Frontiers in Public Health最新文献

{"title":"An expert-informed framework of school conditions potentially supporting adolescent physical activity habits: a three-stage consultation in China.","authors":"Shaojuan Hu, Yi Su, Dong Han, Liting Li, Ran Wang, Yihang Liu, Jie Xiong, Xinyuan Li","doi":"10.3389/fpubh.2026.1962254","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1962254","url":null,"abstract":"<p><strong>Background: </strong>Schools can provide conditions that may support repeated physical activity, but expert endorsement of those conditions does not demonstrate habit formation. This study developed an expert-informed content framework for Chinese adolescents aged 12-18 years.</p><p><strong>Methods: </strong>A three-stage, Delphi-informed consultation comprised qualitative elicitation and item development, one full quantitative rating stage, and targeted review of proposed final decisions. Of 25 experts approached, 23, 18, and 16 were reported to complete Stages 1, 2, and 3, respectively. The reported analyses used 16 complete cases. Seven earlier-stage contributors withdrew consent; their data are excluded and recorded as no longer retained, preventing full-stage reanalysis. Five theory-informed domains guided the interviews; a predominantly deductive qualitative analysis using a codebook specified before the interviews supported indicator refinement rather than independently establishing their structure. Forty-five literature-derived provisional indicators and five interview-derived additions were consolidated into 34 candidates. Importance, feasibility, and clarity were rated on five-point scales. The importance-based retention rule specified before rating combined a mean ≥4.00, coefficient of variation ≤0.20, and ≥80% ratings of 4 or 5.</p><p><strong>Results: </strong>Thirty-three candidates met the retention rule; SPC9 did not. The retained indicators received uniformly high importance endorsement, but concordance in relative rankings was limited (Kendall's W: importance 0.115, feasibility 0.160, clarity 0.163). Individual-level Stage 3 confirmation distributions were not available in the submitted analytic record, and quantitative convergence across stages was not assessed. The exploratory, sample-relative importance-feasibility matrix assigned 10, 5, 10, and 8 indicators to its four quadrants; 11 of 33 indicators changed quadrant in at least one leave-one-expert-out analysis.</p><p><strong>Conclusion: </strong>The resulting curricular, extracurricular, peer, cultural, and institutional indicators specify school conditions that experts considered potentially relevant to habit support. The findings do not establish strong inter-expert consensus, a validated measurement instrument, actual habit formation, or causal effects. Complete-case selection, limited stakeholder representation, and incomplete process records restrict interpretation. More complete source documentation, stakeholder co-design, and prospective measurement and implementation studies are needed.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1962254"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244036","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":"Development and evaluation of an intelligent centralized transportation dispatching information system in a large tertiary hospital: a single-center retrospective observational study.","authors":"Mengjiao Zhang, Jin Xue, Rui Shi","doi":"10.3389/fpubh.2026.1949019","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1949019","url":null,"abstract":"<p><strong>Background: </strong>Traditional hospital central transportation adopts manual telephone dispatch, bringing high communication costs, poor traceability, mismatched resources and weak quality control, which impede clinical efficiency and patient safety. This study designs an intelligent dispatching system integrating RFID, IoT and mobile terminals, and assesses its performance in a large tertiary hospital.</p><p><strong>Methods: </strong>A single-center retrospective observational study was carried out at West China Hospital. The system combines RFID-IoT real-time positioning and multi-objective scheduling algorithms, with two-way connections to HIS, examination platforms and PDAs. We analyzed system data of transport tasks, time metrics, tool utilization and patient satisfaction from Jan 1 to Jun 30, 2026 (post-implementation). Pre-2025 non-digital records were only used for qualitative reference; incomplete raw data excluded formal statistical comparison and inter-period hypothesis testing. Continuous variables were median (interquartile range); categorical variables <i>n</i> (%).</p><p><strong>Results: </strong>Over 6 months, the system handled four core transport scenarios. Post-implementation median single-task dispatch time reached 0.57 (0.31-0.82) min, and emergency examination transport time 24.3 (13.41-32.87) min. Among 24,545 tool records, independent ambulation (54.5%) and wheelchairs (32.0%) made up 86.5% of transports, stretchers (6.5%) and hospital beds (7.0%) for critical and postoperative patients accounted for the rest 13.5%. In 5,508 surveyed inpatients, overall transport satisfaction hit 97.78%, with item-level satisfaction rates ranging from 95.51% (staff attentiveness) to 98.14% (staff appearance/professional grooming).</p><p><strong>Conclusion: </strong>This single-center retrospective evaluation shows the RFID/IoT intelligent dispatching system achieves brief dispatch & transport durations and high patient satisfaction. Without matched complete pre-implementation baseline data, results only describe post-launch performance instead of causal improvement evidence. Prospective multi-center or interrupted-time-series studies with standardized baselines are required to verify its incremental value.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1949019"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244122","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":"The psychological configuration of suicidal ideation in depressive disorder: an integrative and predictive approach.","authors":"Sebastian Mihai Armean, Codruţa Alina Popescu, Bogdan Florin Covaliu, Bogdana Adriana Năsui, Roxana Şipoş, Romulus Dan Nicoară","doi":"10.3389/fpubh.2026.1958636","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1958636","url":null,"abstract":"<p><strong>Background: </strong>Suicidal ideation in depression is increasingly understood as a multidetermined phenomenon shaped by emotional distress, emotion regulation deficits, maladaptive coping, and contextual vulnerability. The present study examined the psychological correlates and predictors of suicidal ideation and tested the mediating roles of emotion regulation difficulties and quality of life in adults with depressive disorder.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 172 adults with depressive disorder. Participants completed standardized measures of suicidal ideation and suicidal behavior (C-SSRS), depressive severity (MADRS), emotional distress (DASS-21R), emotion regulation difficulties (DERS-SF), coping strategies (Cognitive Emotion Regulation Questionnaire [CERQ] and Strategic Approach to Coping Scale [SACS]), and quality of life (QOLI). Spearman correlations, hierarchical regression analyses, and mediation models with bootstrapping (5,000 samples) were performed.</p><p><strong>Results: </strong>Suicidal ideation was positively associated with depressive severity, anxiety, stress, several dimensions of emotion regulation difficulties, and maladaptive coping strategies, and negatively associated with quality of life. Hierarchical regression analyses identified depressive severity and quality of life as the most robust contributors in the first model, while maladaptive behavioral and cognitive coping strategies contributed additional explanatory value in the second model. Mediation analyses indicated that emotion regulation difficulties significantly mediated the association between depressive severity and suicidal ideation, and that a significant serial indirect effect also operated through reduced quality of life. In both models, the direct effect of depressive severity remained significant, indicating partial mediation.</p><p><strong>Conclusions: </strong>Suicidal ideation in depressive disorder is associated with a broader psychological configuration involving emotional distress, emotion regulation difficulties, maladaptive coping, and diminished quality of life. These findings support an integrative, multivariable approach to understanding suicidal ideation in depression and highlight clinically relevant psychological factors that may inform assessment and intervention.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1958636"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243965","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":"Artificial intelligence applications in exercise and physical activity for public health: a scoping review.","authors":"Sinem Parlakyıldız, Funda Koçak","doi":"10.3389/fpubh.2026.1888805","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1888805","url":null,"abstract":"<p><strong>Background: </strong>Physical activity and exercise are important components of public health strategies for preventing and managing chronic conditions and promoting health and quality of life. Advances in artificial intelligence (AI) have broadened its applications in this field, from personalized interventions and monitoring to risk prediction, professional decision support, and planning. This scoping review aimed to map the literature on AI-based exercise and physical activity applications from a public health perspective, characterize their functional roles, and examine the scope and maturity of the research.</p><p><strong>Methods: </strong>This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and JBI methodological guidance. Web of Science, Scopus, and PubMed were searched for eligible studies published between 2015 and 2025. Two Reviewers independently conducted title and abstract screening and full-text assessment, resolving disagreements by consensus. Of 612 records identified, 601 remained after duplicate removal and 24 studies met the eligibility criteria. The included studies were characterized by publication year, country, study design, AI technology and function, and stage of evidence development. Key findings were synthesized across the identified functional categories.</p><p><strong>Results: </strong>Among the included studies, publication activity was highest in 2024, while China accounted for the largest number of studies. Five functional categories were identified: Intervention Delivery or Adaptation, Monitoring or Assessment, Prediction or Risk Stratification, Professional Decision Support, and System and Environmental Planning. Research maturity differed across these functions. Technical development and validation studies often reported promising performance, whereas intervention findings were less consistent and did not always show additional benefit over comparison conditions. Many studies remained at the model-development, technical-validation, feasibility, or pilot stage.</p><p><strong>Conclusion: </strong>AI is being used across several functions in exercise and physical activity, although evidence of consistent clinical or public health benefit remains limited. Current findings support its complementary use in personalization, monitoring, prediction, and professional decision support; the available findings do not justify autonomous clinical decision-making. Further controlled studies, external validation, longer follow-up, and real-world evaluation are needed to establish whether technical capabilities translate into sustained physical activity and meaningful health outcomes. Implementation should also account for professional oversight, data protection, and the needs of diverse populations.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1888805"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243970","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":"Dynamics of Canadian perceptions of low-dose radiation following science-based educational communication sessions.","authors":"Francisco Javier Sahagún-Aguilar, Margot Hurlbert","doi":"10.3389/fpubh.2026.1976699","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1976699","url":null,"abstract":"<p><p>This study examined whether participation in science-based Educational Communication Sessions (ECS) involving infographic-based materials, scientist-attributed information, and focus-group discussion was associated with changes in public perceptions of low-dose radiation (LDR). Surveys conducted in Alberta, Saskatchewan, and Ontario measured participants' self-reported perceptions before and immediately after participation in ECS involving two infographic formats: one explaining LDR through everyday analogies and another describing safety protocols in hospitals and nuclear power plants. Binary logistic regression was used to explore associations between demographic characteristics and whether participants reported improved LDR perceptions following participation in the ECS. Participants generally reported more favorable perceptions of LDR and high levels of trust in scientists following participation in the ECS. Participants attending sessions involving the analogy-based infographic showed more consistent favorable shifts across provinces, whereas larger favorable shifts were observed in Saskatchewan and Ontario than in Alberta following sessions involving the safety-focused infographic. These findings suggest that science-based ECS incorporating infographic materials may be associated with immediate self-reported improvements in LDR perceptions. Given the exploratory design, the absence of a control group, the modest sample size, and the non-representative sample, the findings should be interpreted cautiously as preliminary evidence to inform future research on science communication and public perceptions of low-dose radiation.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1976699"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244127","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":"Rabies immunoglobulin utilization and delayed presentation following category III rabies exposure: a 10-year retrospective study in Hangzhou, China.","authors":"Jing Wang, Weiwei Cai, Jiaxin Chen, Jing Chen, Wanli Yang","doi":"10.3389/fpubh.2026.1916685","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1916685","url":null,"abstract":"<p><strong>Background: </strong>Rabies is an almost invariably fatal, vaccine-preventable zoonosis. Rabies immunoglobulin (RIG) is recommended for Category III exposures, yet real-world RIG utilization remains poorly characterized. This study examined temporal trends and factors associated with RIG utilization and delayed presentation among Category III exposure patients in China.</p><p><strong>Methods: </strong>A retrospective study was conducted using clinical records of Category III exposure patients presenting to a high-volume rabies prevention clinic in Hangzhou, China, from 2015 to 2024. Calendar year 2018 was treated as a temporal reference year for descriptive comparison. Multivariable logistic regression identified factors associated with RIG non-administration and delayed presentation (>24 h post-exposure).</p><p><strong>Results: </strong>A total of 14,270 eligible cases were analyzed. Overall RIG utilization was 37.54%, declining from 53.09% in 2015 to 7.14% in 2022. RIG non-administration was independently associated with male sex (OR 1.20, 95% CI 1.11-1.29), age 18-59 years (OR 3.25, 95% CI 2.95-3.59), exposure at home (OR 1.47, 95% CI 1.33-1.63), presentation in 2018 (OR 2.38, 95% CI 2.01-2.82) and in 2019-2024 (OR 4.49, 95% CI 3.96-5.09), and delayed presentation (OR 1.43, 95% CI 1.32-1.55). The overall delayed presentation rate was 34.47%; independent risk factors included age 18-59 years (OR 1.37, 95% CI 1.24-1.52), exposure at home (OR 1.57, 95% CI 1.41-1.74), and presentation in 2018 (OR 1.61, 95% CI 1.40-1.86) and in 2019-2024 (OR 1.77, 95% CI 1.62-1.94).</p><p><strong>Conclusion: </strong>RIG utilization was low and showed marked temporal variation during 2015-2024, and one third of patients presented more than 24 h after exposure. Both outcomes were concentrated among working-age adults and domestic exposure settings. These findings describe service utilization patterns and identify subgroups in which gaps in PEP delivery are concentrated; targeted risk communication and routine monitoring of RIG utilization and presentation timeliness are needed.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1916685"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243977","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":"Bone health, obesity, and multimorbidity risk among teachers in under-resourced South African public primary schools: results from a cross-sectional DXA study.","authors":"Nandi Joubert, Larissa Adams, Harald Seelig, Emma Cora Gardiner, Riaan van de Venter, Jan Degen, Danielle Dolley, Ivan Müller, Siphesihle Nqweniso, Nicole Probst-Hensch, Peter Steinmann, Uwe Pühse, Rosa du Randt, Markus Gerber, Jürg Utzinger, Cheryl Walter","doi":"10.3389/fpubh.2026.1794604","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1794604","url":null,"abstract":"<p><strong>Introduction: </strong>In low- and middle-income countries, adverse body composition risk is increasingly driven by structural determinants, including rapid urbanisation, nutrition transitions, and reduced opportunities for physical activity. Quantifying and interpreting bone, fat and lean mass risks require appropriate measurement and context-sensitive thresholds to detect subclinical vulnerability in under-resourced settings. Few studies, particularly from Africa, have quantified how these risks intersect and cluster with cardiometabolic and socio-demographic determinants. The purpose of this study was to characterise body composition profiles, estimate the prevalence and co-occurrence of risk phenotypes and examine their distribution across health determinants.</p><p><strong>Methods: </strong>The study was carried out in under-resourced public schools in Gqeberha, Eastern Cape, South Africa, as part of the <i>KaziBantu</i> project (ISRCTN18485542). A school-based workplace health intervention was conducted, using cross-sectional assessments. We employed dual-energy X-ray absorptiometry (DXA), assessed metabolic indicators, behavioural indicators (alcohol and tobacco use, device-measured physical activity, handgrip strength), and obtained demographic and medical data.</p><p><strong>Results: </strong>Among 136 apparently healthy teachers (85% women; age 21-72 years; mean = 47 years; standard deviation = 11 years), body composition risk was prevalent: fat mass risk 91.8% (<i>n</i> = 123/134; 95%CI 85.8-95.8%), lean mass risk 15.7% (<i>n</i> = 21/134; 95%CI 10-23%) and bone mass risk 29.9% (<i>n</i> = 40/134; 95%CI 22.3-38.4%). The most frequent combined phenotype was bone-fat risk (27.6%; <i>n</i> = 37; 95%CI 20.2-36%), while 6% (<i>n</i> = 8; 95%CI 2.6-11.4%) exhibited all three risks concurrently. Metabolic syndrome criteria were met in 53% (<i>n</i> = 70; 95%CI 44.2-61.8%) of teachers, and adverse risk phenotypes were associated with elevated multimorbidity and poorer metabolic health.</p><p><strong>Conclusion: </strong>This is the first study from South Africa's Eastern Cape to report DXA-derived body composition profiles. Body composition risks and multimorbidity were prevalent, with likely substantial impacts on quality of life. Protecting teachers' health will require multi-level strategies, including workplace-based screening with low-cost tools (e.g., bioelectrical impedance), culturally responsive prevention such as targeted weight-bearing and resistance activity, and action on structural inequities, such as more equitable resourcing across schools to reduce occupational strain and stronger pathways that turn teachers' existing health coverage into timely screening and treatment. These strategies aim to safeguard well-being and sustain teachers' pivotal role in educating future generations.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1794604"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244048","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":"Leadership, burnout, and organizational mental health: a neuroscience-informed perspective.","authors":"Gisele Kitayama, Federico Gerardo de Cosio","doi":"10.3389/fpubh.2026.1881851","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1881851","url":null,"abstract":"<p><p>This article argues that the persistent burden of burnout reflects a fundamental conceptual problem-burnout continues to be framed primarily as an individual condition rather than as an occupational phenomenon shaped by interacting structural, organizational, and leadership conditions. Burnout has emerged as a major occupational health challenge. In a 2024 survey across eight predominantly high and upper-middle-income countries, 48% of respondents reported currently grappling with burnout. Separately, depression and anxiety cost the global economy approximately one trillion dollars annually in lost productivity. Drawing on evidence from neuroimaging, stress biology, cognitive neuroscience, and organizational research, this article examines plausible pathways through which leadership behavior may influence conditions that contribute to or protect against burnout, including social threat-reward processing, cognitive flexibility, emotional intelligence, psychological safety, emotional contagion, and stress-related neurobiological responses. Among physicians, burnout has been associated with depression and anxiety, while evidence regarding substance abuse is less consistent. These proposed mechanisms are proximal and potentially modifiable, but operate within broader structural conditions that constrain or enable their effects. Human-centered work design and neuroleadership-informed leadership practices are proposed as complements to broader structural interventions, with implications for health systems, workforce sustainability, and policy design.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1881851"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244050","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":"Large language models as sources of diabetic retinopathy patient education: a comparative evaluation of safety, health information quality, and readability.","authors":"Zhiqi Chen, Wen Liu, Jing Zhang, Tian Zheng, Ying Li, Qing Bao, Pingting Ji, Hongmei Yao, Ying He","doi":"10.3389/fpubh.2026.1945318","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1945318","url":null,"abstract":"<p><strong>Background: </strong>Patients increasingly use large language models (LLMs) to seek medical information, but their performance in answering diabetic retinopathy (DR) questions remains insufficiently characterized.</p><p><strong>Objective: </strong>To evaluate the safety, accuracy, patient-centered communication, information quality, transparency, and readability of diabetic retinopathy information generated by widely accessible large language models.</p><p><strong>Methods: </strong>Fifty standardized DR patient questions were submitted to ChatGPT, Gemini, DeepSeek, Doubao, Copilot, and Perplexity. Responses were independently evaluated by five raters using guideline-based reference answer elements. Rater-based outcomes included Safety, Accuracy, Empathy, DISCERN, EQIP, JAMA benchmark criteria, and Global Quality Score (GQS). Readability was assessed using the Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Gunning Fog Index, SMOG, and Flesch Reading Ease Score. Inter-rater agreement and between-model differences were analyzed using appropriate agreement statistics and paired nonparametric tests.</p><p><strong>Results: </strong>Inter-rater agreement was moderate for Safety (Fleiss' κ = 0.581) and good for non-binary outcomes, with ICC (2,1) values ranging from 0.806 to 0.870. Most responses were classified as safe, with safe response rates ranging from 86.0 to 94.0%, and no significant between-model difference was observed. Accuracy scores were generally high across models, although between-model differences were statistically significant with a small effect size. Empathy varied more noticeably, with Copilot scoring highest and Doubao and Perplexity scoring lower. Perplexity achieved the highest DISCERN and JAMA scores, while Copilot performed best on EQIP. GQS differences were small. Readability differed significantly across models, with Gemini generally producing the most readable responses; however, all models exceeded the recommended sixth-grade reading level, and all Flesch Reading Ease Scores were below the recommended threshold.</p><p><strong>Conclusion: </strong>No single LLM performed best across all domains. Although the evaluated models generally provided safe and accurate responses to DR patient questions, limitations remained in safety escalation, empathy, transparency, and readability. LLM-generated DR information may support general patient education but should not replace professional ophthalmic consultation.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1945318"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244052","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":"Equity in access through a digital hospital appointment system: a reflexive thematic analysis of frontline registration staff perspectives in Türkiye.","authors":"Habibullah Akıncı, Sema Dalkılıç","doi":"10.3389/fpubh.2026.1958637","DOIUrl":"https://doi.org/10.3389/fpubh.2026.1958637","url":null,"abstract":"<p><strong>Introduction: </strong>Digital appointment systems increasingly mediate access to healthcare. However, not all individuals benefit equally from these systems, and the experiences of the frontline staff responsible for operating them remain underexplored. This qualitative study examined how hospital registration staff perceive access inequities, exercise discretion when formal procedures fail to meet patients' needs, and understand equality and equity.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 20 frontline registration staff working in two public hospitals in Central Anatolia, Türkiye. Data were analyzed using reflexive thematic analysis, combining semantic and latent interpretation. Coding was conducted primarily in a data-driven manner, while the multidimensional model of access, street-level bureaucracy theory, and a social justice perspective informed the analytical interpretation.</p><p><strong>Results: </strong>The analysis generated five interconnected themes. The findings indicate that formally equal access to the appointment system does not translate into substantively equal opportunities to obtain care. Differences in digital proficiency, social support, transportation access, and temporal flexibility shape patients' ability to navigate the system, while social connections may provide additional informal access advantages. Staff exercise discretion to assist patients when formal procedures prove insufficient. However, such assistance may make access dependent on staff members' willingness and capacity to intervene, as well as on organisational approval and available resources. Support for disadvantaged patients is commonly understood not as an institutional right but as an act of conscience and humanity.</p><p><strong>Discussion: </strong>Overall, the findings reveal a process of conscience-based repair of structurally unequal access: staff attempt to reduce inequities through individual efforts, while the underlying structural conditions remain unchanged. When equitable access is not institutionally guaranteed, responsibility for compensating for these inequalities is partly transferred to frontline staff. Transparent, consistent, and rights-based institutional arrangements are therefore needed to ensure equitable access.</p>","PeriodicalId":12548,"journal":{"name":"Frontiers in Public Health","volume":"14 ","pages":"1958637"},"PeriodicalIF":4.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244137","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}