Frontiers in Public Health最新文献

Previous research has examined the experiences of voluntary, community, and social enterprise (VCSE) group providers, but the voices of group users, especially those recovering from, or living with SMI, are sparse. This study addresses that gap, using the COVID-19 pandemic lockdown as a natural experiment to gain insights into the experiences of individuals participating in VCSE-run creative and social groups, and comparing this with the experiences of providers. We conducted photo-elicitation focus groups to explore group members' perspectives. Lockdown highlighted to group members what they valued most, and therefore what they missed about attending groups. Participants reflected on how significant their group was to their experiences of social connectedness and belonging. Group members' experiences differed significantly from providers' experiences of delivering online groups during lockdown. In some cases lockdown exacerbated existing challenges for marginalized individuals, highlighting the critical importance of compassionate, skilled, and well-informed group leadership. The needs of marginalized populations and the risk that these may be overshadowed by other public health priorities were highlighted. Our findings underline the urgency of developing inclusive policies and practices that prioritize voices of marginalized groups. By listening to these voices, policymakers and group leaders can create fairer and more responsive support systems.

Introduction: Q fever is an underestimated zoonotic disease with serious human health implications. This study explores patient experiences to characterize the impact of illness on quality of life, the pathway to diagnosis, and satisfaction with healthcare.

Methods: An online survey was conducted to gather self-reported cases of Q fever, and follow-up interviews were carried out with consenting survey participants to represent a range of experiences related to diagnosis and illness severity. Quantitative data were analyzed descriptively, and thematic analysis was performed on qualitative data.

Results: Quality of life was severely affected in 74% of patients, with many requiring hospitalization (48%) and taking time off work or school (87%). While some participants reported being unwell for over 10 years, the majority seem to recover within 6 months. Diagnosis was delayed for several participants, many of whom had multiple medical visits (>10) and were ill for years before receiving a medical diagnosis. The majority of diagnoses were made by general practitioners, whose knowledge of Q fever was an important factor in achieving timely diagnosis. The majority of participants reported being exposed to livestock around the time they likely contracted the illness. Six main themes were derived from the interviews: experience of physical illness, impact on life, emotional experience, managing and surviving Q fever, experience with the medical process, and importance of awareness.

Conclusion: Q fever has the potential to cause severe and life-changing consequences. Obtaining a timely diagnosis can be difficult, and many patients reported dissatisfaction with the quality of their healthcare. Adopting a model of patient-centered care and increasing awareness of Q fever could improve health outcomes and provide better support for affected patients.

Artificial intelligence (AI) policy is increasingly used to align digital transformation with the Sustainable Development Goals by fostering decent work, innovation, and reduced inequality. Youth entrepreneurship is a key channel through which these objectives materialize, yet the micro level pathways linking AI policy to entrepreneurial entry among young adults remain under specified. Using five waves of China Family Panel Studies microdata from 2014 to 2022 and the staggered introduction of AI pilot cities, I estimate a two way fixed effects difference in differences model with rich individual, household, and regional controls. AI pilot status increases the probability of youth entrepreneurship, with baseline effects statistically significant at conventional levels and robust to event study tests of parallel trends, placebo reallocations, alternative time trend controls, and trimming of extreme values. Mechanism analyses show that AI policy operates by reducing relational spending and relaxing credit constraints, as verified by structural equation modeling and multiple mediation tests. Effects are stronger among healthier respondents, those with internet access, and rural residents. This study contributes to the international literature by providing micro-evidence from an emerging economy on how place-based AI policies can function as environmental equalizers. The findings suggest that the observed surge in youth entrepreneurship is structurally motivated by the substitution of digital rules for informal Guanxi and the replacement of physical collateral with digital credit scoring, offering scalable lessons for designing inclusive innovation policies.

Background: Active aging is pivotal for addressing population aging. Older adults chronic disease patients face greater active aging challenges, and while social support and coping strategies correlate with it, their mediating mechanism in this population remains underverified. This study investigated the effect of social support on the level of active aging among older adults with chronic diseases and further examined whether coping styles play a mediating role in this relationship.

Methods: Between August 2024 and May 2025, patients were surveyed using the Chinese versions of the Active Aging Scale, the Medical Coping Modes Questionnaire, and the Social Support Questionnaire. In addition, demographic information was collected, and statistical analyses were conducted to evaluate the data. Correlation analyses and mediation effect tests were performed using SPSS 25.0 and Amos 24.0, respectively.

Results: The results showed that social support was significantly and positively associated with both active aging (r = 0.422, p < 0.01) and medical coping styles (r = 0.408, p < 0.01). In addition, medical coping styles were strongly and positively correlated with active aging (r = 0.485, p < 0.01). Mediation analysis further demonstrated that medical coping styles partially mediated the relationship between social support and active aging. Specifically, the direct effect of social support accounted for 71.72% of the total effect, whereas the indirect effect transmitted through coping styles explained the remaining 28.28%. Among the coping dimensions, the confrontation coping style exerted a significant positive influence on active aging (β = 0.474, p < 0.001).

Conclusion: Social support contributes to higher levels of active aging among older adults with chronic diseases through both direct and indirect pathways. In addition to its direct influence, social support indirectly promotes active aging by encouraging patients to adopt a confrontation-oriented coping style. These findings indicate that coping style functions as a key mediating mechanism linking social support to active aging in older adults individuals with chronic conditions.

Objective: To examine how algorithmic inducement mechanisms are associated with digital addiction among Chinese adults aged 60 and above.

Methods: A cross-sectional survey was conducted among older users of major Chinese digital platforms. After data screening, 367 valid questionnaires were analyzed. Digital addiction was measured using the Mobile Phone Addiction Index (MPAI), while a self-developed 16-item scale assessed four algorithmic inducement dimensions: preferential incentives-profit-seeking psychological induction, interactive incentives-emotional compensation induction, stage goals-feedback effect induction, and customized recommendations-exploratory psychological induction. Multiple linear regressions were performed, controlling for age, living arrangement, and daily smartphone use duration.

Results: Digital addiction was widespread, within the sample, with 77.11% of participants scoring in the moderate or higher range. All four algorithmic dimensions were positively associated with digital addiction (p < 0.01). Interactive incentives showed the strongest association (β = 0.343), followed by preferential incentives (β = 0.227); stage goals (β = 0.160) and customized recommendations (β = 0.163) were smaller yet significant. The model explained 79.1% of the variance (R ² = 0.791).

Conclusion: Algorithmic inducements-economic, social-emotional, task-feedback, and exploratory mechanisms-are jointly associated with a shift in older adults' digital use from instrumental participation to immersive dependence. The study introduces an analytical framework, "algorithmic drive-psychological compensation-structural constraint-behavioral reinforcement," and calls for coordinated algorithm governance and digital literacy initiatives to promote healthy aging in the digital era.

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.

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.

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.

Background: Countries in the Western Balkans (WBCs) fall behind the European Union in implementing effective health promotion. This study explores the key components of national health promotion policies and action plans in Albania, Federation of BiH, and the Republic of Srpska, Montenegro, North Macedonia, and Serbia, with the aim of describing key action trends, gaps, and challenges, and recommendations for health promotion implementation improvement.

Methods: Within the framework of the "Western Balkan Strategic Partnership for Health Protection" (WASP) project, implemented in five WBCs on behalf of the Global Health Protection Programme (GHPP), 2023-2025, and using the" Ottawa Charter for Health Promotion" a descriptive observational study was employed, combining data and information provided from the desk review of national legal frameworks, country-specific reports and consultative meetings to describe health promotion policies and action plans implementation in the period from 2010 to 2022.

Results: WBCs highlight diverse national priorities, such as promoting education and healthy lifestyles (e.g., Albania, Serbia, Federation of BiH, and the Republic of Srpska), addressing health inequalities (e.g., Federation of BiH, and the Republic of Srpska, Serbia), and digital health systems. The strategies and action plans of WBCs have common health promotion goals, and challenges. Community engagement and enforcement of public health policies are insufficient. Preventive care services are notably underdeveloped in rural areas with inadequate healthcare infrastructure. Although legal frameworks show that there is commitment to health promotion, putting action plans into practice is still a challenge, especially when it comes to involving communities and focusing on prevention. Budget transparency and working together across the region could also be improved to better tackle health inequalities and build stronger health systems.

Conclusion: While WBCs demonstrate growing political commitment to health promotion, substantial gaps remain in translating strategies into sustainable action. Strengthening intersectoral collaboration, improving monitoring systems, securing stable financing, and expanding community participation are crucial for advancing equitable, prevention-oriented health systems across the region.

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.