Frontiers in Public Health最新文献

Introduction: Scorpion envenomation is a major but persistently under-recognized public health problem in tropical and subtropical regions. Its occurrence arises from complex interactions among climatic, ecological, socioeconomic, and health-system drivers. Despite sustained high incidence and expanding risk associated with climate and land-use change, these relationships remain insufficiently synthesized. Addressing this gap requires an integrative framework capable of capturing the multi-level determinants shaping scorpionism risk and outcomes.

Methods: Drawing on Human Ecology Theory and socio-ecological systems thinking, we developed an integrated conceptual model to organize determinants of scorpion envenomation. The framework synthesizes evidence from environmental science, climate impacts, scorpion biology, venom characteristics, epidemiology, and clinical and public health interventions. More than thirty determinants were categorized into six components: (1) physical-climatic variables, (2) scorpion behavior and ecology, (3) venom composition and toxicity, (4) human exposure and envenomation risk, (5) health impacts and public health response, and (6) socioeconomic factors. The model is structured in two stages: a risk-and-vulnerability stage and a scorpionism-occurrence stage.

Results: The resulting conceptual model provides a unified systems-based framework that integrates environmental, ecological, behavioral, socioeconomic, and health-system determinants of scorpion envenomation. It clarifies pathways linking upstream drivers to exposure, clinical outcomes, and public health responses, enabling interpretation of regional heterogeneity in incidence. The framework also identifies priority leverage points for intervention and offers a structured basis for empirical research, risk mapping, and early-warning development.

Discussion: This work highlights the importance of adopting a socio-ecological systems perspective to better understand and address scorpionism. By integrating diverse determinants into a coherent analytical framework, the model serves as a hypothesis-generating and interpretive tool rather than a predictive model. The approach supports the development of targeted prevention and control strategies and reinforces the need to recognize scorpionism within the broader agenda of neglected tropical health conditions, particularly given its substantial burden and strong socio-ecological determinants.

Background and objective: Age-related hearing loss (ARHL) is a significant risk factor for cognitive decline that can be mitigated using hearing aids (HAs). This study investigated the impact of HAs on cognitive function in ARHL, specifically targeting delayed recall and spatial orientation, and identified the influencing factors using multivariate logistic regression.

Methods: This is a cross-sectional study. A total of 104 ARHL patients from July 2023 to October 2025 were enrolled, dividing them into HA users (HA+ group, n = 47) and non-HA (HA- group, n = 57). The patients underwent audiological and cognitive assessments, including pure tone average (PTA), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE). Group comparisons were performed using these measures. Logistic regression was used to identify predictors of impaired delayed recall and spatial orientation, considering variables such as age, sex, HA+/- status, education, severity of hearing loss, depressive symptoms, living alone, smoking, alcohol consumption, diabetes, and hypertension.

Results: The HA + group had significantly better MoCA (24.49 ± 2.78 vs. 21.00 ± 3.63; Z = -4.881, p < 0.001) and MMSE (25.81 ± 2.45 vs. 23.33 ± 3.33; Z = -4.118, p < 0.001) scores than the HA- group, notably in delayed recall (Z = -2.653, p = 0.008) and spatial orientation (Z = -3.643, p < 0.001). HAs were a significant protective factor for both delayed recall [OR = 0.271, 95% confidence interval (CI) = (0.080, 0.914)] and spatial orientation [OR = 0.233, 95% CI = (0.066, 0.823)]. Additionally, higher educational levels were associated with better cognitive function.

Discussion: HAs improved cognitive function in patients with ARHL, especially in terms of delayed recall and spatial orientation, with education offering additional protection.

Background: Workplace health promotion (WHP) is critical for occupational health management, yet empirical evidence on determinants of corporate health investment remains limited. This study examines whether ESG performance promotes workplace health investment in Chinese biopharmaceutical enterprises and investigates the mediating role of financing constraints.

Methods: Using panel data from 55 A-share listed biopharmaceutical companies (2015-2023, 495 firm-year observations), we employed fixed effects models with manually collected health expenditure data. The three-step method tested financing constraints as a mediator. Heterogeneity analyses and multiple endogeneity treatments were conducted.

Results: ESG performance significantly promotes workplace health investment (β = 0.0024, p > 0.01), with financing constraints mediating 20.8% of the total effect. The Social dimension shows the strongest association. Effects are stronger in non-state-owned enterprises, high R&D intensity firms, and vaccine/blood products companies. Health expenditure reduces R&D personnel turnover and enhances innovation output.

Conclusion: ESG performance effectively promotes workplace health investment by alleviating financing constraints, providing empirical support for integrating occupational health promotion into corporate sustainability strategies. Theoretically, this study bridges corporate finance and occupational health research by revealing the transmission mechanism of "ESG → financing constraint alleviation → workplace health expenditure." Practically, the findings suggest that ESG improvement can serve as a market-based lever for promoting organizational investment in employee health programs.

Introduction: With health systems facing increasing challenges, it is important to define new care models that may release some of the burden on the workforce, whilst maintaining quality and improving patient convenience. The objective of this study was to create a taxonomy of pharmacist-led interventions aimed at supporting improved health outcomes of people self-managing cancer medication.

Methods: The list was developed following a literature search conducted in Cochrane Library and MEDLINE (PubMed) databases. The Capacity, Motivation and Opportunity (CMO) model developed for people living with HIV was used as theoretical framework to organise the pharmacist-led interventions emerging from literature. A panel of experts (hospital pharmacists with experience in oncology) selected through national hospital pharmacy societies was invited to participate in a consensusseeking Delphi survey, focusing on the most important and feasible interventions.

Results: A total of 28 experts answered and rated 39 interventions. Whilst 35 of the proposed pharmacist-led interventions were considered important (median score above 8, on a scale of 1 to 9, without disagreement among experts), only eight were considered feasible for implementation in practice. The most frequently mentioned reasons for others not to be feasible were understaffing and excessive workload. Nevertheless, there were interventions considered vital for patients' care and hence kept in the final taxonomy.

Discussion: Future hospital-based studies should incorporate this taxonomy based on the CMO model to measure pharmacists' interventions in real clinical practice.

Introduction: Persistent functional impairment and psychological distress are common after stroke, highlighting the need for effective post-discharge nursing strategies. We performed a retrospective cohort study evaluating the associations of a family-centered, new-media continuous nursing intervention on stroke recovery outcomes.

Methods: The study included 107 patients with first-ever ischemic stroke who received either routine post-discharge care or a family-centered new-media continuous nursing intervention. Functional status, depressive symptoms, and quality of life were assessed at baseline and 6 months. Rehabilitation adherence, platform engagement indicators, and selected serum biomarkers related to neuroplasticity and inflammation were analyzed. Multivariable models were used to adjust for baseline clinical factors.

Results: At 6 months, the intervention group showed significantly greater improvements in Barthel Index scores, larger reductions in Patient Health Questionnaire-9 scores, and greater gains in quality of life compared with routine care. Rehabilitation compliance and medication adherence were higher in the intervention group. Within this group, greater platform engagement was associated with larger improvements in depressive symptoms and quality of life. In addition, patients receiving the intervention exhibited greater increases in serum brain-derived neurotrophic factor and endothelial progenitor cell counts, along with more pronounced reductions in IL-6 and TNF-α. Participation in the intervention remained independently associated with functional and psychological improvement after adjustment.

Discussion: Family-centered new-media continuous nursing is associated with improved functional independence, psychological recovery, adherence behaviors, and favorable biological changes in patients with ischemic stroke.

This study examines how bullying experiences are associated with retaliatory impulses among autistic university students, highlighting minority stress as a key mediating mechanism and sexual and gender minority (SGM) status as a moderating condition within an intersectional framework. Guided by Minority Stress Theory and Social Information Processing Theory, we surveyed 280 autistic undergraduates; 35% identified as SGM. Participants completed validated measures of bullying, minority stress, retaliatory impulse, and related psychosocial factors. Structural equation modeling and multi-group analyses were conducted to evaluate the proposed mediation and moderation patterns while adjusting for gender, grade level, social support, autistic traits, and internet use. The measurement model showed good reliability and convergent validity (Cronbach's α = 0.84-0.89; AVE = 0.62-0.69). Bullying was positively associated with minority stress, which was in turn associated with retaliatory impulses, supporting partial mediation [indirect effect = 0.42, 95% CI (0.36, 0.50)]. Multi-group results indicated stronger path coefficients in the SGM group (bullying → stress β = 0.72; stress → retaliation β = 0.66) than among non-SGM (heterosexual and cisgender) peers, consistent with the possibility that compounded stigma heightens emotional reactivity and defensive processing. Minority stress remained the strongest correlate of retaliatory impulses after covariate adjustment, whereas social support showed a protective association. Taken together, the findings suggest that retaliatory impulses among autistic students are better understood in relation to sustained identity-based exclusion and structural stressors rather than as simple dispositional aggression. The results also imply that effective prevention may require institutional and relational strategies-alongside individual support-such as inclusive curricula, peer sensitization, and policies that strengthen belonging and psychological safety in higher education.

Background: Tobacco use remains a leading cause of preventable morbidity and mortality worldwide. While smoking prevalence has recently declined in Hong Kong, progress has slowed. Plain packaging may reduce product appeal and enhance the impact of pictorial health warnings (PHWs), supporting reduced tobacco use.

Methods: A cross-sectional study was conducted from August to November 2023 among 1,256 adult smokers in Hong Kong. Participants were recruited at outdoor public smoking hotspots and shown branded and plain cigarette packs with 85% PHWs. Perceptions of pack attractiveness, noticeability of PHWs, smoking-related harm, behavioural intentions, and support for plain packaging were assessed through structured interviews. Quantitative data were weighted by age and sex, and qualitative responses were analysed thematically.

Results: Most participants perceived plain packs as less attractive (79.8%) and PHWs on plain packs were more noticeable (57.5%) than branded packs. About 45.1% perceived plain packs as disgusting, and 28.0% agreed they better conveyed severe smoking harms than branded packs. While only 17.3% reported plain packs may reduce their intention to smoke, 33.1% reported that it could deter youth from smoking. Support for plain packaging was moderate, with 35.7% in favour and 34.5% neutral. The qualitative findings reinforced these perceptions.

Conclusion: Smokers perceived plain packaging as less attractive, the PHWs on it as more noticeable, and potentially useful in preventing smoking initiation in youth. These findings support the integration of plain packaging into Hong Kong's tobacco control strategy and offer valuable insights for jurisdictions considering similar legislation.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), the biggest publicly financed health insurance program in the world, has substantial use issues, especially in places like Jammu and Kashmir that are affected by conflict. Despite the program's goal of ensuring equal and cashless access to healthcare, the existing literature does not offer region-specific insights into the actual obstacles preventing its adoption. This study intends to identify and measure the physical, administrative, financial, and informational hurdles experiences by the beneficiaries in the urban and semi-rural areas of Jammu and Kashmir face when utilizing PM-JAY. Primary data was gathered through structured interviews with 320 randomly chosen PM-JAY recipients using a cross-sectional approach. To evaluate the relative effects of various obstacles on scheme use, the study used binary logistic regression, chi-square tests, Pearson correlation, and descriptive statistics. Despite being enrolled, only 48.4% of enrollees reported accessing PM-JAY services. The most significant positive predictors of usage were health literacy and awareness gaps, notably knowledge of empanelled hospital lists (OR = 1.245, p < 0.05) and awareness of scheme entitlement (OR = 1.253, p < 0.05). A statistically significant negative factor was inadequate road infrastructure (OR = 0.761, p < 0.05). Despite being often mentioned, administrative and financial obstacles were surprisingly not significant in the regression model. There were no discernible variations in use between the two districts, indicating problems with systemic access. Increasing PM-JAY use in disadvantaged areas requires more than just financial incentives; it also requires better physical infrastructure and informational availability. To convert coverage into useful access, policymakers should concentrate on region-specific IEC initiatives, transportation connectivity, and health system navigation support mechanisms. These interventions are essential for translating PM-JAY's theoretical coverage into meaningful, equitable healthcare access, particularly in underserved and fragile regions like Jammu and Kashmir.

Objective: Bacillary dysentery (BD) remains a public health concern in China, with its incidence influenced by multidimensional and interconnected factors. This study aimed to quantify the correlations between meteorological conditions, socioeconomic status, health resources, forest coverage, and BD incidence-an integrated analysis lacking in previous research. The results provide a comprehensive evidence base for formulating targeted BD prevention strategies.

Methods: Using panel data from 31 Chinese provinces (2014 ~ 2018), including BD incidence rates and 12 indicators of proxy variables at the ecological level, fixed-effects and random-effects models with Driscoll-Kraay robust standard errors were applied.

Results: The results of the random-effects model incorporating multidimensional factors showed that a 1% increase in the number of beds per 1,000 people in healthcare facilities, GDP per capita, and forest coverage was significantly associated with decreases in BD incidence rates of 2, 0.8, and 0.6%, respectively, (all p < 0.05). These findings indicate ecological associations with the incidence of BD across different provinces in China.

Conclusion: Improvements in regional investment in healthcare resources, economic development, and forest coverage were inversely associated with BD incidence, suggesting potential protective effects at the population level.