Frontiers in Public Health最新文献

Introduction: To evaluate the levels of occupational fatigue and work stress experienced by nursing managers in western China and to identify the factors influencing occupational fatigue.

Methods: This study recruited 248 nursing managers from 186 hospitals across 28 Chinese provinces, of which 91.1% are located in western China and 78.2% are tertiary hospitals. The nursing managers included in this study were actively engaged in their managerial roles throughout the data collection period, discharging associated administrative and clinical responsibilities.

Results: Western Chinese nursing managers reported mid-low to mid-high levels of occupational chronic fatigue, mid-high to high levels of acute fatigue, and mid-low to mid-high levels of inter-shift recovery. Effort and overcommitment were significantly associated with all levels of fatigue. Chronic fatigue was associated with hospital grade, while acute fatigue was associated with hospital grade, position title, and working hours per week. Inter-shift recovery was linked to weekly working hours.

Conclusion: Effort and overcommitment were significantly associated with occupational fatigue levels among western Chinese nursing managers. Additionally, fatigue severity correlated with hospital grade, weekly working hours, and position title. Policy guidance, organization support, and work competency training may be beneficial.

Introduction: Death literacy has gained attention in recent years, and the use of the Death Literacy Index (DLI) has been increasing. It measures knowledge about the death system. After being translated and used in multiple countries, the original authors incorporated feedback from various countries and revised the DLI to become the DLI-R. A shorter version, the DLI-9, was also developed for practical use. This study aimed to validate the DLI-R and DLI-9 in the Chinese population.

Methods: The DLI was forward- and backward-translated into Chinese by two expert panels. A pilot test was conducted before the main survey. A total of 1,147 participants were recruited online from three cities in southern China (Shenzhen, Foshan, and Macao) to examine the factor structure, validity, and reliability of the translated DLI-R and DLI-9.

Results: Exploratory factor analysis showed a five-factor structure. The Cronbach's alpha of the Chinese DLI-R was 0.92, and the five factors were between 0.78 and 0.95, accounting for 65.06% of cumulative variance. The Cronbach's alpha of the Chinese DLI-9 was 0.79, accounting for 52.56% of cumulative variance. The five-factor structure was confirmed by a confirmatory factor analysis. The overall scale and subscales showed high internal consistency reliability and satisfactory validity.

Discussion: The Chinese DLI-R was shown to be a reliable and valid instrument for measuring death literacy among individuals in southern China and is suitable for both research and clinical use. Several demographic characteristics, cultural adaptation issues, and applicability considerations were also identified for the Chinese DLI-9.

Background: Medication adherence is essential for effective hypertension management, yet its social and behavioral determinants remain incompletely understood. In particular, the influence of education and comorbid diabetes on adherence is unclear.

Objectives: To examine factors associated with blood pressure control and medication adherence among patients with hypertension, with emphasis on nonlinear educational effects and subgroup differences by sex and comorbidity.

Methods: Using a multistage random sampling design, we recruited 40,037 adults with physician-diagnosed hypertension across all 11 prefecture-level cities in Zhejiang. Participants were identified through electronic chronic disease registries and completed standardized questionnaires. Blood pressure control was defined according to national guidelines, and medication adherence was measured by self-reported consistent use of prescribed antihypertensive medication in the past 2 weeks. Multivariable logistic regression models were fitted to identify associated factors, and restricted cubic spline and quadratic models were applied to assess nonlinear education-adherence relationships.

Results: Medication adherence strongly predicted hypertension control (aOR = 1.35, 95% CI: 1.25-1.46). Adherence was higher among patients with comorbid diabetes (aOR = 1.52, 95% CI: 1.39-1.66) and those with higher income, but declined at the highest education levels. Nonlinear analyses revealed inverted U-shaped associations, with thresholds around 4-8 years of schooling. These patterns differed by sex and comorbidity status.

Conclusion: Education exerts threshold-dependent effects on adherence, modified by sex and diabetes comorbidity. By uncovering nonlinear and subgroup-specific patterns, this study extends prior evidence and underscores the need for tailored interventions to reduce disparities in hypertension management.

Background: Steel workers are often exposed to various occupational hazards over the long term, which may be associated with hypertension. Previous studies mainly focused on the relationship between single occupational hazard and hypertension, but the comprehensive effects of multiple occupational hazards and the potential regulation of telomere length are still unclear. This study aims to investigate the relationship between combined exposure to multiple occupational hazards and hypertension in male steel workers, and to assess whether relative telomere length (RTL) plays a mediating role in this relationship.

Methods: A 1:1 matched case-control study was conducted, with cases and controls matched on similar age (±2 years). The study included 350 hypertensive male steel workers and 350 normotensive controls. Occupational hazards [including heat, noise, dust, carbon monoxide (CO), shift work, and occupational stress] and relative telomere length (RTL) were assessed. An occupational hazardous factors score (OHFS) was constructed using the XGBoost model and SHapley Additive exPlanations (SHAP). Conditional logistic regression and quantile regression were used to analyze the associations. Mediation analysis was performed to evaluate the potential mediating effect of RTL in the relationship between OHFS and hypertension.

Results: The risk of hypertension among male steel workers in the higher OHFS groups (24.74~, 38.98~, and ≥56.58) was 1.81, 2.17, and 3.46 times higher than that in the lower OHFS group (< 24.74), respectively (24.74~: OR = 1.81, 95% CI: 1.14-2.86; 38.98~: OR = 2.17, 95% CI: 1.39-3.39; ≥56.58: OR = 3.46, 95% CI: 2.18-5.49). The risk of hypertension among male steel workers in the shorter RTL group was 1.45 times higher than that in the longer RTL group (OR = 1.45, 95% CI: 1.04-2.03). A significant multiplicative interaction was observed between OHFS and RTL on hypertension (P < 0.001). Mediation analysis showed a partial mediating effect of RTL on the association between OHFS and hypertension (proportion mediated: 16.67%).

Conclusion: Among male steel workers, higher OHFS is associated with an increased risk of hypertension, and RTL plays a partial mediating role in the relationship between OHFS and hypertension.

Background: Varicella has been subject to mandatory reporting to the China Information System for Disease Control and Prevention (CISDCP) by health agencies within 24 h of diagnosis since 2019. However, even if two-dose varicella vaccination has been recommended to be administered to children at 1 and 4 years of age in Hangzhou since 2014, emerging evidence of increasing breakthrough varicella cases in outbreaks challenges the present varicella vaccination schedule and its protective effect. We seek to identify hotspot areas and temporal trends of varicella at the township level in Hangzhou in the recent 6 years by using spatiotemporal analysis.

Methodology: Varicella cases diagnosed by medical practitioners from 2019 to 2024, demographic data, and clinical data were extracted from CISDCP. Township-level population figures were estimated using a constant-share proportional allocation method based on the seventh census data in China. Global I statistics and the local index spatial autocorrelation (LISA) method were used to identify global autocorrelation and local autocorrelation, respectively. Retrospective spatial scan statistics were undertaken to explore potential spatiotemporal clusters of varicella. A harmonic regression model was used to quantify seasonality, and an age-specific trend was evaluated through the Cochrane-Armitage test.

Result: A continuous decline in reported incidence of varicella in Hangzhou from 2019 to 2024 was observed, with 97.95 per 100,000 and 52.23 per 100,000 in 2019 and 2024, respectively. Seasonality of the bimodal peak was observed, with the first peak of varicella cases observed from May to July, whereas the second peak typically occurs from November to February of the following year. A pronounced reduction in varicella incidence among younger children (5-9) and a relatively slower decline in older pediatric and adolescent groups (10-19) were found. The spatial distribution pattern of varicella in Hangzhou at township levels was non-random, and hotspots tend to be more frequent in the suburbs than in downtown areas. A total of 34 significant varicella spatiotemporal clusters were identified by retrospective space-time scan statistics, the vast majority of which were located in suburban areas.

Conclusion: Varicella incidence has dramatically declined over the past 6 years. The 10-19-year-old age band exhibited a slower reduction than the 5-9-year-old age-band. Moreover, the tendency for varicella clusters to appear more frequently in suburban areas reflects disparities in varicella incidence geographically. Specific surveillance and control measures should be undertaken in high-incidence regions in Hangzhou.

[This corrects the article DOI: 10.3389/fpubh.2025.1631442.].

Introduction: Domestic violence (DV), as a global pandemic, poses a significant challenge within the field of public health, gravely impacting the mental and physical health of victims. Modern digital technologies have been proposed as promising interventions for DV-related mental health problems. We therefore evaluated their effectiveness.

Objective: To systematically review digital interventions targeting the mental health of DV survivors and to summarize implications for health professionals and policy makers.

Methods: We searched PubMed, EBSCO, and Web of Science (January 1, 2020-April 23, 2024) following PRISMA guidelines. Two reviewers independently screened records, applied predefined eligibility criteria, and extracted data. Owing to heterogeneity, we performed a narrative synthesis. Meanwhile, based on the results of the literature review, this paper proposes a series of policy recommendations from a post-COVID-19 era perspective, integrating societal context and relevant policies.

Results: Nine studies met the inclusion criteria. Three reported no significant mental-health benefits, whereas the remainder showed improvements in outcomes such as depression, anxiety, PTSD symptoms, emotion regulation, perceived support, or safety preparedness using tools including mobile apps, web-based programs, virtual reality, chatbots, and video adjuncts.

Conclusion: Digital interventions show promise for improving mental-health outcomes among DV survivors, but their implementation requires attention to safety, engagement, cultural adaptation, and integration with offline services.

Systematic review registration: PROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD42023488560.

Background: The use of prescription opioids has risen dramatically in South Korea in recent years; however, there is no standardized Korean-language instrument to assess opioid withdrawal. The Clinical Opiate Withdrawal Scale (COWS) is a widely used clinician-rated measure for assessing the severity of opioid withdrawal. We aimed to validate the Korean version of the COWS (K-COWS) among patients receiving opioid therapy.

Methods: We translated and culturally adapted the 11-item COWS into Korean. A total of 66 adult patients with opioid use disorder who were experiencing withdrawal symptoms were assessed. Each patient was evaluated using the K-COWS and completed the Subjective Opiate Withdrawal Scale (SOWS), the brief 3-item Opioid Craving Scale (OCS-3), and the single-item Opioid Craving Visual Analog Scale (OC-VAS). We examined the internal consistency, factor structure [through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA)], and convergent/discriminant validity of the K-COWS.

Results: The K-COWS showed good internal consistency (Cronbach's α = 0.79; 95% CI = 0.71-0.86). EFA supported a two-factor structure (physical vs. autonomic clusters) that explained 39% of the variance. In CFA, the two-factor model showed a marginally acceptable fit (χ²  = 47.76, CFI = 0.915, RMSEA = 0.082), whereas the unidimensional alternative showed a poor fit. The K-COWS strongly correlated with the SOWS (r = 0.74, 95% CI = 0.61-0.83, p < 0.001), indicating good convergent validity for withdrawal. In contrast, correlations with the craving measures were weak (OCS-3: r = 0.19, p > 0.05; OC-VAS: r = 0.20, p > 0.05), supporting discriminant validity.

Conclusion: The K-COWS is reliable and has demonstrated construct validity for withdrawal severity in Korean clinical settings. Given the preliminary nature of the factor structure, the total score is recommended for clinical decision-making. Future studies should assess inter-rater reliability and confirm the structure in larger, more diverse samples.

Background: With increasing global cancer survivorship, understanding differential trends by age at diagnosis is crucial for developing targeted care strategies. This study examines 27-year trends in early-onset (20-49 years) vs. late-onset (≥50 years) cancer survivorship in the US population.

Methods: We analyzed nationally representative data from the National Health Interview Survey (1997-2023), identifying adults surviving ≥5 years post-diagnosis. Weighted prevalence estimates were calculated, and temporal trends were analyzed using Joinpoint regression to compute average annual percentage changes (AAPCs) with 95% confidence intervals (CIs).

Results: Women represented 72.7% of early-onset cancer survivors, compared to 51.5% of late-onset cancer survivors. From 1997 to 2023, both prevalence of early-onset (AAPC 1.7, 95% CI: 1.4 to 2.0) and late-onset (AAPC 1.9, 95% CI: 1.7 to 2.1) cancer survivors increased significantly. The prevalence of male early-onset cancer survivors rose the most sharply (AAPC 3.1, 95% CI: 2.5 to 3.8), compared to prevalence of late-onset (AAPC 1.9, 95% CI: 1.6 to 2.3) or female cancer survivors (AAPC early-onset 1.3, 95% CI: 1.0 to 1.6; late-onset 1.7, 95% CI: 1.5 to 2.0). College-educated individuals had higher baseline prevalence and faster growth. Similarly, high-income groups showed elevated prevalence (early-onset 2.65%; late-onset 8.22%) and the most rapid increase was found in late-onset cancer survivors (AAPC 3.2, 95% CI: 2.5 to 3.9).

Conclusion: These findings demonstrate universal increases in cancer survivorship with distinct socioeconomic and gender patterns, highlighting the need for tailored survivorship programs and targeted policies to address emerging disparities in long-term cancer care.

Objective: The aim of the present study was to describe short-term trends in the prevalence of high cardiovascular risk and the prevalence, awareness, treatment, and controlled hypertension in the high altitude of Peru, during the years 2017 to 2023, using data from the Demographic and Family Health Survey.

Methods: A cross-sectional analysis was carried out using secondary data of six representative surveys nationwide (2017-2023, excluding the 2020 survey). For the analysis of hypertension and cardiovascular risk, we included 56,404 and 38,221 participants residing in high-altitude areas, respectively. The mean and age-standardized prevalence were calculated with their respective 95% confidence intervals and the trends of the estimated proportions were evaluated with Mann-Kendall test. A value p < 0.05 statistically significant was considered.

Results: An increase in the age-standardized prevalence of hypertension, disease knowledge, treatment, and controlled hypertension was identified between 2017 and 2023; however, no statistically significant trends were observed in these prevalences. The proportion of participants with high cardiovascular risk remained constant during this period.

Conclusion: In participants residing in high-altitude cities in Peru, no statistically significant trends were found in the age-standardized prevalences of hypertension, disease knowledge, treatment, controlled hypertension, or cardiovascular risk between 2017 and 2023.