International Journal of Environmental Research and Public Health最新文献

Parental perceptions of healthy eating often diverge from children's actual diets, but this gap is poorly documented in Central Asia. We examined how parents' priorities for key food groups relate to nutrient intakes in 390 urban children aged 1-6 years in Central Kazakhstan. In a cross-sectional study, parents completed a 24 h multiple-pass dietary recall and rated the importance of fats and sweets, meat and fish, dairy, vegetables and fruits, and bread and potatoes on 5-point scales. Nutrient intakes were calculated using software, compared with national DRIs, and analyzed using rank-based tests and Spearman correlations. Parents reported near-ceiling priority for restricting fats and sweets and consistently high priority for bread and potatoes, whereas vegetables, fruits, meat/fish, and dairy were rated moderately important, with dairy under-prioritized in 1-2-year-olds. On the recalled day, median intakes of fat, dietary fiber, vitamin C, and calcium were below national recommendations at all ages, and median intakes of iron, thiamine, and niacin were particularly low at 3-4 years, while sodium intake exceeded recommended levels; the 3-4-year group showed the most pronounced clustering of shortfalls. Prevalence estimates indicated that most children had intakes below recommendations for dietary fiber and calcium and above recommendations for sodium, underscoring population-wide nutritional imbalance. Across all scales, parental priorities showed only weak, non-significant associations with nutrient intakes (|r| < 0.11). These findings indicate a perception-intake gap and support interventions that ensure adequate fats, fiber, vitamin C, calcium, and bioavailable iron in preschool diets.

This study examines how parental legal status operates as a fundamental social determinant of health and educational equity, focusing on long-term outcomes among U.S.-born and foreign-born children of immigrants. We hypothesized that intergenerational stress and institutional exclusion associated with undocumented status would lead to lower educational attainment and poorer health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort, participants were classified by inferred parental legal status: native-born, documented immigrant, and undocumented immigrant. Outcomes included high school graduation, college enrollment, depression scores, and chronic health conditions. Children of undocumented parents exhibited the most adverse outcomes-lower graduation (63.8%) and college enrollment rates (39.9%), higher depression, and greater chronic illness. In models controlling for socioeconomic factors, parental undocumented status independently predicted reduced odds of college enrollment (OR = 0.61, p < 0.001) and increased odds of reporting fair/poor health (OR = 2.10, p < 0.001). Findings highlight legal precarity as a potent driver of intergenerational disadvantage and underscore the need for policies addressing the barriers faced by children in undocumented families to promote health and educational equity.

Suicide in children and young adults is a leading cause of premature mortality, and there is a need to develop a more profound understanding of the factors that contribute to these deaths. This study is part of the nationwide Retrospective Investigation of Health Care Utilization in Individuals who died by Suicide in Sweden 2015, conducted at Lund University, Sweden. The aim was to examine symptoms and diagnoses in children and young adults who died by suicide, as documented in their medical records at their last visits for primary care, somatic specialist care, or psychiatric care 24 months prior to suicide, and to apply contemporary psychological research in youth suicidality to the findings to formulate clinical implications. The proportions of symptoms and diagnoses in children (0-17 years), young adults (18-24 years), males, and females are described. The main symptoms noted in the cohort were depressive symptoms (28%), anxiety symptoms (26%), and pain (25%). The diagnoses predominately covered mental and behavioural disorders, and the most frequent of the mental and behavioural diagnoses were neurotic, stress-related, and somatoform disorders (32%) and mood (affective) disorders (29%). The diagnoses and symptoms were not sufficient to uncover suicidality in children and young adults. The clinical implications for alternative assessments and preventive interventions are discussed.

Obesity is a growing health concern in Western countries and the link between obesity and mental disorders has been extensively studied, although less attention has been paid to post-traumatic stress spectrum symptoms (PTSS). This observational study aimed at exploring the correlations between lifetime trauma exposure and its related PTSS and maladaptive eating behaviours in obese patients who are candidates for bariatric surgery. A total of 189 obese candidates for bariatric surgery were recruited at the Azienda Ospedaliero-Universitaria Pisana (AOUP) and assessed by the Trauma and Loss Spectrum-Self-Report (TALS-SR Lifetime Version), Emotional Eating Scale (EES), Night Eating Questionnaire-Italian Version (I-NEQ), Grazing Questionnaire (GQ), and Eating Disorder Examination (EDE-Q), Eating Disorder Inventory (EDI). Based on the TALS-SR (Lifetime Version) scores, patients were dichotomised as either with low PTSS scores or high PTSS scores. Results showed high PTSS scores in more than a third of the sample (36.5%), with these individuals showing statistically significant higher total and EES domain scores, total and controllability GQ domain scores, I-NEQ mood/sleep domain scores, and EDE-Q shape concern domain score. A logistic regression showed an association between higher burden of emotional eating and greater probability of lifetime PTSS. PTSS appear to be frequent among bariatric surgery candidates and are related with maladaptive eating behaviours, suggesting accurate evaluation to optimise surgical outcomes.

Aging induces sarcopenia and reduces bone mineral density, altering body composition. These modifications contribute to physical decline, increase non-communicable disease risk and increase the likelihood of hospitalization, thereby representing a substantial public health burden. In this study, we assessed the effects of isometric training with neuromuscular electrical stimulation conditioning contractions (ISO-NMES) and dynamic resistance training (DRT) on physical and functional capacities. Moreover, we investigated the impact of ISO-NMES training on the force and power of the trained and untrained leg. Eighteen sessions of ISO-NMES training for knee extensors were performed by 10 older adults (age: 70.1 ± 4.9 years; ISO-NMES group). The DRT group (n = 12; age: 70.5 ± 2.8 years) performed 18 sessions of dynamic resistance training at a local fitness center. Maximum voluntary contraction (MVC) and peak power (P) of lower limbs as well as functional capacities assessed with the 5 Sit to Stand, Timed Up and Go and 6 Minutes Walking Tests were examined in both groups before and after the related training protocols. At the end of the training period, only the ISO-NMES group had improved MVC (+30.4%, p < 0.001) and bilateral force (ISO-NMES: +6.3%, p = 0.032). Moreover, both groups had significantly improved functional capacities. Finally, in the ISO-NMES group, MVC, force and power significantly increased in both legs with a greater effect for MVC in the trained than untrained leg (+30.4 vs. +13.5%, p < 0.001). These findings suggest that ISO-NMES training was an effective strategy to improve physical and functional capacities in older adults. Thus, it could be considered as a potential intervention, particularly when the mobility to perform physical training is limited.

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model.

Gender discrimination is a pervasive and multifaceted phenomenon rooted in cognitive, emotional, and social mechanisms that operate across individual, interpersonal, and structural levels. This umbrella review synthesizes systematic reviews and meta-analyses published between 2013 and 2024 examining the relationship between gender, stereotypes, and discrimination. Following PRISMA 2020 guidelines, searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science, yielding 22 eligible reviews after screening 684 records. Thematic synthesis identified two overarching domains: manifestations of discrimination and health and professional outcomes. Discrimination emerged as structural, interpersonal, and implicit, operating through institutional barriers, microaggressions, and stereotyping mechanisms. These dynamics were found to significantly affect mental health, and particularly anxiety, depression, and psychological distress, as well as physical health, including cardiovascular outcomes and maternal morbidity. Professional and social functioning were also impaired, with gender-based inequalities documented in pay, promotion, and role allocation across multiple occupational contexts. Despite consistent evidence of harm, the literature revealed limited consensus in conceptualization and a lack of longitudinal and intervention research. Collectively, findings underscore that gender discrimination constitutes both a public health concern and a systemic social mechanism that shapes individual cognition, emotion, and behaviour, demanding multi-level psychological and policy responses.

Objectives: To integrate clinical and economic evidence on the main non-pharmacological interventions aimed to reduce the burden of caregivers of people with dementia, with specific attention to stated preference measures (SPM), Willingness-to-Pay (WTP) and Willingness-to-Accept (WTA), alongside other cost-effectiveness indicators (ICER, QALY).

Methods: A systematic review was conducted on randomized and quasi-experimental evaluations, economic models, and preference studies concerning psychoeducational/coping interventions, activity-centered/occupational programs (TAP), technological solutions and tele-support, and goal-oriented cognitive rehabilitation (CR). For each study, the following indexes were extracted: design, sample size, psychological outcomes (anxiety/depression, burden, engagement), utility per QALY, costs per perspective (the health-social and the broader societal perspectives), ICER, WTP/WTA, and sensitivity results.

Results: Psychoeducational programs and CR show consistent benefits on distress, anxiety/depression, and caregiver quality of life; TAP reduces caregiver burden and patient behavioral problems, with favorable signs of cost-effectiveness; results on the effects of technologies are heterogeneous, but online modules with telephone support improve psychological morbidity. QALY improvement is generally modest, but the probability of cost-effectiveness remains high when costs do not differ significantly from treatment as usual, or when, from a societal perspective, the unpaid caregiving time of the caregiver is valued. Preference studies indicate positive WTP for additional hours of home care, health-social integration, and facilitated groups; evidence on WTA is scarcer and methodologically variable.

Conclusions: Short, structured interventions with a human support component offer good value-for-money; the adoption of societal perspectives and the systematic use of WTP/WTA can better capture the value perceived by caregivers. Heterogeneity issues persist.

Childhood overweight and obesity is a growing public health challenge in Indonesia, affecting approximately one in five school-aged children. Because children spend substantial time at school and frequently obtain meals and snacks from on-site canteens, these settings represent an important opportunity for nutrition-focused interventions. As an initial step towards understanding factors influencing canteen stocking decisions, we assessed perceived taste, acceptability, and feasibility of healthier local foods and beverages from the perspectives of canteen owners and school administrators (n = 10) across five primary schools (n = 2 urban, n = 3 rural) in Magelang, Indonesia. Participants completed in-person taste tests of selected food and beverage options and participated in in-depth interviews exploring drivers of stocking decisions. IndoMilk (multi-cereal, reduced-sugar dairy beverage) received the most favorable taste ratings and was perceived as the most feasible option to sell, followed by sate telur puyuh (braised quail eggs) and sate buah (fresh fruit skewers). In contrast, gethuk (cassava/coconut cake) and polo pendem (steamed tubers with boiled peanuts) were viewed as less appealing to children and unlikely to be sold. Participants identified children's taste preferences, affordability, visual appeal, and profitability as key considerations influencing stocking decisions, while perceptions of nutrition varied. Findings from this pilot study highlight contextual factors shaping school canteen food environments and may inform future interventions aimed at introducing healthier options while accounting for children's preferences and canteen operational constraints.

The agri-food supply chain is a relevant contributor to the Italian economy but shows a high incidence of occupational injuries and musculoskeletal disorders, such as lower back pain. Repetitive manual handling and biomechanical overload highlight the need for a prevention-oriented, system-level assessment. This protocol aims to implement a harmonized One Health approach procedure for the multidimensional evaluation of food supply chain workers in real-world settings. The protocol integrates bioelectrical impedance vector analysis (BIVA), nutritional parameters, quality-of-life and psychological measures, and assessments of systemic oxidative stress and systemic serotonin levels. Data from active workers will be compared with those from sedentary individuals. The study will evaluate whether BIVA profiles differ between these groups and examine how the additional indicators contribute to a multidimensional well-being framework. By operationalizing an integrated One Health approach that bridges nutritional, psychological, and biomarker domains, this protocol is designed to guide targeted preventive and educational strategies and inform evidence-based occupational and public health policies across the food supply chain. Trial registration: NCT06896877 (ClinicalTrials.gov), 26 March 2025.