Frontiers in Public Health最新文献

Microplastics (MPs) are pervasive environmental contaminants with significant bioaccumulation potential, posing a growing threat to global health through multi-organ toxicity. This review systematically synthesizes current knowledge on MPs-induced organ-specific damage and its systemic health implications. We detail the accumulation of MPs in major organ systems, including the liver, brain, lungs, kidneys, intestines, heart, and reproductive organs. Furthermore, we emphasize the critical role of inter-organ communication in amplifying toxicity, such as gut-liver axis-mediated hepatotoxicity and gut-brain axis-driven neurotoxicity. Emerging evidence on the transgenerational adverse effects of parental MPs exposure is also discussed. The core cellular and molecular mechanisms across these organs are examined, with a particular focus on oxidative stress, inflammatory activation, mitochondrial dysfunction, and programmed cell death. This review is distinct in its integrative approach, offering a novel perspective by synthesizing organ-specific pathologies with cross-organ communication networks and transgenerational effects, thereby providing a more holistic understanding of MPs' systemic toxicity. Collectively, this review elucidates the exposure-organ damage correlation, analyzes the underlying pathogenic mechanisms, and aims to provide a scientific foundation for public health risk assessment and informed environmental policy formulation.

Background: To investigate the impact of social support factors on the acceptance of rapid initiation of antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA), and to provide evidence for developing personalized interventions to improve the rapid ART initiation rate.

Methods: A cross-sectional study was conducted among patients visiting Lanzhou Pulmonary Hospital between September 2024 and January 2025. Data were collected via questionnaires. Variable selection was performed using univariable logistic regression; those with a significance level of p < 0.05 were included in a multivariable logistic regression model. Group differences in rapid initiation rates were assessed using the chi-square test.

Results: Among the 530 participants (506 males, 481 Han ethnicity), the highest proportion was in the 31 to <46 age group. Univariable analysis showed that age, education, cross-regional treatment, marital status, monthly income, disclosure to spouses/family, and having infected peers were associated with rapid ART initiation. The multivariable model identified that younger age groups (15- < 31 and 31- < 46), cross-district treatment within the city, monthly income ≥5,000 CNY, disclosure to spouses/family, and having infected peers were facilitators, while being unmarried was a barrier. Rapid initiation rates differed significantly based on spouses'/family members' attitudes post-disclosure (χ ² = 4.281, p = 0.039) and provision of support (χ ² = 4.281, p = 0.039), but not on peer support provision (p = 0.058). Among the support provided by spouses/family members, psychological support was the most common and was associated with the highest rapid ART initiation rate. The proportions of financial support and material support were similar, and their corresponding rapid initiation rates were also comparable. PLWHA who received no support had the lowest rapid initiation rate, which was significantly lower than rates observed with any form of support. Similar results were observed in the subgroup with infected peers: psychological support had the highest proportion and the greatest rapid ART initiation rate, while the absence of peer support was associated with the lowest proportion and the smallest rapid initiation rate.

Conclusion: Integrating social factors into rapid ART initiation interventions, through a support network connecting families, peers, and healthcare institutions, can enhance treatment willingness and timeliness, ultimately improving outcomes for PLWHA.

Background: To reduce chronic diseases, evidence-based health promotion interventions (EBIs) must be effectively implemented and sustained in settings such as schools. This review assessed the extent to which EBIs sustained their effects following the completion of an effective implementation trial. It also explored the use of recommended sustainment practices in follow-up studies.

Materials and methods: A Cochrane systematic review served as the basis for identifying school health promotion EBIs with demonstrated implementation effectiveness. Eligible studies were controlled trials in elementary or secondary schools that evaluated an implementation intervention and reported a statistically significant implementation effect. Forward citation searches were conducted across three electronic databases and two trial registration databases to identify relevant follow-up studies. To be included, follow-up studies needed to report comparable quantitative data (i.e., similar samples and outcome measures) to the original trial and to have been collected at least 6 months after the intervention ended. Two independent reviewers screened studies and extracted data using a predetermined template, with input from a third reviewer as needed. The included papers were assessed against sustainment-promoting practices, including whether they planned for, defined, or used a sustainment framework. The percentage of the original implementation effect sustained at follow-up was calculated.

Results: Of the 23 EBIs with a significant implementation effect in the original review, 26% (n = 6) were found to have eligible follow-up studies. These targeted physical activity (n = 3), diet (n = 2), and tobacco prevention (n = 1). Four studies reported implementation outcomes, and two reassessed behavioral outcomes. The percentage of the implementation effect sustained ranged from 51 to 122%, with a median of 76% (IQ1 = 56%, IQ3 = 107%).

Conclusion: To the best of our knowledge, this is the first review to quantify the sustainment of EBIs in schools following an effective implementation trial and to assess the extent to which best-practice sustainment principles were applied. Few studies described sustainment planning or used comparable follow-up measures. Improving long-term outcome measurement and integrating sustainment frameworks into planning and implementation could help sustain effective school health promotion EBIs.

Introduction: The potential buffering role of benefit finding, a cognitive and behavior adaptation process, in the relationship between financial concerns and psychological distress is not well understood among Asian American populations. Our study examined how financial concerns impacted Asian Americans' mental health, specifically in the presence of benefit finding and received pay during the COVID-19 pandemic.

Methods: Survey-weighted data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project was analyzed to test the associations between financial concerns and psychological distress among Asian American adults 18 years or older (unweighted N = 3,152). Multivariable linear regression models included an interaction term for benefit finding, financial concerns, and received pay to test the moderation effect of benefit finding on psychological distress.

Results: Reporting financial concerns increased the likelihood of psychological distress (β: 1.24, 95% CI: 0.91, 1.56). Asian Americans who reported greater levels of benefit finding had lower psychological distress, but benefit finding alone did not moderate the relationship between financial concerns and psychological distress. However, having both greater levels of benefit finding and received pay protected Asian American participants the most from psychological distress when experiencing financial concerns.

Discussion: Our findings suggest that benefit finding and received pay combined may have important implications for interventions and policy-level changes targeting financial concerns among Asian Americans. Future research should explore the relationships between benefit finding and health outcomes over the life course, other protective coping responses for Asian Americans, and potential differences by Asian ethnicity or specific subgroups.

Objective: This study aims to bridge the existing gap in knowledge by assessing the financial impact of image-guided brachytherapy (IGBT) in the management of cervical cancer in Thailand.

Methods: A web-based questionnaire was developed in 2019 to collect data from 14 radiotherapy centers across all regions of Thailand. The survey gathered information on the use of brachytherapy for cervical cancer treatment, encompassing both conventional brachytherapy (point-based prescription) and IGBT (volume-based prescription). Data on infrastructure, workforce, and costs were also collected, and predictions for radiotherapy usage in cervical cancer were calculated. The actual image-guided brachytherapy utilization (A-IGBTU) rate was calculated by dividing the IGBT fractions by the total brachytherapy fractions and multiplying the result by 100. The Radiotherapy Resources and Cost Calculator (RRCC; version 21.0) was used to assess shortages, while the economic model was based on clinical outcomes and toxicity models.

Results: Our survey revealed that 18,024 new patients were treated with radiotherapy, including 2,950 patients with gynecological cancers. Among these, cervical cancer accounted for 72% of the cases. The actual utilization rate of IGBT for cervical cancer was 33%. The RRCC (version 21.0) highlighted workforce shortages for radiation oncologists (ROs), medical physicists (MPs), and radiation technologists (RTTs) at 42, 63, and 61%, respectively. In the clinical outcome model, IGBT generated a total income of USD1,492,563. In the toxicity model, IGBT reduced the costs associated with treating grade-3 and grade-4 toxicities by at least 50%.

Conclusion: The actual utilization rate of IGBT for treating cervical cancer patients was 33%. The RRCC (version 21.0) highlighted workforce shortages across all roles. In our analysis, IGBT generated higher total income and significantly reduced the costs associated with treating severe toxicities.

Background: The scarcity of COVID-19 vaccines raised tough questions about who should get them first. While global guidelines stress fairness, they may overlook local realities and community voices. Without understanding these perspectives, efforts to ensure equity and build trust risk falling short. Therefore, this study aimed to assess the multifaceted perceptions, knowledge, and attitudes of community influencers in Uganda regarding COVID-19 vaccination.

Methods: This study adopted a mixed-methods cross-sectional descriptive design. The study participants were identified through community-based organizations (CBOs) to get a broad representation of the various community members and practical community entry points. Quantitative data were analyzed using the Statistical Package for Social Sciences (SPSS). Qualitative data were analyzed using thematic content analysis with NVivo 12.0 software.

Results: A total of 100 Ugandan participants took part in the study, less than half of the participants 46.0% knew Uganda/MoH guidelines only. Forty two percent (42%) were neutral on vaccines curbing COVID-19 spread, with uniform effectiveness beliefs (p > 0.05). Ninety percent (90%) supported guiding principles. Only few of the participants 31% agreed that they were very likely to contract COVID-19 after vaccination, 81% favored equal treatment but low trust in equity across classes or tribes. From the qualitative data, five themes which included, gender/power imbalances, economic divides, social norms, herbal alternatives, and tribalism. Global equity skepticism was high (57% no trust in LMIC/HIC quality parity); 86% endorsed national equity, but doubts persisted on at-risk prioritization and fair distribution.

Conclusion: While awareness of guidelines is relatively high, it is overshadowed by pervasive skepticism regarding vaccine efficacy, profound distrust in the fairness and integrity of distribution processes, and a feeling of exclusion from decision-making at global and national levels. Therefore, addressing these challenges requires a multi-pronged approach that goes beyond simply disseminating information about COVID-19 vaccination. With the strong support for ethical principles in COVID-19 vaccination, addressing equity gaps through culturally attuned strategies is essential for equitable distribution and sustained public trust in Uganda.

Antimicrobial resistance (AMR) is a persistent global health challenge that is associated with morbidity, mortality, and healthcare costs. In most outpatient (OP) settings, such as emergency rooms, primary and specialty care clinics, and dental clinics, antibiotics are often inaccurately prescribed due to patient expectations, empirical decision-making, and limited access to diagnostic data. Despite existing national frameworks, surveillance systems, and stewardship initiatives, resistance among key pathogens in the United Arab Emirates (UAE), a part of the World Health Organization's (WHO's) Eastern Mediterranean Region (EMR), is increasing. Many OP settings are underdeveloped, as most efforts focus on hospital inpatients, leading to inappropriate antibiotic use, the promotion of resistant pathogens, and an increased risk of community-acquired infections. Intensifying antimicrobial stewardship (AMS) practices in OP settings brings an opportunity to enhance patient care, limit unnecessary prescriptions, prevent adverse reactions, and reduce healthcare costs. This perspective provides insights into regional AMR trends in the EMR, reviews existing governance, regulatory frameworks, and surveillance systems of the UAE, and identifies gaps with OP stewardship practices in the Emirate of Abu Dhabi. It recommends a multi-level framework to support optimisation of OP antibiotic use, guided by regional trends, current practice, and lessons learnt from the COVID-19 pandemic. By adopting this framework, current stewardship efforts can be strengthened, responsible antibiotic use promoted, and surveillance improved, progressing towards a coordinated, multi-sector strategy to preserve antimicrobial efficacy and sustain long-term progress against resistance.

Background: Accurate and interpretable influenza forecasting is critical for public health preparedness, yet many models struggle to capture multi-scale temporal dynamics and to provide reliable uncertainty estimates. These challenges are particularly pronounced in China, where influenza seasonality differs between northern temperate and southern subtropical regions.

Methods: We propose FaXNet, a frequency-adaptive, explainable, and uncertainty-aware deep learning framework that integrates data-driven spectral representation with interpretable component selection and probabilistic forecasting. We compiled weekly influenza positivity rates from the Chinese National Influenza Center and aligned them with ERA5-Land meteorological variables (temperature, dew point, and precipitation) for northern and southern China from 2011 to 2023. FaXNet was evaluated against representative statistical, machine learning, deep learning, and decomposition-based baselines for 1-4-week-ahead forecasting using standard accuracy and calibration metrics.

Results: FaXNet achieved consistently superior performance in both regions, with 1-week-ahead R² of 0.9319 (north) and 0.8665 (south), and 4-week-ahead R² of 0.4493 (north) and 0.4960 (south). The proposed method maintained a statistically significant performance advantage against all benchmarks across varying horizons, validating the effectiveness of frequency-adaptive modeling in mitigating error accumulation. Model explanations highlighted precipitation as the dominant meteorological driver in the north and temperature as the primary factor in the south.

Conclusion: FaXNet provides accurate, interpretable forecasts with calibrated prediction intervals across 1-4-week horizons, offering actionable lead time for region-specific risk assessment and resource planning. Performance may depend on surveillance data completeness and the limited set of exogenous covariates considered, motivating future extensions with additional drivers (e.g., mobility or vaccination) and broader external validation.

Importance: Low-dose computed tomography (LDCT) lung cancer screening (LCS) has been shown to significantly reduce mortality rates. As its effectiveness relies on LDCT uptake, understanding uptake rates and their determinants can enhance the implementation and effectiveness of screening programs.

Objective: This study aimed to analyze LDCT uptake and its influencing factors in lung cancer screening within an Asian population.

Methods: Studies published between 1 January 2011 and 31 October 2025 were retrieved from four databases, and those reporting LDCT uptake and/or the factors influencing it were included. A random-effects model was applied to combine the effect estimates and 95% confidence intervals. Subgroup analyses were conducted to explore heterogeneity.

Results: A total of 35 studies involving 1,716,756 participants were analyzed, yielding a pooled LDCT uptake rate for lung cancer screening of 46% (95% confidence interval [CI], 41-51%). Program-level factors included sample scale, year of LDCT uptake, and program setting (p < 0.05). Patient-level factors that facilitated participation included a family history of lung cancer (odds ratio [OR], 1.95; 95%CI, 1.45-2.63), harmful occupational exposure (OR, 1.48; 95%CI, 1.33-1.64), chronic respiratory diseases (OR, 1.97; 95%CI, 1.62-2.38), alcohol consumption (OR, 1.20; 95%CI, 1.06-1.36), passive smoking exposure (OR, 1.43; 95%CI, 1.24-1.64), a higher body mass index (BMI; OR, 1.12; 95%CI, 1.05-1.20), and higher education levels (OR, 1.35; 95%CI, 1.17-1.56). Patient-level barriers included being a man (OR, 0.61; 95%CI, 0.55-0.68), engaging in frequent exercise (OR, 0.89; 95%CI, 0.84-0.94), smoking (OR, 0.76; 95%CI, 0.66-0.88), and being middle-aged (OR, 0.92; 95%CI, 0.85-0.99).

Conclusion: LDCT uptake for lung cancer screening is lower in Asia than in academic programs, and it varies widely due to program design and population characteristics. Adopting smaller-scale screening designs and targeting key populations may help improve implementation efforts.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025641277, identifier CRD42025641277.