Frontiers in Public Health最新文献

Key variables from Moral Foundations Theory and the Cultural Theory of Risk were examined in relationship to COVID-19 attitudes and behaviors. Two surveys were conducted with unvaccinated U. S. adults (n = 1,025) that assessed five moral foundations (care, fairness, authority, loyalty, and purity), two dimensions of Cultural Cognition Worldviews (individualism-communitarianism and hierarchy-egalitarianism), COVID-19 vaccination likelihood and related attitudes (including measures of perceived risk, protective behavior, and trust), political orientation, and demographic characteristics. The individualism-communitarianism scale, derived from the Cultural Theory of Risk, was the most impactful predictor across surveys. When controlling for responses to all other measures, participants who placed greater emphasis on individualism tended to report a lower likelihood of getting a COVID-19 vaccination, to perceive a lower level of risk from COVID-19, and to express greater distrust in the safety of vaccines developed by the government. Many other moral and cultural worldview dimensions were uniquely predictive of COVID-19 attitudes as well, while political orientation and demographic characteristics were generally weak or non-significant in multiple regression models. Findings underscore the sociocultural foundations of health behavior.

Background: Catheter-related bloodstream infection (CRBSI) is a prevalent nosocomial infection in neonatal units. The incidence of CRBSI can prolong hospitalization, cause irreparable harm, and negatively affect newborn survival and quality of life. Previous research has identified risk factors for CRBSI, but the findings have been inconsistent, and all predisposing factors have not been systematically described. This study aimed to investigate the risk factors for developing CRBSI in neonates and to provide a scientific basis for decision-making in the prevention of neonatal CRBSI.

Methods: A systematic search of PubMed, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), and the Wanfang Database was performed from the time of each database's inception to 1 October 2025. The search strategy combined subject terms and free-text keywords. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the literature, and meta-analysis was carried out using RevMan 5.3. Heterogeneity was evaluated using the I² statistic method, and publication bias was analyzed with funnel plot tests.

Results: A total of 18 articles involving 11,963 participants were included in this study. In the meta-analysis, the risk factors for the development of CRBSI in neonates, ranked from strongest to weakest association, were as follows: Multi-lumen central venous catheters (CVCs) ≥ 2, 5-min Apgar score≤7, number of manipulations≥2, catheter indwelling time>14d, gestational age≤32w, parenteral nutrition (PN), maternal disease, birth weight<1,500 g, male sex, and catheterization of the upper and lower limbs. These risk factors were found to be significantly associated with the development of CRBSI.

Conclusion: This meta-analysis identifies key modifiable risk factors for CRBSI in neonates, informing a proposed evidence-based prevention bundle. This bundle targets factors such as catheter dwell time, aseptic technique, and nutrition management to reduce CRBSI incidence and improve resource efficiency, especially in high-risk neonates.

Background: Molecular transmission networks enable successful identification of core transmitters compared to traditional epidemiological surveillance; however, behavioral characteristics and psychological drivers of these spreaders remain poorly characterized. Adverse childhood experiences (ACEs) are significantly more common among HIV-positive individuals than in the general population; yet empirical evidence showing that ACEs increase transmission risk among men who have sex with men (MSM) remains limited. This study investigates transmission risk in molecular network associations with sexual behaviors and adverse childhood experiences among MSM.

Methods: This study was a Case-Control Study based on molecular networks. A molecular transmission network was constructed using HIV-1 pol sequences from 1,691 newly diagnosed MSM in Guangzhou (2018-2020). Cases were defined as individuals with a network degree ≥3 (high transmission risk group) and controls were defined as those with a degree <3 (low transmission risk group), matched 1:1 by age (±5 years). Data on sexual behavior and adverse childhood experiences were collected via electronic questionnaires from 2023 to 2024. Logistic regression was used to analyze associations between these factors and transmission risk.

Results: Among 1,691 participants, 40.57% were included in the molecular network, comprising 238 high-risk and 448 low-risk individuals. After matching, 119 pairs were analyzed. High-risk MSM exhibited significantly elevated transmission risks associated with sexually transmitted infections (aOR = 2.947, 95% CI: 1.084-8.008); versatile sexual role (aOR = 2.856, 95% CI: 1.323-6.165); infrequent sexual activity (monthly: aOR = 6.487, 95% CI: 1.594-26.407; ≤quarterly: aOR = 6.708, 95% CI: 1.668-26.984); no stable partner or multiple stable partners (aOR = 2.516, 95% CI: 1.231-5.140); childhood sexual abuse (aOR = 2.791, 95% CI: 1.268-6.146); physical neglect (aOR = 2.386, 95% CI: 1.087-5.238).

Conclusion: Unsafe sexual behavior and ACEs significantly increased the likelihood of becoming a core transmitter within MSM networks. Integrating screening for these factors into prevention programs could optimize early identification of high-transmission-risk MSM and enhance precision interventions.

Background: Family stability is a key determinant of psychological well-being; however, culturally adapted and psychometrically robust assessment tools are lacking in the Arabic context. This study aimed to develop and validate the Family Stability Scale (FSS) for Saudi women, addressing a critical measurement gap in the region.

Methods: A cross-sectional psychometric validation study was conducted between January and June 2025 in Riyadh, Saudi Arabia. Women aged 18 years or older were recruited from different provinces in Saudi Arabia. The newly developed 15-item FSS, along with the Arabic versions of the Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), was self-administered. Content validity was analysed via expert panel review and pilot testing. Construct validity was examined using confirmatory factor analysis. Criterion and incremental validity were assessed via correlation and hierarchical regression analyses. Reliability was evaluated through Cronbach's alpha and split-half reliability.

Results: A total of 501 women participated, with 89.8% providing complete data. Confirmatory factor analysis revealed a clear unidimensional structure, with good model fit (CFI = 0.917, TLI = 0.903, SRMR = 0.042). The FSS demonstrated excellent internal consistency (Cronbach's α = 0.932) and strong split-half reliability (Spearman-Brown coefficient = 0.904). The FSS exhibited significant negative correlations with anxiety (r = -0.48) and depression (r = -0.50), indicating strong criterion validity. The scale accounted for an additional 23% of variance in anxiety symptoms and 24% in depressive symptoms beyond demographic variables, supporting its incremental validity.

Conclusion: The FSS is a psychometrically sound, reliable, and valid Arabic instrument for assessing perceived family stability among Saudi women. It fills an important gap for clinical and research applications by enabling comprehensive evaluation of family functioning within the Saudi context.

Background: Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults, and enhancing public health literacy through effective education is crucial for its prevention and management. With the rise of mobile internet and short video platforms such as TikTok, new opportunities have emerged for disseminating medical knowledge. However, concerns remain regarding the accuracy and quality of this content.

Methods: A cross-sectional search was conducted on September 18, 2025. A total of 200 Mandarin-language TikTok videos directly relevant to DR were included after screening. Baseline characteristics, uploader type, and user engagement metrics were extracted. Video quality was assessed independently by two trained reviewers using the DISCERN tool and the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). Content coverage was evaluated against the American Academy of Ophthalmology (AAO) Preferred Practice Pattern®. Inter-rater reliability was measured by intraclass correlation coefficients (ICCs). Group comparisons and correlation analyses were performed.

Results: Significant differences were observed in quality scores across uploader categories (one-way ANOVA, p < 0.001). Non-profit organizations achieved the highest DISCERN scores (59.4 ± 8.2) and PEMAT-A/V understandability (88.5%), while for-profit accounts had the lowest DISCERN scores (23.0 ± 6.5; understandability 61.5%). Videos from non-profit sources also demonstrated balanced coverage across six core DR themes (14-20% per theme). Inter-rater reliability was excellent for all tools (ICC range 0.825-0.933). Engagement metrics were strongly correlated with DISCERN scores (likes r = 0.76, comments r = 0.64, favorites r = 0.73, shares r = 0.71; all p < 0.05), whereas video duration showed no significant correlation with quality (p > 0.05).

Conclusion: The quality of DR-related educational short videos on TikTok varies widely, with the source of the video emerging as the key determinant. High-quality content from non-profit organizations and medical professional users not only demonstrates greater reliability but also fosters comprehensive health education. Strengthening professional participation, platform regulation, and evidence-informed communication strategies is essential to maximize the potential of short videos in DR health education and ultimately improve patient outcomes.

Background: To evaluate anticancer medicines' availability, price and affordability in nine prefecture-level cities, Jiangsu Province.

Methods: Based on the standard methods recommended by the World Health Organization (WHO) and the Health Action International (HAI), a cross-sectional survey was performed to collect information about 24 essential anticancer medicines (EAMs) and 17 innovative anticancer medicines (IAMs) in hospitals and 45 community pharmacies in Jiangsu Province from July to November 2021.

Results: In general, the availability of EAMs during the study period was higher than that of IAMs, and the availability of the Lowest-priced generics (LPGs) was higher than that of the originator brands (OBs). Anticancer medicines in hospitals were more available than those in community pharmacies. Specifically, the availability of anticancer medicines positively correlated with different cities' economic status. However, there were no significant changes in the availability of IAMs among different cities. The median price ratio (MPR) value of OBs was greater than that of LPGs, and both were greater than one. There were no significant changes in the MPR value of EAMs among different economic regions (p > 0.05). The price of IAMs was significantly greater than the median price of 18 European countries. There were significant changes in the affordability of EAMs and IAMs among different cities (p < 0.05). In this research context, IAMs had poor affordability, but LPGs had good affordability for the residents. The affordability of urban residents was better than that of rural residents.

Conclusion: The availability of anticancer medicines in community pharmacies was low, especially in intravenous anticancer preparations. The Chinese government formulated a dual-channel policy to improve the availability of anticancer medicines in community pharmacies. However, implementing the dual-channel policy required the effective interaction and cooperation of the hospitals, community pharmacies, medical insurance, and other departments. The price of IAMs was still the main obstacle to receiving treatment for cancer patients; therefore, the government should further optimize the price of IAMs through various strategies to achieve a reasonable price. Expanding the coverage of EAMs was conducive to improving treatment affordability for cancer patients.

Background: Cytokeratin 19 fragment (CYFRA 21-1) is an important biomarker of lung cancer. There are clinical observations of elevated serum levels of lung cancer biomarkers in patients with viral pneumonia. However, the clinical significance of CYFRA 21-1 in coronavirus disease 2019 pneumonia has not been investigated.

Methods: This retrospective study included 252 patients with community-acquired pneumonia (CAP) between December 1, 2022, and September 30, 2023. They were classified into three groups by clinical diagnosis and severity, namely mild non-COVID-19 CAP (n = 86), mild COVID-19 (n = 100), and severe COVID-19 (n = 66). Demographic characteristics, history, outcomes, and laboratory tests, including CYFRA 21-1 levels, were collected and compared among the groups. Risk factors associated with the diagnosis of COVID-19 pneumonia and severity were explored using appropriate statistical methods.

Results: CYFRA 21-1 levels progressively increased from mild non-COVID-19 CAP to mild COVID-19 and severe COVID-19. Lower lymphocyte and platelet counts, alongside elevated CYFRA 21-1 levels, were associated with COVID-19 pneumonia. Multivariate analysis identified CYFRA 21-1 as an independent diagnostic [diagnosis odds ratio (OR) = 2.369; 95% confidence interval (CI) = 1.638-3.605; p < 0.001] and prognosis factor of COVID-19 pneumonia (severity OR = 1.416; 95% CI = 1.119-1.867; p = 0.01). The area under the receiver operating characteristic curve of CYFRA 21-1 for predicting the development of severe COVID-19 pneumonia was 0.913. Spearman analysis showed a negative correlation between CYFRA 21-1 levels and oxygenation index, with a correlation coefficient of -0.278 (p = 0.024).

Conclusion: CYFRA 21-1 may be a potential diagnostic and prognostic indicator of COVID-19 pneumonia. Prospective multicenter studies are needed to confirm its clinical value.

Background: Rabies remains a major public health concern in many parts of the world, including Palestine. Although preventable through vaccination and timely post-exposure prophylaxis (PEP), rabies continues to cause preventable deaths, particularly in disadvantaged populations. This study aims to assess public knowledge, awareness, and practices related to rabies prevention in Palestine.

Methods: A cross-sectional survey was conducted from March to August 2025, involving 417 Palestinian adults (≥18 years) from urban and rural areas. A structured, self-administered, pre-validated questionnaire was used to assess awareness, knowledge, and practices related to rabies prevention. Descriptive statistics and multivariable logistic regression were used to analyze the data.

Results: While 89.0% of respondents had heard of rabies, only 42.3% achieved satisfactory knowledge (≥50% correct answers), with significant gaps in understanding the viral etiology and preventive measures. The majority (83.2%) reported they would seek medical care following a dog bite; however, only 11.8% identified wound washing with soap and water as a key first-aid measure. A substantial portion of respondents (67.9%) perceived local veterinary services as inadequate. Knowledge was significantly associated with education level and age, with higher education correlating with better knowledge, while older adults had lower knowledge scores.

Conclusion: Despite high awareness of rabies, critical gaps in knowledge and practices remain in Palestine, particularly concerning transmission routes, prevention, and first-aid measures. Tailored educational campaigns are needed to address these gaps, focusing on the importance of timely wound care and PEP. Additionally, strengthening veterinary services and integrating a One Health approach will be essential to improve rabies prevention and control in Palestine.

Early identification of trauma patients at risk of in-hospital death is essential for guiding time-critical resuscitation and operative strategies. We developed and evaluated a multi-model machine learning framework that integrates vital signs, and routine laboratory and blood-gas metrics indices obtained within 30 min of emergency department arrival to predict in-hospital mortality. This single-center retrospective study included 408 critically injured trauma patients treated at the Emergency Department of the Affiliated Kunshan Hospital of Jiangsu University (January 2020-December 2021). We implemented multiple machine learning models [logistic regression, Random Forest, Gradient Boosting, XGBoost, LightGBM, and multilayer perceptron (MLP)], and constructed stacking and soft-voting ensembles. On the test set, single-model AUROC ranged from 0.743 to 0.927, with corresponding AUPRC spanning 0.438 to 0.904. The stacking ensemble achieved AUROC 0.9462 and AUPRC 0.8679; the voting ensemble achieved AUROC 0.9506 and AUPRC 0.8715. Permutation importance in the stacking model prioritized Injury Severity Score (ISS) (mean AUROC decrease 0.0360), base excess (BE) (0.0258), Glasgow Coma Scale (GCS) (0.0247), and pH (0.0153). In conclusion, an ensemble machine learning approach integrating early vital signs and laboratory data provides excellent discrimination and calibration for in-hospital mortality after severe trauma, with dominant contributions from ISS, GCS, and acid-base variables. These findings support the feasibility of interpretable ensemble learning for early mortality risk stratification in severe trauma.