International Journal of Environmental Research and Public Health最新文献

Family caregivers provide up to 90% of care in Alberta's communities and play an essential role in sustaining the province's health and social care systems, yet they remain under-recognized and insufficiently supported. To address this gap, we co-designed the Alberta Family Caregiver Strategy and Action Plan (2024-2025), a provincial framework developed through participatory research and collective impact methods. Guided by principles of co-production, equity, and lived experience, the project engaged over 500 stakeholders, including caregivers, healthcare providers, educators, employers, and policymakers, through Phase 1 interviews (health/community leaders, n = 44; Family and Community Support Services (FCSS), n = 47; navigation experts, n = 9), Phase 2 co-design team consultations, and Phase 3 sector roundtables (n = 52). Using reflexive thematic analysis, we identified four foundational caregiver strategies, Recognition, Partnership, Needs Assessment, and Navigation, and four enabling conditions: Education, Workplace Supports, Policy and Research and Data Infrastructure. These elements were synthesized into an eight-priority Alberta Caregiver Strategy and Action Plan Framework, a practical way to connect validated priorities with coordinated, measurable implementation across settings. Participants emphasized four key enablers essential to making caregiver inclusion more feasible and sustainable: education, workplace supports, policy infrastructure, and research and evaluation. Findings highlight strong cross-sector consensus that caregiver inclusion must be embedded into routine practice, supported by consistent policy, and reinforced through provincial coordination with local adaptation. The Alberta Family Caregiver Strategy provides a practical, evidence-informed plan for transforming fragmented supports into a coherent, caregiver-inclusive ecosystem that strengthens both caregiver well-being and system sustainability.

Background: The COVID-19 pandemic exposed major deficiencies in global health governance, including fragmented authority, inequitable resource distribution, and weak compliance mechanisms. Although the WHO Pandemic Agreement (2025) addresses several of these gaps, significant operational and institutional challenges remain. This study aims to develop and empirically validate a Global Governance for Health (GGFH) Framework that strengthens leadership, financing, equity, and legal accountability across global, regional, and national levels.

Methods: A three-round Delphi study was conducted. Thirty-one experts from diverse sectors, including public health, international law, economics, environment, and diplomacy, evaluated 32 structured governance statements across seven domains. Experts rated all statements using a 7-point Likert scale. Consensus was determined using a strict threshold median ≥ 6; SD ≤ 1.35; ≥75% agreement. Open-text comments were systematically reviewed through thematic analysis. All statements were systematically mapped to the WHO Pandemic Agreement articles to identify areas lacking operational clarity or enforceability.

Results: All seven governance domains achieved consensus by Round 3. High agreement emerged on strengthening WHO leadership, implementing sustainable and equitable financing mechanisms, embedding LMIC representation, establishing legal preparedness and capacity-building, and integrating independent accountability tools. Correlation and interdependence analyses demonstrated that governance goals form an integrated, mutually reinforcing system, with financing, equity, and legal frameworks identified as core enablers of effective treaty implementation.

Conclusions: The Delphi process validated a comprehensive and operational Global Governance for Health Framework. The GGFH complements the WHO Pandemic Agreement by addressing its unresolved governance, financing, and equity limitations and offers a structured roadmap to guide global pandemic preparedness and treaty implementation.

Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO₂/VO₂). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition on body composition and metabolic outcomes in sedentary overweight and obese women. Forty-four women mean age 43 years; BMI 30.1 kg·m^-2) were randomized to low-intensity continuous training (LICT; RER ≈ 0.75), moderate-intensity intermittent training (MIIT; RER ≈ 0.85), or high-intensity continuous training (HICT; RER ≈ 0.95). Following a 2-week dietary lead-in with an individualized ~200 kcal·day^-1 energy deficit, participants completed an 8-week RER-guided walking program (5 sessions·week^-1; 15-50 min·session^-1). Assessments included air-displacement plethysmography (BodPod) body composition, resting metabolic rate and substrate utilization, and oxygen uptake at the first ventilatory threshold (VT1). Data were analyzed using ANCOVA, mixed-factorial ANOVA, and Pearson correlations. Percent body fat decreased significantly across participants (p < 0.0001, η² = 0.827), with MIIT demonstrating the most favorable integrated outcomes. MIIT elicited the largest reductions in total body mass (-11.2%), fat mass (-25.9%), and percent body fat (-17.1%), alongside improvements in VT1 VO₂ (Δ = 1.487 ± 0.895 L·min^-1; p = 0.038). Resting respiratory quotient (RQ) declined in LICT and MIIT but increased in HICT, corresponding with increased fat oxidation in LICT and MIIT and reduced fat oxidation in HICT. Changes in RQ were significantly associated with changes in percent body fat (r = 0.316, p = 0.039). Metabolically guided moderate-intensity intermittent walking combined with whole-food, plant-based nutrition produced the most consistent improvements in adiposity, substrate utilization, and submaximal fitness, supporting the public-health feasibility of a community-deliverable, substrate-informed walking prescription.

Objectives: The popularity of racket sports has been increasing globally in recent years, with tennis remaining the most played sport worldwide and pickleball gaining popularity in the United States. While many studies have addressed injuries associated with racket sports in adult athletes, minimal data are available focusing on young athletes in pediatric and adolescent populations. This study aimed to review the various injuries associated with racket sports in pediatric and adolescent populations.

Methods: Using the PubMed database, we searched for studies completed in the last 10 years that addressed injuries due to racket sports in age groups up to 18 years old, as well as adult studies that included pediatric and adolescent populations.

Results: In total, 60 studies met our inclusion criteria, of which 18 were descriptive studies. The most common injuries reported in the studies were lower extremity injuries, specifically knee and ankle injury. Upper extremity injuries were the next most common, specifically shoulder injuries. Most of the studies reported multiple musculoskeletal injuries as opposed to just one. Tennis was found to be the racket sport that caused the highest number of injuries, as well as the most severe injuries.

Conclusions: There are few studies on musculoskeletal injuries from racket sports in pediatric and adolescent populations. This review found that tennis had the highest number of studies, and different types and severities of injuries were well-described. Lower extremity overuse injuries were the most common, followed by upper extremity injuries. Eye injuries were less common but serious. Injuries cause pain, time loss in school, and increased healthcare burden, so there is public health relevance to conducting more racket sport studies. There is a significant amount of physical and mental growth occurring during childhood and adolescence; therefore, more kinematic studies and systematic reviews should be conducted pertaining to racket sports, which will hopefully help with injury prevention in these age groups.

Endometriosis affects one in seven women in Australia and is a significant public health concern. Access to appropriate health information is essential for informed decision-making and quality of life, especially for culturally and linguistically diverse (CALD) women who may face additional communication and health literacy barriers. This study explored the information-seeking behaviours and experiences of CALD women living with endometriosis using semi-structured interviews. Through convenience and snowball sampling via social media, eleven women were recruited. Data were analysed using thematic analysis. The results showed that although women often did not view their cultural background as influential, taboos and stigma can shape information-seeking behaviours. Women primarily relied on healthcare professionals, online resources, and other women with endometriosis as information resources. Healthcare professionals were appreciated for providing tailored information, but some were perceived to have limited knowledge of endometriosis, reducing their usefulness. Online information was abundant and easily accessible but often overwhelming and difficult to navigate. Information from other women with lived experience provided both practical insights and validation, though participants recognised its limited transferability to their own circumstances. These findings highlight the need for information pathways, including better patient education through healthcare providers, as well as accessible and evidence-based online resources.

Accessible and inclusive community environments support physical activity and health equity for people with disabilities, yet gaps in design, maintenance, and communication limit safe, independent use. This statewide cross-sectional audit assessed park accessibility and usability and playground safety in publicly accessible, non-fee-based Delaware community parks with playgrounds. Fifty stratified sites were evaluated using the Community Health Inclusion Index and the America's Playgrounds Safety Report Card by trained raters with strong interrater reliability. Descriptive analyses summarized accessibility, usability, communication, and safety features by county, with exploratory urban-suburban/micropolitan contrasts. Most sites provided wide, smooth paths, shade, and strong playground visibility, but foundational accessibility varied. Only 30% had a nearby transit stop, fewer than 10% of crossings included auditory or visual signals. Curb-ramp completeness was inconsistent, with detectable warnings frequently absent. Restrooms commonly lacked low-force doors or operable hardware, and multi-use trails often had obstacles or lacked wayfinding supports. Playground accessibility features were present at approximately two-thirds of sites, and 62% were classified as safe, although 10% were potentially hazardous or at-risk. Higher playground accessibility scores were strongly associated with lower life-threatening injury risk. Overall, gaps in transit access, pedestrian infrastructure, amenities, and communication support limit equitable, health-supportive park environments and highlight priority improvement areas.

Breastfeeding is universally regarded as the cornerstone of infant feeding, as it is the ideal infant feeding choice for optimal nutrition and development. Socio-structural factors of breastfeeding in child health play an important role in guiding women's decisions on options to feed their babies. A cross-sectional study was conducted among mothers with infants aged 0-6 months in Mthatha, Eastern Cape, with the aim of assessing the role of socio-structural factors in shaping feeding intentions and practices among mothers with infants. Written Informed consent was obtained in accordance with the Declaration of Helsinki from the participants prior to data collection. Data was gathered with a validated designed questionnaire as well as analyzed using Social Sciences (SPSS) version 29. A total of 181 mothers were enrolled. Only 45.9% reported that they exclusively breastfed their babies, of which the highest proportion of exclusive breastfeeding (EBF) was observed among the 21-29 age group at 51.8%, and the lowest among those aged 20 years and below (3.6%). Marital status (p = 0.005) and employment status (p < 0.001) were significantly associated with exclusive breastfeeding, with higher EBF rates observed among married mothers and those who were self-employed. Both the EBF mothers and non-EBF mothers shared a common belief that colostrum was not beneficial for infants (p = 0.854), whereas their views differed significantly on the amount of water given to infants before they reached six months (p = 0.001). There was no significant relationship between EBF status and having a family member who had breastfed in the past six months (p = 0.815); also, a weak association was noted for having a friend who had breastfed recently (p = 0.057). The difference in EBF practice between those receiving antenatal care (ANC) breastfeeding education and those not receiving it was not statistically significant (p = 0.591). A statistically significant association was found between the support level and exclusive breastfeeding status (p < 0.001). This study highlights that the successful practice of exclusive breastfeeding (EBF) is strongly associated with high levels of social support. Interventions are needed to engage active partners, family members, and community members in creating a supportive environment for breastfeeding mothers.

Locus of control is a psychological construct that influences how individuals perceive their ability to manage life events. Although its relationship with mental health has been widely studied, limited evidence exists among Latin-American university student populations. To assess the association between locus of control and symptoms of depression, anxiety, and stress among university students in Nuevo León, Mexico. A cross-sectional, analytical study was conducted using data from the Healthy Lifestyle Promotion Program at the Universidad Autónoma de Nuevo León. A total of 815 students completed a digital survey assessing sociodemographic variables, DASS-21, and Burger's Locus of Control Scale. Participants had a mean age of 19.8 ± 3.4, 57.1% were women. The prevalence of symptoms was 64.4% for depression, 55.8% for stress, and 74.1% for anxiety. Women exhibited higher severity across all dimensions (p < 0.001). Locus of control scores decreased significantly as the severity of depression, stress, and anxiety increased, particularly in moderate to extremely severe categories. An external locus of control was consistently associated with higher frequency of severe psychological symptoms. An external locus of control was strongly associated with poorer mental health outcomes. Strengthening internal locus of control may enhance resilience, reduce psychological distress, and improve academic performance.

Public health restrictions during COVID-19 disproportionately affected older adults, especially those in long-term care (LTC) and their families. Family caregivers (FCs) are essential care partners in LTC settings, yet pandemic policies largely excluded them, creating emotional and systemic consequences. This study explored FCs' experiences of visitation restrictions in British Columbia, Canada, using an arts-based qualitative approach within a larger mixed-methods project. Eight FCs participated in completing a total of twelve artworks, including photographs, collages, and creative writing that reflected their experiences. Virtual talking circles were used to facilitate the sharing and description of their experiences. Findings revealed three interconnected theme categories with eleven sub-themes. These themes suggest a plausible pathway: infection-control rules may lead to caregiver exclusion, disrupting relational continuity and oversight and contributing to distress and task-centered care. While context-specific and exploratory, results underscore the need for trauma-informed, family-inclusive policies and cultural safety in LTC. Arts-based research methods provided a powerful lens for capturing emotional realities often missed by conventional research.

Local governance has been found to be an important determinant of individuals' subjective well-being (SWB) in cross-municipality studies in Europe and Asia. In addition, previous literature suggests that increasing access to determinants of SWB provides lesser SWB benefit to racial minorities compared to white people in the United States (U.S.). Given this context, we ask the following: (1) does good local governance improve SWB in the U.S.? and (2) does good local governance improve SWB for Black and Hispanic people equally compared to white people? To answer these questions, we examine Chicago, Illinois, the third-largest city in the U.S. with substantial Black and Hispanic populations. We model local governance, our independent variable, as the number of weeks for the municipality to respond to pothole service requests reported to the city's non-emergency services system. Our dependent variable was life satisfaction, measured by the Cantril Ladder. Covariates included self-reported health problems, lack of money for food, sex, age, age-squared, and marital status. Neighborhood race/ethnicity was tested as a moderator of the primary relationships. We estimated linear regression models with and without race × governance interactions. Our findings demonstrate that local governance is an important determinant of SWB, but that it benefits SWB in white neighborhoods more than in Black/Hispanic neighborhoods.