Frontiers in Public Health最新文献

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract, and environmental factors are believed to play an important role in its pathogenesis. Exposure to outdoor artificial light at night (ALAN) has been linked to the globally increasing incidence and prevalence of several diseases; however, its relationship with IBD remains unclear. We aimed to estimate the long-term risk of IBD associated with outdoor ALAN exposure in a large-scale prospective cohort.

Methods: We conducted a large-scale prospective cohort study using the UK Biobank. Outdoor ALAN exposure data were obtained from satellite datasets. The primary outcome was incident IBD. Cox proportional hazards regression was used to examine the association between outdoor ALAN and the incidence risk of IBD, respectively. The non-linear association was further explored using restricted cubic spline (RCS) curves.

Results: During a follow-up period of 13.71 years with 346,163 participants, 1,106 individuals were diagnosed with ulcerative colitis (UC), and 508 developed Crohn's disease (CD). After adjusting for all covariates, outdoor ALAN exposure levels were positively associated with incident UC, and an 8% higher risk of UC [hazard ratio (HR), 1.084; 95% confidence interval (CI), 1.023-1.149; p < 0.001] was associated with each SD increment of outdoor ALAN exposure. The highest level of ALAN exposure was associated with a significantly increased risk of incident UC compared with the lowest level of exposure. (HR, 1.309; 95% CI: 1.12-1.529; p < 0.001). However, no significant association was observed between outdoor ALAN and CD incidence (HR, 1.044; 95% CI: 0.83, 1.308; p = 0.71). Cubic splines further indicated that outdoor ALAN was non-linearly associated with UC (p for non-linear = 0.0063). Additionally, sensitivity analysis revealed similar results, and subgroup analysis highlighted that the interaction between outdoor ALAN and UC was stronger in women than in men.

Conclusion: Our findings provide evidence that a higher ALAN exposure is associated with an increased risk of incident UC, with a significant dose-response relationship, but not with CD. Further studies are needed to elucidate the impact of outdoor ALAN on disease pathogenesis and outcomes.

Introduction: Lecanemab is the second anti-amyloid-β monoclonal antibody to receive FDA approval for the treatment of early Alzheimer's disease (AD), following aducanumab. Unlike aducanumab, which faced restricted Medicare coverage, lecanemab received traditional approval in 2023, resulting in broader access through Medicare. Despite these developments, the comparative cost-effectiveness of lecanemab and aducanumab has not been fully established. This study aimed to assess whether lecanemab is more cost-effective than aducanumab in the management of early AD.

Methods: An indirect comparison of cost-effectiveness was performed due to the absence of head-to-head randomized controlled trials. A five-state Markov model was constructed from the perspective of the US healthcare system with a lifetime horizon and a 1-year cycle length. Model outcomes included life-years (LYs), quality-adjusted life-years (QALYs), and costs, all discounted at an annual rate of 3%. Incremental cost-effectiveness ratios (ICERs) were calculated and compared with established willingness-to-pay (WTP) thresholds. One-way sensitivity analyses identified key drivers of model uncertainty, and a probabilistic sensitivity analysis (PSA) with 1,000 Monte Carlo simulations tested the robustness of the findings.

Results: The incremental cost of the lecanemab group compared to the aducanumab group was $30,018.97, with an increase in quality-adjusted life-years (QALYs) of 0.25, resulting in an ICER of $121,678.49 per QALY gained. The result of the one-way sensitivity analysis showed that the utility of the state of mild dementia due to AD had the most important effects on the ICER of the lecanemab group compared to the aducanumab group. The probabilistic sensitivity analysis showed that lecanemab was more cost-effective than aducanumab across various WTP thresholds.

Conclusion: Our findings suggest that lecanemab provides greater value than aducanumab; however, at current list prices, neither drug is cost-effective compared with the standard of care. Price reductions are necessary to improve affordability, particularly for lecanemab, which is more widely covered by Medicare. Policy implications remain significant, as under the Inflation Reduction Act (IRA), biologics such as lecanemab are exempt from Medicare price negotiations for 13 years post-approval, limiting short-term opportunities for cost adjustment.

Background: High body mass index (BMI)-related hypertensive heart disease (HHD) is increasingly prevalent worldwide. Using Global Burden of Disease (GBD) 2021 data, we analyzed the changes in disability-adjusted life years (DALYs) and age-standardized rate (ASR) of mortality (ASMR) due to high BMI from 1990 to 2021.

Methods: HHD data on high BMI were obtained from GBD 2021 at global, regional, and country levels. Age-standardized DALYs (ASDR) and deaths (ASMR) were calculated, with trends analyzed based on gender, age, and region. The autoregressive integrated moving average (ARIMA) model was used to project the burden through 2035, while the estimated annual percentage change (EAPC) was used to assess future trends.

Results: From 1990 to 2021, global DALYs increased from 5.67 million to 12.55 million (a 1.81% rise in ASR), and deaths rose from 240,000 to 594,000. Men showed an 8.28% increase in DALYs, while women's burden remained stable with a slight ASR decline. The highest burden was observed in those aged 80 and older, with DALYs increasing from 1243.80 to 1604.32. Projections suggest gradual decreases in DALYs and ASMR by 2035, although high BMI-related HHD remains a major public health concern.

Conclusion: High BMI intensifies HHD prevalence, particularly among men and older adults. Despite projected minor decreases by 2035, rising obesity underscores the ongoing need for public health interventions.

[This corrects the article DOI: 10.3389/fpubh.2025.1573783.].

Background: The present study is intended to examine the multiple mediating roles of psychological resilience and subjective well-being in the relationship between social alienation and self-care ability in old age among rural empty-nest older adults.

Methods: From February 17, 2021, to April 20, 2023, a questionnaire survey conducted using a multistage stratifed sampling method among 425 rural empty-nest older adults (60 years and over). These participants were recruited from a rural areas of Liaoning Province, China. The questionnaire included the Social Alienation Scale, the Psychological Resilience Scale, the Subjective Well-being Scale, the Self-care Ability In Old Age Scale. A descriptive analysis was performed to characterize the sample. Linear regression was utilized to evaluate the relationship between social alienation and self-care ability in old age. PROCESS macro (Model 6) was used to analyze the multiple mediated effects of psychological resilience and subjective well-being.

Results: Social alienation exerted a remarkable direct effect on the self-care ability in old age among rural empty-nest older adults (β = -0.678, 95% CI = -0.750- -0.607), which represented 56.45% of the total effect. Through three significantly mediated pathways indirectly affect the self-care ability in old age: (1) through the psychological resilience pathway (β = -0.431, 95% CI = -0.515- -0.350), which represented 35.89% of the total effect; (2) through the subjective well-being pathway (β = -0. 044, 95% CI = -0.089- -0.010), which represented 3.67% of the total effect; and (3) through both the psychological resilience and subjective well-being pathway (β = -0.048, 95% CI = -0.073- -0.029), which represented 3.99% of the total effect. The total mediating effect was 43.55%.

Conclusion: Psychological resilience and subjective well-being mediate the relationship between social alienation and self-care ability in old age among rural empty-nest older adults. Therefore, healthcare professionals and stakeholders should be concerned about the psychological resilience status and mental health of rural empty-nest older adults, strengthen their attention to subjective well-being, and adopt necessary targeted intervention measures to enhance the psychological resilience and subjective well-being of rural empty-nest older adults.

Urban waterfront trails can promote psychological restoration, yet how specific landscape attributes shape scenic beauty and multidimensional restorative perception across different revetment types remains unclear. This study quantified 15 landscape variables (F1-F15) across 30 urban waterfront trail sites and examined their associations with scenic beauty estimation (SBE) and four restorative dimensions (emotional, cognitive, physiological, and behavioral). Spearman correlation analysis, non-parametric group comparisons, and Random Forest modeling were applied to identify key predictors, with variable importance interpreted as predictive contributions rather than causal mechanisms. Partial-mediation structural equation models (SEM) were then constructed for the overall sample and for artificial, mixed, and natural revetment types. Results indicated that F4 was the most influential predictor of SBE, followed by F7, F13, F2, and F5. SEM analyses showed that SBE functioned as a central mediator linking landscape attributes to restorative outcomes: F4 was positively associated with SBE (β = 0.460), and SBE positively predicted all four restorative dimensions (β = 0.802-0.917), with additional direct paths indicating partial mediation. Grouped SEMs further revealed revetment-type-specific pathway structures, suggesting that revetment context conditions which landscape elements most strongly relate to perceived beauty and psychological restoration.

Introduction: With the looming global warming crisis, the question of how to achieve carbon neutrality is becoming an important issue confronting many countries. Although the spatial studies have indicated that education can spatially reduce the carbon intensity, they have ignored the transmission mechanism and dynamic interrelationship between education and carbon intensity.

Methods: Based on spatial economics theory, this study uses a spatial Durbin model and spatial vector autoregressive model to examine how education affects carbon intensity and how they relate to each other in China's 30 provinces from 2000 to 2021.

Results: The results show that education and the carbon intensity have positive global spatial autocorrelation. Education reduces the carbon intensity mainly through the spillover effect. The negative spillover effects in provinces with low carbon intensity are significantly greater than the direct effects are, whereas the spillover effects in provinces with high carbon intensity are negative but not significant. Education reduces the carbon intensity through green technology innovation and consumption structure upgrading. Furthermore, there is a dynamic interrelationship between education and carbon intensity. This study suggests that local governments should increase investment in education and focus on educational equity. They should also consider the spatial spillover effects of education when implementing tailored emission reduction policies based on local conditions. Additionally, educational institutions are encouraged to invest more in researching and promoting green technologies, as well as integrating low-carbon lifestyles into the education system.

Discussion: The findings can help policymakers achieve sustainable development goals 4 and 13 and a net-zero future.

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.