Frontiers in Public Health最新文献

{"title":"Association and attributable hospital costs of chronic pain with relevant geriatric sensitive diseases among the older adults.","authors":"Ting Chen, Tianjiao Lan, Kun Tan, Jay Pan, Xiuli Wang","doi":"10.3389/fpubh.2026.1828836","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1828836","url":null,"abstract":"<p><strong>Background: </strong>The adverse impacts of chronic pain extend far beyond the physical sensation itself. Chronic pain, an age-related condition, exacerbates geriatric disease burden and drives a central sensitivity-neuropsychiatric complex, necessitating urgent preventive care. This study aimed to investigate the impact of chronic pain on two sensitive diseases, depression, and abilities decline in basic or physical activities (functional limitation) among the inpatients in older adults and explore the attributable hospital costs related to chronic pain.</p><p><strong>Method: </strong>Participants were sourced from the 2021-2022 Inpatient Discharge Dataset of Sichuan Province, Diagnosis of depression, functional limitation, and chronic pain were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Logistic regression models were employed to analyze the association between chronic pain and depression and functional limitation. Furthermore, total hospital costs, out-of-pocket costs and length of stay (LOS) were compared between patients (depression and functional limitation) with chronic pain and without using Propensity score matching and Multivariable linear regression.</p><p><strong>Results: </strong>The analysis included 38,372 and 4,996 inpatients in the depression and functional limitation cohorts, respectively. Chronic pain was significantly associated with both outcomes, yielding odds ratios (ORs) of 1.24 (95% CI: 1.20-1.27) for depression and 1.60 (1.44-1.78) for functional limitation (all <i>p</i> < 0.001), and the effect intensified as the number of painful areas increased. Compared to those without pain, depression patients with chronic pain incurred 68.2% higher total hospital costs ( <math><mi>β</mi></math> =0.52, <i>p</i> < 0.001), 169.1% higher out-of-pocket ( <math><mi>β</mi></math> =0.99, <i>p</i> < 0.001) and 60.0% higher LOS ( <math><mi>β</mi></math> =0.47, <i>p</i> < 0.001). Among patients with Functional limitation, chronic pain also significantly increased log-transformed total costs ( <math><mi>β</mi></math> =0.20), out-of-pocket ( <math><mi>β</mi></math> =0.51), and LOS ( <math><mi>β</mi></math> =0.30), representing relative increases of 22.1, 66.5, and 35.0%, respectively (all <i>p</i> < 0.05). These economic impacts were more pronounced among patients with multi-area pain.</p><p><strong>Discussion: </strong>This study provides empirical evidence linking chronic pain to deteriorated psychological and physical health among older adults. It highlights the increased burden of the disease and hospitalization, with a particular emphasis on the dangers of multi-area pain. These findings emphasize that prioritizing mental health-focused pain management in outpatient and emergency settings is crucial for preventing avoidable hospitalizations and hospitalization costs in older adults.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1828836"},"PeriodicalIF":3.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging a machine learning model to predict hospital readmission risk: integrating clinical and social determinants of health data.","authors":"Tianyu Zhang","doi":"10.3389/fpubh.2026.1754585","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1754585","url":null,"abstract":"<p><strong>Background: </strong>Hospital readmissions remain a major challenge for healthcare systems, contributing to higher costs and worse patient outcomes. Although most prediction models rely primarily on clinical data, integrating social determinants of health (SDOH) may improve risk assessment. However, the use of machine learning (ML) to combine clinical and SDOH data for readmission prediction remains limited.</p><p><strong>Objective: </strong>To develop and compare machine learning models for predicting 30-day hospital readmission by integrating clinical and SDOH data.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 3,018 adult patients discharged from a large academic medical center between January 2022 and December 2023. Clinical variables were extracted from electronic health records and linked, through geocoded residential addresses, to area-level SDOH indicators from publicly available census data, including neighborhood deprivation, median income, and educational attainment. Six tabular ML models were trained and evaluated, including Logistic Regression, Random Forest, XGBoost, LightGBM, CatBoost, and Support Vector Machine. Model performance was assessed using the area under the receiver operating characteristic curve (ROC-AUC), precision-recall AUC (PR-AUC), and F1-score. SHapley Additive exPlanations (SHAP) were used to assess feature importance.</p><p><strong>Results: </strong>Ensemble models outperformed Logistic Regression, with XGBoost achieving the best performance on the test set (ROC-AUC 0.79, 95% CI 0.75-0.82; PR-AUC 0.71). In addition to key clinical variables such as prior admissions and comorbidity burden, SDOH features including neighborhood socioeconomic status and household composition were among the most important predictors.</p><p><strong>Conclusion: </strong>Integrating clinical and SDOH data into ML models improved prediction of 30-day hospital readmission. These findings support moving beyond clinical-only models and suggest that SDOH-informed prediction may help identify high-risk patients earlier and guide more targeted care management.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1754585"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital twin for Taekwondo athletes: integrating sports nutrition and psychological readiness using artificial intelligence.","authors":"Adam Tawfiq Amawi, Gerasimos V Grivas, Walaa Jumah Alkasasbeh","doi":"10.3389/fpubh.2026.1822194","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1822194","url":null,"abstract":"<p><strong>Background: </strong>Taekwondo is a high-intensity Olympic combat sport that requires the integration of physical performance, tactical decision-making, and psychological resilience. Athletes face unique challenges such as rapid weight management, fatigue accumulation, injury risk, and competitive anxiety. While sports nutrition and psychological readiness are critical determinants of performance, they are often addressed separately, creating a gap in holistic, individualized athlete monitoring systems.</p><p><strong>Methods: </strong>This narrative review synthesizes interdisciplinary evidence from sport science, nutrition, psychology, and artificial intelligence. A structured literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies related to Taekwondo performance, weight-category nutrition strategies, psychological readiness, and AI-driven technologies including wearable systems, machine learning, and digital twin frameworks.</p><p><strong>Results: </strong>The findings indicate that AI-driven digital twin technology enables the integration of multidimensional athlete data, including nutritional intake, psychological state, training load, and physiological biomarkers (e.g., HRV and cortisol). These systems can generate actionable outputs such as readiness scoring, personalized nutrition strategies, early detection of fatigue and stress dysregulation, and prediction of injury or overtraining risk.</p><p><strong>Conclusion: </strong>Digital twin technology represents a promising framework for transforming Taekwondo athlete management from fragmented monitoring to a holistic, data-driven approach. Practically, this may support coaches in making real-time decisions regarding training load, weight management, recovery, and psychological interventions. However, further empirical validation, ethical considerations, and applied research are required to support real-world implementation in elite combat sport environments.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1822194"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting length of hospital stay in community-acquired pneumonia using clinical and treatment factors: a retrospective study with restricted cubic spline and piecewise regression analysis.","authors":"Hualong Zeng, Chengqing Yang, Min Jiang, Xiaohui Luo, Genxiu Luo, Xianyang Chen, Yige Song, Lei Wang, Xiaojun Zhu, Xiaomin Zheng, Hong Wei, Juewei Pan, Feng Lin","doi":"10.3389/fpubh.2026.1768432","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1768432","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) remains a leading cause of hospitalization worldwide. Accurate prediction of length of stay (LOS) is crucial for optimizing hospital bed turnover, improving clinical resource allocation, and facilitating the development of individualized discharge plans, thereby reducing the strain on healthcare systems.</p><p><strong>Methods: </strong>We retrospectively analyzed 423 adults hospitalized with CAP from January 2022 to December 2023. Clinical characteristics, laboratory data, comorbidities, and treatment variables were extracted from electronic health records. Univariate and multivariable linear regression models were initially employed to identify independent predictors of LOS. The predictive performance of the final multivariable model was assessed using R², adjusted R², Akaike Information Criterion, and 10-fold cross-validation. To further explain the complex relationship between specific treatment factors and LOS, restricted cubic splines and piecewise regression were utilized, specifically to evaluate non-linear associations and identify clinical inflection points.</p><p><strong>Results: </strong>The final model showed strong performance (R² = 0.864; adjusted R² = 0.862). Independent predictors of prolonged LOS included respiratory failure, pressure ulcers, elevated blood urea nitrogen, antibiotic modification during hospitalization, traditional Chinese medicine use, and antibiotic duration. Restricted cubic spline analysis demonstrated a significant non-linear relationship between antibiotic duration and LOS (<i>P</i> < 0.05). Piecewise regression identified an inflection point at 7.398 days, after which LOS increased more rapidly.</p><p><strong>Conclusions: </strong>Multiple clinical and treatment-related factors were associated with LOS in CAP. Antibiotic duration showed a pronounced non-linear pattern, with treatment beyond 1 week linked to markedly longer hospitalization. These findings may help identify patients at risk of prolonged LOS and support more efficient clinical decision-making.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1768432"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"City- and county-level gaps in diabetes mortality improvement in the southeastern coastal region of China from 2005 to 2020, with provincial-level projections to 2030.","authors":"Xiuquan Lin, Chenglin Yang, Yuying Chen, Shaofen Huang, Yanrong Yin, Wenling Zhong, Weimin Ye","doi":"10.3389/fpubh.2026.1836682","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1836682","url":null,"abstract":"<p><strong>Objectives: </strong>The growing health and economic burden of diabetes in China is a result of fast urbanization and lifestyle changes. This highlights the critical need for a comprehensive analysis of epidemiological patterns and forecasts in order to achieve the \"Healthy China 2030\" goals.</p><p><strong>Methods: </strong>Socio-Demographic Index (SDI) factors were used to evaluate data on diabetes mortality and YLL (2005-2020) for adults in 84 Fujian counties. Age-Period-Cohort (APC) models were used to examine the impacts of age, period, and birth cohort, while frontier analysis identified areas for health improvement. Bayesian APC (BAPC) modeling was used to forecast future mortality through 2030.</p><p><strong>Results: </strong>Standardized mortality and YLL rates indicated considerable promise for improvement in high SDI cities like Xiamen and Fuzhou. Age-period-cohort analysis reveals that diabetes mortality increased dramatically with age, reaching 464.79/100,000 for those 85 and older. The mortality risk decreased in subsequent generations after peaking in the 1947 birth cohort (RR = 1.51). Bayesian projections suggest the standardized mortality rate will rise to 17.14/100,000 by 2030, with a greater impact on females. Diabetes-related deaths are expected to rise by 58.88% (to 10,891).</p><p><strong>Conclusion: </strong>High-SDI areas like Xiamen and Fuzhou require optimized resource allocation to reduce mortality. Targeted interventions for older adults are required due to aging and cohort effects. As the 2030 burden intensifies, strengthening early screening and regional strategies is essential to mitigate future impacts.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1836682"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drama-in-education in rural Chinese primary schools: effects on self-concept, social connectedness, and psychosocial wellbeing.","authors":"Renfei Liu, Yiliu Pu, Peng Cui","doi":"10.3389/fpubh.2026.1812030","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1812030","url":null,"abstract":"<p><strong>Introduction: </strong>Self-concept is a central developmental resource supporting children's psychosocial wellbeing, resilience, and school adjustment. In rural and low-resource educational settings, structured and scalable interventions that promote social connectedness and positive self-identity remain limited. Drama-in-Education (DIE), an arts-based group practice grounded in role-taking and collaborative enactment, has shown promise in enhancing socio-emotional competencies; however, evidence for short, high-intensity implementations under real-world school conditions remains scarce. This study evaluated the short-term effects and mechanisms of a structured DIE program on rural primary school children's self-concept.</p><p><strong>Methods: </strong>A quasi-experimental mixed-methods design was employed (<i>N</i> = 300) in a rural Chinese primary school. Classes were assigned to either a 10-day intensive DIE intervention or a waitlist control group. Children completed the Piers-Harris Children's Self-Concept Scale, Second Edition (PHCSS-2), at baseline (T0) and post-intervention (T1). Intervention effects were analyzed using ANCOVA, controlling for pre-test scores. Qualitative data were collected through semi-structured interviews, classroom observations, volunteer logs, and reflective writings, and analyzed using thematic analysis.</p><p><strong>Results: </strong>After adjusting for baseline differences, the intervention group demonstrated significantly greater improvements in total self-concept than the control group (<i>p</i> < 0.001), with a medium between-group effect (ηp² = 0.051) and a large within-group pre-post effect (<i>d</i> = 1.16). Qualitative findings identified three proximal mechanisms: (1) embodied role-taking that fostered competence-based identity reappraisal, (2) emotionally safe spaces that expanded expressive and gender flexibility, and (3) collaborative peer interaction that strengthened belonging and perceived social support.</p><p><strong>Discussion: </strong>Short, intensive DIE programs may offer a feasible, culturally adaptable, school-based strategy to enhance self-concept and social connectedness in rural contexts. By combining structured role engagement with reflective integration, DIE appears to activate both individual and relational pathways of psychosocial development. Limitations include non-random assignment, single-site implementation, and absence of long-term follow-up. Future research should incorporate randomized designs and longitudinal assessments to evaluate sustainability and scalability.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1812030"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing PrEP adoption in sexual health clinics within Ontario's public health system: a qualitative study using the Consolidated Framework for Implementation Research (CFIR).","authors":"Emma Nagy, Beatriz Alvarado, Carmela Rapino, Oluwatoyosi Kuforiji, Nicholas Cofie, Bradley Stoner, Nancy Dalgarno, Pilar Camargo-Plazas, T Hugh Guan, Jorge Martinez-Cajas","doi":"10.3389/fpubh.2026.1760989","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1760989","url":null,"abstract":"<p><strong>Introduction: </strong>HIV pre-exposure prophylaxis (PrEP) utilization in Ontario is concentrated in two large urban centers, resulting in geographic and structural inequities in access. Little is known about adoption in Public Health Sexual Health Clinics (PHSHCs) or the implementation factors influencing uneven uptake. This study aimed to: (1) assess the extent of PrEP adoption in PHSHCs; (2) identify barriers and facilitators affecting implementation; and (3) explore factors supporting successful and equitable PrEP implementation.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 18 staff and managers across 12 PHSHCs. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis, while the Health Equity Implementation Framework (HEIF) was applied to examine structural, organizational, and socio-cultural influences on PrEP access. Clinics were categorized into five adoption categories using the diffusion of innovations model. A content analysis was done to identify common facilitators, barriers, and equity-relevant factors distinguishing clinics at different adoption categories.</p><p><strong>Results: </strong>PrEP adoption varied widely across clinics. Two were innovators, providing on-site PrEP; three were early adopters with formal referral pathways; four were early majority, relying on informal referrals; and five lacked established services. Facilitators included strong PrEP knowledge and beliefs, inter-organizational partnerships, and supportive organizational cultures. Key barriers were post-COVID-19 service recovery constraints, limited external prescribers, insufficient medication funding, constrained internal capacity, and social individual-level barriers. Differences between advanced and less advanced adopters reflected perceived relative advantage of PrEP within PHSHC mandates, workflow integration complexity, and the presence of a supportive learning climate. Equity-focused analysis highlighted obstacles affecting clients experiencing socioeconomic disadvantage, rurality, stigma, and limited healthcare navigation capacity.</p><p><strong>Conclusion: </strong>This study highlights that inequities in PrEP access across Ontario PHSHCs are shaped not only by clinic readiness but also by broader structural and organizational conditions. These findings advance understanding of PrEP adoption outside large urban centers, identifying barriers and strategies to expand services and enhance implementation readiness. Using the CFIR and HEIF, we delineated factors to support adoption in early-stage PHSHCs while learning from those with successful integration. Addressing these factors will be critical to expanding equitable access to PrEP and advancing HIV prevention goals.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1760989"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability of the sleep health index among community-dwelling older adults.","authors":"Miao Miao, Nan Zhang, Bingqian Zhu, Jingyao Yu, Ying Chen, Subiyinuer Maimaiti, Ping Yan","doi":"10.3389/fpubh.2026.1651175","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1651175","url":null,"abstract":"<p><strong>Background: </strong>Sleep health represents a positive and multidimensional framework that extends beyond the absence of sleep disturbances or insufficient sleep duration. Despite its clinical relevance, empirical research on sleep health in older adults remains limited. The Sleep Health Index (SHI) was developed to comprehensively evaluate sleep health. This study aimed to validate the Chinese version of the SHI among community-dwelling older adults.</p><p><strong>Methods: </strong>This is a cross-sectional design. Older adults aged 60 years and above were recruited (<i>n</i> = 274), and a subset (<i>n</i> = 60) was invited to complete the test-retest survey after a two-month interval. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), 15-Item Geriatric Depression Scale (GDS-15), comorbidity burden (aCCI), and handgrip strength (HGS) were administered to assess sleep health and related health indicators. The SHI-C was evaluated for structural, convergent, concurrent, known-group validity, internal consistency, and test-retest reliability.</p><p><strong>Results: </strong>Exploratory factor analysis supported a three-factor structure, which was subsequently confirmed by confirmatory factor analysis (i.e., sleep quality, sleep duration, and disordered sleep), consistent with the original validation study. Parallel analysis further confirmed the three-factor solution. Measurement invariance testing across gender supported full metric and scalar invariance. The SHI-C demonstrated concurrent validity through strong negative correlations with both the PSQI (<i>r</i> = -0.624) and ISI (<i>r</i> = -0.696). It also showed weak but significant associations with the ESS (<i>r</i> = -0.328) and the GDS-15 (<i>r</i> = -0.329). Known-group validity was supported as participants with chronic diseases, insomnia, or depression had significantly lower SHI-C scores (<i>p</i> < 0.001). Furthermore, the total score of SHI-C exhibited a significant negative correlation with the aCCI (<i>r</i> = -0.302) and a significant positive correlation with HGS (<i>r</i> = 0.171), supporting its association with key objective health indicators. The SHI-C showed acceptable internal consistency (Cronbach's <i>α</i> = 0.775) and test-retest reliability (intraclass correlation coefficient = 0.784).</p><p><strong>Conclusion: </strong>The SHI-C is a reliable and valid measurement for assessing sleep health in community-dwelling older adults. These findings suggest its potential utility for the sleep health assessment among this population, thereby contributing to the geriatric care enhancement.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1651175"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe outcomes of individual or multiple respiratory viral infections in a large national healthcare system, 2022-2023.","authors":"Janet M Grubber, Ikwo K Oboho, Kaitlin N Swinnerton, Theodore C Feldman, Nhan V Do, Nathanael R Fillmore, Westyn Branch-Elliman, Paul A Monach","doi":"10.3389/fpubh.2026.1808528","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1808528","url":null,"abstract":"<p><strong>Background: </strong>Routine testing for SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) was deployed in a large US healthcare system in 2022-2023. This policy allowed identification of a large cohort of co-infected patients and comparison of outcomes without confounding by testing indication.</p><p><strong>Methods: </strong>Patients \"triple-tested\" in the US Veterans Health Administration were classified by infection status in the first week of a positive test. Multivariable logistic regression was used to estimate associations of different infections with hypoxemia (SpO₂ < 90% or supplementary oxygen >2 L/min) or death, separately, expressed as adjusted odds ratios (aOR) with 95% confidence intervals (CI).</p><p><strong>Findings: </strong>Among 835,987 triple-tested patients, 170,592 (20.4%) tested positive for SARS-CoV-2 alone, 30,454 (3.6%) influenza alone, 13,207 (1.6%) RSV alone, and 1,300 (0.2%) multiple viruses. Frequencies of hypoxemia and death were 8.0 and 1.9% with SARS-CoV-2, 7.7 and 0.8% with influenza, 9.3 and 1.1% with RSV, 8.7 and 1.5% with multiple viruses, and 8.9 and 2.0% with all-negative tests. After adjustment for age and immune-suppressive drugs, odds of hypoxemia were slightly higher with influenza (aOR = 1.12, CI 1.06-1.17), lower with RSV (aOR = 0.91, CI 0.85-0.97), and not significantly different with multiple viruses (aOR = 1.09, CI 0.89-1.34), relative to SARS-CoV-2 alone. Odds of death were lower with influenza (aOR = 0.52, CI 0.46-0.60) or RSV (aOR = 0.51, CI 0.43-0.60) and no different with multiple infections (aOR = 0.86, CI 0.54-1.36), relative to SARS-CoV-2 alone.</p><p><strong>Interpretation: </strong>Co-infection was rare (0.2% of tested cases), with incidences of hypoxemia and death similar to SARS-CoV-2 alone. Death was less frequent with influenza or RSV than SARS-CoV-2.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1808528"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic reward-penalty incentives and occupational health governance: an evolutionary game analysis with public health implications.","authors":"Yanan Li, Debin Fang, Tong Lou, Luping Jiang","doi":"10.3389/fpubh.2026.1808355","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1808355","url":null,"abstract":"<p><strong>Introduction: </strong>Occupational health risks remain a significant public health concern in environmentally intensive industries, where inadequate regulatory enforcement and weak enterprise compliance can result in persistent workplace health hazards and potentially preventable long-term health burdens for workers. Understanding how environmental regulatory incentives influence enterprise occupational health management is essential for improving occupational health governance and generating public-health-relevant benefits.</p><p><strong>Methods: </strong>This study developed an evolutionary game framework to examine the strategic interactions between local regulators and enterprises under environmental regulation, with a focus on occupational health governance. By comparing static and state-dependent reward-penalty incentive structures, the model explored how different regulatory designs shaped enterprises' investment in occupational health protection over time under imperfect monitoring.</p><p><strong>Results: </strong>The analysis showed that static reward-penalty schemes were insufficient to sustain long-term active occupational health governance. In contrast, dynamically adjusted penalty mechanisms were more effective in promoting proactive enterprise investment in occupational health management and stabilizing long-term occupational health governance. The findings further indicate that enterprise behavioral responses are highly sensitive to not only the structure and intensity of regulatory incentives, but also the monitoring probability that passive governance can be detected under strict supervision.</p><p><strong>Discussion: </strong>These results highlight the importance of incentive design in linking environmental regulation with occupational health governance under imperfect monitoring. By demonstrating how regulatory incentives can improve occupational health governance and strengthen worker health protection in high-risk industrial settings, this study provides policy-relevant insights with broader public health relevance.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1808355"},"PeriodicalIF":3.4,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}