Frontiers in Public Health最新文献

Introduction: The treatment of patients in Short-Stay Psychiatric Units (SSPUs) requires a holistic approach that promotes overall health, enhances patients' personal resources, and supports adaptation to daily life, thereby contributing to a more humane inpatient experience. The role of mental health professionals must extend beyond a traditional symptom-focused approach, with the therapeutic relationship grounded in empathy to provide a safe and trusting environment that enables patients to enhance self-confidence and actively engage in recovery. Preliminary evidence suggests yoga may improve functional outcomes and hospitalization experience.

Methods: This study examined the differential effect of a yoga intervention implemented as an adjunct to comprehensive patient care in the SSPU of the Insular Maternal and Child University Hospital Complex of Las Palmas de Gran Canaria, Spain. The sample comprised 100 patients (52 in the experimental group and 48 in the control group) who completed the Distress Thermometer, the EuroQoL EQ-5D-5L Health Questionnaire, the Client Satisfaction Questionnaire (CSQ-8), and an open-ended questionnaire assessing treatment satisfaction.

Results: Statistically significant improvements were observed following the comprehensive intervention, including reductions in perceived stress and health and functional problems, as well as improvements in self-rated overall health. At the between-group level, the experimental group showed significantly greater improvement in the self-care dimension of the EuroQoL EQ-5D-5L and higher overall treatment satisfaction on the Client Satisfaction Questionnaire. Patients' qualitative descriptions characterized yoga as a beneficial component of care, contributing to relaxation, emotional regulation, feelings of peace and safety, and improved communication and empathy. Co-occurrence analysis suggests that these experiences, together with body awareness, are closely interrelated, reflecting experiential patterns rather than distinct therapeutic mechanisms.

Discussion: This study shows that integrating a yoga-based intervention into comprehensive inpatient care is feasible, well-received, and valued by patients, supporting its potential as a complementary therapeutic activity.

This study aimed to assess the knowledge, attitude and practice (KAP) toward insomnia prevention and treatment among medical students in Inner Mongolia. A cross-sectional study was conducted at Baotou Medical College, Inner Mongolia University of Science and Technology from March 25, 2024 to June 17, 2024, using a self-designed KAP questionnaire. A total of 517 valid questionnaires were collected. Among the respondents, 273 (52.80%) were freshmen, 324 (62.67%) were female, and 112 (21.66%) had subclinical insomnia. The mean scores for knowledge, attitude, and practice were 13.09 ± 2.56 (adequate knowledge >14), 64.99 ± 10.74 (positive attitude >56), and 31.83 ± 8.94 (proactive practice > 31.5), respectively. The correlation analysis indicated a significant positive relationship between knowledge and attitude (r = 0.152, p < 0.001). Additionally, there was a correlation between attitude and practice (r = 0.333, p < 0.001). Multivariate logistic regression revealed that a higher attitude score (OR = 1.055, p < 0.001) and being in a relationship or married (OR = 1.712, p = 0.014) were associated with better practice, while received treatment for insomnia (OR = 0.095, p = 0.024) and clinical insomnia (OR = 0.523, p = 0.006) were negatively associated with practice. Medical students in Inner Mongolia exhibited insufficient knowledge and, while their attitudes were generally positive, students with symptoms demonstrated inadequate practice toward insomnia prevention and treatment. In this cross-sectional study, these findings suggest the need for enhanced screening and targeted interventions to help reduce the potential long-term harm of insomnia.

Background: The uneven distribution of healthcare resources and jobs-housing spatial separation are reshaping the spatiotemporal patterns of urban patient flows. This structural mismatch exacerbates inequalities in service utilization and imposes hidden geographic and social costs. However, conventional static statistics and theoretical models often fail to capture authentic micro-level behavioral patterns, rendering them unable to precisely quantify or deconstruct the inequalities and burdens concealed within patient flows.

Methods: Taking Shanghai as a representative megacity case study, we utilized anonymized mobile signaling data (March 2019) to construct a weighted, directed "demand-supply" patient flows network. We introduced a null model as a random benchmark and employed the channel decomposition method to deconstruct pathway structures. We developed a "bypass premium" index to quantify the specific burden of quality-driven hospital seeking.

Results: (1) Resource siphoning: Patient flows are highly concentrated toward top-tier hospitals, yet their spatial footprint is widely dispersed across the city, a pattern that deviates significantly from the random benchmark. (2) Boundary filtering: Administrative boundaries act as a "value filter." Inter-district flows do not diffuse uniformly but are funneled into backbone pathways leading exclusively to tertiary hospitals. (3) Functional neutrality: Secondary hospitals fail to perform their intended hub-and-diversion function within the hierarchical healthcare system, resulting in a state of functional neutrality. (4) Cost deconstruction: The average bypass premium for reaching a tertiary hospital is 10.24 km. Crucially, 73.54% (7.53 km) of this constitutes passive structural friction required to overcome boundary barriers, while only 26.46% (2.71 km) represents the active selective premium paid for quality-driven access.

Conclusion: This study confirms the non-random polarization of patient flows and the screening mechanism of administrative boundaries in Shanghai. Our findings reveal that the costs of inter-district hospital-seeking stem primarily from passive structural friction rather than active selective premiums, occurring alongside a critical functional deficit in secondary hospitals. Consequently, policy interventions must prioritize strategies of "reducing friction" and "strengthening the middle." Specifically, optimizing transportation networks, insurance integration, and medical consortiums is essential to dismantle barriers and revitalize the hub capacity of the intermediate tier.

Background: Susceptibility to hepatitis A virus (HAV) remains high among young adults in Korea, reflecting birth-cohort effects and vaccination history. Because foodborne transmission has contributed to outbreaks, students in food and nutrition or culinary arts represent a relevant target group as future food handlers. We aimed to estimate anti-HAV immunoglobulin G (IgG) seroprevalence, describe pre- to post-intervention changes in knowledge, perceptions and vaccination intention and report two-dose vaccination completion and its correlates.

Methods: From April 2023 to December 2024, we conducted a campus-based hepatitis A prevention program at four universities. Students completed a baseline questionnaire before the session and a post-intervention questionnaire immediately after the education session and same-visit POCT result feedback. Students who were IgG-negative and had no verified prior two-dose vaccination in the national Immunization Registry Information System (IRIS) were referred to public health centers for no-cost vaccination. Two-dose completion was defined as IRIS documentation of a second HAV vaccine dose by the study end date. We modeled anti-HAV IgG positivity using mixed-effects logistic regression with an institution-level random intercept, and series completion (and correlates) using modified Poisson regression with institution-clustered robust standard errors.

Results: Of 692 participants who underwent anti-HAV IgG POCT, 188 (27.2%) were IgG-positive and 504 (72.8%) IgG-negative. Among IgG-negative participants, 37 had documented prior two-dose vaccination and were not vaccine-eligible. The remaining 467 were vaccine-eligible (0 dose n = 435, 1 dose n = 32). Overall, 354/467 (75.8%) completed the two-dose series. Baseline intention was strongly associated with series completion (aRR 1.55; 95% CI, 1.39-1.72). Among those initially no/undecided (n = 114), endorsing vaccine distrust was associated with higher completion (aRR 1.46; 95% CI, 1.09-1.98).

Conclusion: In a cohort of future food handlers with a susceptibility gap, a campus-based program integrating standardized education with same-visit anti-HAV IgG testing and vaccination record verification achieved high two-dose completion among those without evidence of protection. These findings inform targeted young-adult hepatitis A prevention strategies by using on-site triage to focus counseling and referral on susceptible individuals and reduce reliance on off-site testing and return visits. Comparative studies are needed to assess the incremental value and cost-effectiveness of on-site testing and serostatus feedback.

Introduction: This study examines the contribution of social health to enhancing the quality of life (QOL) among older people in the Kingdom of Saudi Arabia. Given that QOL is a critical health indicator in aging populations, understanding the role of social health is essential for supporting well‑being in later life.

Methods: A descriptive research design was employed using the Social Health Scale for Older People. The study sample consisted of 660 Saudi participants aged 65 years and above, representing 0.1% of the national older population.

Results: It revealed a high overall mean for social health indicators, particularly in the domains of social support (M = 2.6341) and social adjustment (M = 2.4066). Social support included emotional acceptance, comfort, encouragement, and daily care. Social adjustment encompassed employment, household involvement, interpersonal communication, psychological well‑being, and self‑health awareness. The results indicate that older people in Saudi Arabia benefit from strong social health outcomes influenced by cultural values, family‑centered care, and positive youth attitudes.

Discussion: Despite the current strengths in social health, anticipated demographic changes are expected to significantly increase the number of older people in the coming years. This highlights the need for proactive policy interventions. The study recommends strengthening family‑based support through community initiatives, expanding access to institutional care, and promoting intergenerational awareness to ensure sustainable well‑being and dignity for older people in Saudi society.

Background: While antiretroviral therapy (ART) has significantly improved the long-term survival of people living with HIV/AIDS, leading to a chronic disease management model, survival outcomes can be influenced by demographic and clinical factors. There is a need to evaluate the long-term survival of HIV-infected individuals initiating ART and identify local influencing factors to optimize patient management and improve prognosis.

Methods: A retrospective cohort study was conducted on HIV-infected individuals who initiated ART in Zhengzhou between 2014 and 2024. Demographic data and ART-related information were collected from the National AIDS Clinical Data System. The life table method was employed to describe patient survival time, while the Kaplan-Meier method was used to compare survival time differences under various conditions and to plot survival curves. A Cox proportional hazards regression model was applied to analyze risk factors influencing patient survival time.

Results: Among the 3,312 HIV-infected individuals, the total follow-up time amounted to 15,656.5 person-years, with a median follow-up of 4.73 years. A total of 107 deaths were recorded, yielding a mortality rate of 0.68 per 100 person-years. The cumulative survival rates at 1, 3, 5, and 10 years were 99%, 98%, 96%, and 93%, respectively. Multivariate Cox regression analysis identified age greater than 60 years (HR = 5.570, 95% CI: 1.608-19.292) as a risk factor for mortality. Additionally, patients with a baseline CD4⁺ T lymphocyte count of less than 50 cells/μL faced a significantly higher risk of death compared to those with a count greater than 350 cells/μL (HR = 3.777, 95% CI: 1.583-9.014).

Conclusion: From 2014 to 2024, the overall survival of HIV-infected individuals receiving antiviral therapy in Zhengzhou was favorable. However, advanced age and a low baseline CD4⁺ T lymphocyte count were identified as significant factors for an elevated mortality risk. It is recommended to enhance clinical management for older patients and to initiate treatment early to improve CD4⁺ T lymphocyte levels, thereby further improving survival outcomes.

Introduction: Recovery homes are an increasingly important recovery support service for people with substance use disorders, yet limited research has examined the roles of house managers or how individuals are recruited into these positions. This study examines how house managers understand and enact their roles, how recovery home operators recruit for these positions, and how the demands and sustainability of the role are perceived in practice.

Methods: We conducted a qualitative thematic analysis of interviews with 29 operators and staff working in 10 Level II and Level III recovery homes across five Texas cities.

Results: Findings indicate that house managers leverage lived experience to support residents, enforce house rules, and cultivate recovery-oriented house cultures that emphasize mutual accountability, peer engagement, and resident self-regulation. Operators most often recruited house managers from among successful residents with stable recovery and familiarity with house norms, though participants described limitations to this approach and noted that the role is frequently experienced as demanding and transitional.

Discussion: These findings underscore the central role of house managers in shaping recovery home culture and highlight the complexity of a position that combines peer support, leadership, and operational responsibility within social model recovery settings. The results emphasize key balancing factors related to recruitment pathways, training, role sustainability, and length of employment. By documenting how house managers and operators conceptualize the role as both critical, yet often transitional, this study advances understanding of workforce dynamics in Level II and Level III recovery homes and identifies priorities for implementation-focused research on training, support structures, and staffing models that sustain recovery-oriented environments over time.

Background: Northern Thailand experiences severe annual air pollution (PM_2.5 > 35 μg/m³), primarily due to agricultural burning. While ambient PM_2.5 has been linked to gastrointestinal cancer deaths, its effect on colon cancer survival in high-exposure areas remains understudied.

Methods: In this 15-year retrospective cohort study, we used data on 5,018 patients with colon cancer (2003-2018) obtained from the Chiang Mai Cancer Registry. Time-varying exposure to PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃ was evaluated by exploiting annually updated Copernicus Atmosphere Monitoring Service data and linking them to residential districts. Multivariable time-dependent Cox models adjusted for demographics, tumor characteristics, and treatment were used in the analysis.

Results: Over 18,650 person-years of follow-up (PYFU), 72% of patients died (mortality rate: 19.4 per 100 PYFU). Exposure to PM_2.5 ≥ 37.5 μg/m³ (a regionally relevant threshold) was independently linked to double the risk of all-cause mortality (adjusted hazard ratio (aHR) = 1.96, 95% confidence interval: 1.49-2.58, p < 0.001), as was having a low body mass index (aHR = 1.54) and being male (aHR = 1.23). Patients who died had significantly higher mean time-updated PM_2.5 exposure (with consistent annual exposure differences) compared to the survivors (37.7 vs. 35.5 μg/m³; p < 0.001). No significant associations were found between colon cancer and PM₁₀, O₃, NO₂, SO₂, or CO exposure. The PM_2.5 effect size was larger than estimates from regions with lower exposure levels.

Conclusion: Long-term exposure to ambient PM_2.5 markedly increases the risk of death among colon cancer patients in northern Thailand. As a modifiable risk factor, PM_2.5 mitigation urgently needs to be incorporated into environmental and survivorship care strategies in high-exposure areas.

Background: The Hierarchical Medical System (HMS) in China aims to streamline healthcare delivery through structured patient referrals across primary, secondary, and tertiary care. However, the weak collaboration among stakeholders, such as government agencies, medical institutions, and patients has become a significant barrier to its effective implementation.

Methods: This study employed Social Network Analysis (SNA) to explore the social network characteristics and functional positioning of key stakeholders in the HMS. A systematic literature review was conducted to identify 14 primary stakeholders, followed by a survey of 631 experts to assess the relationships between these stakeholders. The expert judgments were used to construct a relationship matrix, which served as the basis for network analysis.

Results: Our findings revealed that stakeholder collaboration within the HMS operates as a moderately connected network, characterized by limited integration and low participation from both patients and primary healthcare institutions. This lack of engagement is a primary barrier to the effective implementation of the system. Among the core stakeholders, including the Health Committee, Finance Bureau, Development and Reform Commission, and Healthcare Security Administration, there was insufficient cohesion and coordination, which weakened the overall network. This lack of integration significantly hampers policy synergy and reduces implementation efficiency.

Conclusions: A collaborative governance framework is proposed to address these challenges. By fostering greater engagement among stakeholders and empowering patients to voice their needs, the system can achieve better integration, equity, and responsiveness. This framework aims to improve system efficiency and policy implementation, facilitating more effective governance and better healthcare outcomes.