Frontiers in Public Health最新文献

Social prescribing involves trusted individuals in clinical and community settings identifying non-medical, health-related social needs and connecting people to community-based supports through a collaboratively developed social prescription. Social prescribing operates within a dynamic, complex adaptive system, making evaluation challenging. This study presents two Australian case studies of co-designed social prescribing programs-Connect Local in Melbourne and Spark in Adelaide-to examine how evaluation can be conceptualized and implemented. Rather than focusing on program delivery, these case studies are used to interrogate the processes, methodological challenges, and system conditions that shape how impact is understood. The evaluation challenges for both initiatives included shared complexities: the need to balance meaningful data collection with individual and community preferences; measuring impact to meet the needs of interest holders; and the evolution of the contexts in which the programs are delivered and their influence on what constitutes 'success.' Analyzing the two case studies against assumptions of linear, simple systems highlighted that a shift in how evaluation is conceptualized and undertaken is required. Impacts were not static, discrete, measurable outputs, but dynamic processes shaped by relationships, shared meaning-making, and adaptive capacity. Conventional evaluation frameworks centered on linear logic models and fixed indicators do not effectively capture impacts driven by relationships, community capacity, and adaptive change. Therefore, program success must be reframed as an emergent presence in which outcomes unfold through interactions between individuals, organizations, and wider systems. This study argues for a shift from milestone-based models to ongoing stewardship-oriented approaches that prioritize monitoring patterns, relationships, and adaptive responses. Indicators may need to shift from static quantitative measures to relational indicators that reflect relationship alignment, coherence of working practices, and growth within the networks and relationships. The question this research poses is: How can evaluators identify and track indicators that remain meaningful when both the context and intervention are evolving, and thereby the outcomes are also changing? By examining the evaluation journeys of Connect Local and Spark, this study demonstrates the need for methodological approaches that align with complexity, center on community voice, and explain the emergent, co-constructed nature of social connection impacts.

Introduction: Social housing plays a critical role in addressing housing inequality and promoting well-being. This paper examines the creation of a registry of social housing sites across all six Ontario Health (OH) regions.

Methods: For all 47 housing service providers in Ontario, social housing address, provider type, and building type were extracted from their website or from documents provided by the housing organization. The Registry included rent-geared-to-income housing with unique or minimally shared postal codes. Descriptive statistics were analyzed for the housing site characteristics aggregated by OH region.

Results: 2,109 social housing sites were included in the final Registry, including 472 designated as seniors only (low-income naturally occurring retirement communities, LI-NORCs). There were regional differences in the proportions of each tenant designation, postal code uniqueness, housing provider types, and building classifications. For instance, the Toronto and North West regions had higher government-owned social housing sites (61% and 57%), whereas the East region had more non-profit owned sites (55%). Apartments were the most common building type across regions (57%), with varying proportions of townhouses and single/semi-detached houses.

Discussion: A social housing registry, the SHO, has been established, serving as a valuable resource for health research, especially for marginalized populations. It can be linked to other datasets for future studies. The SHO Registry provides a robust method for the determination of LI-NORCs (low-income naturally occurring retirement communities).

Background: Menstrual health is a critical public health issue tied to gender equity and adolescent well-being. Brazil's School Health Program (SHP) mandates sexual and reproductive health education, yet structured models for integrating medical students into this policy-driven, community-based work are scarce. This study describes and analyzes an experiential learning project where first-year medical students facilitated menstrual health education within the SHP.

Methods: A qualitative case study was conducted. Six female medical students developed and delivered a developmentally tailored educational session on puberty, menstrual physiology, and dignity to 5th-grade (elementary school) girls at a public school, as part of the 2025 activities of the SHP. Data from structured reflective debriefings with students, supervisor observations, and SHP records were analyzed through thematic content review and consensual validation.

Results: Analysis revealed three primary learning outcomes for medical students: (1) Development of core communication and empathetic skills for discussing sensitive topics; (2) A deepened, experiential understanding of menstrual stigma and social determinants of health; and (3) Practical insights into intersectoral collaboration and public policy implementation through the SHP framework. School staff observed a marked reduction in embarrassment and increased openness to discussion among the adolescent participants.

Conclusion: Integrating menstrual health promotion into early medical training via established public policy platforms like the SHP is feasible, low-cost, and highly effective. This model serves as a dual-purpose intervention, fostering socially accountable, humanistic competencies in future physicians while simultaneously advancing adolescent health literacy and dignity. It provides a replicable framework for community-engaged medical education in Brazil and similar low-resource settings.

[This corrects the article DOI: 10.3389/fpubh.2025.1726568.].

Objective: State legislation addressing postpartum depression varies widely across the U.S. and may play a critical role in shaping access to mental health care and supports that influence state level maternal mortality outcomes. This study examined the relationship between U.S. state legislation on postpartum depression (PPD) and state-level maternal mortality rates.

Methods: Data from PPD-related legislation in 32 states were reviewed and were categorized based on their scope and funding. State-level maternal mortality data was obtained from the CDC, and uninsured rates from the U.S. Census Bureau's American Community Survey.

Results: States with highest policy quality PPD legislation, especially those with funding, and with more PPD-related legislation had lower maternal mortality rates, even after adjusting for uninsured rates. In regression analyses, uninsured rate explained 23% of the variance in maternal mortality; number of PPD policies explained 13%, and PPD policy quality explained 12%.

Conclusions: Higher quantity and highest quality of PPD-related state legislation are associated with lower state-level maternal mortality.

Introduction: Funeral practices were identified as a significant source of Ebola transmission during the 2014-2016 West Africa Ebola outbreak. This study investigated behaviours and contributing factors leading to Ebola exposure during funerals in Montserrado County, Liberia.

Methods: In 2024, a cross-sectional study was conducted using face-to-face interviews with 200 participants (mean age:51 years; 69.5% male) from Clara Town and Vai Town with family members of EVD victims and community leaders in Clara Town and Vai Town.

Results: High-risk behaviour, defined as kissing or touching the deceased without gloves, was reported by 29.5% of participants. In unadjusted analysis, males (COR = 2.40, 95% CI: 1.14-5.03), the Kpelle tribe (COR = 3.17, 95% CI: 1.66-6.05), Christians (COR = 2.69, 95% CI: 1.42-5.09), and community leaders (COR = 2.31, 95% CI: 1.23-4.32) were more likely to engage in high-risk behaviours. In multivariate analysis, only religion remained independently associated; Christians were more likely than Muslims to engage in such behaviours (AOR = 2.70, 95% CI: 1.40-5.18).

Discussion: Kissing the deceased was the main risk behaviour. The study highlights the influence of cultural traditions on Ebola spread and calls for culturally sensitive prevention strategies.

Background: Nurse burnout is prevalent. Most existing studies focus on specialized units-such as ICUs and emergency departments. In China, "Internet+" home care is primarily delivered part-time by clinical nurses from tertiary hospitals. Yet, stress coping strategies and burnout among these nurses remain underexplored. This study examines the relationship between coping styles and burnout in this context.

Method: A cross-sectional design was used. From September to November 2024, a total of 311 nurses from seven tertiary hospitals who performed "internet +" services were surveyed, of whom 287 completed valid questionnaires and were included in the final analysis. The relationship between stress coping styles and job burnout levels was analyzed using the Simplified Coping Style Questionnaire (SCSQ) and the Nurse Burnout Scale (NBS).

Result: Nurses reported low job burnout scores (122.29 ± 28.46; ranging 57-228), indicating either extremely mild or no job burnout. Nurses who employed positive or negative coping strategies reported scores of 22.03 ± 7.56 (range 0-36) and 9.56 ± 5.01 (range 0-24), respectively. Specifically, positive coping styles were negatively correlated with total job burnout scores (r = -0.415, p < 0.01), whereas negative coping styles were positively correlated with total scores (r = 0.174, p < 0.01). Factors that influence job burnout include nurses' clinical department, educational background, marital status, average monthly income from "internet +" nursing services over the past three months, and coping styles. Married nurses with higher academic qualifications working in outpatient and emergency care departments experienced notably lower levels of job burnout.

Conclusion: The stress coping styles of nurses who provide "internet +" nursing services in tertiary hospitals and job burnout levels are significantly correlated. Nursing managers should focus on stress coping strategies and job burnout awareness to create environments in which positive coping strategies are encouraged. This approach may reduce job burnout among nurses in tertiary hospitals while promoting their overall physical and mental wellbeing. Enhancing nurses' job satisfaction and happiness with "internet +" nursing services can improve work quality, reduce turnover, and meet the increasing demand for nursing and health services.

The One Health approach recognizes the interconnectedness of human, animal, and environmental health, offering a critical framework for addressing complex global health challenges. Children occupy a uniquely vulnerable position within this paradigm due to their physiological immaturity, developmental sensitivity, behavioral exposures, and dependence on surrounding ecosystems. This narrative review examines how major contemporary threats-antimicrobial resistance (AMR), climate change, and emerging infectious diseases-intersect to shape child health outcomes within a One Health perspective. We synthesize evidence from human, animal, and environmental health domains to illustrate how children are disproportionately exposed to resistant pathogens, climate-sensitive hazards, and zoonotic and vector-borne infections. Particular attention is given to pediatric and neonatal AMR, climate-related impacts on physical and mental health, and the expanding geographic range of vector-borne diseases affecting children. The review highlights how factors such as antibiotic use in humans and animals, environmental contamination, urbanization, biodiversity loss, and extreme weather events converge to amplify risks during critical developmental windows. We identify major gaps in child-specific surveillance, integrated research, and policy implementation, especially in low- and middle-income countries. We argue that embedding a child-centered lens within One Health research, governance, and interventions is essential to protect current and future generations. Advancing such an integrated approach can enhance prevention, strengthen health system resilience, and promote equity in an era of escalating ecological and infectious threats.

Background: From a cultural perspective on research into homosexual identity, existing studies argue that the cultural foundations of Chinese attitudes toward homosexuality are deeply embedded in Confucian ethics, the family system, and a patriarchal gender order. Building on this foundation, this study adopts "family-based moral regulation" as its core explanatory framework, focusing on value domains such as marriage, reproduction, gender, and intergenerational obligations. It proposes and operationalizes three measurable value dimensions at the levels of the individual, the couple, and the family: premarital sexual attitudes, gender role beliefs, and conceptions of filial piety. This study examines how these dimensions are associated with contemporary Chinese public attitudes toward homosexuality.

Method: Using data from the Chinese sample of the seventh wave of the World Values Survey (WVS), this study explores how three dimensions of Confucian gender ideology relate to attitudes toward homosexuality. It also examines how gender and gender role beliefs interact with views on filial piety and sexual behavior.

Result: The study finds that in a Confucian cultural context, negative attitudes toward homosexuality are driven not by biological sex, but by the degree of adherence to traditional gender role norms. Among the three dimensions of Confucian gender ideology, more permissive premarital sexual attitudes are positively associated with acceptance of homosexuality, while traditional gender role beliefs and stronger filial piety are significantly negatively associated. Finally, by distinguishing the effects of sex and gender role beliefs, the study shows that gender role beliefs significantly amplify the negative impact of sexual attitudes and filial piety on views toward homosexuality, whereas biological sex has no significant effect.

Conclusion: In the Confucian cultural context, negative evaluations of homosexuality are shaped less by biological sex and more by individuals' adherence to traditional gender norms. Compared to biological identity, homophobic attitudes in Chinese society are more strongly linked to values that uphold the gender order. This study frames Confucian tradition as a key cultural foundation for shaping family ethics and offers a differentiated analysis of family-centered moral values, providing new individual-level empirical evidence for understanding attitudes toward homosexuality in non-Western contexts.

Background & aims: The Baveno consensus recommends using liver stiffness measurement (LSM) and platelet count to avoid endoscopy in low-risk patients with compensated advanced chronic liver disease (cACLD). This study aimed to compare the cost-effectiveness of the Baveno-based selective screening vs. universal screening strategy for high-risk varices (HRV) in a Chinese cACLD cohort.

Methods: A state-transition Markov model was constructed from the Chinese healthcare system perspective, simulating a cohort of 1,000 patients with cACLD over a five-year horizon. Model inputs were derived from Chinese real-world data, meta-analyses, and national fee schedules. Outcomes included costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), bleeding events, and endoscopic volumes. Sensitivity analyses and scenario analyses were performed to assess the uncertainty.

Results: The selective screening strategy yielded additional QALYs gain (3.4780 vs. 3.4452) and higher cost ($581 vs. $512) over 5 years compared with universal screening, resulting in an incremental cost of $2,103.66 per additional QALY gained and sparing 26% of patients from initial endoscopy. This ICER falls below China's per-capita GDP-based willingness-to-pay (WTP) threshold, indicating that the selective screening is cost-effective in the Chinese context. Deterministic analysis supported these findings, and probabilistic sensitivity analysis showed that selective screening was the preferred strategy in the majority of simulations.

Conclusion: Within China's healthcare context, the Baveno-based selective screening strategy is a cost-effective option for screening of high-risk varices in patients with cACLD, suggesting that it should be considered for widespread implementation on clinical and economic grounds.