International Journal of Environmental Research and Public Health最新文献

This study synthesizes the evidence on effective interventions for the prevention of breastfeeding-related nipple-areolar injuries. A systematic review was performed and guided by the evidence synthesis manual of the Joan Briggs Institute, carried out in six databases, with only intervention studies. Interventions with a positive outcome for the prevention of nipple-areolar lesions were considered effective. Methodological quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation. The final sample of 14 articles found the following to be effective strategies: educational practices (simulations and demonstrations of the breastfeeding technique, with a qualified professional or by video) and the use of peppermint (aqueous solution or gel), extra virgin olive oil, honey, guaiazulene ointment, and venix caseosa. Each intervention was used in specific situations and ways, which should be considered for use in clinical practice. The interventions discussed can help prevent nipple-areolar lesions and breastfeeding difficulties, encouraging breastfeeding.

This study analyzed baseline data from a six-month longitudinal cohort to describe the demographic, occupational, and symptom profiles of Japanese working women and to examine associations between menopausal symptoms, workplace openness, and work productivity. A total of 4000 women aged 40-60 years completed the Simplified Menopause Index (SMI), a commonly used measure in Japan to assess menopausal symptoms, and the validated Health and Work Performance Questionnaire (HPQ) to assess self-rated work productivity. Multiple regression analyses were conducted, adjusting for demographic and occupational covariates. Psychological symptoms showed the strongest negative association with work productivity (β = -0.186, p < 0.001), while vasomotor symptoms showed a small positive coefficient (β = 0.054, p = 0.007). Somatic symptoms were not significant (β = -0.033, p = 0.121). Lower perceived workplace openness was associated with lower productivity (β = -0.149, p < 0.001), such that employees who felt uncomfortable or unsure about discussing health concerns reported lower productivity. Higher educational attainment, longer working hours, and longer years of service were also associated with higher productivity. These findings indicate that psychological and physical symptoms are associated with lower work functioning during midlife, while supportive organizational environments appear to be relevant in this context. These cross-sectional findings provide a foundation for future longitudinal analyses and highlight the potential relevance of workplaces that promote open health communication.

Objective: This study analyzes temporal trends in occupational cancer mortality in Brazil and its federative units from 1990 to 2023, focusing on regional and gender disparities.

Methods: We conducted an ecological time-series analysis using data from the Global Burden of Disease (GBD) database. We included deaths from malignant neoplasms attributable to occupational exposures and calculated age-standardized mortality rates. We applied segmented regression with the Joinpoint Regression Program (version 5.4) to estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) for Brazil and its states, stratified by sex.

Results: Occupational cancer mortality declined nationally (AAPC = -1.08; 95% CI: -1.37 to -0.85), with a more substantial decrease among men. Marked regional differences emerged: the South, Southeast, and Midwest regions showed consistent declines, while several states in the North and Northeast exhibited stable or rising rates, especially among women. Part of the observed recent decline coincided with the COVID-19 pandemic (2019-2023), suggesting potential underdiagnosis or underreporting.

Conclusion: Brazil has experienced a national decline in occupational cancer mortality; however, regional and gender inequalities persist. Territorial, economic, and occupational contexts shape these differences. Strengthening surveillance systems, updating exposure registries, and developing policies sensitive to regional and gender disparities may contribute to improving occupational cancer prevention and control.

Background/objectives: Effective use of health services is essential for universal health coverage, yet many adults in Peru still forgo formal care despite illness. Evidence describing national trends and determinants of non-use of formal health services remains limited. This study aimed to estimate national trends from 2015 to 2024 and identify factors associated with non-use among Peruvian adults.

Methods: We conducted a repeated cross-sectional analysis of annual secondary microdata from the Peruvian National Household Survey (ENAHO, 2015-2024). Adults aged ≥ 18 years who reported a health problem in the last four weeks were included. Non-use was defined as not seeking care at any public or private provider (IPRESS). Survey-weighted descriptive analyses and modified Poisson regression models estimated prevalence ratios (PRs) with 95% confidence intervals, adjusting for sex, age, education, marital status, health insurance, chronic illness, disability, area, and region.

Results: Among 330,165 adults, 41.5% did not use formal health services. Non-use declined until 2019, rose sharply during 2020-2021, and partially recovered thereafter. In adjusted models, non-use was lower among women (PR = 0.92; 95% CI 0.91-0.93), those with higher education (PR = 0.88; 0.86-0.90), and participants insured by EsSalud (PR = 0.65) or SIS (PR = 0.76). It was higher in the Highlands (PR = 1.07) and lower in Metropolitan Lima (PR = 0.88).

Conclusions: Non-use of formal health services in Peru remains high and unequal. Expanding effective coverage, strengthening primary care, and improving health literacy are essential to achieve equitable access.

Leafy green vegetables provide important nutrients for human growth; however, human health is highly compromised through consumption of vegetables contaminated by heavy metals. Therefore, the study aimed to investigate the bioaccumulation of heavy metals in five different leafy green vegetables and soils and determine the human health risks that may arise from consuming those vegetables from Tonga town in Mpumalanga province, South Africa. Soils and five edible leafy vegetables (i.e., lettuce, cabbage, rape, pumpkin leaves, and spinach) were assessed for bio-concentration factor, daily intake of metals, health risk, and target hazard quotient across the study sites. The Si, K, Na, Ca, Mg, Al, and Fe concentrations were high in the soils. In general, vegetables exhibited elevated Ca, Fe, Si, Al, and Sr levels, although spinach had high Na concentrations. The bioconcentration factor showed the following trends: Mg > B > Si > V for trace metals and Cr > Co > Mn > Ni > B for heavy metals in lettuce, spinach, and pumpkin leaves. The human risk index for all vegetables showed that all metals were not likely to induce any health hazards to humans, and the target hazard quotient for B, Si, V, Al, Cr, Mn, Fe, Ni, Zn, and Pb showed potential for substantial health risk hazard. The findings of this study generally reveal that the concentrations of the analysed metals exceeded the permissible limits established by the World Health Organisation and the Food and Agricultural Organisation. Given the high levels of metals detected in the soil and vegetables within the study area, it is important to investigate the potential implications for human health and mitigate both acute and chronic health challenges associated with heavy metal exposure. Furthermore, this study will guide policymakers in developing improved regulations and safety standards for agricultural practices and environmental protection, particularly for vulnerable peri-urban and rural communities.

Background/objectives: Prostate cancer is a major public health concern and a leading cause of cancer-related morbidity and mortality among men worldwide, with disproportionately high mortality rates in sub-Saharan Africa. Late diagnosis, limited access to screening services, low health-seeking behaviour, and sociocultural barriers contribute to poor outcomes, particularly in rural settings. However, evidence on effective and context-appropriate strategies for prostate cancer prevention and early detection in African countries remains fragmented.

Objective: This scoping review protocol aims to map and synthesize existing evidence on strategies implemented to reduce the burden of prostate cancer in Africa, with a focus on prevention, screening, community engagement approaches, and their acceptability.

Methods: This scoping review protocol will be conducted in accordance with established methodological frameworks and reported following the PRISMA-ScR guidelines. A comprehensive search will be undertaken in PubMed (MEDLINE), EBSCOhost, ScienceDirect, CINAHL, and ProQuest. Studies conducted in African countries and published in English, French, or Portuguese will be included. Study selection and data extraction will be managed using Covidence, and findings will be summarized descriptively and thematically.

Expected results: This review is expected to identify and categorize existing prostate cancer prevention and early detection strategies implemented across African settings. Gaps in evidence, differences in implementation, and reported levels of acceptability among men are anticipated to be highlighted.

Conclusions: The completed scoping review is expected to provide a comprehensive overview of prostate cancer prevention and early detection strategies implemented in Africa and to identify gaps in evidence. The evidence will inform the development of culturally responsive and context-specific interventions, with particular relevance for rural South African settings. This manuscript presents a protocol for a scoping review; no review findings are reported.

Background: Local networks between General Practitioners (GPs) and Parish Ministers (PMs) have been piloted in Denmark to address the lack of collaboration between the two groups in order to strengthen existential and spiritual support in primary care. Evidence on how such collaborations are experienced by practitioners is limited.

Aim: The objective was to explore the experience of GPs and PMs participating in locally established interdisciplinary networks.

Design and methods: Within a Ricoeur-inspired phenomenological hermeneutical framework, we conducted five focus group interviews with five GPs and nine PMs from four Danish localities engaged in a step-by-step, participant-validated networking manual. Data was analyzed using a three-level process, including naïve reading, structural analysis, and critical interpretation and discussion.

Results: Participants described the collaboration as an educational, relationship-building process that required time and trust. Four themes emerged: (1) sharpening professional identity (GPs reframed limits of "fixing," and PMs broadened pastoral scope); (2) building relationships (mutual prejudices surfaced and were dismantled; in-person meetings were pivotal); (3) serving the patient's perspective better (PMs offered a non-clinical space for existential issues; early patient involvement energized groups); and (4) envisioning PMs' role in primary care (promise of complementarity vs. value of remaining outside formal health system documentation).

Conclusions: Locally grown GP-PM networks can reframe practice for both professions and open a pragmatic pathway for addressing patients' existential concerns. Relationship-building and early, appropriate patient inclusion appear central to momentum. Further research should examine patient outcomes and feasible models for collaboration that preserve confidentiality and role clarity.

Ongoing conflicts in sub-Saharan Africa negatively affect the population's mental health and weaken health care systems. Collaboration among stakeholders is recommended to strengthen mental health services in post-conflict settings, despite limited evidence on context-specific strategies. This paper aimed to identify strategies for collaboration between traditional and biomedical services to improve mental health care. An adapted nominal group technique was employed during a one-day stakeholder workshop. Fourteen participants representing traditional and biomedical mental health services discussed and prioritised strategies based on importance and feasibility to reach consensus. Five collaborative care strategies were prioritised based on stakeholder consensus regarding importance and feasibility: (1) collaborative learning, (2) formalising coordination, (3) capacity building, (4) joint intervention programs, and (5) regulatory support. Key mechanisms for implementing these strategies were also identified, including piloting integrated interventions, appointing a dedicated focal person to coordinate, providing basic psychosocial counselling skills, reducing harmful practices, and strengthening supportive supervision. Mutual learning was identified as a crucial cross-cutting component of all approaches. The conclusion was that implementing these prioritised strategies could improve mental health care. Further research is needed to evaluate the effectiveness of these strategies in enhancing collaborative care and improving mental health outcomes for individuals.

Spiritually integrated group therapy aims to support coping, meaning-making, and existential recovery in patients receiving psychiatric care. SPIRIT (Spiritual Psychotherapy for Inpatient, Residential and Intensive Treatment) is a structured, flexible protocol implementing this approach into intensive or residential settings. This study examines (1) the impact of SPIRIT on patients' lives and (2) their needs in terms of aftercare to determine whether and how its benefits can be sustained long term. Data were collected from multiple sources: patient evaluation forms (n = 118); in-depth interviews with patients (n = 19) and caregivers providing the therapy (n = 8); and two focus groups with both caregivers and patients. Transcripts were analyzed using qualitative content analysis. Results indicate that for most participants, the therapy positively impacted their lives through increased awareness or behavioral change, highlighting the relevance of maintaining these insights after group therapy, either at home or within the treatment setting. We recommend broader training of mental health professionals, and the introduction of programs like these to the entire care team to ensure awareness and support. A 'dual motor model' is proposed. Addressing religious, spiritual, and meaning-related themes in ongoing therapy and the psychosocial and pastoral support network can support recovery both by reducing symptoms and by fostering a health-promoting context.

The COVID-19 pandemic has revealed profound social-psychological vulnerabilities and strengths across societies worldwide. Beyond its immediate health implications, the pandemic has triggered a wave of mental health issues, disrupted social cohesion, and challenged community resilience. This paper synthesizes the current literature, critically discusses five recent studies as part of the Special Issue "Mental Health Consequences of COVID-19: The Role of Social Determinants", and articulates an agenda for future research within a social-psychological framework. Moving beyond mere negative effects such as anxiety, this review highlights the role of resilience, prosocial behavior, (digital) mental health interventions, and community social capital. Correspondingly, I advocate for interdisciplinary efforts to enhance awareness, preparedness, and adaptive capacity during health crises, emphasizing the need for a clearer focus on vulnerable social groups. In sum, recognizing the evolving global landscape, this work underscores the urgency of integrating psychological insights into public health policies to build resilient societies capable of confronting future pandemics and health emergencies.