Frontiers in Public Health最新文献

Background: Inexperienced nursing care can compromise the quality of care and the well-being of patients. The aim of this study was to assess the main sources of stress encountered by nurses and novice nurses in a setting not previously experienced.

Methods: A systematic review was conducted following the PRISMA format in Pubmed, Scopus, Web of Science, and CINAHL electronic databases in March 2024. A total of 395 studies were identified, of which 16 met the inclusion criteria. Selection was made on the basis of topic relevance and methodological quality, assessed using the critical tools of the Joanna Briggs Institute (JBI).

Results: A total of 16 studies were included in this review. Of the 16 selected, 10 were cross-sectional studies, 3 were cohort studies, 2 were qualitative, and 1 was a systematic review. The studies revealed that the main stressors for novice nurses included time management, workload, and interpersonal relationships. The results underline that organizational factors, such as lack of support and high work demands, play a key role in generating stress.

Conclusion: Identifying and addressing the key challenges faced by novice nurses, such as workload, adjustment to the environment, professional expectations, and interpersonal relationships, is crucial to sustain their professional engagement and ensure the quality of health care. This understanding is essential for creating efficient policies and practices that enhance the occupational well-being and stability of nurses in the workforce.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024520651, CRD42024520651.

Background: Cardiometabolic multimorbidity (CMM) and aging are increasing public health concerns. This prospective study used UK Biobank cohort to investigate the relationship between biological aging and the trajectory of CMM to dementia and mortality.

Methods: CMM is the coexistence of at least two cardiometabolic diseases (CMD), including stroke, ischemic heart disease, and diabetes. Biological age was calculated using the KDM-BA and PhenoAge algorithms. Accelerated aging indicated biological age advances more rapidly than chronological age.

Results: The study included 415,147 individuals with an average age of 56.5 years. During the average 11-year follow-up period, CMD-free individuals with accelerated aging had a significantly greater risk of CMD (KDM-BA, HR 1.456; PhenoAge, HR 1.404), CMM (KDM-BA, HR 1.952; PhenoAge, HR 1.738), dementia (KDM-BA, HR 1.243; PhenoAge, HR 1.212), and mortality (KDM-BA, HR 1.821; PhenoAge, HR 2.047) in fully-adjusted Cox regression models (p < 0.05 for all). Accelerated aging had adjusted HRs of 1.489 (KDM-BA) and 1.488 (PhenoAge) for CMM, 1.434 (KDM-BA) and 1.514 (PhenoAge) for dementia, and 1.943 (KDM-BA) and 2.239 (PhenoAge) for mortality in participants with CMD at baseline (p < 0.05 for all). CMM significantly mediated accelerated aging's indirect effects on dementia by 13.7% (KDM-BA, HR) and 21.6% (PhenoAge); those on mortality were 4.7% (KDM-BA) and 5.2% (PhenoAge). The population attributable-risk of Life's Essential 8 score (≥80 vs. <80) were 0.79 and 0.43 for KDM-BA and PhenoAge accelerated aging, respectively.

Conclusion: Biological aging involves the entire trajectory of CMM from a CMD-free state to CMD, to CMM, and ultimately to dementia and death. Life's Essential 8 may be a potential target to counter age acceleration.

Objective: The aim of this study is to explore the inherent classification of social support among individuals residing in rural areas of China. Additionally, we aim to examine the attributes and variations in health literacy scores among patients with diabetes mellitus (DM) within diverse social support categories.

Design: Cross-sectional study.

Methods: Employing the multi-stage stratified sampling technique, we enrolled 2,178 patients diagnosed with DM residing in the rural regions of Guangxi Province. We utilized the General Information Questionnaire, Social Support Rating Scale (SSRS), and Functional, Communicative and Critical Health Literacy Instrument.

Results: The rural patients with DM were categorized into four distinct groups based on the types and levels of their underlying social support. These groups included a low-level social support utilization group (43%), a low-level objective social support group (17%), a moderate-level social support group (20%), and a high-level social support and high-level utilization group (20%). Statistical analysis revealed significant differences among the four groups in terms of age, disease duration, and blood sugar control level (p < 0.05). Furthermore, health literacy scores and scores across various dimensions for rural patients with DM demonstrated variability in accordance with latent profiles of social support, with statistically significant differences observed (p < 0.05). A positive correlation was identified between the level of social support and all dimensions of health literacy among rural patients with DM (p < 0.05).

Conclusion: The social support available to individuals with DM in rural settings can be categorized into four distinct types, and its manifestation is influenced by demographic factors. The health literacy of rural patients with DM is intricately linked to the extent of social support they receive. For enhanced outcomes, interventions targeted at enhancing health literacy and quality of life among rural patients with DM should be tailored to address the heterogeneity observed in latent profiles of social support.

Background: Research for personalised therapies concerning the Systemic Inflammatory Response Syndrome (SIRS) in children involves the utilisation of OMICS technologies and Artificial Intelligence (AI).

Methods: To identify specific ethical challenges through the perspective of healthcare professionals, we conducted 10 semi-structured interviews. The development of interview questions for the interviews was preceded by a systematic review of the scientific literature. To address the complexities of paediatric emergency research, informed consent, and data processing, experts with expertise in paediatric intensive care, computer science, and medical law were sought. After the transcription and anonymisation, the analysis followed established guidelines for qualitative content and thematic analysis.

Results: Interviewees highlighted the intricacies of managing consent in personalised SIRS research due to the large amount and complexity of information necessary for autonomous decision-making. Thus, instruments aimed at enhancing the understanding of legal guardians and to empowering the child were appreciated and the need for specific guidelines and establishing standards was expressed. Medical risks were estimated to be low, but the challenges of securing anonymisation and data protection were expected. It was emphasised that risks and benefits cannot be anticipated at this stage. Social justice issues were identified because of possible biases within the research population. Our findings were analysed using current ethical and legal frameworks for research with a focus on the particularities of the patient group and the emergency background. In this particular context, experts advocated for an enabling approach pertaining to AI in combination with OMICS technologies.

Conclusion: As with every new technological development, ethical and legal challenges cannot be foreseen for SIRS-personalised treatment. Given this circumstance, experts emphasised the importance of extending the ethics-legal discourse beyond mere restrictions. The organisation of supervision should be reconsidered and not limited only to the precautionary principle, which per se was seen as impeding both the medical progress and clinical flexibility. It was noted that the establishment and monitoring of guidelines were emergent and should evolve through an interdisciplinary discourse. Therefore, it was recommended to enhance the qualifications of physicians in the field of computer science, impart ethics training to AI developers, and involve experts with expertise in medical law and data protection.

Objective: To investigate how Chinese residents perceived changes in their protective behaviors in the early stage after the lifting of the dynamic zero-COVID policy, and to explore the associations between the overall perceived change and factors such as demographic and health-related information, COVID-19 related perceptions, negative emotions, and coping styles.

Methods: This cross-sectional study involved 798 Chinese residents who completed an online questionnaire between 16 and 25 December 2022. The questionnaire covered demographic and health-related information, COVID-19 related perceptions, negative emotions, coping styles, and perceived changes in protective behaviors. Multiple linear stepwise regression analysis was used to determine the factors associated with the overall perceived change in protective behaviors.

Results: The mean score for perceived protective behavioral change among participants was 61.38 (SD = 10.20), which was significantly higher than the hypothesized no-change value of 49 (p < 0.001). The mean scores for each of the 15 behaviors (excluding the two vaccination-related items) were significantly greater than the hypothesized no-change value of 3 (p < 0.001). The mean scores for the two vaccination-related items were significantly greater than the hypothesized no-change value of 2 (p < 0.001). Among all behaviors, avoiding dining out or gathering with friends had the highest mean score (Mean = 4.16), while engaging in regular physical activity had the lowest (Mean = 3.32). Avoiding dining out or gathering with friends had the highest percentage of individuals reporting an increase (71.3%), whereas maintaining a social distance of more than 1 m had the highest percentage of individuals reporting a decrease (17.5%). Regression analysis indicated that age, worry, positive coping, female sex, negative coping, and perceived severity were associated with the overall perceived change in protective behaviors, with worry being the most predictive variable.

Conclusion: This study suggested that Chinese residents perceived an increase in their protective behaviors in the early stage after the policy change, with varying magnitudes across behaviors. We identified some potentially modifiable factors associated with perceived protective behavioral change, with worry emerging as the strongest predictor, followed by positive coping, negative coping, and perceived severity. These insights offer valuable information for developing effective communication strategies, psychological support, and comprehensive models in health behavior research.

Introduction: Polychlorinated Biphenyls (PCBs) persist in the environment and accumulate in humans. Currently, there is a lack of understanding about the overall impact of PCBs on human health, and effective interventions for exposed populations are insufficient.

Methods: Our study aimed to assess the impact of PCBs on various diseases and mortality risks using data from the National Health and Nutrition Examination Survey, while proposing lifestyle adjustments, particularly dietary modifications, to mitigate mortality risk. Statistical analyses employed principal component analysis, multifactorial logistic regression, multifactorial Cox regression, comorbidity network analysis, and machine learning prediction models.

Results: Results indicated significant associations between 7 types of PCBs and 12 diseases (p < 0.05), with 6 diseases showing significant positive correlations (OR > 1, p < 0.05), along with listing the 25 most relevant diseases, such as asthma and chronic bronchitis (OR [95% CI] = 5.85 [4.37, 7.83], p < 0.0001), arthritis and osteoporosis (OR [95% CI] = 6.27 [5.23, 7.55], p < 0.0001). This suggested that PCBs may be intimately involved in the development and progression of multiple diseases. By constructing multidimensional machine learning models and conducting multiple iterations for precision and error measurement, PCBs may have the potential to become specific biomarkers for certain diseases in the future. Building upon this, we further suggested that controlling dietary intake to reduce dietary inflammatory index (DII) could lower mortality and disease risks.

Discussion: While PCBs were independent risk factors for mortality, substantial evidence suggested that adjusting DII might mitigate the adverse effects of PCBs to some extent. Further physiological mechanisms require deeper exploration through additional research.

Background: Aging and obesity are considered causes of arterial stiffness, which triggers hypertension in the older population. However, a substantial number of older adults without obesity have hypertension, suggesting that arterial stiffness and hypertension are related to different risk factors in older adults without obesity. This cross-sectional study aimed to determine whether sarcopenia is related to arterial stiffness or hypertension in older Korean adults without underweight and obesity.

Methods: A total of 2,237 male and female adults in the Korea National Health and Nutritional Examination Survey who were ≥60 years and did not have underweight and obesity (18.5 ≤ body mass index <25.0 kg/m²) were involved. They were classified as moderate- (n = 276) or severe-sarcopenia (n = 528) as their sarcopenia index was 1 or 2 standard deviations lower than the mean of the young reference group. Arterial stiffness was confirmed using an estimated pulse wave velocity (ePWV) formula, and hypertension was diagnosed based on blood pressure or antihypertensive medication use.

Results: Arterial stiffness and systolic and diastolic blood pressure showed an increasing trend from normal to moderate-to-severe sarcopenia (p < 0.001 for both). The distribution of subjects in the highest ePWV tertile and hypertension from normal to moderate-to-severe sarcopenia showed an increasing trend (p < 0.001 for both). Subjects with moderate or severe sarcopenia were 3.545 or 8.903 times more likely to be in the highest tertile of ePWV, and those with moderate or severe sarcopenia were 2.106 or 11.725 times more likely to be hypertension (p < 0.001 for all).

Conclusion: Sarcopenia severity is related to arterial stiffness and hypertension in older Korean populations without underweight and obesity.

Objective: Exposure to incivility and bullying among students in higher education institutions may have detrimental health and well-being outcomes. Nevertheless, the mechanism and interconnected pathways through which incivility and bullying are linked with poor health and well-being remain largely unexplored. The aim of this study is to investigate the relationships between incivility, bullying, and poor health and well-being among students in higher education institutions in Sweden, and whether gender influences these relationships. Furthermore, we examine whether bullying plays a mediating role in the relationship between incivility and poor health and well-being.

Methods: We analyzed a cross-sectional dataset of students drawn from 38 universities that are members of the association of Swedish higher education institutions. The data were collected from May to July 2021, covering 11,162 women and 6,496 men. Confirmatory factor analysis and structural equation modeling (SEM) were utilized to estimate the relationships between incivility, bullying, and poor health and well-being. Additionally, multigroup analysis was applied to estimate the interactive effect of gender in these relationships.

Results: Reports of both incivility and bullying were more prevalent among women than men. The results showed that incivility had direct relationships with both bullying $\left(\beta =0.578,p<0.01\right)$ and poor health and well-being $\left(\beta =0.301,p<0.01\right)$ . However, the relationship between bullying and poor health and well-being was not significant. There were statistically significant gender differences in the relationships between incivility, bullying, and poor health and well-being ( $\Delta {\chi }^2\left(23\right)=179.18,p<0.01)$ . Nevertheless, bullying did not significantly mediate the relationship between incivility and poor health and well-being.

Conclusion: The current study demonstrates that governments, university authorities, and policymakers must consider gender differences in incivility and bullying when developing policies and interventions intended to reduce these kinds of behaviors in organizations.

Introduction: Variation in smoking cessation behaviors and motivators across the United States may contribute to health disparities. This study investigates regional differences over time in two key cessation motivators (quit interest and doctor's advice to quit) and two cessation behaviors (past-year quit attempts and recent successful cessation) across diverse demographic factors.

Methods: Data were analyzed from two releases of the Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey (TUS-CPS) for the years 2014-15 and 2018-19. The analysis included sex, age, race and ethnicity, education, marital status, employment status, and household income.

Results: Findings from 2018 to 2019 TUS-CPS revealed that quit interest was highest in the Northeast and lowest in the Midwest, while doctor's advice to quit was most prevalent in the Northeast and least in the West. Past-year quit attempts were most common in the Northeast and least in the South. Recent successful cessation (defined as quitting for 6 to 12 months) was highest in the Northeast and Midwest, with the South showing the lowest rates. Compared to the 2014-15 survey, 14 demographic groups (7 in the Midwest, 6 in the South, and 1 in the West) showed decreases in both quit interest and actions to quit. Notably, the Asian non-Hispanic group in the Northeast experienced a significant decrease in quit interest (-17.9%) but an increase in recent successful cessation (+369.2%).

Discussion: Overall, the study indicates that while quit interest was highest in the West, the South exhibited the lowest rates of quit attempts and successful cessation. Significant differences were also noted between age groups. These findings highlight the need for further research into cessation behaviors at more granular levels to inform policies aimed at reducing smoking-related health disparities among populations facing the greatest challenges in cessation.

Introduction: The COVID-19 pandemic led to major disruptions in the lives of university students, which is a population that is already at a greater risk of mental health concerns. Little is known about how the pandemic impacted distress and mental health services utilization among university students across the United States.

Methods: Using survey data from the National College Health Assessment, both before the COVID-19 pandemic (pre-March 2020, n = 88,986) and during the pandemic (Spring 2021, n = 96,489), the present study examined mental health symptoms and utilization of mental health services among undergraduate students attending four-year universities in the United States.

Results: There were notable increases in measures of psychological distress and reductions in well-being from before the pandemic to during the pandemic. However, overall utilization rates of mental health services slightly decreased from pre-pandemic to during the pandemic. Predictors of severe psychological distress included those who experienced loneliness, COVID-19 related stressors, and loss of a loved one from COVID-19. COVID-related stressors and loneliness were associated with higher utilization rates of mental health services, while well-being and resilience were associated with lower utilization rates.

Discussion: Analyses revealed that several demographic groups were at an elevated risk for severe psychological distress, including non-binary, female, and sexual minority students, and especially those who identify as both non-binary and non-heterosexual. Results indicated that students of color, especially female students of color, were less likely to receive mental health services. Future research is needed to increase our understanding of the barriers to mental health service use among high-risk university students.