Frontiers in Public Health最新文献

Background: Advancements in artificial intelligence (AI) and natural language processing have enabled the widespread application of large language models. However, the ability of AI models to provide dietary guidance for pregnant women remains unclear. This study aims to explore the capabilities of DeepSeek-R1 and ChatGPT-4.0 in generating dietary plans for pregnant women with different activity levels.

Methods: Personalized diet plans were generated using DeepSeek-R1 and ChatGPT-4.0. Through calorie calculation, Diet Quality Index-International (DQI-I) assessment, and cost analysis, the dietary quality and cost performance were evaluated.

Results: The requested caloric targets in DeepSeek's diet plans were superior to those of ChatGPT. All plans achieved a satisfactory DQI-I score (≥ 70). The "adequacy" score of DeepSeek-R1 was much higher (DeepSeek-R1 35.8 ± 0.7 vs. ChatGPT-4.0 33.9 ± 0.8, p < 0.001), while ChatGPT-4.0 performed better in the "moderation" aspect (ChatGPT-4.0 22.3 ± 2.2 vs. DeepSeek-R1 17.0 ± 3.4, p = 0.004). ChatGPT-4.0 demonstrated better performance in terms of cost-effectiveness (p = 0.017).

Conclusion: This study shows that DeepSeek-R1 and ChatGPT-4.0 can be helpful in providing personalized and reasonable dietary advice for pregnant women. In some aspects, such as food type adequacy, the emerging model "DeepSeek" performs better than ChatGPT.

Background: In the post-pandemic era, medical students face increased occupational uncertainty. Future work self-salience as a prospective dimension of self-awareness, shapes career choices and constitutes a core driver of professional engagement. However, few studies have explored the relationship between future work self-salience and occupational sense of mission among medical students or its underlying mechanisms. This study examines the associations among professional identity, future work self-salience, and occupational sense of mission in medical students in the post-pandemic era, as well as heterogeneity in these constructs.

Methods: Using a cross-sectional design and random sampling, 568 medical students were recruited from three comprehensive universities in Sichuan Province, China. Validated instruments measured future work self-salience, occupational sense of mission, and professional identity. A variable-centered approach (PROCESS Model 4) tested the mediating role of professional identity. A person-centered approach employed latent profile analysis to identify subtypes based on future work self-salience and professional identity, with one-way ANOVA examining differences in occupational sense of mission across profiles.

Results: Variable-centered analyses showed that future work self-salience positively predicted occupational sense of mission, with professional identity partially mediating this relationship. Person-centered analyses identified three distinct profiles: (1) High Future Work Self-salience-High Professional Identity, (2) Moderate Future Work Self-salience-Moderate Professional Identity, and (3) Low Future Work Self-salience-Low Professional Identity. ANOVA revealed that the High Future Work Self-salience-High Professional Identity profile exhibited the highest occupational sense of mission.

Conclusion: In the post-pandemic era, medical students' future work self-salience enhances their occupational sense of mission by strengthening professional identity; however, individual heterogeneity leads to differential effect magnitudes. Educational interventions targeting students with low occupational sense of mission should strengthen future work self-salience and professional identity training to elevate overall occupational sense of mission and support sustainable development of healthcare professionals in the post-pandemic context.

Objectives: Adolescent self-harm is a major global health concern, yet evidence focused specifically on those aged 10-19 years remains limited. This study comprehensively assessed its global burden.

Methods: Using data from the Global Burden of Disease Study 2021, we analyzed trends in incidence, years lived with disability (YLDs), disability-adjusted life years (DALYs), and risk factors from 1990 to 2021, and projected trends to 2035. Frontier analysis, health inequality assessment, and autoregressive integrated moving average (ARIMA) models were applied, and average annual percent change (AAPC) was estimated for 204 countries and territories.

Results: In 2021, the global incidence of adolescent self-harm was 66.75 per 100,000 (95% CI: 43.34 to 97.12). Females showed 1.85-fold and 1.82-fold higher incidence and YLDs rates than males, while males had 1.16-fold higher DALYs rates. Greenland ranked highest across all three rates. From 1990 to 2021, incidence, YLDs, and DALYs rates declined in absolute terms, yet 91 countries exhibited increasing AAPC values (relative rise). The incidence and YLDs rates were significantly associated with the socio-demographic index (SDI), while DALYs were not. The Slope Index of Inequality decreased to -17.74, reflecting a growing concentration of burden in low-SDI settings, whereas some high-SDI settings showed persistent health-efficiency gaps. The population attributable fractions of high alcohol use and high temperature increased to 2.82 and 2.80%, respectively. Forecasts suggest declining incidence and DALYs rates but a rising YLDs rates by 2035.

Conclusion: Nearly half of all countries show rising trends in adolescent self-harm incidence, with burdens shifting toward non-fatal outcomes and low-SDI settings, underscoring the need for gender-sensitive, equity-focused, and prevention-oriented global strategies to guide future self-harm intervention policies.

Introduction: Evaluations of public health interventions often prioritise outcomes while neglecting contextual and implementation factors essential for sustainability. Using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), this study assessed the Young@Heart (Y@H) student-led cardiovascular disease (CVD) screening clinic-a community-based initiative that simultaneously delivers preventive health services and experiential learning for undergraduate pharmacy students.

Methods: A concurrent mixed-methods case study was conducted across organisational, service, and individual levels over 12 months. Data sources included semistructured interviews with academic staff, patients, and external stakeholders; focus groups with student volunteers; service-activity data from 1,152 clinic attendees; and 20 fidelity assessments of service delivery. Quantitative and qualitative data were analysed independently, then integrated using the RE-AIM framework to triangulate findings across datasets.

Results: Reach: the clinic attracted 1,152 participants (mean age 53 years), with representation from all socioeconomic deciles and 31% from the most deprived quintiles, demonstrating strong accessibility but limited engagement from younger adults. Effectiveness: High rates of modifiable risk were detected (44% elevated blood pressure, 62% overweight/obese, 36% cholesterol >5 mmol/L). Significant pre-post gains in self-reported motivation for dietary and physical-activity change (p < 0.001) aligned with qualitative reports of increased awareness and intention to act. Adoption: Stakeholders and participants valued the clinic's dual educational-public health role; however, formal referral rates were low (9%), highlighting weak system integration. Implementation: fidelity checks showed >80% adherence in 18/20 observations, indicating strong interpersonal delivery but procedural inconsistency in referral and signposting practices. Maintenance: participants and stakeholders perceived the model as sustainable if embedded within curricula and supported by stable funding, though absence of follow-up data limited assessment of long-term behavioral maintenance.

Conclusion: Applying the RE-AIM framework provided a comprehensive evaluation of the Y@H clinic, evidencing its accessibility, effectiveness, and educational value. While strong interpersonal delivery and measurable health impact were achieved, structural limitations in referral systems and follow-up impede sustained outcomes. Strengthening cross-sector referral pathways, standardising procedures, and embedding routine evaluation will be essential to ensure scalability, equity, and long-term sustainability of this innovative student-led community health model.

Introduction: Stigma is a common and recurring feature of infectious disease outbreaks where it may have detrimental effects on individual wellbeing and undermine outbreak response. This systematic review explores stigma reduction interventions in infectious disease outbreaks.

Methods: Eligible studies were searched for in Medline, Embase, PsycINFO, and Global Health databases and through reference screening. Risk of bias was assessed using study design-specific tools and the results of included studies underwent narrative synthesis.

Results: Eleven studies conducted across coronavirus disease 2019 (COVID-19), Ebola disease, mpox, severe acute respiratory syndrome (SARS), and a hypothetical infectious-disease scenario, met the inclusion criteria. Five studies reported reductions in stigma, four reported mixed or null results, and two reported increases in stigma. The most promising strategies for outbreak-related stigma reduction were embedding anti-stigma messaging within health communication, providing psychosocial support, and fostering genuinely participatory community involvement.

Discussion: Evidence on how to effectively reduce stigma during outbreaks remains limited. Strengthening the theoretical foundations, measurement tools, and evaluation designs of stigma-reduction interventions will be essential to inform evidence-based outbreak preparedness and response policies. This would help decision-makers ensure that risk communication, community engagement, and service delivery minimise stigma and improve uptake of testing, care, and preventive measures.

Microplastics (MPs) are pervasive environmental contaminants with significant bioaccumulation potential, posing a growing threat to global health through multi-organ toxicity. This review systematically synthesizes current knowledge on MPs-induced organ-specific damage and its systemic health implications. We detail the accumulation of MPs in major organ systems, including the liver, brain, lungs, kidneys, intestines, heart, and reproductive organs. Furthermore, we emphasize the critical role of inter-organ communication in amplifying toxicity, such as gut-liver axis-mediated hepatotoxicity and gut-brain axis-driven neurotoxicity. Emerging evidence on the transgenerational adverse effects of parental MPs exposure is also discussed. The core cellular and molecular mechanisms across these organs are examined, with a particular focus on oxidative stress, inflammatory activation, mitochondrial dysfunction, and programmed cell death. This review is distinct in its integrative approach, offering a novel perspective by synthesizing organ-specific pathologies with cross-organ communication networks and transgenerational effects, thereby providing a more holistic understanding of MPs' systemic toxicity. Collectively, this review elucidates the exposure-organ damage correlation, analyzes the underlying pathogenic mechanisms, and aims to provide a scientific foundation for public health risk assessment and informed environmental policy formulation.

Background: To investigate the impact of social support factors on the acceptance of rapid initiation of antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA), and to provide evidence for developing personalized interventions to improve the rapid ART initiation rate.

Methods: A cross-sectional study was conducted among patients visiting Lanzhou Pulmonary Hospital between September 2024 and January 2025. Data were collected via questionnaires. Variable selection was performed using univariable logistic regression; those with a significance level of p < 0.05 were included in a multivariable logistic regression model. Group differences in rapid initiation rates were assessed using the chi-square test.

Results: Among the 530 participants (506 males, 481 Han ethnicity), the highest proportion was in the 31 to <46 age group. Univariable analysis showed that age, education, cross-regional treatment, marital status, monthly income, disclosure to spouses/family, and having infected peers were associated with rapid ART initiation. The multivariable model identified that younger age groups (15- < 31 and 31- < 46), cross-district treatment within the city, monthly income ≥5,000 CNY, disclosure to spouses/family, and having infected peers were facilitators, while being unmarried was a barrier. Rapid initiation rates differed significantly based on spouses'/family members' attitudes post-disclosure (χ ² = 4.281, p = 0.039) and provision of support (χ ² = 4.281, p = 0.039), but not on peer support provision (p = 0.058). Among the support provided by spouses/family members, psychological support was the most common and was associated with the highest rapid ART initiation rate. The proportions of financial support and material support were similar, and their corresponding rapid initiation rates were also comparable. PLWHA who received no support had the lowest rapid initiation rate, which was significantly lower than rates observed with any form of support. Similar results were observed in the subgroup with infected peers: psychological support had the highest proportion and the greatest rapid ART initiation rate, while the absence of peer support was associated with the lowest proportion and the smallest rapid initiation rate.

Conclusion: Integrating social factors into rapid ART initiation interventions, through a support network connecting families, peers, and healthcare institutions, can enhance treatment willingness and timeliness, ultimately improving outcomes for PLWHA.

Background: To reduce chronic diseases, evidence-based health promotion interventions (EBIs) must be effectively implemented and sustained in settings such as schools. This review assessed the extent to which EBIs sustained their effects following the completion of an effective implementation trial. It also explored the use of recommended sustainment practices in follow-up studies.

Materials and methods: A Cochrane systematic review served as the basis for identifying school health promotion EBIs with demonstrated implementation effectiveness. Eligible studies were controlled trials in elementary or secondary schools that evaluated an implementation intervention and reported a statistically significant implementation effect. Forward citation searches were conducted across three electronic databases and two trial registration databases to identify relevant follow-up studies. To be included, follow-up studies needed to report comparable quantitative data (i.e., similar samples and outcome measures) to the original trial and to have been collected at least 6 months after the intervention ended. Two independent reviewers screened studies and extracted data using a predetermined template, with input from a third reviewer as needed. The included papers were assessed against sustainment-promoting practices, including whether they planned for, defined, or used a sustainment framework. The percentage of the original implementation effect sustained at follow-up was calculated.

Results: Of the 23 EBIs with a significant implementation effect in the original review, 26% (n = 6) were found to have eligible follow-up studies. These targeted physical activity (n = 3), diet (n = 2), and tobacco prevention (n = 1). Four studies reported implementation outcomes, and two reassessed behavioral outcomes. The percentage of the implementation effect sustained ranged from 51 to 122%, with a median of 76% (IQ1 = 56%, IQ3 = 107%).

Conclusion: To the best of our knowledge, this is the first review to quantify the sustainment of EBIs in schools following an effective implementation trial and to assess the extent to which best-practice sustainment principles were applied. Few studies described sustainment planning or used comparable follow-up measures. Improving long-term outcome measurement and integrating sustainment frameworks into planning and implementation could help sustain effective school health promotion EBIs.

Introduction: The potential buffering role of benefit finding, a cognitive and behavior adaptation process, in the relationship between financial concerns and psychological distress is not well understood among Asian American populations. Our study examined how financial concerns impacted Asian Americans' mental health, specifically in the presence of benefit finding and received pay during the COVID-19 pandemic.

Methods: Survey-weighted data from the 2021 Asian American and Native Hawaiian/Pacific Islander COVID-19 Needs Assessment Project was analyzed to test the associations between financial concerns and psychological distress among Asian American adults 18 years or older (unweighted N = 3,152). Multivariable linear regression models included an interaction term for benefit finding, financial concerns, and received pay to test the moderation effect of benefit finding on psychological distress.

Results: Reporting financial concerns increased the likelihood of psychological distress (β: 1.24, 95% CI: 0.91, 1.56). Asian Americans who reported greater levels of benefit finding had lower psychological distress, but benefit finding alone did not moderate the relationship between financial concerns and psychological distress. However, having both greater levels of benefit finding and received pay protected Asian American participants the most from psychological distress when experiencing financial concerns.

Discussion: Our findings suggest that benefit finding and received pay combined may have important implications for interventions and policy-level changes targeting financial concerns among Asian Americans. Future research should explore the relationships between benefit finding and health outcomes over the life course, other protective coping responses for Asian Americans, and potential differences by Asian ethnicity or specific subgroups.

Objective: This study aims to bridge the existing gap in knowledge by assessing the financial impact of image-guided brachytherapy (IGBT) in the management of cervical cancer in Thailand.

Methods: A web-based questionnaire was developed in 2019 to collect data from 14 radiotherapy centers across all regions of Thailand. The survey gathered information on the use of brachytherapy for cervical cancer treatment, encompassing both conventional brachytherapy (point-based prescription) and IGBT (volume-based prescription). Data on infrastructure, workforce, and costs were also collected, and predictions for radiotherapy usage in cervical cancer were calculated. The actual image-guided brachytherapy utilization (A-IGBTU) rate was calculated by dividing the IGBT fractions by the total brachytherapy fractions and multiplying the result by 100. The Radiotherapy Resources and Cost Calculator (RRCC; version 21.0) was used to assess shortages, while the economic model was based on clinical outcomes and toxicity models.

Results: Our survey revealed that 18,024 new patients were treated with radiotherapy, including 2,950 patients with gynecological cancers. Among these, cervical cancer accounted for 72% of the cases. The actual utilization rate of IGBT for cervical cancer was 33%. The RRCC (version 21.0) highlighted workforce shortages for radiation oncologists (ROs), medical physicists (MPs), and radiation technologists (RTTs) at 42, 63, and 61%, respectively. In the clinical outcome model, IGBT generated a total income of USD1,492,563. In the toxicity model, IGBT reduced the costs associated with treating grade-3 and grade-4 toxicities by at least 50%.

Conclusion: The actual utilization rate of IGBT for treating cervical cancer patients was 33%. The RRCC (version 21.0) highlighted workforce shortages across all roles. In our analysis, IGBT generated higher total income and significantly reduced the costs associated with treating severe toxicities.