International Journal of Environmental Research and Public Health最新文献

The rise in mental illnesses after the COVID-19 pandemic is well documented. However, it is not known whether the rates of mental illness comorbidity increased. The objectives of this study were to compare mental illness comorbidity rates before and after the pandemic among inpatients with SUD and to test associations between mental illness comorbidity, physical illness, and demographics. We used a retrospective cross-sectional design in a sample of inpatient discharges (N = 233,017) at Virginia public hospitals from January 2018 to December 2022. We used Z tests to compare rates of mental illness comorbidity pre- and post-pandemic and Chi-square tests to examine associations of mental illness comorbidity with physical illness and demographics. Single and comorbid mental illness significantly increased from pre- to post-pandemic, p < 0.0001. Mental illness comorbidity was significantly associated with sex, age, race, insurance, COVID-19/Long COVID, HIV/AIDS, COPD, hypertension, obesity, CVD, cancer, and diabetes (p < 0.0001). There was a significant increase in mental illness comorbidity, which was significantly associated with age, race, sex, and physical illnesses. Children/adolescents, females, American Indians, and individuals with HIV/AIDS had the highest rates of mental illness comorbidity. Public health action is needed to address the increase in complex medical needs among people with SUD.

Background: The Rohingya refugee crisis is one of the largest humanitarian emergencies of the 21st century, with nearly one million Rohingya residing in overcrowded camps in southern Bangladesh. Women and children face the greatest vulnerabilities, including inadequate access to education and healthcare, which exacerbates their risks and limits opportunities for personal and community development. While international organizations continue to provide aid, resources remain insufficient, particularly in maternal and child healthcare, highlighting the urgent need for sustainable interventions.

Objectives: The Hope Foundation for Women and Children in Bangladesh launched a pilot project for the Health Assistant Training (HAT) program to address critical gaps in healthcare and education for the Rohingya community. This nine-month training program equips young Rohingya women with essential knowledge and skills to support maternal health services in both clinical and community settings.

Design: We conducted a qualitative evaluation of the HAT Program to explore its acceptance and anticipated benefits for both participants and the community.

Methods: The research team used semi-structured interviews, focus groups, and field observations to explore the HAT Program's impact on young Rohingya women and their community. They analyzed data through thematic analysis, developing a coding framework and identifying key themes to uncover patterns and insights.

Results: The results were categorized into four themes: (1) community acceptance of the HAT Program, (2) the HAT Program's impact on the health assistant trainees, (3) the impact of the HAT Program on the community, and (4) the potential ways to expand the HAT Program.

Conclusions: This research underscores the program's impact on improving healthcare access, enhancing women's empowerment, and promoting community resilience. By situating this initiative within the broader context of refugee health, education, and capacity-building, this research highlights the HAT program's potential as a replicable model in Bangladesh and in other humanitarian settings.

Background: Work-related anxiety can result in prolonged work incapacity and reduce return-to-work probabilities. Despite the prevalence of work-related anxiety in somatic rehabilitation settings, there has been little research examining the experiences of affected patients from a public health perspective. This research project aims to address this gap by providing initial insights into the care provided to patients with somatic complaints and patients with additional work-related anxiety.

Methods: A sequential mixed methods approach was employed, beginning with semi-structured interviews (2022, n = 18 orthopedic rehabilitation patients), followed by questionnaire distribution (2023, n = 53). Qualitative analysis distinguished between patients with higher (JA) and lower (nJA) Job Anxiety Scale scores (cut-off 2.5).

Results: The findings highlight notable differences between JA and nJA patients. JA patients often report that they face unmet psychological needs, limited work-related treatment focus, financial barriers, and inadequate occupational support, relying more on self-initiative for reliable information. In contrast, nJA patients appear to benefit from stronger social networks, stable financial resources, and improved access to healthcare. Both groups report mixed experiences with workplace support. For professionals the findings underline that JA patients are specifically in need of work-related interventions, even patients themselves remind about this.

Conclusions: The findings illustrate significant differences between JA and nJA patients in terms of their experiences, challenges, and support needs within healthcare, workplace, and rehabilitation contexts. While qualitatively insightful, these findings are pilot and explorative and warrant further research.

Trial registration: DRKS00029004 (25 May 2022).

Nature-based health interventions (NBHIs) are increasingly used in the healthcare system to support people with anxiety, depression and/or stress, highlighting the need for systematic development and evaluation. This study aims to identify target group, professionals, mechanisms, and outcomes of NBHIs for people with mild to moderate anxiety, depression, and/or stress. A Delphi-based study was conducted to explore core components of NBHIs in healthcare settings. Thirteen vs. eleven researchers with expertise related to the target group responded in two rounds. Respondents rated statements on a 7-point Likert scale and prioritised core components regarding target group, professionals, mechanisms, and outcomes. A thematic analysis was applied to synthesise qualitative responses. Consensus was achieved on 12 of 21 items across the four domains. Highest agreement concerned core mechanisms (nature interaction, social community, and physical activity), outcome priorities (mental wellbeing and quality of life), and professional competencies. Greater variation was observed regarding group composition and team delivery. Analysis of qualitative expert responses highlighted four key themes: (1) Balancing Group Composition, (2) Adapting Competencies to Context, (3) Core Mechanisms for Change, and (4) Weighing Perspectives in Outcome Selection. By setting out guiding principles for a programme theory, the study lays the foundation for the design and implementation of context-adapted NBHIs. The study underscores the need to approach NBHIs as complex interventions, thus contributing to a paradigm shift towards a new era of a bio-psycho-social health perspective.

Background: Early childhood growth trajectories can influence the risk of chronic diseases in adulthood. Improvements in environmental sanitation may affect child development in low-resource settings.

Objective: to examine the associations among socioeconomic factors with nutrition indicators, and trajectories of anthropometric indicators across three epidemiological cohorts that reflect different phases of environmental sanitation implementation.

Methods: A longitudinal study was conducted in Salvador, Brazil, from 1997 to 2013. A total of 1429 children were recruited across three epidemiological cohorts, corresponding to the phases of a sanitation program: pre-intervention (n = 299), intervention (n = 1007), and post-intervention (n = 123). Height-for-age (HAZ) and BMI-for-age (BAZ) z-scores were assessed at four time points. Multilevel linear models were used to adjust for socioeconomic factors.

Results: A total of 992 children (68.7%) completed follow-up. Post-intervention children showed improved HAZ trajectories, with sex-specific patterns that varied across cohorts. Birth weight is positively associated with HAZ across all cohorts (0.34-0.49 kg increase per z-score). Household overcrowding (>2 persons/room) is consistently associated with lower HAZ (-0.34 to -0.63 z-score reduction). Children who were never exclusively breastfed in the post-intervention phase had a higher BAZ (0.76 z-score increase). Caesarean delivery is associated with higher BAZ in the pre-intervention (0.23) and intervention (0.27) cohorts.

Conclusions: Children born in later time periods showed better growth trajectories, which may reflect the combined effects of sanitation improvements, economic development, and other societal changes in Brazil during this period. Further research using experimental or quasi-experimental designs is needed to isolate the specific contribution of sanitation to child growth.

Women with intellectual disabilities (IDs) face persistent health inequities, particularly in preventive services such as breast cancer screening, where participation rates remain disproportionately low. These disparities contribute to higher mortality and poorer survivorship outcomes, often linked to later-stage diagnoses. To better understand these challenges and inform the development of inclusive screening programs, this qualitative study conducted in Austria explored barriers, facilitators, and needs related to breast cancer screening from the dual perspectives of 17 women with mild-to-moderate IDs aged 45 and older and 10 caregivers. Semi-structured focus groups and interviews were analyzed thematically within a constructivist framework, integrating perspectives from both groups. Barriers included social taboos around sexuality, psychological distress, exclusion through standardized procedures, and unclear responsibility among stakeholders. Facilitators involved person-centered communication, accessible information, emotional and practical support, and familiar healthcare environments. Women with IDs expressed a strong desire for education, autonomy, and inclusion, while caregivers played a pivotal role in enabling access. These findings demonstrate that low screening participation among women with IDs is driven by systemic and organizational barriers rather than lack of health awareness or willingness to participate. Without structurally inclusive design, organized screening programs risk perpetuating preventable inequities in early detection. Embedding accessibility, clear accountability, and person-centered communication as standard features of breast cancer screening is therefore a public health priority to reduce avoidable late-stage diagnoses and narrow survival disparities for women with IDs.

Children and adolescents with disabilities experience disproportionate challenges in achieving recommended levels of physical activity (PA) and adequate sleep, two core determinants of health and functional well-being. This systematic review examined associations between meeting PA guidelines and sleep duration among youth with disabilities. Following PRISMA guidelines, MEDLINE, PsycARTICLES, and SPORTDiscus were searched through Spring 2024 for studies assessing PA and sleep in children and adolescents (<18 years) with disabilities using subjective or objective measures. Data were extracted from 28 studies (N = 138,016) and synthesized using qualitative methods and regression-based quantitative analyses to examine the effects of diagnosis category and PA guideline adherence on sleep duration. The diagnosis type was associated with sleep duration, with youth with autism spectrum disorder (ASD) exhibiting shorter sleep than those with physical disabilities. Meeting PA guidelines (≥60 min/day) was associated with longer sleep duration among youth with ASD, but not consistently across other diagnostic groups. Qualitative findings further indicated diagnosis-specific variability, with PA positively associated with sleep outcomes in ASD, attention deficit/hyperactivity disorder, and epilepsy, and mixed associations observed for cerebral palsy and intellectual disability. These findings suggest that PA may support sleep health in specific disability groups. Given persistently low PA participation among youth with disabilities, integrating accessible, diagnosis-specific PA opportunities within school, community, and clinical settings may represent a feasible strategy to improve sleep and overall health.

Occupational exposure to sharps waste represents a critical challenge for public health systems, directly affecting healthcare workers' safety, institutional costs, and environmental sustainability. This study aimed to analyze sharps waste management practices and to structure improvement actions for biosafety governance in Brazilian Emergency Care Units (ECUs) through the application of the Lean Six Sigma (LSS) and DMAIC method (Define, Measure, Analyze, Improve, and Control). A single multiple-case study was conducted across three public units in different regions of Brazil, combining direct observation, regulatory checklists based on ANVISA Resolution No. 222/2018 (RDC), and cause-and-effect (5M) analysis. The diagnostic phase identified recurrent nonconformities in labeling, documentation, and internal transport routes, primarily due to managerial and behavioral gaps. Based on these findings, the DMAIC framework supported the development of a low-cost, evidence-based action plan that outlined proposed interventions, including visual checklists, standardized internal routes, and key performance indicators (KPIs), intended to strengthen biosafety traceability and occupational safety. The se proposed actions are expected to support continuous learning, staff engagement, and a culture of shared responsibility for safe practices. Overall, the study provides a structured basis for future implementation and empirical validation of continuous improvement initiatives, aimed at enhancing public health governance and occupational safety in resource-constrained healthcare environments.

Problem statement: Upper crossed syndrome (UCS), as first described by Janda, refers to a group of muscle imbalances in which tightness in the upper trapezius and levator scapulae dorsally cross with tightness in the pectoralis major and minor muscles, and weakness of deep cervical flexors cross ventrally with weakness of the middle and lower trapezius. Postural alterations from this dysfunction, including forward head, rounded shoulders, and scapular dyskinesis, contribute to upper-back and shoulder pain, particularly among office workers who spend long periods of the workday on a computer. Upper crossed syndrome is a significant contributor to both neck pain and shoulder pain among computer users, which have been rated at 55-69%, and 15-52%, respectively. Despite its prevalence, knowledge about UCS and its treatment remains spotty among primary care physicians. In addition, improvements in workstation ergonomics along with hourly work breaks may be considered as primary prevention strategies for UCS.

Objectives: This narrative review examines and synthesizes evidence about the epidemiology and diagnosis of UCS, along with clinical recommendations for physiotherapeutic approaches to treatment. Ergonomic measures in the workplace, including changes in the design of computer workstations so that both the keyboard and monitor are at the proper heights to minimize the risk of long-term musculoskeletal disorders, are also critical.

Methods: The first author, a Doctor of Behavioral Health, performed the initial literature search, which was reviewed by the second author, a PhD in sports injury epidemiology. The third author, a chiropractor and practice owner, provided clinical recommendations for stretching and strengthening exercises, which were also described in the literature.

Discussion: While easily treatable when caught early, UCS may become resistant to noninvasive approaches over time, and more severe pathologies of the neck and shoulder, including impingement, thoracic outlet syndrome, and cervicogenic headaches may result. Because there is no specific ICD code for UCS, it is important for physicians to recognize the early signs, consider them in the context of workplace-related injuries, and understand physiotherapeutic strategies for symptom resolution.

Objective: To analyse written submissions from individuals and families with lived experience of attention-deficit hyperactivity disorder (ADHD) to the 2023 Australian Senate Inquiry, using artificial intelligence (AI)-assisted thematic analysis. The aim was to identify priority concerns, service needs, and community-proposed solutions.

Methods: A mixed-methods study of 505 publicly available submissions from individuals with ADHD and their families. Submissions were analysed using large language model (LLM)-assisted data extraction and thematic clustering, with human validation and review.

Main outcome measures: Frequency and thematic distribution of (1) problems experienced; (2) services wanted; and (3) solutions suggested.

Results: Thematic analysis of 480 eligible submissions revealed high costs and long wait times for assessment and treatment (each cited by 46%), lack of specialised care (39%), diagnostic delays (36%), and gender bias (27%). The most common service request was for affordable and accessible ADHD-specific care (71%), followed by services tailored to diverse populations and life stages. Proposed solutions focused on Medicare-funded access to psychological and psychiatric services (68%), expanded roles for general practitioners, improved provider training (39%), and recognition of ADHD under the National Disability Insurance Scheme. Submissions also highlighted misalignment between current clinical guidelines and public expectations.

Conclusions: The findings highlight substantial unmet needs and systemic barriers in ADHD diagnosis and care in Australia. The AI-assisted analysis of consumer submissions offers a scalable method for integrating lived experience into policy development, providing numerical weighting to the individuals' responses. Coordinated reforms in access, funding, and workforce training are needed to align services with both clinical evidence and community expectations.