International Journal of Environmental Research and Public Health最新文献

Housing insecurity is a growing public health concern linked to adverse health outcomes and lifelong vulnerability. Although housing is a well-established social determinant of health, this review employs a life-course framework to explain how housing insecurity contributes to the accumulation of health inequities and chronic disparities across the different stages of human development. A rapid review was conducted across PubMed, Google Scholar, SCOPUS, and Web of Science, focusing on peer-reviewed studies published between 1991 and 2025. Studies were screened using predefined eligibility criteria, and the selection process was documented through a PRISMA flow diagram. Fifty-five studies met the inclusion criteria. Housing insecurity was consistently associated with adverse health outcomes across pregnancy, infancy, childhood, adolescence, adulthood, and older age. Each life stage presents distinct vulnerabilities shaped by environmental and social conditions, which are manifested through physiological and psychosocial pathways. While physical health effects were most frequently reported, developmental and mental health impacts accumulated over time, amplifying overall burden. The findings demonstrate a clear life-course pathway linking housing insecurity to immediate and long-term health risks. Early-life disadvantages create lasting, preventable consequences, underscoring the urgent need for policies that embed housing stability within broader public health planning.

Diabetes self-management education (DSME) programs are evidence-based interventions that improve glycemic control and self-care behaviors, yet their effectiveness may be limited by unaddressed health-related social needs (HRSN) (e.g., food insecurity, housing or utility instability, transportation barriers). This qualitative multiple case study examined the feasibility of integrating HRSN assessments into DSME delivery within three community-based organizations (CBOs) across urban and rural U.S. settings. Guided by the Consolidated Framework for Implementation Research, semi-structured interviews were conducted with 15 DSME facilitators and program leadership to identify contextual factors influencing implementation. Findings revealed that while DSME's structured, manualized design promotes fidelity and client autonomy, it constrains responsiveness to the client's HRSN. Facilitators expressed openness to integrating HRSN screening, particularly during intake, yet cited limited infrastructure, role clarity, and training as key barriers. CBOs were recognized as trusted, accessible spaces for holistic care, but growing expectations to address HRSN without adequate resources for referral created sustainability concerns. Participants recommended a parallel support model involving navigators or community health workers to manage HRSN screening and referrals alongside DSME sessions. Integrating HRSN assessment processes into DSME may enhance engagement, reduce attrition, and extend the reach of diabetes education to populations most affected by HRSN. However, successful implementation requires dedicated funding, workforce development, and cross-sector coordination. Findings underscore the importance of supporting CBOs as critical partners in bridging diabetes education and social care to advance whole-person, chronic disease management.

The aim of this study was to map global research on community-based strategies to reduce risky alcohol consumption and promote health, aiming to clarify growth, leading contributors, thematic structure, and integration with public-health frameworks. Using a PubMed corpus, we analyzed production, authorship, and collaboration indicators, built a thematic map (centrality/density) to identify core topics, and applied Multiple Correspondence Analysis to assess conceptual proximity between alcohol-specific and broader prevention domains. The dataset comprised 2607 documents across 916 sources, with output led by the USA, with substantial contributions from Australia, Canada, the UK, and rising activity in sub-Saharan Africa. The thematic map showed a mature core centered on adolescents and pregnancy, cross-cutting foundations in health education and sexual behavior with substance-related disorders, measurement-oriented niches at the periphery, and emerging work linking family planning. The Multiple Correspondence Analysis positioned alcohol-prevention terms close to health promotion, primary prevention, and epidemiology, with maternal-child health bridging community programs and clinical prevention. Overall, community-based alcohol prevention is expanding, globally distributed, and embedded in mainstream public-health practice. Limitations include the absence of citation data in PubMed, and future work should integrate citation-enabled databases and compare patterns across income groups.

Insufficient physical activity (PA) is a significant health challenge among working-age populations. This study aimed to develop context-specific processes to promote PA among adults aged 35-60 years. A participatory action research approach was conducted across seven provinces in upper southern Thailand. The study consisted of three phases: (1) preparation and situation analysis, (2) development and implementation of PA promotion programs, and (3) program evaluation and lessons learned. In Phase 1, the working-age population was categorized into four groups: Group 1: PA occupation and exercise; Group 2: PA occupation but non-exercise; Group 3: non-PA occupation but exercise; Group 4: non-PA occupation and non-exercise. In Phase 2, an exercise program and PA tracking guide were developed and implemented over a 6-month period. In Phase 3, based on the complete-case analysis, 175 participants enrolled, with 101 (57.7%) and 100 (57.1%) remaining at 3 and 6 months, respectively. Based on the last observation carried forward analysis (n = 175 across the 6 months), the proportion achieving global recommended PA levels and time spent in weekly moderate- to vigorous-intensity PA increased significantly in the non-exercise groups (Groups 2 and 4). All participants in the exercise groups (Groups 1 and 3) met the recommended PA level at baseline; however, this level was not maintained at the endpoint. The context-based PA promotion programs improved PA participation among non-exercise working-age adults. Future research should identify strategies to enhance program uptake and sustain engagement.

Ecological momentary assessment (EMA) captures real-time data on thoughts, emotions, and behaviours within individuals' natural environments. Although EMA has been increasingly used to examine self-harm, existing reviews have not focused specifically on adolescents. This systematic review examines EMA research on adolescent self-harm, focusing on methodological considerations and key risk and protective factors for self-harm. Five databases, plus pre-print, unpublished and grey literature sources, were searched up to 30 January 2024. Studies were included if published in English, used EMA methodology, included adolescents aged 10-24 years and measured suicidal ideation, suicidal behaviours, or self-harm. The review included 79 studies, published from 2009 to the present. Self-harm was associated with numerous risk factors, including negative affect, stress, interpersonal influences and sleep. EMA was generally well-accepted by adolescent participants, with high compliance rates. The findings highlight the value of EMA in capturing real-time fluctuations in self-harm and associated risk factors among adolescents. EMA demonstrates strong potential for improving understanding and prediction of self-harm; yet challenges remain, including variability in study designs and a lack of clear reporting of the methodologies. Future research should focus on standardising methodologies, increasing participant diversity, and exploring the clinical utility of EMA in early intervention and prevention strategies.

Aquatic environments have been a critical source of nutrition for millennia, with wild fisheries supplying protein and nutrients to populations worldwide. A notable shift has occurred in recent decades with the expansion of aquaculture, now representing a fast-growing sector in food production. Aquaculture plays a key role in mitigating the depletion of wild fish stocks and addressing issues related to overfishing. Despite its potential benefits, the sustainability of both wild and farmed aquatic food systems is challenged by anthropogenic pollution. Contaminants from agricultural runoff, industrial discharges, and domestic effluents enter freshwater systems and eventually reach marine environments, where they may be transported globally through ocean currents. Maintaining water quality is paramount to food safety, environmental integrity, and long-term food security. In addition to conventional seafood products such as fish and shellfish, foods such as those derived from microalgae are gaining attention in Western markets for their high nutritional value and potential functional properties. These organisms have been consumed in Asia for generations and are now being explored as sustainable foods and ingredients as an alternative source of protein. Contaminants in aquatic food products include residues of agrochemicals, persistent organic pollutants (POPs) such as dioxins, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances (PFASs), as well as brominated flame retardants and heavy metals. Public and scientific attention has intensified around plastic pollution, particularly microplastics and nanoplastics, which are increasingly detected in aquatic organisms and are the subject of ongoing toxicological and ecological risk assessments. While the presence of these hazards necessitates robust risk assessment and regulatory oversight, it is important to balance these concerns against the health benefits of aquatic foods, which are rich in omega-3 fatty acids, high-quality proteins, vitamins, and trace elements. Furthermore, beyond direct human health implications, the environmental impact of pollutant sources must be addressed through integrated management approaches to ensure the long-term sustainability of aquatic ecosystems and the food systems they support. This review covers regulatory frameworks, risk assessments, and management issues relating to aquatic environments, including the impact of climate change. It aims to serve as a comprehensive resource for researchers, policymakers, food businesses who harvest food from aquatic systems and other stakeholders.

Background: Physiotherapy University students frequently experience psychological challenges such as depression, anxiety, and stress. These issues are shaped by various individual, health-related, and social factors. Understanding these influences is essential for identifying vulnerable subgroups and guiding effective support strategies. Aim and Objectives: This study aims to assess the prevalence and severity of depression, anxiety, and stress among physiotherapy students. Specific objectives include (1) analyzing mental health variations across demographic variables such as gender, nationality, marital status, and year of study; (2) evaluating the impact of physical and mental health conditions on psychological distress; and (3) investigating the protective role of perceived social support from family, friends, and faculty. Methods: A cross-sectional study was conducted among 282 physiotherapy students at Kuwait University, focusing on students from the Physical Therapy Department in the College of Allied Health Sciences, of whom 89% were aged 18-22 years and 10% were aged 23-27 years. Participants were selected through purposive and convenience sampling, including second-, third-, and fourth-year students. Data were collected using the DASS-21 scale along with demographic, health, and social support information. Descriptive statistics and ANOVA tests were used to analyze associations between psychological outcomes and the studied variables. Results: Anxiety was the most prevalent condition, with 39.4% of students reporting extremely severe levels. Depression and stress affected 14.2% and 11.3% of students at the same severity level, respectively. Gender differences were examined among the participants (259 females and 23 males), with female students showing significantly higher stress levels than males and second-year students reporting greater depression and stress compared to their senior peers. Students who received support from family and friends exhibited lower levels of psychological distress. Conclusions: This is the first study in Kuwait to examine mental health among physiotherapy students, revealing a high prevalence of depression, anxiety, and stress in this group. The findings highlight the unique academic and clinical pressures faced by physiotherapy students, including intensive coursework, frequent assessments, physically demanding clinical placements, close patient interaction, and the need to integrate theoretical knowledge with hands-on clinical practice, while also emphasizing the protective role of social support. These insights call for targeted mental health strategies and support systems within physiotherapy education to promote student well-being and foster a healthier learning environment.

Artificial intelligence (AI) has become a strategic technology for global health, with increasing relevance amid the climate emergency and persistent digital inequalities. This study examines how AI has been applied in Brazilian healthcare through a scoping review with an in-depth methodological synthesis, focusing on Transfer Learning (TL) and Federated Learning (FL) as approaches to address data scarcity, privacy, and technological dependence. We searched PubMed, SciELO, and the CNPq Theses and Dissertations Repository for peer-reviewed studies on AI applications in Brazil, screened titles using AI-assisted tools with manual validation, and analyzed thematic patterns across methodological and infrastructural dimensions. Among 349 studies retrieved, six explicitly used TL or FL. These techniques were frequently implemented through multi-country research consortia, demonstrating scalability and feasibility for collaborative model training under privacy constraints. However, they remain marginal in mainstream practice despite their ability to deploy AI solutions with limited computational resources while preserving data sovereignty. The findings indicate an emerging yet uneven integration of resource-aware AI in Brazil, underscoring its potential to advance equitable innovation and digital autonomy in health systems of the Global South.

Background: University students are often exposed to environments that encourage unhealthy eating, but universities can promote better health and sustainability by making sustainable food options more accessible.

Methods: Temporal changes in dietary patterns and environmental footprints of 1684 students at the University of Rijeka, Croatia, over a 16-year period (2009-2025) were retrospectively analyzed using data from 3 cross-sectional studies.

Results: A significant transition toward less sustainable diets, increased consumption of animal-based foods, and proinflammatory eating habits was observed (both p < 0.001). Adherence to the Mediterranean and Planetary Health Diet declined over time (p < 0.001), followed by increased prevalence of overweight and obesity. Three dietary patterns were identified: high fruit and vegetable intake, consistently high milk and dairy consumption, and lower-to-moderate intake of all other food groups with temporal variation. Consumption of most food groups increased, leading to higher water and ecological footprints. Only the intake of fruits, vegetables, whole grains, and fish declined, which corresponded with reduced carbon footprints for these and a few other food groups, while the environmental impact of other foods significantly increased (all p < 0.001). Gender, diet quality, and a proinflammatory diet were significant predictors of dietary environmental footprints.

Conclusions: The findings underscore the need for systemic changes and addressing barriers at the university level to support sustainable eating behaviors. This study offers valuable insights for policymakers, educators, and researchers, which aim to help students become health-conscious and environmentally responsible consumers. Further research is needed to explore the broader factors influencing dietary choices and the long-term impact of future institutional interventions.

Background: Prolonged obesity in children can lead to a gradual decline in postural stability due to changes in biomechanics, musculoskeletal function, and neuromuscular control. Early interventions may help address these issues. This exploratory study examined the potential influence of Thai massage on postural stability in children with overweight and obesity.

Methods: This study employed a quasi-experimental, comparative design and was conducted at the Pa Tueng Sub-district Health Promoting Hospital, Chiang Rai, Thailand. A total of 58 children meeting the criteria for overweight or obesity were systematically assigned to either the Thai massage group or the control group based on the order in which they were recruited. The Thai massage group received 45 min full-body Thai massage sessions combined with stretching exercises twice a week for six weeks (a total of 12 sessions), while the control group was advised to perform daily stretching exercises at home. Postural stability was assessed by measuring sway path length and sway velocity during double-leg and single-leg stances with eyes closed, both before and after the intervention.

Results: While no statistically significant differences were found between the groups, the Thai massage group exhibited a non-significant trend toward reduced sway path length and sway velocity, whereas the control group showed a significant increase in both measures (p < 0.05), indicating a decline in postural stability over time.

Conclusions: These findings suggest that Thai massage showed a potential trend toward stabilizing postural stability in children with overweight and obesity; however, the between-group differences were not statistically significant. As an exploratory study, further research with longer intervention durations and follow-up assessments is needed to determine whether clinically meaningful effects can be established.