Frontiers in Public Health最新文献

Background: Despite the growing availability of Employee Assistance Programs (EAP) aimed at improving workplace psychological wellbeing, the implementation and effectiveness of EAPs has not been well described nor well studied in the literature. This study seeks to describe and evaluate an insourced, multidisciplinary EAP consisting of Occupational Medicine Physicians, Psychiatrists, Psychologists as well as Human Resource Professionals to promote psychological wellbeing among healthcare workers in a tertiary hospital in Singapore.

Methods: This study utilized a health service evaluation framework and analyzed the implementation of the EAP across five dimensions, namely: Reach and Adoption, Effectiveness, Implementation and Maintenance. Anonymous longitudinal data of all participants enrolled into the EAP program between 01 Jan 2024 to 30 April 2025 were collected for analysis.

Results: Data from a total of 39 EAP participants were analyzed. Nursing staff formed the largest proportion of staff who utilized the EAP at 51.3%. The most common route of access to the EAP program was through referral by the staff's department at 43.6%, followed by self-referral (23.1%) and referral by a peer-supporter (23.1%). The most common reason for EAP attendance was work-related stressors at 48.7%. A statistically significant decrease between the median pre-EAP Patient Health Questionnaire-4 (PHQ-4) score (7) and median post-EAP PHQ-4 score (2) was noted. 59% of participants were able to return to work. An estimated average running cost of $648.48 per participating staff was required to sustain the program.

Conclusion: This is the first longitudinal study in Southeast Asia describing the evaluation of an EAP. Using an objective clinical questionnaire, an improvement in psychosocial wellbeing was noted for EAP participants. The evaluation methods and outcomes described provide a framework for companies and human resources department to review ongoing EAPs as the organization and structure of EAPs continue to evolve.

Introduction: Childhood and adolescence are decisive life stages during which social and health inequalities emerge and widen. Schools represent a privileged setting for health promotion, particularly through the development of psychosocial resources such as life skills (LS), self-efficacy (SE), life satisfaction (LSa), and health literacy (HL). The Explo'Santé program is a French school-based health promotion intervention that combines structured health education sessions with supportive environments.

Methods: This longitudinal cohort study followed 744 pupils from 4th grade in primary school to the first year of middle school. LS, SE, LSa, and HL were assessed at six time points across three annual intervention cycles, each including ten weekly school-based health education sessions.

Results: Linear mixed models showed short-term gains in LS, SE, and LSa during primary school, followed by a marked decline after the transition to middle school, whereas HL increased steadily throughout the 3 years. Girls consistently scored higher than boys but also showed sharper decreases once in 6th grade. Territorial disparities were observed, with some districts showing strong improvements while others consistently lagged.

Discussion: These findings suggest that the Explo'Santé program supports the development of key psychosocial competencies, but that the transition to middle school represents a critical turning point which challenges their sustainability. By highlighting gendered vulnerabilities and contextual inequalities, this work contributes to understanding how schoolbased health promotion can foster more equitable developmental trajectories.

Chinese rural areas have entered a stage of moderate population aging ahead of urban regions, where mismatches between the supply and demand of older population care services are particularly pronounced. Establishing a socialized older population care service system has therefore become a critical response to the challenges posed by rural aging. This study develops a theoretical framework to explain the demand generation mechanism for rural socialized older population care services, identifying key influencing factors under both policy-driven and individual choice scenarios. Using data from the China Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2018, we employ a hierarchical age-period-cohort (HAPC) model to examine the effects of age, period, and cohort on service demand. The results show that period effects are characterized by fluctuating upward trends in demand for both basic and expanded care services, primarily driven by changes in policy environments and economic conditions. Cohort effects significantly shape demand for expanded care services, but not for basic care services, with notable heterogeneity across regions and gender groups. Overall, rural demand for socialized older population care services is jointly influenced by age, period, and cohort dynamics. These findings suggest that optimizing the supply of older population care services in rural areas requires better alignment with differentiated demand characteristics to improve service relevance and effectiveness.

In an era of ubiquitous digital communication, online social anxiety has become an increasingly salient issue in the context of digital wellbeing. While procrastination is a known risk factor for psychological distress, the cognitive pathways linking it to online anxiety-and the protective factors that might mitigate these associations-remain poorly understood. Drawing on Conservation of Resources (COR) theory, this study examines a theorized "depletion-overload-anxiety" pathway by testing whether cognitive overload mediates the association between procrastination and online social anxiety, and whether mindfulness buffers this process. A cross-sectional survey of 580 adults measured procrastination in online social contexts, cognitive overload, online social anxiety, and trait mindfulness. The results showed a significant positive association between procrastination and online social anxiety, which was partially mediated by cognitive overload. Mindfulness functioned as a protective resource, moderating both the link between procrastination and cognitive overload and the direct association with anxiety; specifically, higher mindfulness attenuated the adverse associations of procrastination with both overload and anxiety. These findings suggest that procrastination may be related to elevated online social anxiety partly through increased cognitive overload, whereas mindfulness may buffer this association by supporting more adaptive attentional regulation. By framing procrastination-related strain in digital communication as a digital wellbeing issue, the study speaks to public digital health efforts aimed at reducing technology-related stress and improving psychological functioning in everyday online interaction. Given the cross-sectional design, the findings should be interpreted as patterns of association consistent with the proposed model rather than causal effects. Accordingly, digital wellbeing initiatives may consider incorporating mindfulness-based strategies to help reduce the psychological strain associated with procrastination in digital communication settings.

Objectives: Chronic diseases have emerged as a significant global health threat, making the effective management of these conditions crucial for improving patients' quality of life. Wearable devices, a significant innovation in digital healthcare, offer new solutions for managing the health of patients with chronic diseases. This study integrates the UTAUT model with the Health Belief Model (HBM) to analyze key factors influencing the adoption of wearable devices by patients with chronic diseases, aiming to provide a more comprehensive understanding of their behavioral patterns and motivations.

Methodology: A cross-sectional survey was conducted among Chinese patients with chronic diseases, yielding 432 valid responses. Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to construct the analytical model and examine the effects of latent variables on patients' behavioral intention and actual use of wearable devices.

Findings: The findings reveal that performance expectancy, effort expectancy, social influence, and facilitating conditions have a significant, positive influence on behavioral intention, which, in turn, positively affects actual use behavior. Performance expectancy mediates the relationships between social influence, perceived susceptibility, and perceived severity on behavioral intention. However, physical activity does not moderate the relationship between Performance Expectancy and Behavioral Intention.

Conclusion: Performance expectancy, effort expectancy, social influence, and facilitating conditions are identified as key determinants of patients with chronic diseases' adoption intention. Additionally, patients' perceived severity and perceived susceptibility indirectly influence their usage intention through performance expectancy.

Implications: These findings provide a theoretical foundation and practical guidance for optimizing the use of wearable devices in the management of chronic diseases. The study suggests that product development should focus on enhancing device performance, simplifying operational procedures, and strengthening social support systems.

Background: Physical activity is essential for improving population health, and participation levels are a key indicator of national social sports development. However, extant literature has largely focused on individual characteristics, with limited attention to the influence of the community environment. This study investigates how the community environment shapes physical activity among rural older adults in China and explores the mechanisms underlying these effects, providing evidence to support strategies aimed at promoting activity participation among rural older adults.

Methods: Data from 5,668 respondents were obtained from the 2023 Chinese Longitudinal Ageing Social Survey. Binary logistic regression was applied to evaluate the influence of key community environmental attributes, including the availability of fitness facilities, the presence of outdoor activity spaces, and the provision of activity guidance, on physical activity participation among rural older adults in China after controlling for socio-demographic variables.

Results: Among rural older adults, age, gender, educational level, marital status, and total personal income were significantly associated with physical activity participation, whereas living arrangement and self-rated health were not statistically significant. Access to fitness facilities was associated with a higher likelihood of engaging in physical activity, outdoor activity spaces showed a modest positive association, and activity guidance exhibited the strongest association.

Conclusion: The community environment, including access to fitness facilities, outdoor activity spaces, and activity guidance, is associated with promoting physical activity among rural older adults. Strengthening the development of fundamental activity facilities in rural communities and accelerating the establishment of a community-based physical activity instructor system are recommended to advance the implementation of the national fitness strategy.

Objectives: Occupational stress in nursing is a critical issue that can have significant implications for both workforce stability and personal health. This study aimed to identify subgroups of occupational stress among Chinese female clinical nurses using latent profile analysis, compare sociodemographic differences across these subgroups, and examine their associations with premenstrual syndrome (PMS).

Methods: A cross-sectional study was conducted among female nurses in tertiary hospitals in Huai'an City, Jiangsu Province, China, from November to December 2023. We recruited participants via convenience sampling, and 400 valid questionnaires were collected. Data were collected using a researcher-developed general information questionnaire, the standardized Chinese Nurses Stressor Scale (35 items), and the Premenstrual Syndrome Scale. Latent profile analysis (LPA) was performed with Mplus 8.0 to identify occupational stress subtypes. Sociodemographic predictors of these subtypes were explored using chi-square tests and multivariate logistic regression in SPSS 25.0. The association between stress subtypes and PMS symptoms was assessed using ANOVA. A p-value of < 0.05 was considered statistically significant for all analyses.

Results: Three clinical female nurse occupational stress subtypes were identified: overall low-stress (38.3%, n = 153), moderate stress-slight overload care (38.5%, n = 154), and high stress-overload nursing and career development challenge (23.2%, n = 93). Age, years of work experience, and monthly night shifts were key influencing factors. The results revealed a statistically significant difference in PMS scores across the stress groups (p < 0.001). Specifically, nurses in the high stress-overload nursing and career development challenge group faced a significantly higher risk for PMS, whereas those in the overall low-stress group exhibited the fewest related symptoms.

Conclusion: This study identified significant heterogeneity in occupational stress among clinical female nurses, categorized into three distinct subtypes differing in stress levels and demographic characteristics. These findings highlight the importance of considering individual differences when developing interventions to address occupational stress. The study advocates for the implementation of intervention strategies targeting different types of stress in nursing education and organizational reform to better support nurses in fulfilling their responsibilities.

Background: Older adults with mild to moderate depressive symptoms are at high risk of developing severe depression along with complications, disability, and mortality. Early intervention during mild to moderate stages of depressive symptoms is important to prevent further deterioration. Exercise as a readily available approach has been recognised for reducing depressive symptoms. High-intensity interval training (HIIT), a novel form of exercise that has the potential to improve both depressive symptoms and physical health, has garnered increasing attention. However, the application of HIIT to address depressive symptoms among older adults remains scarce.

Aims: This proposed study aims to investigate the effects of HIIT on depressive symptoms, biomarkers of depressive symptoms, physical fitness, sleep quality, and quality of life in Hong Kong community-dwelling older adults with mild to moderate depressive symptoms.

Methods: This study will be a single-blinded, cluster-randomised, controlled trial comprising three groups and three assessments. The three groups will consist of a HIIT group, a Baduanjin Qigong control group, and a recreation workshop non-exercise control group. The 144 eligible participants from 9 community centres (clusters) will be randomly allocated in a 1:1:1 ratio to three groups for 16 weeks through cluster randomisation. The primary outcome measure will be self-reported depressive symptoms. The secondary outcome measures will include salivary cortisol (a biomarker of depressive symptoms), physical fitness, sleep quality, and quality of life. The outcomes will be assessed at baseline, after completion of the intervention, and at a three-month follow-up.

Discussion: This study will provide valuable evidence on whether older adults in the HIIT group could gain more improvement in depressive symptoms and other health-related benefits compared to the control groups. If HIIT demonstrates superiority, it could be prescribed as a new exercise regimen to benefit older adults with depressive symptoms in future studies. The research findings may have considerable impacts on the future prevention and treatment of mental disorders and may also contribute to promoting healthy aging among Hong Kong older adults.

Clinical trial registration: ClinicalTrials.gov, identifier NCT06014294.

A significant research gap exists regarding the implementation of child protection policies (CPP) within the unique sociocultural context of the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) in the Southern Philippines. This qualitative case study aimed to explore public secondary school teachers' perceptions of the effectiveness of the CPP of the Ministry of Basic, Higher, and Technical Education and the challenges they encounter. Data were collected through key informant interviews and focus group discussions with 10 teachers in Bongao, Tawi-Tawi, and analyzed using inductive thematic analysis. The findings reveal that while teachers perceive the policy as vital for safeguarding students, its effectiveness is hampered by inconsistent implementation, a pronounced lack of continuous training and awareness among teachers and parents, student resistance, and external challenges such as resource limitations and cultural factors. The study's originality and value lie in its specific regional focus, applying Bronfenbrenner's Ecological Systems Theory to frame these challenges as interconnected issues across the micro-, meso-, exo-, and macro-levels. It provides context-specific evidence for policymakers and school administrators to design culturally sensitive, multilevel interventions, including robust training, strengthened community collaboration, and addressing systemic barriers, to enhance child protection in similar post-conflict and culturally distinct regions.

Introduction: Coronary heart disease (CHD) is a major global health burden requiring long-term management. Despite the essential role of health information seeking behavior (HISB) in disease self-management, current levels among CHD patients remain low, and research on its influencing factors is limited.

Objectives: This study aimed to explore HISB among patients with CHD and to identify factors associated with variations in HISB using the Risk Perception Attitude (RPA) framework.

Methods: A cross-sectional study of 330 CHD patients was conducted in China, using convenience sampling method. Data were collected through validated questionnaires assessing sociodemographic and clinical characteristics, HISB, risk perception, and self-efficacy. K-means clustering based on the RPA framework was employed to empirically identify distinct patient subgroups. Multivariate linear regression identified factors associated with of HISB within each subgroup.

Results: Four distinct subgroups were identified based on risk perception and self-efficacy: Responsive (6.7%), Proactive (41.2%), Indifference (8.2%), and Avoidance (43.9%). Multivariate regression revealed subgroup-specific factors: for Responsive, physical diagnosis and treatment risk was significant [β = 2.049, 95%CI (0.528,3.570)]; For Proactive, higher education [β = 4.725, 95%CI (2.272,7.178)], per capita monthly household income and self-efficacy were positively associated, while type of medical insurance [β = -5.814, 95%CI (-8.800, -2.828)], number of other diseases, and economic risk were negative predictors; For Indifference, only type of medical insurance was significant [β = -6.447, 95%CI (-12.503, -0.391)]; For Avoidance, older age was linked to lower HISB [β = -4.757, 95%CI (-8.525, -0.989)], whereas higher education increased it [β = 5.432, 95%CI (2.353, 8.511)].

Conclusions: This study validates the heterogeneity of CHD patients through RPA-based subgrouping, revealing that health information seeking behaviors are driven by distinct psychological and socioeconomic mechanisms across different groups. These findings underscore the limitation of uniform health education approaches and highlight the necessity of implementing subgroup-tailored strategies. By aligning clinical and public health interventions with the specific psychographic profiles of patient groups, healthcare providers can significantly enhance the precision and effectiveness of chronic disease management.

Registration: www.chictr.org.cn, identifier: ChiCTR2300069238.