International Journal of Environmental Research and Public Health最新文献

In recent decades, technological shifts within the healthcare sector have significantly transformed healthcare management and utilization, introducing unprecedented possibilities that elevate quality of life. Organizational factors are recognized as key drivers in technology adoption, but involvement of hospitals in community-oriented activities and promotion of health equity are underexplored. This study investigated the impact of community social determinant activities and health equity activities on the adoption of AI and telehealth services within U.S. hospitals. The data were collected from the 2021 American Hospital Association (AHA) annual survey and were analyzed using multiple logistic and linear regression models to examine activities related to addressing population health, particularly social determinants and health equity, and their impacts on the adoption of AI and telehealth among U.S. hospitals. The results indicate a significant positive association between the community social determinant indicator and health equity indicator in adopting AI and telehealth services. Organizational factors were also major drivers of AI and telehealth adoption. The active incorporation of hospital strategies that address social determinants and promote health equity leads to the integration of advanced technologies and improves hospital conditions, enabling more adaptability to the changing healthcare landscape, which enhances healthcare services and accessibility.

Background: Youth with disabilities (YWD) often exhibit deficits in physical fitness, but much of the literature is limited by small, non-representative samples. The purpose of this study was to examine differences in musculoskeletal fitness between youth with and without disabilities from the 2012 National Youth Fitness Survey (NYFS).

Methods: A secondary analysis was conducted with cross-sectional data from the 2012 NYFS of youth, 6 to 15 years of age. Fitness measures included plank, modified pull-ups, and grip strength. Disability was identified by multiple parent report items. Logistic regression with sampling weights was employed to examine group differences and associated factors.

Results: A total of 1177 youth were analyzed, including 173 YWD. A significantly greater proportion of YWD demonstrated low fitness in all three measures compared to youth without disabilities. Factors associated with low fitness included sex, engagement in physical activity, and the body mass index category. Age was not a significant factor for any fitness measure.

Conclusions: This secondary analysis provides additional evidence for lower musculoskeletal fitness among YWD, in particular for females and youth with obesity. Physical fitness continues to be an area in need of intervention to improve overall health among YWD.

Citizens Advice on Prescription (CAP), a Liverpool (UK)-based service, provides welfare advice and link worker social prescription support to people experiencing and at risk of experiencing financial or social hardship. CAP, which receives referrals from healthcare and third-sector services, aims to improve service users' financial security, health, and wellbeing. A mixed-methods social return on-investment (SROI) analysis was used to evaluate this service. Between May 2022 and November 2023, a subset of service users (n = 538) completed the Short Warwick-Edinburgh Mental Wellbeing Survey (SWEMWBS) at baseline and a 2-month follow-up. Supporting quantitative and qualitative economic data were also collected (February 2023-February 2024) through semi-structured interviews (n = 16). Changes in social value were determined by comparing pre- and post-SWEMWBS scores. These scores were then mapped to monetary values using the Mental Health Social Value Bank (MHSVB). SROI ratios were then calculated by dividing the change in social value by the associated service provision costs. The mean social value change per person ranged from GBP 505.70 to GBP 697.52, and the mean service provision cost was GBP 148.66 per person. The overall study reported a positive SROI return range of GBP 1: GBP 3.40-GBP 4.69. The results indicate that non-clinical support services, like CAP, may be an effective intervention for addressing the wider determinants of health and wellbeing.

This is the first study to analyze the coverage and profile of establishments registered on a meal delivery application (MDA) in small and medium-sized cities in Brazil. The app serves 497 municipalities across 22 states, offering 28,325 establishments. App coverage was measured as the ratio of cities served to the total small and medium-sized cities in each Brazilian region. The establishments were categorized using keyword analysis into six groups: International Cuisine, Snacks, Bakery Products, Complete Meals and Side Dishes, Sweets, Ice Creams and Desserts, and Healthy Options. Greater app coverage was observed in the South (13.68%) and Southeast (13.63%) regions. In contrast, lower coverage was noted in the North (2.46%) and Northeast (2.30%) regions. The keyword category 'Snacks' was the most used across all Brazilian regions, while 'Healthy Options' was the least utilized. Positive correlations were identified between the number of establishments on the app and the Municipal Human Development Index (r = 0.30; p < 0.001), demographic density (r = 0.23; p < 0.001), and urban population (r = 0.55; p < 0.001). The use of keyword categories varied across municipalities based on their demographic and socioeconomic characteristics. Our findings reveal significant asymmetries in app coverage and the types of registered establishments, which may further exacerbate inequalities in food access.

Latinx communities face disproportionate environmental injustices and are targeted due to systematic economic and political inequities. This research evaluates the ease at which links between industrial releases and risk of adverse health effects can be defined to influence policy change in Houston, TX. The Environmental Protection Agency (EPA)'s Toxic Release Inventory (TRI) is the most comprehensive public database on industrial facilities' toxic chemical releases in the US. TRI is presented within a risk-based context through the Risk Screening Environmental Indicators (RSEI) scores. TRI and RSEI datasets for Houston in 2022 were assessed in QGIS to analyze chemical release and risk in neighborhoods using Community Tabulation Areas (CTAs), identifying demographics of communities facing disproportionate industrial releases and consequent potential health risks. Geospatial visualizations reflected Latinx communities to house the heaviest polluting industrial facilities in Houston. As a result, these communities face the highest potential risk of adverse health effects due to exposure to a multitude of chemicals-particularly 1,3-butadiene, benzene, and chromium-as reflected in cumulative RSEI scores. An analysis of TRI and RSEI datasets elucidates the burden of gathering and analyzing chemical release data in a public health context, reflecting why change beginning at the local level can be difficult for under-resourced Latinx communities facing industrial pollution. Improving the accessibility and utility of the EPA resources will provide a resource to advocate for data-driven policy change.

The role of General Practice Pharmacists (GPPs) has expanded in response to increasing demands on primary care services, particularly in managing chronic conditions. While GPPs are recognised for their contributions to medication optimisation and patient care, challenges such as role clarity, workload pressures, and confidence in clinical decision-making remain underexplored. This study aims to investigate the tasks, professional identity, confidence levels, and challenges faced by GPPs in Northern Ireland. A mixed-methods design was employed, incorporating a questionnaire distributed to GPPs across Northern Ireland. The questionnaire comprised 20 multiple-choice questions and 5 open-ended questions, focusing on demographics, tasks, confidence levels, role clarity, and professional challenges. Quantitative data were analysed using descriptive and inferential statistics, while qualitative responses underwent thematic analysis using NVIVO software. A total of 44 GPPs participated, with a majority being female and aged 34-39 years. Most participants had 4-6 years of experience as GPPs. Quantitative findings revealed significant correlations between clinical confidence and factors such as years of experience, age, and employment type. Qualitative analysis revealed key themes: clinical confidence was enhanced by training and experience, but workload pressures often limited time for patient care. Variability in role integration and the lack of public awareness were highlighted as barriers to maximising the GPP role. This study highlights the key challenges of workload distribution and role ambiguity in the GPP role. Delegating administrative tasks and developing clear frameworks for role integration could address these barriers. Additionally, targeted training programs and public education campaigns are essential to enhance the impact of GPPs in primary care.

Most drugs excreted in urine are not filtered by wastewater treatment plants and end up in aquatic systems. At concentrations measured in waters, toxic effects on species have been described. Second, most of the drug consumption is attributable to primary care prescriptions. We thus present here, an ecotoxicity classification of the most sold drugs in primary care in Switzerland. Three datasets were combined: (1) surveyed ecotoxic drugs by the Swiss National Surface Water Quality Monitoring Programme and its European equivalent, (2) the top 50 drugs by sale in primary care in Switzerland, and (3) active pharmaceutical ingredient (API) concentrations in Lake Geneva and the rivers of the canton of Vaud between 2017 and 2022. We classified APIs into five categories from the safest to the least safe: (1) APIs found in concentrations (C) <10× their environmental quality standard (EQS·10^-1), (2) EQS·10^-1 < C < EQS and not listed by the Swiss or the EU Watch List, (3) EQS·10^-1 < C < EQS and listed, (4) C > EQS and not listed, and (5) C > EQS and listed. We obtained full ecotoxicological data for 35 APIs. Fifteen APIs were designated as safe (category (1):paracetamol, tramadol, amisulpride, citalopram, mirtazapine, metformin, gabapentin, lamotrigine, primidone, candesartan, irbesartan, atenolol, hydrochlorothiazide, ofloxacin, sulfadiazine), eleven as intermediately safe, and nine were of concern (azithromycin, ciprofloxacin, clarithromycin, sulfamethoxazole, carbamazepine, diclofenac, ibuprofen, iomeprol, iopromide). Full data were available for only one-third of the drugs most sold in primary care. Where data do exist, we observed significant differences in environmental impact among the same class of drugs. Our classification could therefore help guide doctors to adopt more eco-friendly prescriptions.

Problem: Chronic back pain (CBP) is a major cause of disability, contributing significantly to healthcare costs and primary care visits. Pharmacotherapy alone is insufficient in managing CBP. Integrated behavioral health interventions that include psychoeducation are critical for a more holistic, sustainable treatment of CBP.

Objectives: This review explores CBP treatments that includes psychoeducation as part of patient care.

Methods: In the Fall of 2024, the first author searched Google Scholar, PubMed, and Scopus using search terms related to chronic back pain and integrated behavioral interventions to increase patients' self-efficacy to manage CBP. The team included articles in the review that were published more recently and seminal articles in the field of managing CBP.

Results: Given the complex biopsychosocial factors influencing CBP, and the individualized nature of each patient's pain experience, patient psychoeducation should include a multimodal approach, which may include cognitive behavioral strategies to address pain, pain neuroscience education, and education related to lifestyle behaviors such as physical activity, sleep, nutrition, and stress management. Patient education and behavioral interventions integrated within primary care can significantly improve patient engagement and self-reported improvements in pain intensity, functionality, and quality of life.

Conclusion: Psychoeducation is foundational for integrative programs aimed at managing CBP.

Body image (BI) plays a critical role in mental health, with negative perceptions often linked to feelings of low mood. Physical activity (PA) has been shown to enhance self-acceptance and reduce negative emotions, suggesting it may help mitigate the impact of BI on low mood. This study examines the relationship between BI and low mood among adolescents, and explores the role of PA as a mediator in this relationship. The study had a cross-sectional design. Data were collected from 154,183 adolescents (average age 13.6 ± 1.6 years) across 43 countries, using the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. BI was assessed through self-perceived body size, low mood was measured on a scale from "about every day" to "rarely or never", and PA was evaluated by the number of days per week participants engaged in at least 60 min of activity. The study used multinomial logistic regression and a mediation model to analyze the relationships of BI, PA, and BMI with low mood. The multinomial logistic regression showed that daily PA reduces the risk of low mood, especially with higher PA frequency, such as PA on 6 days (OR = 0.72) and PA on 5 days (OR = 0.86). Age, BMI, BI, and sex also influence low mood, with males showing lower odds (OR = 0.40 to 0.77), normal weight individuals having a reduced risk, and thinner individuals having lower odds of low mood (OR = 0.12 to 0.50), with PA partially mediating the relationship between BI and low mood (p < 0.001), contributing to 9% of the total effect. PA partially mediates the relationship between BI and low mood, with a direct negative impact of BI on low mood. In addition, girls, older adolescents, and those with negative BI and irregular PA have a higher risk of low mood.

Myalgic encephalomyelitis (ME/CFS) a chronic, disabling illness with no established etiopathology. It has been indicated in some population-based studies that Black and ethnic minority populations are underdiagnosed with ME/CFS. The aims of the present study were to (1) identify the agreement between receiving an ME/CFS diagnosis and meeting diagnostic criteria, (2) identify the demographic characteristics associated with receiving a diagnosis, and (3) explore patient satisfaction with healthcare. Self-reported medical history and symptoms were collected via online survey from respondents with and without fatigue. The agreement between self-reporting an ME/CFS diagnosis and meeting the Center for Disease Control's (CDC) ME/CFS criteria or Institute of Medicine (IOM) criteria was assessed with Cohen's kappa. Patient characteristics predicting a physician diagnosis were analyzed with logistic regression. Associations between diagnosis, demographics, and healthcare satisfaction were assessed with chi-square tests of independence. There were 1110 responses. The agreement between meeting ME/CFS criteria and reporting an ME/CFS diagnosis was fair (CDC: κ = 0.29; SE = 0.02; IOM: κ = 0.28, SE = 0.03). White respondents had 2.94 greater odds of being diagnosed with ME/CFS than non-White respondents. Having an ME/CFS diagnosis was associated with dissatisfaction with healthcare (χ² (3, N = 1063) = 14.17, p = 0.003). The findings suggest racial disparities in the diagnostic processes for ME/CFS.