisfaction, engagement, burnout, and turnover intent-we assessed reliability and construct validity of the long- (30 reduced to 29-item) and short- (8-item) form TfWQ versions. We recommend omitting one of the original items from the long-form for use in older workers. Instrument reliability was high (α = 0.94 long-form; 0.90 short-form). Model fit was established for both long- and short-form versions with acceptable model fit indices. Convergent validity was supported by strong, theory-consistent correlations with the external constructs. Older workers, compared with those 20-49 years, had higher scores of thriving from work as well as differences identified on nine items. These age-patterned differences highlight actionable levers for occupational-health age-sensitive policy, wellbeing interventions, and workforce planning. The TfWQ offers a robust, reliable, valid, and practically oriented tool for evaluating older workers' wellbeing with utility across research, practice, and policy.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Dual Role of Trace and Toxic Elements in Pregnancy-Related Health Outcomes.","authors":"Thaveesak Sai-Ong, Donrawee Waeyeng, Tanaporn Khamphaya, Yanisa Rattanapan, Warinya Hnoocham, Katesiri Samaphong, Soisungwan Satarug, Supabhorn Yimthiang","doi":"10.3390/ijerph22091423","DOIUrl":"10.3390/ijerph22091423","url":null,"abstract":"<p><p>Maternal health during pregnancy can be influenced by exposure to essential trace and toxic elements, notably cadmium, lead, chromium, and arsenic. Using inductively coupled plasma optical emission spectrometry, this study determined blood concentrations of toxic elements together with zinc, copper, and iron, which are nutritionally essential, in 200 pregnant women who attended the antenatal care at Thasala Hospital, Nakhon Si Thammarat, between January and July 2023. Associations of maternal clinical outcomes with the measured blood elemental composition were evaluated by Spearman's rank correlation analysis. Iron showed the highest concentration among trace elements (75,178 ± 12,045 µg/dL), followed by zinc (1189.20 ± 211.38 µg/dL) and copper (294.72 ± 67.19 µg/dL). Among the toxic elements, lead had the highest concentration (5.59 ± 1.61 µg/dL), followed by chromium (2.80 ± 1.47 µg/dL), with arsenic and cadmium having the lowest concentrations. Synergistic associations were observed among lead, zinc, and iron. Blood lead concentration correlated inversely with hematocrit, while blood arsenic and blood cadmium both showed inverse association with urine glucose. Plasma glucose concentration varied directly with zinc and iron. These findings indicate effects and interactions of essential versus toxic elements on the health of pregnant women. They underscore the need to continue research into the strategies to minimize the impact of toxic elements and to further improve the nutritional status of zinc and iron during pregnancy.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological Resilience in Latin America Nursing Students Using the Wagnild and Young Scale: A Scoping Review.","authors":"William Donegá Martinez, Marco Antonio Ribeiro Filho, Tiago Casaleiro, Marcos Sanches Rodrigues, Emerson Roberto Dos Santos, Daniele Nunes Longhi Aleixo, João Daniel de Souza Menezes, Matheus Querino da Silva, Renato Mendonça Ribeiro, Luiz Vianney Saldanha Cidrão Nunes, Rauer Ferreira Franco, Amanda Oliva Spaziani, Marli de Carvalho Jerico, Alex Bertolazzo Quitério, Weslley Dos Santos Borges, Christian Guilherme Capobianco Dos Santos, Maysa Alahmar Bianchin, Luís Cesar Fava Spessoto, Maria Helena Pinto, Fernando Nestor Facio Júnior, Ronize Aparecida Domingues de Almeida Prado, Ana Paula Bernardes da Rosa, Marlene da Silva, Sabrina Ramires Sakamoto, Neuza Alves Bonifácio, Suzimar de Fatima Benato Fusco, Rita de Cássia Helú Mendonça Ribeiro, Denise Cristina Mós Vaz Oliani, Antônio Hélio Oliani, Júlio César André","doi":"10.3390/ijerph22091425","DOIUrl":"10.3390/ijerph22091425","url":null,"abstract":"<p><p>Nursing students frequently experience considerable stress, impacting their mental well-being and preparedness for professional practice. Psychological resilience is paramount in navigating these demands. This scoping review synthesized studies on resilience levels in nursing students, particularly those in their entry year, utilizing the Wagnild and Young Resilience Scale within the Latin American academic context. Following JBI methodology and PRISMA guidelines, a systematic search identified six relevant studies. Findings indicate that newly enrolled nursing students often exhibit low to moderate resilience, which may decline during the first academic year. Importantly, resilience acts as a protective factor against psychoemotional stress, depressive symptoms, and poor sleep quality. Family support, engagement in leisure activities, and course satisfaction positively correlate with higher resilience. These findings underscore the imperative for educational institutions to actively integrate resilience-building strategies, such as curricular adjustments and psychoeducational programs, to bolster student well-being and cultivate competent future professionals. Further longitudinal research is essential to deepen understanding and evaluate intervention efficacy.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Stratified Analysis of the Associations of Hearing Loss and Allergic Rhinitis with Attention Deficit Hyperactivity Disorder in Children: A Population-Based Cross-Sectional Study in Korea.","authors":"Bo Ram Yang, Bong Jik Kim","doi":"10.3390/ijerph22091422","DOIUrl":"10.3390/ijerph22091422","url":null,"abstract":"<p><p>We conducted a cross-sectional, population-based study to investigate the association between hearing loss and allergic rhinitis with attention deficit hyperactivity disorder (ADHD) using pediatric patient samples from the Korea Health Insurance Review and Assessment Service database (2009-2018). Baseline demographics and the relationships of both conditions with ADHD were analyzed. Both hearing loss and allergic rhinitis were significantly associated with ADHD, and patients with both hearing loss and allergic rhinitis showed a stronger association with ADHD compared to patients with either hearing loss or allergic rhinitis alone. The association of hearing loss with ADHD appeared to be stronger in girls than in boys. Our study revisited the link between hearing loss and allergic rhinitis with ADHD, using healthcare big data to provide more definitive evidence. Contrary to expectations, hearing loss demonstrated a stronger association with ADHD in girls than in boys, suggesting it could serve as an independent risk factor for ADHD.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Users' Perspectives on Primary Care and Public Health Services in the State of Rio de Janeiro, Brazil: A Cross-Sectional Study with Implications for Healthcare Quality Assessment.","authors":"Igor F L Ferraz, Mariana C Raimundo, Natalia M A M Barros, Jhoyce S Souza, Barbará M V Lucio, Thiago P Tenreiro, Edna A Reis, Danielle Maria de Souza Serio Dos Santos, Luisa A Chaves, Brian Godman, Stephen M Campbell, Johanna C Meyer, Isabella Piassi D Godói","doi":"10.3390/ijerph22091424","DOIUrl":"10.3390/ijerph22091424","url":null,"abstract":"<p><p>This study focuses on the Unified Health System (SUS) in five regions of the state of Rio de Janeiro, Brazil, one of Brazil's most important states, as part of a comprehensive analysis of a research project, which has generated publications in earlier phases. The objective was to assess users' perceptions of SUS in terms of access to and the quality of public health services, including primary care and pharmaceutical services. A cross-sectional study was conducted using a structured questionnaire comprising 66 questions, administered to a purposive sample of 1000 participants between August 2023 and August 2024. Data were analyzed using Pearson's chi-square test with R software version 4.3. Among the participants, 54.5% were female, 62.5% were aged between 26 and 60 years, and 29% reported having private health insurance. Vaccination services were the most frequently used SUS service (25.1% of respondents). Participants who reported more frequent use of SUS services rated access more positively than those who used them less frequently (<i>p</i> = 0.002). The regions that evaluated SUS access and quality most favorably were Middle Paraíba and the metropolitan region, while the Coastal Lowlands region received the most negative assessments. Participants with lower socioeconomic status gave more favorable evaluations of access to public health services (<i>p</i> = 0.001). These findings highlight concerns about access to, and the quality of, SUS healthcare services and regional disparities in users' perceptions of SUS services in Rio de Janeiro. The results underscore the importance of social participation as a key element in the evaluation and continuous improvement of responsive public healthcare.</p>","PeriodicalId":49056,"journal":{"name":"International Journal of Environmental Research and Public Health","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}