Frontiers in Public Health最新文献

This study examines how bullying experiences are associated with retaliatory impulses among autistic university students, highlighting minority stress as a key mediating mechanism and sexual and gender minority (SGM) status as a moderating condition within an intersectional framework. Guided by Minority Stress Theory and Social Information Processing Theory, we surveyed 280 autistic undergraduates; 35% identified as SGM. Participants completed validated measures of bullying, minority stress, retaliatory impulse, and related psychosocial factors. Structural equation modeling and multi-group analyses were conducted to evaluate the proposed mediation and moderation patterns while adjusting for gender, grade level, social support, autistic traits, and internet use. The measurement model showed good reliability and convergent validity (Cronbach's α = 0.84-0.89; AVE = 0.62-0.69). Bullying was positively associated with minority stress, which was in turn associated with retaliatory impulses, supporting partial mediation [indirect effect = 0.42, 95% CI (0.36, 0.50)]. Multi-group results indicated stronger path coefficients in the SGM group (bullying → stress β = 0.72; stress → retaliation β = 0.66) than among non-SGM (heterosexual and cisgender) peers, consistent with the possibility that compounded stigma heightens emotional reactivity and defensive processing. Minority stress remained the strongest correlate of retaliatory impulses after covariate adjustment, whereas social support showed a protective association. Taken together, the findings suggest that retaliatory impulses among autistic students are better understood in relation to sustained identity-based exclusion and structural stressors rather than as simple dispositional aggression. The results also imply that effective prevention may require institutional and relational strategies-alongside individual support-such as inclusive curricula, peer sensitization, and policies that strengthen belonging and psychological safety in higher education.

Background: Tobacco use remains a leading cause of preventable morbidity and mortality worldwide. While smoking prevalence has recently declined in Hong Kong, progress has slowed. Plain packaging may reduce product appeal and enhance the impact of pictorial health warnings (PHWs), supporting reduced tobacco use.

Methods: A cross-sectional study was conducted from August to November 2023 among 1,256 adult smokers in Hong Kong. Participants were recruited at outdoor public smoking hotspots and shown branded and plain cigarette packs with 85% PHWs. Perceptions of pack attractiveness, noticeability of PHWs, smoking-related harm, behavioural intentions, and support for plain packaging were assessed through structured interviews. Quantitative data were weighted by age and sex, and qualitative responses were analysed thematically.

Results: Most participants perceived plain packs as less attractive (79.8%) and PHWs on plain packs were more noticeable (57.5%) than branded packs. About 45.1% perceived plain packs as disgusting, and 28.0% agreed they better conveyed severe smoking harms than branded packs. While only 17.3% reported plain packs may reduce their intention to smoke, 33.1% reported that it could deter youth from smoking. Support for plain packaging was moderate, with 35.7% in favour and 34.5% neutral. The qualitative findings reinforced these perceptions.

Conclusion: Smokers perceived plain packaging as less attractive, the PHWs on it as more noticeable, and potentially useful in preventing smoking initiation in youth. These findings support the integration of plain packaging into Hong Kong's tobacco control strategy and offer valuable insights for jurisdictions considering similar legislation.

Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), the biggest publicly financed health insurance program in the world, has substantial use issues, especially in places like Jammu and Kashmir that are affected by conflict. Despite the program's goal of ensuring equal and cashless access to healthcare, the existing literature does not offer region-specific insights into the actual obstacles preventing its adoption. This study intends to identify and measure the physical, administrative, financial, and informational hurdles experiences by the beneficiaries in the urban and semi-rural areas of Jammu and Kashmir face when utilizing PM-JAY. Primary data was gathered through structured interviews with 320 randomly chosen PM-JAY recipients using a cross-sectional approach. To evaluate the relative effects of various obstacles on scheme use, the study used binary logistic regression, chi-square tests, Pearson correlation, and descriptive statistics. Despite being enrolled, only 48.4% of enrollees reported accessing PM-JAY services. The most significant positive predictors of usage were health literacy and awareness gaps, notably knowledge of empanelled hospital lists (OR = 1.245, p < 0.05) and awareness of scheme entitlement (OR = 1.253, p < 0.05). A statistically significant negative factor was inadequate road infrastructure (OR = 0.761, p < 0.05). Despite being often mentioned, administrative and financial obstacles were surprisingly not significant in the regression model. There were no discernible variations in use between the two districts, indicating problems with systemic access. Increasing PM-JAY use in disadvantaged areas requires more than just financial incentives; it also requires better physical infrastructure and informational availability. To convert coverage into useful access, policymakers should concentrate on region-specific IEC initiatives, transportation connectivity, and health system navigation support mechanisms. These interventions are essential for translating PM-JAY's theoretical coverage into meaningful, equitable healthcare access, particularly in underserved and fragile regions like Jammu and Kashmir.

Objective: Bacillary dysentery (BD) remains a public health concern in China, with its incidence influenced by multidimensional and interconnected factors. This study aimed to quantify the correlations between meteorological conditions, socioeconomic status, health resources, forest coverage, and BD incidence-an integrated analysis lacking in previous research. The results provide a comprehensive evidence base for formulating targeted BD prevention strategies.

Methods: Using panel data from 31 Chinese provinces (2014 ~ 2018), including BD incidence rates and 12 indicators of proxy variables at the ecological level, fixed-effects and random-effects models with Driscoll-Kraay robust standard errors were applied.

Results: The results of the random-effects model incorporating multidimensional factors showed that a 1% increase in the number of beds per 1,000 people in healthcare facilities, GDP per capita, and forest coverage was significantly associated with decreases in BD incidence rates of 2, 0.8, and 0.6%, respectively, (all p < 0.05). These findings indicate ecological associations with the incidence of BD across different provinces in China.

Conclusion: Improvements in regional investment in healthcare resources, economic development, and forest coverage were inversely associated with BD incidence, suggesting potential protective effects at the population level.

Introduction: Gendered voice perception is central to gender recognition and can be a major source of distress for transgender people, yet voice and voice therapy remain marginal in medical curricula. This study examined how a digital, experiential seminar using voice-feedback applications can foster medical students' understanding of gendered voice and transgender health.

Methods: We conducted a qualitative observational study within a 135-min online seminar, "Feminize Your Resonance!", embedded in a fourth-year public health module at the Medical University of Vienna. One hundred medical students used commercially available voice apps to experiment with their own pitch and resonance and submitted app screenshots and written reflections via an online learning platform. We applied a narrative analysis, based on narrative episodes in students' accounts, using a multi-stage coding process supported by qualitative data analysis software to map learning processes in several stages.

Results: Analysis yielded three interlinked themes-implicit voice awareness, technology engagement, and sharing transgender experience-organized into a five-phase learning journey from pre-existing discomfort with one's recorded voice to social awareness with voice challenges of transgender individuals. Students moved from internal, often negative, self-evaluation to critical appraisal of app algorithms, exploration of their own vocal plasticity, and perspective-taking on the challenges of gender-affirming voice transition.

Conclusion: Technologically mediated voice exploration can catalyze transformative learning about the role of voice in gender incongruence and support the development of affective and clinical competencies in medical education. Potentially the training facilitates communicating with transgender individuals empathically, not only related to transgender-affirming care but in all healthcare settings.

Background: Severe Fever with Thrombocytopenia Syndrome (SFTS) is characterized by high mortality and rapid progression, necessitating accurate early prognosis to optimize supportive care. However, current predictive tools often lack interpretability, require sophisticated tests unavailable in resource-limited areas, or suffer from poor generalizability. This study aimed to develop an interpretable, parsimonious, and deployable machine learning model for early mortality prediction in SFTS.

Methods: We analyzed data from 834 SFTS patients across three medical centers in Anhui, China. A LightGBM model was developed using a derivation cohort (n = 571) and validated on internal (n = 143) and two independent external cohorts (n = 80 and n = 183). Model interpretability was enhanced using SHapley Additive exPlanations (SHAP), and a web-based calculator was deployed for clinical use.

Results: The LightGBM model identified six routine clinical parameters-Age, Lactate Dehydrogenase (LDH), Activated Partial Thromboplastin Time (APTT), Uric Acid (UA), Creatinine (CRE), and Body Temperature-as the most influential predictors. Integrating these features, the model achieved robust discrimination with an Area Under the Curve (AUC) of 0.960 in the training set and 0.938 in the internal validation set. Crucially, it maintained strong performance in two independent external validation cohorts (AUC 0.871 and 0.877). SHAP analysis revealed that Age and LDH were the strongest risk factors, while Temperature exhibited a non-linear relationship with mortality risk.

Conclusion: We developed and validated a high-performance, interpretable ML model for SFTS prognosis relying on only six readily available parameters. By deploying this parsimonious model as an online calculator, we provide a practical decision-support tool to facilitate early risk stratification and timely intervention, particularly in resource-limited settings.

Background: Socioeconomic deprivation and environmental heat exposure each increase cardiovascular risk, yet evidence is limited on how these stressors co-occur and jointly shape disease burden within cities. Mapping their overlap can inform equity-oriented planning and needs-based allocation of health and social protection resources.

Methods: We conducted an ecological geospatial analysis of 2,513 census tracts in Los Angeles County. Adult coronary heart disease (CHD) prevalence was obtained from CDC Population Level Analysis and Community Estimates (2021). Socioeconomic deprivation was measured using the Social Deprivation Index (SDI), and heatwave surface heat hazard was measured using land surface temperature (LST) retrieved from the ECOsystem Spaceborne Thermal Radiometer Experiment on Space Station. We identified hot spots and overlaps using Getis-Ord Gi^* statistics. Associations between SDI, LST, and CHD were estimated using z-score-standardized OLS regression with tract-level sociodemographic controls; we assessed spatial dependence and applied geographically weighted regression (GWR) with adaptive bandwidths to characterize spatial heterogeneity.

Results: CHD hot spots overlapped with high-deprivation and high-heat areas, concentrated in the south and east of Los Angeles County. In standardized OLS models (z-scored outcome and predictors), a 1-SD increase in SDI was associated with a 0.163-SD higher CHD prevalence (p < 0.001), and a 1-SD increase in LST was associated with a 0.070-SD higher CHD prevalence (p < 0.001). GWR revealed substantial geographic variation: the SDI-CHD association was strongest in central and southern tracts, whereas the LST-CHD association was strongest in central and eastern tracts, suggesting that dominant risk drivers and intervention priorities differ by neighborhood.

Conclusion: To address this, socioeconomic deprivation and urban heat indicators should be used to inform transparent resource allocation for chronic disease prevention and management. Neighborhoods with high deprivation and heat exposure should be prioritized for cooling infrastructure, home heat mitigation, and urban greening initiatives. Finally, public health, housing, and social services must work together to effectively address the structural drivers of cardiovascular disease disparities.

Background: This study aimed to assess the knowledge, attitude, and practice (KAP) of older adults patients with rheumatoid arthritis (RA) regarding disease management.

Methods: This multicenter cross-sectional study enrolled older adults patients with RA between November and December 2024 in Sichuan Province, China. Self-administered questionnaires were utilized to collect demographic information and evaluate KAP scores.

Results: A total of 488 participants were included in the study, with 72.54% aged 60-69 years and 70.29% female. The mean KAP scores were 10.72 ± 4.68 (possible range: 0-20), 20.11 ± 2.31 (possible range: 6-30), and 25.05 ± 6.10 (possible range: 7-35), respectively. Spearman correlation analysis revealed that knowledge positively correlated with both attitude (r = 0.1293, p = 0.0042) and practice (r = 0.5037, p < 0.001), while attitude positively correlated with practice (r = 0.2066, p < 0.001). The structural equation model showed that knowledge directly affected attitude (β = -0.56, p < 0.001) and practice (β = 0.61, p < 0.001), while also indirectly affected practice through attitude mediation (β = 0.52, p < 0.001). Furthermore, attitude demonstrated a direct effect on practice (β = -0.93, p < 0.001).

Conclusion: This study found that older adults patients with RA generally exhibited insufficient knowledge and predominantly negative attitudes toward disease management, although many reported relatively proactive behaviors in managing their condition. Targeted educational interventions are necessary to improve knowledge and attitudes, which may further enhance disease management practices among older adults RA patients.

Introductions: This study investigates the relationship between stigmatization and stress levels among mothers of children with autism spectrum disorder (ASD).

Methods: Using items from standardized psychometric tools, the study explores how emotional burden, social strain, and coping strategies contribute to parents' perceived stigma.

Results: Findings suggest that indirect measures of stigma through psychological assessment offer a more comprehensive understanding than direct questioning, which may elicit guarded responses.