International Journal of Environmental Research and Public Health最新文献

Non-communicable diseases (NCDs) remain a major contributor to global morbidity and mortality, with India bearing a substantial share of this burden. The COVID-19 pandemic disrupted routine clinical care and accelerated the transition to telemedicine for chronic disease management. This study explores healthcare providers' perspectives on the use of telemedicine for NCD care during and after the pandemic, including its perceived benefits, limitations, and future relevance within the broader digital health landscape. Semi-structured interviews were conducted with 33 purposively selected healthcare providers with experience in telemedicine for NCD care between February and June 2025, audio-recorded, transcribed verbatim, and thematically analyzed using NVivo 15. Providers reported that telemedicine supported continuity of care, reduced the need for in-person visits, facilitated medication adherence, and offered reassurance for patients during periods of restricted mobility. However, limitations were identified, including the inability to conduct physical examinations, connectivity challenges, and low digital literacy, particularly among older adults. While overall satisfaction with telemedicine was positive, participants emphasized the need for strengthened digital infrastructure, greater patient awareness, and simplified platforms to improve usability. The findings underscore telemedicine's continued relevance for NCD management beyond the pandemic, contingent on improved accessibility and system integration.

Background: This study explores the interplay between environmental stressors and intimate partner violence (IPV) in Dar es Salaam, Tanzania.

Methods: Drawing on participants' interviews, visual ethnography, thematic analysis, and a review of secondary sources, the research examines how resource scarcity, displacement, and climate change intersect with social determinants of health to intensify IPV.

Results: Using an ecological systems perspective, the study demonstrates how structural vulnerabilities and environmental degradation disproportionately affect residents of informal urban settlements, particularly women, who face intersecting vulnerabilities due to poverty, inadequate services, and gender-based discrimination.

Conclusions: The findings from this study underscore the need to integrate gender-sensitive urban planning and policy that address both environmental risks and existing social inequalities, thereby enhancing household and community resilience.

Sleep is a fundamental aspect of physiological and psychological functioning, and the beneficial effect of exercise on sleep quality and quantity, depending on training modality, remains underexplored. This study compared the effects of high-intensity interval training (HIIT) versus a moderate-intensity continuous training (MICT) regime on sleep quality. Twenty-five participants (sixteen men, nine women) were randomly assigned to 8-week HIIT or MICT programs. Anthropometric data, blood pressure, and maximal exercise tests (VO_2max, lactate, heart rate) were conducted one week before and after training. Sleep quality was evaluated daily through self-reported perception and duration and via the Pittsburgh Sleep Quality Index (PSQI) at baseline, one week, and two weeks post-intervention. Data were analyzed in SPSS version 29 using repeated-measures ANOVA. PSQI scores improved significantly over time (p = 0.013), regardless of modality, with no significant group or interaction effects. Cardiorespiratory fitness improved for all participants, with significant gains in VO_2max (p = 0.009), maximal aerobic speed (p < 0.001), and reduced maximal heart rate (HIIT: p = 0.003; MICT: p = 0.021). Sleep perception showed no significant change during training (p = 0.063), with a slight improvement trend. In conclusion, exercise training improves sleep quality regardless of modality. Running three sessions per week for eight weeks enhances both aerobic and cardiorespiratory fitness, along with sleep quality. Physical activity is therefore an effective non-pharmacological strategy to improve sleep.

Introduction: Sleep is an essential dimension of good physical and mental health. Lesbian, gay, and bisexual (LGB) women experience inequities in sleep duration and disturbance compared to heterosexual women. Psychosocial and behavioral characteristics are important to sleep in the general population; they may advance our understanding about sleep inequities among LGB women and provide key information for developing promising interventions.

Methods: Data for this project were provided by the Women's Health Initiative (WHI). The sample size for this project was 1436: 884 LG women and 552 bisexual women. Outcome variables were sleep duration and disturbance. The authors sought to clarify the associations, including the strength, between psychosocial factors and sleep outcomes among LGB women. Associations between psychosocial characteristics, health behaviors, and sleep outcomes were tested using multivariable, hierarchical, nested, linear regression models, stratified by sexual orientation.

Results: Social strain, social function, optimism, and negative emotional expressiveness were significantly associated with sleep outcomes for LGB women. Health behaviors were not consistently or strongly associated with sleep outcomes for LGB women.

Conclusions: The findings point to the importance of social strain, social function, negative emotional expressiveness, and optimism in LGB women's sleep. It is possible that LGB women's sleep could be improved with evidence-based interventions that use our findings.

Maintaining sustainable mental health is an increasing societal challenge in Japan, where psychological distress and sleep problems have become major public health concerns. This study examined how three culturally grounded dimensions of self-construal-Subjective Self (SS), Objective Self (OS), and Autonomous Self (AS)-relate to both positive and negative indicators of psychological adjustment among Japanese adults. This study aimed to examine whether internally guided forms of self-regulation (SS and AS) function as psychological resources, whereas externally guided self-regulation (OS) operates as a potential vulnerability factor in a culturally tight social context. By simultaneously examining multiple indicators of adjustment, this research clarifies how culturally shared self-regulatory patterns are linked to distress and sleep difficulties that affect large segments of the population. From a public health perspective, the findings highlight socially reinforced risk and protective patterns that can inform population-level prevention and mental health promotion in settings such as schools, workplaces, and communities, rather than relying solely on individual clinical intervention. These results underscore the importance of integrating cultural psychology into public health frameworks aimed at promoting sustainable mental health in contemporary and increasingly diverse social environments.

Access to valid and reliable measures of structural racism is essential for addressing health inequities, yet few validated ecological-level indices exist for assessing structural racism affecting Black and Hispanic populations in the United States. Guided by the National Institute on Minority Health and Health Disparities framework, our interdisciplinary team undertook the development of an ecological-level structural racism index. In the process, we encountered substantive methodological and data-related challenges that warrant explicit documentation. This paper describes the methodological process used to identify and select indicators of structural racism, including a modified Delphi consensus process involving social epidemiologists, health inequality researchers, community members, economic inequality specialists, and psychometricians. We outline a five-step approach for extracting and harmonizing geographic-level data from publicly available sources and discuss key challenges encountered, including limited availability of granular geographic data, insufficient data documentation guidelines, inconsistent reporting frequencies, and difficulties in adapting publicly available datasets for structural racism measurement. Rather than presenting a finalized index, this paper serves as a methodological guide and cautionary account for researchers seeking to develop ecological measures of structural racism, emphasizing the importance of transparency, adaptability, and rigorous data selection in advancing public health equity research.

The mental health of people living in farming communities has been identified as an important public health issue. Cumulative exposure to a range of situational factors contributes to heightened risk of poor mental health and suicide. Access to evidence-based psychological treatments is limited by the availability of skilled mental health professionals. The aim of this trial-co-designed by members of the farming community-is to establish the feasibility of conducting randomised controlled, trial-testing, peer-worker-delivered Behavioural Activation in the farming community. We will undertake a single-blind, parallel group, randomised controlled feasibility trial in rural Australia. People living in farming communities aged over 15 years and experiencing moderate to moderately severe depression symptoms will be included in the trial. Participants will be randomly allocated on a 1:1 ratio to 10 sessions of peer-worker-delivered behavioural activation (Back-on-Track) or a self-help workbook (Managing Stress on the Farm). Peer workers are members of the farming community that have completed training in behavioural activation and demonstrated competence. Feasibility outcomes include establishing recruitment rates, willingness to be randomised, dropout rate from trial, acceptability of peer delivered behavioural activation, and willingness to complete trial measures. The trial will contribute high quality evidence of the feasibility of undertaking a full-scale, randomised controlled trial of peer-delivered Behavioural Activation in farming communities in rural Australia.

How people perceive their neighborhoods can impact their aging trajectories, with less known regarding neighborhood perceptions among older adults from minoritized groups. This study examined the impacts of behavioral and psychosocial factors on neighborhood perceptions among non-Latino (NL) Black and Latino older adults. Participants (N = 506) were NL Black (n = 372) and Latino (n = 134) older adults (x¯ age = 79 years) without dementia. Participants completed a modified Perceptions of Neighborhood Environments Scale (mPNES; higher scores indicate more favorable perceptions) and measures of behavioral and psychosocial factors. We performed fully saturated linear regression analyses to assess how each factor related to the mPNES, followed by stepwise linear regression analyses to determine final predictive models for the full sample and each ethnoracial group. For the full sample, higher purpose in life, more physical activity, less discrimination, and higher income were associated with higher mPNES scores. For NL Black older adults, more physical activity, less discrimination, and higher income were associated with higher mPNES scores. For older Latinos, more purpose in life and a larger social network size were associated with higher mPNES scores. Distinct associations exist by ethnoracial group and suggest unique considerations to facilitate positive neighborhood perceptions among NL Black and Latino older adults.

The OHI demonstrated moderate internal consistency and consistent associations with oral health-related quality of life and cardiovascular risk indicators.

Objective: The primary objective was to propose and internally assess an Oral Health Index (OHI) which integrates multiple clinically assessed oral health variables. The secondary objective was to investigate its association with oral health-related quality of life (OHRQoL) and common clinical cardiovascular risk (CVR) factors.

Material and methods: This observational study included 191 participants. Seven parameters (tooth loss, periodontal disease, endodontic involvement, residual roots, extractions due to periodontitis, inflammatory oral mucosal diseases, and dental maintenance and rehabilitation status) were combined using Z-scores to compute the OHI, with higher scores indicating poorer oral health. CVR factors included age/sex thresholds, education level, BMI, smoking status, diabetes, hypertension, pulse pressure, and lung function. OHRQoL was assessed using the Oral Health Impact Profile.

Results: Higher OHI scores were associated with poor oral health-related quality of life. Participants with cardiovascular risk factors had significantly higher OHI scores. The analysis demonstrated that the OHI was directly associated with worse oral health-related quality of life and a greater cardiovascular risk burden, independent of age, sex, and comorbidities.

Conclusions: This study proposed and internally assessed the Oral Health Index, designed to integrate multiple clinical parameters into a single standardized measure of oral health. The OHI demonstrated moderate internal consistency and showed consistent associations with poorer oral health conditions, reduced oral health-related quality of life, and a greater cardiovascular risk burden.

The COVID 19 pandemic may have influenced smoking behaviours, including decisions to quit smoking. This study aimed to investigate smoking cessation following the first two waves of the COVID-19 pandemic in Switzerland and to assess whether cessation differed according to participants' SARS-CoV-2-related experiences. Data from SérocoViD, a Swiss repeated cross-sectional study comprising five surveys in the canton of Vaud, was used. A total of 2454 participants aged 15 years and older from the first (May-July 2020) and third (February 2021) surveys were included. Association between SARS-CoV-2 infection experiences and cigarette smoking cessation were analyzed using logistic regression; both factors were unadjusted and adjusted for age and gender. Overall, 21.2% of participants reported being ex-smokers, but only a small proportion of the entire study population (i.e., including both smokers and non-smokers) reported quitting during the pandemic (0.5% in the first sample, 1.5% in the second). Participants who were smokers before the pandemic and had undergone diagnostic testing for SARS-CoV-2 showed a trend toward smoking cessation during the pandemic (non-adjusted odds ratio = 2.15; 95% confidence interval: 0.79-5.87). No such trends were found with a positive diagnostic test or serological result, or with COVID-19-like symptoms. These findings suggest that individuals seeking testing may be more health-conscious, potentially contributing to smoking cessation. For these individuals, the pandemic may represent a critical opportunity to promote smoking cessation, which should be leveraged by healthcare professionals and public health policies.