Frontiers in Public Health最新文献

Background and purpose: Social workers in dental education champion the inclusion of social drivers of health and advocate for the needs of vulnerable communities using anti-oppressive, psychosocial-cultural, and systems approaches. However, despite these significant contributions, social workers' unique roles and impact in these settings remain underexplored. This study examines these professionals' role in advancing health equity in dental education settings.

Methods: An explanatory sequential mixed methods design was used to explore the role and integration of social work in oral health settings. Data were collected from the Social Work in Dentistry (SWID) group, a national peer network of social workers who work in oral health settings. In the study's first phase, quantitative data were collected via survey methods (N = 11) on their role. In the second phase of the study, one-time semi-structured interviews (N = 6) were conducted to gain a deeper understanding of participants' perceptions of their roles, and their contributions to health equity. Mixed methods integration occurred in developing the semi-structured interview guide from the survey results and the analysis phase.

Results: Social workers have multifaceted roles in dental education. Their roles included direct clinical practice (81.8%), patient care coordination (81.8%), dental education (90.9%), and supervising social work practicums (81.8%). When describing how their role contributes to health equity, the main themes that emerged were: (1) Increased access to dental care and community resources for patients, (2) educating the future dental workforce to address social drivers of health, and (3) influencing a new dental culture of practice.

Conclusions and implications: This study highlights the unique perspectives and skills that social workers bring to oral health. In oral health, social workers play a dynamic role, engaging in cross-system collaborations that enhance patient and student outcomes. The findings demonstrate that these professionals, in collaboration with dental providers, can play a significant role in promoting health equity, leading to improved care delivery and outcomes for communities. Furthermore, integrating social workers into oral health settings shapes a new generation of dental providers better equipped to address patients' psychosocial needs and deliver collaborative, person-centered care.

Background: Exclusive breastfeeding (EBF) is essential for infant health. Parental postpartum depression (PPD) may play a crucial role in shaping maternal intention and behavior to breastfeeding. This study, grounded in the ABC model of behavior theory, aimed to examine the direct and indirect pathways linking maternal and paternal PPD with EBF intention and practice.

Methods: A total of 273 couples attending postpartum health check-ups were invited to complete structured questionnaires with assistance from trained interviewers. Symptoms of PPD in both mothers and fathers were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analyses were conducted to examine the associations between parental PPD and intention and practice related to EBF. Path analysis was further employed to identify potential pathways linking parental PPD, maternal intention to EBF, and EBF practice. Direct and indirect effects were estimated within the path model using the weighted least squares mean and variance adjusted (WLSMV) estimator. Standardized path coefficients (β) were reported for all effects.

Results: Among 273 couples, 41.0% of mothers and 28.5% of fathers screened positive for PPD. Although most mothers (93.4%) showed a positive intention to EBF, only 52.4% practiced it. Maternal depression was associated with a less positive intention to EBF (adjusted OR = 0.20, 95% CI: 0.06-0.64). Path analysis further revealed that paternal PPD indirectly influenced maternal intention through maternal PPD (β _indirect = -0.177, p = 0.001), while maternal PPD exerted an indirect effect on EBF practice through intention (β _indirect = -0.189, p = 0.038). These findings highlight a family-level psychological pathway linking parental mental health to breastfeeding behaviors.

Conclusion: A substantial gap was found between willingness and actual practice of EBF. Both maternal and paternal postpartum depression were directly and indirectly associated with breastfeeding intention and practice. Early identification and intervention for parental depression are essential to promote exclusive breastfeeding.

Background: Gestational diabetes mellitus (GDM) is increasingly prevalent worldwide and is associated with substantial short- and long-term risks for mothers and offspring, making high-quality, accessible health information essential. At the same time, artificial intelligence (AI) chatbots based on large language models are being widely used for health queries, yet their accuracy, reliability and readability in the context of GDM remain unclear.

Methods: We first evaluated six AI chatbots (ChatGPT-5, ChatGPT-4o, DeepSeek-V3.2, DeepSeek-R1, Gemini 2.5 Pro and Claude Sonnet 4.5) using 200 single-best-answer multiple-choice questions (MCQs) on GDM drawn from MedQA, MedMCQA and the Chinese National Medical Examination item bank, covering four domains: epidemiology and risk factors, clinical manifestations and diagnosis, maternal and neonatal outcomes, and management and treatment. Each item was posed three times to every model under a standardized prompting protocol, and accuracy was defined as the proportion of correctly answered questions. For public-facing information, we identified 15 core GDM education questions using Google Trends and expert review, and queried four chatbots (ChatGPT-5, DeepSeek-V3.2, Claude Sonnet 4.5 and Gemini 2.5 Pro). Two obstetricians independently assessed reliability using DISCERN, EQIP, GQS and JAMA benchmarks, and readability was quantified using ARI, CL, FKGL, FRES, GFI and SMOG indices.

Results: Overall MCQ accuracy differed significantly across the six chatbots (p < 0.0001), with ChatGPT-5 achieving the highest mean accuracy (92.17%) and DeepSeek-V3.2 and Gemini 2.5 Pro performing comparably well, while ChatGPT-4o, DeepSeek-R1 and Claude Sonnet 4.5 scored lower. Newer model generations (ChatGPT-5 vs. ChatGPT-4o; DeepSeek-V3.2 vs. DeepSeek-R1) consistently outperformed their predecessors across all four domains. Among the four models evaluated on public-education questions, ChatGPT-5 achieved the highest reliability scores (DISCERN 42.53 ± 7.20; EQIP 71.67 ± 6.17), whereas Claude Sonnet 4.5, DeepSeek-V3.2 and Gemini 2.5 Pro scored lower. JAMA scores were uniformly low (0-0.07/4), reflecting poor transparency. All models produced text above the recommended sixth-grade reading level; ChatGPT-5 showed the most favorable readability profile (for example, FKGL 7.43 ± 2.42, FRES 62.47 ± 13.51) but still did not meet guideline targets.

Conclusion: Contemporary AI chatbots can generate generally accurate and moderately reliable GDM-related information, with newer model generations showing clear gains in diagnostic validity. However, limited transparency and systematically high reading levels indicate that these tools are not yet suitable as stand-alone resources for GDM patient education and should be used as adjuncts to clinician counseling and professionally curated materials.

Background: Alzheimer's disease (AD) poses a pressing public health burden globally. Evidence linking long-term ambient particulate matter exposure to AD risk remains inconsistent, necessitating systematic quantification to inform prevention policies.

Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library up to September 2025 for cohort studies with ≥1 year of particulate exposure (PM_2.5, PM₁₀, NO₂, NO_x, O₃) and incident/diagnosed AD. Quality was assessed via the Newcastle-Ottawa Scale (NOS), with random-effects models pooling hazard ratios (HRs) and 95% CIs; subgroup analyses explored heterogeneity by study design, region, and follow-up duration.

Results: Twenty-five high-quality (NOS ≥ 7/9) cohort studies involving over 170 million participants were included. Meta-analyses showed higher AD risk with each 5 μg/m³ increase in PM_2.5 (HR = 1.24, 95%CI: 1.10-1.39), 10 μg/m³ in PM₁₀ (HR = 1.16, 95%CI: 1.01-1.33), 10 μg/m³ in NO₂ (HR = 1.06, 95%CI: 1.00-1.12), and 10 μg/m³ in NO_x (HR = 1.05, 95%CI: 1.03-1.07). For O₃, four included studies showed no significant association (HR = 1.23, 95%CI: 0.65-2.31) with extremely high heterogeneity (I ² = 99.8%), indicating inadequate and unstable evidence. Subgroup analyses confirmed effect modification by study design, region, and follow-up duration; publication bias was low for most pollutants.

Conclusion: We recommend high-risk population screening, stricter emission standards, and prioritizing emission reduction in AD primary prevention-aligning with global efforts to address environmental determinants of neurological health.

Systematic review registration: PROSPERO with the registration number CRD420251174986, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251174986.

Objective: Based on an epidemiological investigation of 2-h of daily physical activity among primary and secondary school students across China's seven major administrative regions, this study analyzes the association between social support and cognitive factors, thereby providing recommendations for policy formulation.

Methods: A cross-sectional study was conducted using random cluster sampling across seven Chinese administrative regions from May to July 2025. Data were collected using standardized scales measuring physical activity levels, achievement of the daily 2-h physical activity target, academic stress, and health cognition. Statistical analyses, including descriptive statistics, chi-square tests, and multivariable logistic regression, were performed using SPSS 26.0.

Results: (1) The prevalence of insufficient 2-h daily physical activity showed significant differences across various demographic variables (all p < 0.001). Higher prevalence rates were observed among students in rural areas (30.50%), private schools (29.41%), boarding students (30.03%), and those with lower frequency of reunions with parents. (2) Key risk factors identified included lack of health cognition, low perceived value of physical activity, lack of sports facilities, insufficient allocated physical education time, and lack of access to smart devices. (3) Significant urban-rural/regional disparities were found regarding access to smart devices (t = 3.142, p = 0.002) and academic stress levels (t = 2.499, p = 0.012).

Conclusion: Health cognition, resource availability, and time allocation are significant factors associated with the insufficiency of daily 2-h physical activity among Chinese primary and secondary school students. The education department has increased the guarantee of student system construction, and has implemented differentiated management for higher grades.

Objective: Clinical reasoning is a fundamental and critical competency for physicians. However, how to effectively help resident trainees to develop and enhance this ability remains a challenge for medical instructors. In this study, a teaching approach that combines simulation-based "Debriefing with Good Judgment" (DwGJ) with Case-Based Learning (CBL) was employed to improve the clinical reasoning among standardized training residents. The effectiveness of teaching strategy was evaluated.

Methods: This study was designed and conducted as a randomized controlled educational trial. A total of 70 residents at the Clinical Skills Training Center of the First Affiliated Hospital of Jinan University, Guangzhou, China, were recruited in the 2023-2024 academic year. These residents from Internal Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Emergency Medicine, and Intensive Care Medicine, were randomly assigned to either a control group or a DwGJ group. There were 35 participants in each group. The control group received conventional CBL instruction, practicing skills within a clinical scenario, while the DwGJ group incorporated a DwGJ session following hands-on practice session. Upon course completion, participants evaluated the instructor and course, their clinical reasoning competencies (including clinical thinking, and systematic thinking, and evidence-based thinking) were surveyed, and theoretical and practical examination scores were compared.

Results: There was no significant difference between two groups in instructor evaluation. However, the DwGJ group reported significantly higher satisfaction with the course. Moreover, the DwGJ group outperformed the control group in all subcomponents of clinical reasoning, including critical thinking, systematic thinking, and evidence-based thinking. Both the theoretical test scores and skill scores were significantly higher in the DwGJ group (64.40 ± 13.22 and 80.54 ± 7.4, respectively) compared to the control group (52.34 ± 18.42, p = 0.02 and 72.32 ± 7.6, p < 0.01, respectively).

Conclusion: The integration of simulation-based DwGJ with CBL demonstrates more efficacy in enhancing resident trainees' clinical reasoning abilities, through fostering their critical, systematic, and evidence-based thinking.

Background and objectives: Substance use among college students in the U.S. remains a pressing concern and may have intensified during the COVID-19 pandemic due to increased stress, uncertainty, and academic disruptions. This study investigates the relationship between non-prescription drug use and various demographic, mental health, and behavioral factors among college students during the pandemic's early stages.

Methods: Data were collected through online and in-person surveys in the summer semester of 2021. Behavioral health was assessed using validated instruments: the Patient Health Questionnaire-9 (PHQ-9) for depression and the Drug Abuse Screening Test-20 (DAST-20) for substance use. Demographic and behavioral variables were gathered via structured surveys through convenience sampling. Bivariate analyses were followed by logistic regression to identify significant predictors of drug use.

Results: Preliminary analysis (n = 576) showed that 71.53% of participants were female, but non-prescription drug use was more commonly reported among male students (20.81%) than female students (13.11%). African American students reported the highest rate of non-prescription drug use (38.16%) among the different races/ethnicities explored for drug use behavior. Most participants were undergraduates (71.48%), and 44.10% identified as first-generation college students. Logistic regression (n = 503) revealed that African American students had nearly three times the odds of drug use compared to Caucasian students (OR = 2.962). Students with depressive symptoms were twice as likely to report drug use (OR = 2.023). Alcohol use was a strong predictor: students drinking two to four times monthly had over three times the odds of drug use compared to non-drinkers (OR = 3.223). Students aged 22-23 had nearly four times the odds compared to those aged 20 (OR = 3.976). However, gender, COVID-19 positivity status, first-generation status, academic classification, and on-campus residence were not significantly associated with drug use (p > 0.05).

Conclusion: This study identifies key demographic and behavioral health correlates of non-prescription drug use during a time of heightened stress. The findings underscore the need for targeted behavioral health interventions in college settings, particularly during public health crises. Understanding these risk factors can inform campus health strategies and support services aimed at reducing substance use and promoting student wellbeing.

Background: There is a need to more fully integrate Planetary Health and One Health principles into current medical education programs. The Medicine for a Changing Planet (MCP) curriculum is a set of online, freely available, competency-based clinical cases developed by the authors to address this gap. This study was conducted to pilot and evaluate the MCP curriculum using a mixed methods approach.

Materials and methods: Residents were invited to participate in interactive didactic sessions during which the authors piloted the content of the 11 MCP cases and collected feedback. Each session included a pre-test, case delivery using one of the MCP slide sets, and a post-test. Feedback was obtained using a structured questionnaire and focus group discussions.

Results: Total attendance across all didactic sessions was 87, including 57 unique participants. The median pre-test score was 67%, and the median post-test score was 83% (p < 0.01). All participants agreed that understanding how environmental changes, including climate change, impact human health is important. The majority agreed that the case enhanced their understanding of the topic and that the material was useful for their clinical practice. All agreed that the case material and clinical concepts were clear. Themes that emerged from focus group discussions included (1) the importance of integrating Planetary Health and One Health principles into medical education, (2) enhancing relevance to the local context, (3) balancing detail with overarching principles, (4) maximizing the impact of the "Beyond the Clinic" and "Call to Action" sections, (5) optimizing content delivery, and (6) balancing action and despair in the face of a changing environment.

Conclusion: The MCP curriculum was effective in increasing understanding and recognition of how Planetary Health and One Health approaches can improve patient care, and there was strong demand to integrate this content into medical education.

Introduction: In the context of heightened economic uncertainty and frequent extreme events, enhancing the resilience of pharmaceutical supply chains, safeguarding their security and stability, and promoting high-quality development in China's pharmaceutical industry have become pressing issues requiring in-depth research.

Methods: This study takes China's pharmaceutical industry from January 1, 2012, to March 31, 2023, as the research subject. The TENET method is employed to construct a tail risk network for the pharmaceutical supply chain. We examine its structural characteristics and dynamic temporal patterns, while analyzing variations in risk spillover effects across different tail risk events. Results: At the overall supply chain level, tail risks exhibit notable time-varying characteristics, with total connectedness rising significantly during risk events. At the module level, the production module serves as the primary source of both risk input and output. Cross-module analysis reveals clustering characteristics in risk spillovers between the production and distribution modules. Additionally, bidirectional spillovers are observed between the service and distribution modules, as well as between these modules and the production module. At the institutional level, the in-degree and out-degree of pharmaceutical institutions are not correlated with market capitalization. Hengrui Pharmaceuticals, Aier Eye Hospital, and Fosun Pharma are identified as systemically important institutions in the supply chain. Furthermore, the characteristics of the risk network vary under different tail risk events: financial crises elevate the overall risk level of the supply chain, whereas public health events do not significantly impact the overall risk level. Nonetheless, tail events universally increase the frequency of risk propagation within the supply chain.

Discussion: While the TENET model employed in this study serves as a powerful tool for analyzing tail risk networks, it possesses inherent limitations. Future research could integrate structured econometric models, such as the introduction of exogenous instrumental variables, or adopt high-frequency data causal discovery techniques. These approaches would help disentangle intrinsic causal pathways and further reveal the "topology of risk transmission.