Frontiers in Public Health最新文献

Introduction: The expansion of Home Hospitalization (HH) services has prompted the need for standardized pharmaceutical care models to ensure safe and efficient medication management in the home setting. However, Hospital Pharmacy (HP) departments are often heterogeneously involved in HH programs, and there is a lack of consensus on their roles and responsibilities. The objective was to develop a consensus-based activity dashboard to guide HP departments in implementing standardized pharmaceutical care within HH units in Spain.

Methods: A modified Delphi method was conducted in five phases: constitution of a coordinating group, definition of candidate activities, selection of a national expert panel, evaluation of the list of activities (two-round consensus process), and analysis of the results. Experts rated the necessity and feasibility of implementing 44 proposed activities by an HP department, using a 9-point Likert scale (in total, 88 items were rated). Activities were included in the final dashboard if ≥75% of panelists rated both dimensions in the 7-9 range.

Results: A total of 23 multidisciplinary experts participated in the Delphi panel. Consensus was achieved for 60 out of 88 evaluated items (68.2%), with 17 activities rated as both necessary and feasible for inclusion in the final dashboard. These activities spanned six domains: drug dispensing, clinical pharmacy care, risk management, communication and patient education, home administration of antineoplastic agents, and clinical research. Several activities were rated as necessary but lacked feasibility consensus, highlighting systemic and resource-based limitations.

Conclusion: This study provides the first structured consensus on pharmaceutical care activities in HH in Spain, resulting in a practical dashboard to guide HP departments. Its implementation may facilitate the harmonization of care models, may enable the optimization of medication safety, and may support the growing role of pharmacists in home-based care. Addressing feasibility barriers is essential to fully realize the potential of pharmaceutical care in HH programs.

Introduction: This study proposes a public health strategy to combat sarcopenia in rapidly aging societies, addressing systemic gaps in preventive healthcare through a proactive, design-driven framework.

Methods: A mixed-methods approach was adopted, integrating participatory questionnaires (n = 1,683) and grounded theory-analyzed interviews (n = 48). Stage classification was validated through triangulation of self-reported activity limitations, clinimetric scoring, and biomechanical assessments. The Analytic Hierarchy Process was employed to decode dynamic weighting mechanisms among physiological determinants, psychological factors, and fixed environmental parameters.

Results: The study constructed a self-evaluated four-stage progression model applicable to urban contexts. By bridging clinical diagnostics with daily life narratives, the framework enables earlier risk identification outside healthcare settings. A novel mapping algorithm was devised, correlating patient-reported disease staging with evidence-based intervention tiers. The resultant three-tier system operationalizes cognitive reframing and behavioral reconfiguration mechanisms, aligning patient self-assessment with targeted intervention design.

Discussion: This interdisciplinary model synergistically addresses three critical objectives: healthcare resource optimization, social participation longevity enhancement, and disability trajectory modulation. By positioning design as an ecological mediator, the framework supports the transition of healthcare systems from acute care paradigms to preventive ecosystem orchestration, ultimately fostering equitable health resilience within aging societies.

Introduction: As populations age worldwide, promoting health and autonomy in later life has become a shared policy imperative. However, little is known about how concurrent lifestyle behaviors among physically active seniors influence their perceived health outcomes.

Methods: Using data from the 2023 National Survey on Physical Activity, this study analyzed 1,729 physically active older adults in South Korea. Descriptive statistics, independent t-tests, and multiple regression analyses were conducted to examine the associations between exercise participation, co-occurring health behaviors, and self-reported gains related to daily functioning and healthcare costs.

Results: Regular diet management and nutritional supplementation, along with abstinence from alcohol and smoking, were consistently associated with greater perceived assistance in daily activities and reduced healthcare costs. In contrast, regular physical activity and adequate rest showed no significant associations with most positive outcomes, except for a modest link with reduced healthcare costs. Self-reported gains-especially in daily activity assistance and cost reduction-were positively associated with perceived health and fitness status.

Discussion: Among already active seniors, integrated lifestyle strategies emphasizing dietary management and substance abstinence appear to yield more tangible benefits than exercise alone. Policy and practice should therefore complement exercise promotion with nutrition support and cessation programs, leveraging community sports-club infrastructures to sustain these behaviors in aging societies.

We describe characteristics and results from the DREAM Program, a public health program initiated in Mozambique in 2002 to fight AIDS and other chronic diseases in Sub Saharan Africa. The DREAM Program is currently implemented in 10 countries providing free-of-charges services to over 110,000 patients. DREAM achieved remarkable success in the prevention of mother to child transmission of HIV, in adherence and retention support, in viral load monitoring. Among the challenges: the limited therapeutic options for people living with HIV experiencing virological failure and limited access to resistance tests.

Objective: The global prevalence of obesity is rising, and prior research has established a strong link between obesity and hepatitis C prognosis. However, the impact of high body mass index (HBMI) on the HCV burden remains uncertain. This study sought to clarify the overall HCV burden related to HBMI and examine temporal trends.

Methods: Public data from the Global Burden of Disease (GBD) database (1990-2021) were utilized to analyze the global and different Socio-demographic index (SDI) regional burden of HCV associated with obesity, focusing on Deaths, Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs). Trends in the HCV burden were assessed using Estimated Annual Percentage Changes (EAPCs) and Average Annual Percentage Changes (AAPCs) via Joinpoint regression. The age-period-cohort (APC) model was used to examine the effects of age, period, and cohort on disease burden, respectively. The Das Gupta decomposition analysis method was applied to evaluate the contributions of population growth, population aging, and epidemiological changes to the burden. Frontier analysis was conducted to explore the relationship between the HCV burden linked to HBMI and Socio-demographic development. An ARIMA model was then developed to forecast the Age-standardized Mortality Rate (ASMR) and Age-standardized DALYs Rate (ASDR) of HBMI-associated hepatitis C over the next 15 years.

Results: From 1990 to 2021, global HCV deaths related to obesity rose from 3,835 to 17,090, with DALYs increasing from 94,503 to 389,263. The EAPCs for ASMR and ASDR were 2.20 and 2.10, respectively. Obesity posed a greater burden on female patients infected with HCV virus compared to males. In terms of age, the effect of HBMI on HCV patients increased with age. Over the past 30 years, ASMR and ASDR have consistently risen across all SDI regions (All regions: EAPCs > 0, 95% CIs > 0). The High SDI region reported the highest deaths, DALYs, ASMR, and ASDR annually, indicating the greatest obesity impact on HCV burden of this area. However, obesity also had an increasingly large impact on the HCV disease burden in the Middle SDI and Low-middle SDI regions. Regionally, Africa, the Middle East, and Central Asia bear a relatively heavy burden of HCV associated with HBMI, and the burden in North America and Oceania cannot be ignored. At the national level, Mongolia and Egypt have the heaviest burden. The results of decomposition analysis show that epidemiological changes are the main cause of the increased burden. Projections suggest a continued increase in the obesity-related HCV burden globally and across different SDI regions over the next 15 years.

Conclusion: Obesity poses an increasing disease burden for people infected with hepatitis C virus. Targeted public health interventions are urgently needed to alleviate this burden.

Mobile phone data provide high-resolution, near real-time measurements of population mobility and have become an increasingly valuable source for public health research, enabling rapid evaluation of policy impacts on human movement and pandemic control. However, the methodological challenges surrounding the extraction, governance, and validation of mobile phone data for the public health community remain insufficiently explored. Following the PRISMA-ScR framework, we conduct a scoping review to synthesize major research themes, opportunities, and challenges in the use of mobile phone data for public health, particularly pandemic-related studies. Our findings highlight limitations in the empirical use of these datasets, including demographic and population coverage, representativeness, and equity issues, as well as the transparency of data extraction and processing. We also provide guidance for future research, including the development of standardized frameworks for data curation and validation, a clear understanding of algorithms that extract mobility information, and rigorous interpretation of mobility metrics.

Background: There is ample evidence that senior day centres can provide rehabilitation, increase activity and support social participation for older adults.

Aim: The aim of this scoping review is to provide an overview of the scientific literature in this field and investigate whether there is scientific evidence for the efficacy of rehabilitation interventions at senior day centres for older adults.

Methods: The scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data were collected from databases between January 2010 and December 2020 and updated December 2023. The scoping review was conducted in the databases CINAHL, Cochrane Library and PubMed and 29 articles were identified for inclusion.

Results: Rehabilitation interventions at the senior day centres varied considerably. The main findings concern interventions of a physical, cognitive and/or social character. The most common dimensions of outcome were improvements in physical and cognitive ability and quality of life. There was also considerable variation in the professionals involved. Other important factors to observe when participating in interventions at senior day centres could be loneliness and risk of falls.

Conclusion: While rehabilitation interventions at senior day centres are striving towards person-centred care, there is room for improvement to meet older adults' individual needs. In conclusion, this scoping review shows that greater focus is needed to strengthen the evidence base for examine interventions that are most effective in these settings.

Objective: This study aims to summarize current applications of artificial intelligence (AI) for chronic disease self-management, critically appraise their effectiveness, and identify implementation challenges and future directions for research and clinical integration.

Methods: A narrative literature review of peer-reviewed, English-language studies identified via PubMed, Web of Science, and Scopus was conducted, using combinations of "artificial intelligence," "chronic disease," "self-management," "remote monitoring," "predictive analytics," "conversational agent," and "mobile health." Reference lists of key reviews were snowballed. We included studies that described or evaluated AI-enabled self-management tools or interventions for chronic conditions and excluded non-AI, acute-care, editorial, and non-human studies. Findings were synthesized thematically.

Results: The literature consistently identifies four roles of AI in chronic care: (1) personalized decision support and treatment optimization; (2) continuous monitoring and risk prediction from patient-generated data; (3) conversational agents delivering education, adherence support, reminders, behavioral coaching, and mental-health support; and (4) AI-enabled Mobile health (mHealth) platforms that connect patients with clinicians and coordinate care. Recurrent challenges reported include data privacy and security risks, algorithmic bias and limited generalizability, interoperability and workflow-integration barriers, variable usability and sustained engagement (digital divide- inequalities in access to digital technologies and the internet, often influenced by age, income, or geography), and insufficient high-quality evidence on clinical effectiveness and cost-effectiveness.

Conclusion: Future directions focus on developing more accurate, explainable, and trustworthy AI models, better clinical integration, leveraging advanced AI for engagement, rigorous evaluation, and addressing ethical and implementation barriers to realize AI's full potential in empowering patients and improving chronic disease outcomes.

Extending healthy life expectancy requires attention not only to physical fitness but also to the development of cognitive self-regulation skills during childhood, which play a critical role in establishing lifelong health behaviors. Early health education has traditionally emphasized physical activity and lifestyle, yet cognitive aspects of self-control and inhibitory processes have received comparatively little attention. Inhibitory control is a central component of executive function, enabling children to regulate impulses, follow rules, and adapt to changing environments. Deficits in this capacity are associated with academic challenges, risk-taking behaviors, and poorer health outcomes later in life. Thus, incorporating assessments of cognitive inhibitory control into early health education may provide valuable insights for both educational and preventive health strategies. This pilot longitudinal study examined the feasibility of using the go/no-go task to assess inhibitory control in children aged 3-14 years in Nagano Prefecture, Japan. Assessments were conducted in 1998, 2008, and 2018, enabling exploration of changes over two decades. The task included three phases-formation, differentiation, and reverse differentiation-allowing for evaluation of both reaction times and error rates as indicators of speed-accuracy trade-offs in inhibitory performance. Results showed that children in 2018 exhibited significantly shorter reaction times but higher error rates compared with those assessed in 2008, suggesting a shift toward prioritizing speed over accuracy. These changes may reflect broader environmental and behavioral influences, such as increased exposure to digital devices, altered patterns of daily activity, or evolving educational contexts. Importantly, these findings indicate that inhibitory control, as captured by a simple cognitive paradigm, can reveal population-level shifts in child development over time. Incorporating cognitive tasks such as the go/no-go paradigm alongside conventional physical fitness testing in school-based health education may therefore enrich understanding of children's self-regulatory capacity. This approach has the potential to strengthen early identification of cognitive and behavioral trends, support tailored educational interventions, and inform broader community health promotion programs. By linking cognitive development with public health practice, it may contribute to strategies aimed at extending healthy life expectancy across the lifespan.

Background: Delayed or reduced antenatal care use by pregnant women may result in poorer outcomes. 'Candidacy' is a synthetic framework which outlines how people's eligibility for healthcare is jointly negotiated. This meta-ethnography aimed to identify - through the lens of candidacy - factors affecting experiences of care-seeking during pregnancy by women from underserved communities in high-income countries (HICs).

Methods: Six electronic databases were systematically searched, extracting papers published from January 2018 to January 2023, updated to May 2025, and having relevant qualitative data from marginalized and underserved groups in HICs. Methodological quality of included papers was assessed using the Critical Appraisal Skills Program. Meta-ethnography was used for analytic synthesis and findings were mapped to the Candidacy Framework.

Results: Studies (N = 51), with data from 1,347 women across 14 HICs were included. A total of 12 sub-themes across five themes were identified: (1) Autonomy, dignity, and personhood; (2) Informed choice and decision-making; (3) Trust in and relationship with healthcare professionals; (4) Differences in healthcare systems and cultures; and (5) Systemic barriers. Candidacy constructs to which themes were mapped were predominantly joint- (navigation of health system), health system- (permeability of services), and individual-level (appearances at health services). Mapping to Candidacy Framework was partial for seven sub-themes, particularly for individuals with a personal or family history of migration. The meta-ethnography allowed for the theory: 'Respect, informed choice, and trust enhances candidacy while differences in healthcare systems, culture, and systemic barriers have the propensity to diminish it'.

Conclusion: Improvements in antenatal care utilization must focus on the joint (service-user and -provider) nature of responsibility for care-seeking, through co-production. We suggest two additional Candidacy Framework constructs: 'intercultural dissonance' and 'hostile bureaucracy', which reflect the multi-generational impact of migration on healthcare utilization and the intersection of healthcare utilization with a hostile and bureaucratic environment.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023389306, CRD42023389306.