Frontiers in Public Health最新文献

Objective: This study aimed to develop a machine learning-based model to predict recurrence risk after perianal abscess surgery, thereby supporting personalized follow-up and intervention strategies.

Methods: Clinical data were collected from patients with perianal abscess who underwent surgery at Nanjing Hospital of Chinese Medicine, Affiliated to Nanjing University of Chinese Medicine between January 2022 and June 2023. Significant predictors were identified using the least absolute shrinkage and selection operator (LASSO) algorithm combined with multivariate logistic regression. The Synthetic Minority Over-sampling Technique (SMOTE) was applied to balance class distribution, and several machine learning (ML) algorithms were employed for model construction. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Model calibration was assessed using calibration curves. The effectiveness was evaluated through Decision Curve Analysis (DCA). Finally, the SHapley Additive ExPlanations (SHAP) were used to interpret the best-performing model and quantify the contribution of each predictor to its predictions.

Results: A total of 737 patients with perianal abscess were included in the study. A history of diabetes, abscess space, and the aggregate index of systemic inflammation (AISI) were identified as the three strongest predictors of recurrence. Among all evaluated models, the CatBoost model showed the highest discriminatory power in the training set (AUC = 0.821, 95% CI: 0.777-0.864), validation set (AUC = 0.744, 95% CI: 0.616-0.872), and temporal validation set (AUC = 0.735, 95% CI: 0.649-0.821).

Conclusion: The machine learning-based model effectively identifies patients at high risk of recurrence after perianal abscess surgery. The CatBoost model achieved the best predictive performance, while SHAP analysis enhanced interpretability, supporting individualized patient management.

Introduction: To reinforce and re-build the public health workforce, many capacity building interventions are in place. While pre-post assessments are often used to describe short-term outcomes, methods to assess and describe longer-term outcomes and impacts are wanting. Our work aimed to help close this gap by exploring ways to assess and describe longer-term outcomes, including how capacity gains contribute to new actions taken by individual workers and organizations in support of public health goals. We hoped this work might inform development of an evaluation framework able to measure outcomes and impacts of public health workforce capacity-building initiatives.

Methods: Building from short-term outcomes data demonstrating changes in participant capacity (knowledge, skill, confidence), we used a multiple case study design to explore outcomes resulting from the use of the online Public Health Essentials (PHE) capacity building intervention. We conducted in-depth interviews with a purposive sample of eight PHE graduates (Summer 2023-Spring 2024) to elucidate both medium-term outcomes and potential longer-term impacts. Qualitative interviews were coded and analyzed using a priori and emergent themes (Spring-Fall 2024).

Results: Interview analysis revealed outcomes grouped into 13 themes. PHE graduates described how capacity growth influenced seven individual capabilities and their ability to take collective or shared actions in three areas. Further, they described their ability to influence changes in conditions in three areas critical public health: health equity, social determinants of health, and prevention.

Conclusion: Evaluating longer-term outcomes and impacts of capacity building interventions is crucial to both improve and justify public health workforce development initiatives, particularly as prevention and population health needs persist. We posit that evaluations will be more effective if standardized methods are used across interventions, and if there is a greater push to share and publish results. We present a conceptual framework that may inform and guide future evaluation and process improvement efforts.

Background: Traumatic brain injury (TBI) has been known to cause physical and psychological dysfunction among patients. Most family members face numerous physical and psychological difficulties in caregiving, yet effective interventions remain limited. This study aims to (a) identify the effects of caregiver interventions on caregiver burden for traumatic brain injury patients, (b) evaluate the effects of these programs on caregivers' psychological distress.

Methods: A systematic search was conducted in Pubmed, Medline and PsycINFO to search for randomized control trials (RCTs) that report the effects of caregiver interventions on care partners of TBI patients above the age of 18. The primary outcome was caregiver burden, which was measured mainly using the Zarit Burden Interview (ZBI). The secondary outcome was psychological distress, with the Brief Symptom Inventory-18 (BSI-18) as the main assessment used. The RoB-2 tool was used to assess the risk of bias.

Results: Thirteen RCTs were identified after screening. Meta-analysis of the primary outcome (ZBI) showed significant improvements (p < 0.05) favoring intervention despite high heterogeneity in the 5 studies. Meta-analysis of the secondary outcome (BSI-18) indicated smaller but significant improvement (p = 0.02) with low heterogeneity in 3 studies.

Conclusion: Results suggest that caregiver interventions are effective in improving caregiver burden and psychological distress in the future. However, due to high risk of bias in studies, the conclusion should be interpreted with caution before clinical application. Higher quality research should be conducted to ensure the effectiveness of caregiver programs.

Background: Emergency nurses face high occupational stress and long working hours, which may contribute to sleep disorders. However, the extent and nature of this association remain unclear.

Objective: This study assessed the relationship between occupational stress and sleep disorders among emergency nurses and identified their contributing factors.

Study design: A stratified cluster sampling method was employed between 26 December 2023 and 18 January 2024, based on the seven geographical regions of China (Northeast, North, East, Central, South, Southwest, and Northwest China). Emergency nurses aged ≥18 years, with ≥1 year of emergency care experience, and no psychiatric disorder history were included. Nurses undergoing advanced training or those on sick leave, maternity leave, or breastfeeding leave for ≥1 month were excluded. Participants completed a structured questionnaire including demographic data, an occupational stress assessment using a five-point Likert scale from 1 to 5, and sleep disorder quality evaluation. Logistic regression analysis was conducted to identify factors associated with sleep disorders, whereas Spearman's correlation analysis evaluated the relationship between occupational stress and sleep disorders.

Results: A total of 1,551 questionnaires were collected. After excluding 11 invalid responses, 1,540 were analyzed. Binary logistic regression identified key risk factors for sleep disorders, including 11-15 years of work experience (OR = 1.692), weekly working hours of 49-58 h (OR = 1.784) or ≥59 h (OR = 2.268), night shift frequency, and overcommitment scores (OR = 1.098). A significant positive correlation was found between occupational stress and sleep disturbances (p < 0.05).

Conclusion: These findings highlight the need for hospital administrators to implement targeted interventions, such as psychological support programs, shift rotation optimization, and stress management training. Future research should focus on longitudinal designs to establish causal pathways and evaluate the effectiveness of interventions aimed at improving sleep quality among emergency nurses.

Background: Remote rehabilitation treatment delivered via the Internet may serve as an effective approach for managing osteoarthritis (OA). One of its primary advantages is that patients can conveniently access rehabilitation services at any time and from any location. However, there remains a lack of reliable and up-to-date systematic reviews and meta-analyses to confirm the effectiveness of this therapy in improving clinical outcomes for older adult with OA.

Purpose: Our study aims to conduct a systematic review and meta-analysis of the available evidence regarding the effectiveness of telerehabilitation in older adult patients with OA.

Methods: A systematic search was performed in the Medline, Web of Science, Cochrane databases, and Embase from their inception up to August 2025. Trials focusing on the effects of telerehabilitation for older adult individuals suffering from OA were included. Two reviewers, working independently, carried out the selection of studies and the extraction of data. The assessment of bias risk utilized the Cochrane Risk of Bias tool.

Results: We selected 13 randomized clinical trials, which included a total of 1,845 participants. Overall quality of the included studies was rated as moderate-to-high quality. Our findings indicate that telerehabilitation effectively alleviates pain (standardized mean difference, SMD: 0.40, 95% confidence interval, CI: 0.11 to 0.69, I ² = 88.3%), enhances physical function (SMD: 0.61, 95% CI: 0.16 to 1.05, I ² = 91.5%), and improves the quality of life (SMD: 0.42, 95% CI: 0.07 to 0.77, I ² = 90.1%) in older adult individuals suffering from OA. The subgroup analysis results showed that remote exercise interventions based on APP, mobile phones, and web platforms were all effective in improving the pain levels of older adult patients with OA, and interventions with a duration of more than 3 months significantly enhanced the improvement in pain.

Conclusion: Remote exercise rehabilitation interventions have been shown to effectively alleviate pain, improve quality of life, and enhance physical function in older adult individuals with OA. This approach offers a viable alternative to traditional face-to-face exercise rehabilitation for older adult patients suffering from OA.

Systematic review registration: PROSPERO: CRD420251159586.

Background: Intimate partner violence (IPV) is a global public health problem and a violation of human rights that affects nearly half of humanity. It inflicts both physical and emotional suffering, imposing an avoidable and preventable burden on health systems and societies.

Methods: This study used de-identified data from the 2022 Ghana Demographic and Health Survey to conduct a secondary analysis on the lifetime prevalence of IPV and its associated factors. IPV was defined as violence committed by the current or most recent husband or male intimate partner. The analysis involved twelve socio-demographic and related attributes among women aged 15-49 years. Bivariate analysis was performed using simple binary logistic regression models to identify statistically significant factors. These were then used in the multivariable binary logistic regression model to determine their associations with IPV.

Results: Overall, 36.17% of women reported having experienced emotional, physical, and/or sexual violence from a current or most recent husband or intimate partner. The most common form of IPV was emotional violence, affecting 31.32% of respondents, followed by physical violence at affecting 16.85%. In total, 20.62% of women reported to have experienced physical and/or sexual IPV. The educational levels of both the woman and her intimate partner, number of living children, her acceptance of IPV, her partner's alcohol use, awareness of her father having ever beaten her mother, and the level of marital control exerted by her intimate partner were statistically significant association with IPV in the multivariable logistic regression model.

Conclusion: IPV is associated with multiple complex factors. About 1.8 women out of every five women in Ghana have experienced IPV in their lifetime. These findings emphasize the urgent need for effective public health and economic strategies to reduce this preventable form of violence for women in Ghana.

Background: Neglected tropical diseases (NTDs) remain a significant public health concern despite control efforts. Current control strategies rely heavily on mass drug administration (MDA), often overlooking complementary interventions like social and behavior change communication (SBCC). Given the complexity of behavior and its role in intervention uptake, this study explored experiences, best practices, and lessons learned from integrating a tailored SBCC approach into MDA campaigns in Jimma, Ethiopia.

Methods: A descriptive qualitative study was conducted following the implementation of SBCC integrated into two MDA campaign for target NTDs (OV and STH) between June and September 2022 in Jimma, Ethiopia. Purposive sampling was used to select participants from community members and stakeholders involved in the implementation of the project. A total of four focus group discussions, five expert group discussions and 10 key informant interviews were conducted. Guided by the RE-AIM framework, data were collected through four focus group discussions, five expert group discussions, and 10 key informant interviews. The data analyses were facilitated by Atlas.ti version 7.1.5.

Results: The study found that the intervention successfully reached diverse community groups through home visits, religious leaders, schools, and IEC materials, raising awareness and demand for MDA services. SBCC was integrated at key touch points, such as community registration, where early hygiene and NTD prevention education ensured informed participation. Community mobilization efforts, including local leaders and megaphones, expanded message reach, while schools and drug distributors amplified outreach and reinforced adherence. The approach was highly accepted, with stakeholders supporting its long-term sustainability and scale-up. However, challenges such as limited time, human resource constraints, and operational workload affected full integration and various adaptive strategies, helped improve implementation.

Conclusion: Integrating SBCC into MDA campaigns showed strong potential in enhancing community engagement and improving treatment coverage in a context with behavioral and social barriers. While not universally required, SBCC may serve as a strategic complement in settings facing such challenges. The findings provide practical insights for guiding the context-specific application of SBCC to strengthen the effectiveness and sustainability of NTD interventions.

Objectives: To assess the periodontal health, perceived quality of life, and oral health values among Portuguese Air Force (PT-AF) pilot cadets.

Methods: This cross-sectional study included cadets from the PT-AF Academy (December 2024-Mar 2025). Participants completed sociodemographic, behavioral, Oral Health Impact Profile-14 (OHIP-14) and Oral Health Values Scale-12 (OHVS-12) questionnaires, followed by full-mouth periodontal examinations to compute Periodontal Inflamed Surface Area (PISA) and Periodontal Epithelial Surface Area (PESA), and classify periodontal status according to the 2017 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) criteria. Descriptive and inferential analyses were conducted, with a significance level set at p ≤ 0.05.

Results: Among 90 participants (72% of the contingent; mean age 21.1 ± 1.7 years), 22.2% [95% confidence interval (CI): 14.6-31.6] had periodontitis and 22.2% (95% CI: 14.6-31.6) gingivitis. Only 34.4% reported regular interproximal cleaning. Periodontitis was significantly associated with smoking habits (p = 0.029) and was more prevalent among 5th-year cadets (p = 0.002). No significant differences were found in OHIP-14 or OHVS-12 scores by periodontal status, except for the "Appearance and Health" OHVS-12 domain, where those with periodontitis scored higher (p = 0 034). Age correlated positively with PISA (p = 0.003).

Conclusions: Despite their young age and military fitness, nearly half of PT-AF cadets presented clinical signs of periodontal disease. The findings underscore the importance of structured and integrating oral health surveillance and preventive strategies within military occupation health programs.

Background: Integrated service models aim to improve HIV-tuberculosis (TB) comorbidity management, yet little is known about how frontline providers perceive adherence challenges under China's Integrated Prevention and Control of Four Diseases (IPC4D) policy. This mixed-methods study explored healthcare workers' assessments of adherence, perceived barriers, and policy effects in Liangshan Prefecture-a high-burden, resource-limited, multi-ethnic region.

Methods: Between May and June 2025, an online survey of 492 healthcare workers and 30 in-depth interviews were conducted. Quantitative data were analyzed using descriptive statistics and ordinal logistic regression [odds ratios (ORs), 95% confidence intervals (CIs)]; qualitative data underwent thematic analysis.

Results: Overall, 64.0% of respondents rated patient adherence as "good" or "very good," yet intermittent medication use (50.4%), unsupervised discontinuation (43.7%), and missed follow-ups (37.8%) remained common. Key perceived barriers included low health literacy (86.8%), regimen complexity (62.8%), side effects (61.2%), financial burden (59.8%), and limited family support (52.2%). Female respondents were less likely to report high adherence (OR = 0.57, 95% CI: 0.36-0.91), while clinicians (OR = 2.67, 95% CI: 1.35-5.31) and those in infectious disease departments (OR = 2.38, 95% CI: 1.23-4.64) reported more favorable assessments. Standardized adherence assessment correlated with lower reported adherence (OR = 0.16, 95% CI: 0.09-0.28), whereas institutional efforts to reduce financial burden were linked to higher adherence (OR = 1.78, 95% CI: 1.02-3.11). Qualitative findings highlighted persistent stigma, socioeconomic barriers, and mixed experiences with IPC4D implementation.

Conclusion: Healthcare workers recognize IPC4D's value in improving coordination and access but report enduring multilevel barriers. Strengthening policy impact requires standardized adherence monitoring, socioeconomic support, workforce development, and culturally sensitive patient education.

Background: In 2020, the Global Research, Implementation, and Training (GRIT) Lab at the University of Southern California was forced to quickly shift its large community-based youth public health training programs to respond to the COVID-19 realities. This resulted in the implementation of the Youth Public Health Ambassador (YPHA) program, initially launched in Lira district, Uganda, and since expanded to include Kibera, Nairobi, Kenya. The program serves as a model for other youth-focused, community-based public health education, research, and policy advocacy programming effective in both rural and urban settings.

Program components: The YPHA Program consists of a multi-year training initiative led by public health students and professionals from East Africa and the United States. The program identifies and empowers youths (aged 18-24) as peer educators, data collectors, and agents of change. The program consists of three distinct components: basic public health education, implementation of a community-based participatory research study, and community outreach and data dissemination. Ambassador proficiency in public health and leadership skills were assessed throughout.

Program outcomes: Upon program completion, YPHAs showed greater mastery and indicated having higher confidence in educating their community members in all topic areas. YPHAs were also able to successfully conduct a comprehensive community health assessment by collecting and analyzing data from households, health facilities, and schools. YPHAs then disseminate their results within their communities and to local and national policymakers, the Ministries of Health, and the United States Embassy.

Conclusion: The program's findings will hopefully encourage further investment in youth-centered health promotion programming, further incorporation of youth-led programs for low-income communities, and youth-driven policy advocacy.