Frontiers in Public Health最新文献

[This corrects the article DOI: 10.3389/fpubh.2025.1713841.].

Objective: To develop and internally validate an individualized nomogram integrating intestinal barrier-specific biomarkers and systemic clinical indicators to help assess intestinal barrier function and provide a reference for prognosis prediction in patients with severe sepsis.

Methods: Three hundred fifty-two patients with severe sepsis admitted between January 2022 and December 2024 were continuously enrolled and randomly divided into training (n = 246) and validation (n = 106) sets. Plasma samples and clinical data-including demographics, injury assessments, and initial laboratory indicators-were collected. Prognosis-related variables were identified via univariate analysis. LASSO regression was used for variable selection, and multivariate logistic regression identified independent predictors of poor prognosis. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) in both training and validation sets.

Results: Baseline characteristics did not differ significantly between sets (all P > 0.05). Multivariate analysis identified admission SOFA score, intestinal fatty acid-binding protein, D-lactate, procalcitonin, and blood lactate as independent risk factors for poor prognosis (all P < 0.05). The nomogram demonstrated good calibration and fit, with C-indexes of 0.771 (training) and 0.641 (validation), mean absolute errors of 0.026 and 0.043, and non-significant Hosmer-Lemeshow test results (P = 0.423 and P = 0.496, respectively). The AUCs were 0.771 (95% CI: 0.698-0.845) and 0.641 (95% CI: 0.512-0.770), with sensitivities of 0.672 and 0.462, and specificities of 0.804 and 0.800.

Conclusion: The constructed nomogram, incorporating intestinal barrier biomarkers and systemic clinical indicators, can help assess intestinal barrier-related risk and provide a reference for predicting adverse outcomes in severe sepsis. It offers a valuable decision-support tool for early goal-directed intervention and demonstrates significant clinical translational potential.

Background: Adolescent obesity poses a major challenge to declining strength fitness. Body Roundness Index (BRI) provides superior quantification of central adiposity over traditional metrics. However, evidence regarding the BRI-strength fitness correlation remains underexplored in youth populations.Therefore, this study aims to explore the association between BRI levels and muscular fitness in senior middle school students.

Methods: A cross-sectional study was conducted in 2024 among 3,822 senior senior middle school students (grades 10-12) from Jiangxi, Zhejiang, and Fujian provinces in China using stratified random cluster sampling. Data were collected through sociodemographic questionnaires, anthropometric measurements (height/waist circumference), and strength fitness tests (grip strength/sit-ups/standing long jump). Multivariable logistic regression and restricted cubic spline (RCS) models were used to analyze associations.

Results: A total of 3,822 senior middle school students were included. Significant gender differences were found in grip strength, sit-ups, standing long jump, and BRI (all P < 0.01). The rates of substandard performance were 13.8% for grip strength, 19.7% for sit-ups, 17.4% for standing long jump, and 74.9% for overall strength fitness (P ₇₅ cutoff). Strength fitness deficits varied significantly across physical activity levels, grade, parental education, household income, and other sociodemographic factors (P < 0.05). Higher BRI levels (Q4) were associated with increased risk of failing sit-ups and standing long jump, especially in boys. BRI showed a non-linear dose-response relationship with grip strength, standing long jump, and overall strength fitness, and a linear negative association with sit-ups.

Conclusion: An appropriate BRI level may contribute to the enhancement of strength-related fitness, while an excessively high BRI could potentially inhibit strength performance. Therefore, more attention should be payed on abdominal fat management and healthy dietary habits promotion and physical activity. Meanwhile, gender differences require personalized intervention strategies.

Background: Due to the challenges posed by aging such as decreased physical abilities and higher susceptibility to chronic illnesses, effective exercise interventions are crucial for older individuals. Despite the potential benefits of aquatic exercise, there is a lack of robust evidence supporting their efficacy. To address this gap, a systematic review and meta-analysis were conducted in this study to comprehensively assess the impact of aquatic exercise on muscle strength, body composition, and related physical (flexibility, mobility) and metabolic indicators (lipid profiles) in the older adults, aiming to inform the development of intervention strategies.

Methods: We searched seven databases (ClinicalTrials.gov, Scopus, Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from inception to August 1, 2025. Our analysis included 19 Randomized controlled trials (RCTs) (n = 866 participants) and adhered to Preferred Reporting Project for Systematic Reviews and Meta-analyses (PRISMA) guidelines, employing meta-analytical methods for outcome assessment. Meta-analyses and meta-regressions were conducted to determine the mean difference Additionally, heterogeneity, risk of bias, and certainty of evidence were evaluated.

Results: The meta-analysis findings indicated significant enhancements in muscle strength and flexibility among older adults engaging in aquatic exercise. Additionally, improvements in functional mobility were observed, as evidenced by better performance on the Timed Up and Go test. Moreover, reductions in body fat percentage and total cholesterol levels were observed as notable improvements in metabolic indicators. Nonetheless, the intervention did not yield significant effects on body weight, body mass index, or levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides.

Conclusion: This review indicates that aquatic exercise may serve as a viable intervention strategy for preserving muscle function, flexibility, and lipid homeostasis in the older adults population, thereby offering a novel perspective on maintaining functional independence. These findings underscore the potential application of aquatic exercise in geriatric care; however, a multicenter study with large sample sizes and long-term follow-up is necessary to further validate the generalizability of the metabolic benefits and long-term safety.

Systematic review registration: Identifier CRD42024568443.

Background: Exercise intolerance after percutaneous coronary intervention (PCI) is a common yet often overlooked condition in patients with coronary artery disease (CAD), associated with impaired cardiopulmonary recovery and poor prognosis. However, an accurate and easily applicable non-exercise-based model for predicting post-PCI exercise intolerance remains lacking. This study aimed to develop and validate such a model using electronic medical record (EMR) data.

Methods: Between June 2020 and June 2024, clinical data were retrospectively collected from Quanzhou First Hospital. Forty-five variables were considered as candidate predictors, and seven machine learning algorithms were developed to estimate the risk of post-PCI exercise intolerance. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PRC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. Calibration and clinical utility were assessed via calibration plots, Brier score, Hosmer-Lemeshow (H-L) goodness-of-fit test, and decision curve analysis. Model interpretability was examined using Shapley additive explanations, and an interactive web-based calculator was deployed for clinical use.

Results: A total of 575 patients were included, with an incidence of exercise intolerance of 22.0%. Eight key variables were selected: age, sex, BMI, smoking status, diabetes status, hemoglobin level, red blood cell count, and resting heart rate. The multilayer perceptron (MLP) model achieved the best performance (threshold = 0.30): an AUC-ROC of 0.911 (0.854-0.956), an AUC-PRC of 0.706 (0.548-0.846), an accuracy of 0.87, a sensitivity of 0.82, a specificity of 0.88, a PPV of 0.67, and an NPV of 0.94 (Brier = 0.108; H-L test p = 0.493).

Conclusion: The proposed EMR-based model effectively identifies patients at high risk of post-PCI exercise intolerance, supporting early screening and targeted clinical interventions.

Background: Research indicates that mild cognitive impairment (MCI) in older adults is associated with physical activity levels (PAL) and sedentary behavior duration. However, the precise nature of the relationships between these factors and MCI warrants further investigation.

Methods: A cross-sectional survey was conducted from August to October 2025 using cluster sampling in community settings, involving 1,465 older adults. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). PAL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), while sedentary time was self-reported. Logistic regression models were employed to analyze the associations between PAL, sedentary time, and MCI. Restricted cubic spline (RCS) analysis was used to further explore the dose-response relationships. Sensitivity analyses were also performed to validate the observed associations.

Results: Logistic regression analysis revealed that the second and fourth quartiles of PAL (vs. the first quartile) were associated with a significantly reduced risk of MCI (OR = 0.544, p < 0.05 and OR = 0.345, p < 0.05, respectively). The second quartile of sedentary time (vs. the first quartile) was also associated with a significantly lower MCI risk (OR = 0.561, p < 0.05). RCS analysis showed that as PAL increased, the risk of MCI gradually decreased, with the most pronounced cognitive benefit observed at approximately 1,485 MET-min/wk. However, when PAL exceeded 4,000 MET-min/wk., the MCI risk tended to increase. For sedentary time, MCI risk initially decreased and then increased with longer duration. The lowest risk was observed at around 150 min/day, with risk beginning to rise after exceeding 200 min/day. Sensitivity analysis confirmed that the relationships between PAL, sedentary time, and MCI remained robust.

Conclusion: Both physical activity and sedentary time are closely associated with the incidence of MCI in older adults. Maintaining a weekly PAL between 1,485 and 4,000 MET-min/wk. and limiting daily sedentary time to under 200 min may help reduce the risk of MCI.

Interoperability challenges in healthcare frequently lead to fragmented patient records and duplicated procedures, negatively affecting continuity of care and operational efficiency. Although multiple theoretical frameworks and standards have been proposed to address these issues, practical and fully implemented solutions enabling secure and controlled data exchange remain limited. To address this gap, we developed Wirachain, a decentralized application that integrates blockchain technology with the HL7 FHIR standard for electronic health record management. The system enables patient-controlled permission granting and revocation, incorporates authentication and role-based access control, and supports persistent storage using both FHIR-compliant and traditional databases. Validation was conducted using synthetically generated clinical data and stress-testing scenarios to assess system performance under load. The results demonstrate that the proposed application can reliably manage access permissions and clinical data exchange across interoperable components. The system maintained efficient operation and secure data handling under simulated clinical workflows and increased load conditions. These findings indicate that fully implemented blockchain-based solutions can effectively bridge the gap between conceptual interoperability frameworks and practical healthcare applications. Wirachain illustrates the feasibility of combining blockchain and FHIR standards to support secure, patient-centered, and interoperable clinical operations.

[This corrects the article DOI: 10.3389/fpubh.2023.1278008.].

Aim: To develop and validate a predictive model for identifying clinical nurses at high risk of mental workload (MWL) using a nomogram-based approach, grounded in the Job Demands-Resources theoretical framework.

Methods: Guided by the Job Demands-Resources model, a total of 826 clinical nurses were recruited from nine tertiary hospitals. Data were collected through standardized questionnaires assessing demographic characteristics, mental workload, and psychosocial factors including emergency response capacity, perceived social support, and coping style. A total of 16 variables were screened using least absolute shrinkage and selection operator (LASSO) regression. Seven significant predictors were then entered into a binary logistic regression model and used to construct a nomogram. Model performance was assessed using the area under the curve (AUC), calibration curves, Hosmer-Lemeshow test, and 10-fold cross-validation.

Results: Seven variables were identified as independent predictors of high mental workload: gender, salary satisfaction, frequency of night shifts, turnover intention, emergency response capacity, perceived social support, and negative coping style. The nomogram demonstrated good discriminative ability in both the training (AUC = 0.796, 95% CI: 0.741-0.852) and validation cohorts (AUC = 0.793, 95% CI: 0.757-0.830). Calibration curves showed strong agreement between predicted and observed outcomes. The C-index derived from bootstrap resampling was 0.761, while 10-fold cross-validation yielded a mean C-index of 0.771, indicating robust internal validity and consistent performance.

Conclusion: A validated nomogram was developed to predict the risk of high mental workload among clinical nurses. The model exhibited favorable discrimination, sound calibration, and consistent internal reliability, offering an effective means for identification and focused intervention.

Objective: To analyze COVID-19 infection incidence and risk factors among Chinese national team members during overseas training and competitions (April-October 2022) to inform prevention for international events.

Methods: A nationwide cross-sectional survey used electronic questionnaires distributed to 69 national teams. A total of 1,020 valid questionnaires were included for analysis, covering athletes, coaches, medical staff, team leaders, and other support personnel. The χ² test was used to analyse the relationships between infection rates and variables, including individual factors, travel modes, accommodation conditions, and protective behaviors.

Results: The overall infection rate was 35.5%. Infection rates differed significantly across occupational groups: athletes had the highest rate (37.9%), followed by coaches (29.8%) and team leaders (21.7%). Personnel who participated in both overseas training and competitions presented a significantly higher infection rate (47.9%) than did those who only participated in competitions (19.0%) (p < 0.001). Individuals vaccinated with 2 doses had the highest infection rate (48.6%), whereas those receiving ≥4 doses had the lowest infection rate (22.4%). χ² analysis revealed significant risk factors for infection: sharing accommodation floors with foreign personnel, inadequate room ventilation, irregular room disinfection during training periods, taking nondirect flights, and inconsistent mask wearing.

Conclusion: Infection risk among national team members abroad clustered by role, assignment type, and behaviors. Elevated risk was linked to intensive training schedules, suboptimal implementation of prevention protocols, and frequent contact with foreign personnel. Multifaceted interventions-source control, rigorous process management, and strict adherence to personal protective measures-should be strengthened to reduce infection risk.