2026-04-02
Bo Yang, Fatma Ahmed Hassan, Waqar Ahmad, Valentin Marian Antohi, Costinela Fortea, Cătălin Pleșea Condratovici
Air pollution (AIRP) remains a critical public health and environmental challenge in developing Asia, where rapid industrialization and fossil fuel dependence continue to undermine population health and longevity. This study examines the impact of AIRP on life expectancy (LIFE) and investigates whether renewable energy adoption moderates this relationship. AIRP is proxied by carbon dioxide (CO₂) and nitrous oxide (N₂O) emissions, which capture pollution-intensive energy systems, industrial activity, and agricultural practices that jointly generate health-damaging co-pollutants, particularly in contexts where consistent long-term data on ambient pollutants such as PM₂.₅ are unavailable. Using balanced panel data for 30 developing Asian countries from 2000 to 2023, we apply fixed effects, system GMM, and Lewbel IV-2SLS estimators to address unobserved heterogeneity, endogeneity, and persistence in health outcomes, while accounting for key socioeconomic and healthcare-related confounders. The results indicate that higher CO₂ and N₂O emissions significantly reduce LIFE, with CO₂ exerting a relatively stronger adverse effect. Importantly, greater renewable energy adoption weakens the negative association between emissions and LIFE, suggesting a mitigating role of clean energy transitions. While acknowledging that LIFE is influenced by multiple structural factors beyond AIRP, the findings provide robust evidence that renewable energy expansion can contribute to improved environmental quality and long-term health outcomes. These results highlight the potential co-benefits of clean energy policies for environmental sustainability and public health, offering cautious and policy-relevant insights aligned with SDG 3, SDG 7, and SDG 13.
DOI: 10.3389/fpubh.2026.17244022026-04-02
Bahia Galal Abd Elrazik Siam, Khalda Mnawer M. Alshammari, Bassam Shayhan F. Alshammari, Aiman Mojidea M. Alshammari, Saad Majed Saad Alderaan, Saad Thamer Alshammari, Abdulellah Nasser Abdulaziz Alshammari, Omar Nasser Saud Almaslamani, Salman Amish Ayad Alshammari, Wadha Habeeb Almatrafy, Faisal Dakhilallah J. Alruwaili, Abdulaziz Fayez L. Alruwaili, Jawaher Jaza M. Alruwaili, Mashael Musallam Alahmadi, Mona Lahilam Alsamah Aldoghmani, Wejdan Sager S. Alrwaili, Mashal Khaled Alrowily, Hamdah Falgi Basheer Alruwaili
BackgroundCatheter-associated urinary tract infection (CAUTI) is a leading healthcare-associated infection worldwide, associated with increased morbidity, prolonged hospitalization, higher costs, and antimicrobial resistance. Nurses play a critical role in prevention through evidence-based catheter insertion, maintenance, and timely removal.AimTo assess factors associated with knowledge, attitudes, and preventive practices regarding CAUTI among nurses in Aljouf City, Saudi Arabia.MethodsA descriptive cross-sectional study was conducted among 184 registered nurses in governmental hospitals in Aljouf City using a structured questionnaire on demographics, knowledge, attitudes, and practices (KAP) toward CAUTI prevention. Data were analyzed with descriptive statistics, independent t-tests, ANOVA, and Spearman’s correlations.ResultsOverall, 77.7% of nurses had good knowledge, 84.8% showed positive attitudes, and 84.8% had adequate preventive practices. Knowledge scores differed significantly by years of experience (p = 0.001), urinary catheter (UC) insertion frequency (p < 0.001), and CAUTI guideline awareness (p = 0.002). Attitudes varied by hospital (p = 0.014), ward (p = 0.007), and UC insertion frequency (p = 0.032). Practices differed by hospital (p = 0.006), UC insertion frequency (p = 0.009), and guideline awareness (p = 0.049). Spearman’s correlations showed weak knowledge-attitude (r = 0.231, p = 0.002), moderate knowledge-practice (r = 0.446, p < 0.001), and strong attitude-practice (r = 0.525, p < 0.001) associations. Multivariable logistic regression showed that attitude was the strongest independent factor associated with adequate practice (AOR = 0.251, p = 0.005).ConclusionThis study demonstrates generally favorable knowledge, attitudes, and practices toward CAUTI prevention among Al-Jouf nurses, with moderate correlations, attitudes showed the strongest association with preventive practices.
DOI: 10.3389/fpubh.2026.17815752026-04-02
Min Yang, Ying Che, Jiaqi Xu, Xueqian Ma, Hongbo Chen, Baohua Li
ObjectiveThe study aimed to examine the relationship between lifestyle, night shift pattern, mental health and nurses’ metabolic diseases.MethodsWe included 910 nurses from 2018 to 2022. The Growth mixture model was used to identify the trajectories of metabolic diseases among nurses. And multinomial logistic regression was used to examine the relationship between lifestyle, night shift pattern, mental health and the trajectories of metabolic diseases.ResultsThree distinct trajectories were identified: Maintaining-Low, Chronically-High group, Maintaining-Low group. Compared to the Maintaining-low group, the correlates of Chronically-high group were lack of dietary preference for vegetables and exercise. Low depression scores, high anxiety scores, night shift pattern with a slow increase in metabolic diseases.ConclusionThe changes of the number of metabolic diseases among nurses in China are heterogeneous. Lack of dietary preference for vegetables and exercise are significantly related to nurses’ metabolic disorders. Among nurses with high initial health level, the correlates of the increase in the number of metabolic diseases are not unhealthy lifestyles, but mental health and night shift pattern.
DOI: 10.3389/fpubh.2026.17435162026-04-02
Sreya Pulakkat Warrier, Venkatesh Narasimhan, Eline Meijer, Yukino Gütlin, Oliver Nolte, Balaji Veeraraghavan, Adrian Egli
Antimicrobial resistance and emerging infectious diseases remain significant challenges for global health, driving a need for advanced technological solutions. Artificial Intelligence (AI) expanded opportunities in clinical microbiology, infectious diseases, and public health by harnessing vast, structured datasets. Despite impressive analytical capabilities, the clinical integration of AI-based applications is hindered by its opacity. The “black-box” aspect undermines adoption into healthcare workflows. Explainable AI (XAI) methods, including intrinsically interpretable models and post-hoc interpretability tools, such as SHAP, LIME, and Grad-CAM, can address these transparency challenges. This narrative review is intended to be a primer for the interested clinician. It systematically evaluates recent advancements in XAI in the context of clinical applications for clinical microbiology, infectious diseases, and public health. We further discuss the ethical and regulatory landscape shaping AI adoption, including the critical role of open, quality-controlled data, robust performance metrics, and clear interpretability to ensure safe and effective clinical implementation. Lastly, we propose future directions, emphasizing interdisciplinary collaboration, international data-sharing initiatives, and tailored AI literacy training to facilitate trustworthy, equitable, and impactful use of AI in clinical microbiology and infectious diseases.
DOI: 10.3389/fpubh.2026.17769222026-04-02
Su Lin Yeo, Angel Lee, Raymond Han Lip Ng, May O. Lwin, Yumin Lin
IntroductionDespite the growing demand for palliative care, this specialized medical care remains severely underutilized, with almost 50% of countries worldwide lacking access. Given that misperceptions and stigma continue to hinder progress in healthcare policy, this study aims to examine the relationships between palliative care knowledge, attitudes, and receptiveness to better understand how public health communication can enhance awareness and understanding of the topic in Singapore. Applying the adapted knowledge-attitude-practice (KAP) model, it further extends theory by examining the moderating role of media information-seeking between knowledge and receptiveness.MethodsMixed-mode surveys involving 1,226 participants (926 online and 300 in-person respondents), representing various population groups, were carried out in the city-state. To ensure a representative sample of the general population, data from diverse age groups from 21 to 61 years and above were collected to provide a broad and accurate assessment based on five hypotheses guided by our theoretical model. Our respondents’ knowledge of palliative care, attitudes toward end-of-life care planning, receptiveness to palliative care, information-seeking preferences, and demographic profiles were assessed and statistically analyzed using the PROCESS macro in SPSS.ResultsOur findings validated the KAP model (adapted), which suggested that a higher level of knowledge is associated with a more positive attitude, which in turn has a positive impact on receptiveness. Our study further found that the relationship between palliative knowledge and receptiveness was stronger among individuals who frequently acquired information via digital media; however, this relationship did not hold for those who acquired information via traditional media.ConclusionOur findings concurred with previous studies that validated the KAP model used to investigate other public health issues among healthcare professionals. Given that the literature is limited on the validation of this model on the acquisition of palliative care knowledge among population groups, this study closes critical knowledge gaps by being one of the few studies to offer insights into developing effective media strategies needed for public health communication and education to increase awareness of palliative care within a country’s population.
DOI: 10.3389/fpubh.2026.17747492026-04-02
Liangying Ma, Gege Fang, Zhengxin Liu
IntroductionDuring global public health crises, news media play a crucial role in disseminating information about prevention, treatment, and recovery. This study aims to investigate the social and psychological impact of news during the prevention and control process of COVID-19 in China.MethodsWe collected data from 598 participants and employed the Extended Parallel Process Model (EPPM) to analyze the influence of different combinations of perceived threat and perceived efficacy in news on fear, compliance with preventive measures, and health discrimination.ResultsThe findings reveal significant associations between perceived threat and various outcomes: increased fear, enhanced compliance with preventive measures, and heightened health discrimination. In this process, perceived efficacy has a significant moderating effect: under high perceived efficacy conditions, fear's promotion of health discrimination is suppressed, and its encouragement of preventive measures is enhanced.ConclusionThis study highlights that balanced health communication in media, conveying both threats and efficacy, is crucial for mitigating health discrimination and sustaining public motivation for preventive behaviors.
DOI: 10.3389/fpubh.2026.17906762026-04-01
Desirée Estela Porcari, Davide Bottari, Iacopo Giribon, Gabriella Daneluzzi, Emiliano Ricciardi, Maria Donata Orfei
BackgroundThe rapid evolution of technology has triggered profound cultural, social, and psychological changes, along with a constant demand for human adaptation to new challenges. Digital wellbeing (DW) refers to the individual’s positive and healthy relationship with information and communication technology (ICT), characterized by feelings of comfort, support, safety, satisfaction, and low levels of stress during their interactions with ICT. However, DW can be threatened by ergonomic, organizational, and psychological issues, particularly in the workplace. Despite efforts to improve the objective conditions of user experience, the understanding of the role of psychological factors in HCI remains partially disregarded.AimsThis study aimed to validate a new multidimensional psychometric tool designed to assess the perceived quality of HCI in the workplace, the Work-Related Human Computer Interaction Questionnaire (wrHCI-Q).MethodsA sample of 1,198 employees of a large Italian banking group (52% females; age: 49.04 ± 8.7) underwent an online survey. Reliability, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed.ResultsThe wrHCI-Q consisted of 35 items and a four-factor structure (technostress, self-efficacy, positive attitude, and HCI aversion), supported by the CFA indices.ConclusionThe wrHCI-Q is a new, valid, and reliable scale to catch some crucial human factors affecting the quality of HCI. It is expected to foster the understanding of the determinants of individual DWE and to shed light on the factors that undermine a healthy employee’s interaction with ICT.
DOI: 10.3389/fpubh.2026.17780402026-04-01
Abdullah Alkhani, Mariam M. Aleissa, Fahad Almsned, Albara Arefi, Sarah Alsaleh, Aya Mousli, Haifa Almuhanna, Nasser M. Alzain, Sami Alhaider, Raghad Alhuthil, Afaf Alsagheir
PurposeThis research aims to investigate the medical, socioeconomic, and cultural factors influencing the quality of life (QoL) in parents of children with cystic fibrosis (CF), congenital adrenal hyperplasia (CAH), and Duchenne muscular dystrophy (DMD).MethodsThis cross-sectional single-centered study included parents of children diagnosed with CF, CAH, or DMD at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. The QoL was assessed using the PedsQL™ Family Impact Module.ResultsA total of 107 parents participated (response rate: 77%), including CF (n = 40), CAH (n = 26), and DMD (n = 41). Fathers comprised 59.8% of respondents. 85% of fathers were employed compared to 15% in mothers. Consanguinity was reported in 77.6% of families. Diagnostic delays exceeding 1 year occurred in 46.7% of cases, particularly in DMD (82.9%). Only 10.3% of parents participated in support groups. Multi-variate analysis using a generalized linear model showed that frequent emergency department visits (>6 per year) and DMD diagnosis were predictors of lower QoL (p = 0.003) and (p = 0.004), respectively. Higher QoL was associated with maternal status (p = 0.045) and higher income (p = 0.014).ConclusionOverall, the study found that parents of children with rare diseases experience a suboptimal QoL score, with parents of children with DMD faced the greatest challenges, suggesting targeted interventions like enhanced newborn screening and utilizing genetic testing for expedited diagnosis may be beneficial. The study also found that frequent emergency department visits negatively impacted QoL, suggesting that enhancing healthcare access through medical education, and the integration of telemedicine and home healthcare services might alleviate the burden faced by caregivers. Moreover, financial support to these families might play a role in enhancing their quality of life due to high prevalence of sole providers, and caregiver saturation. The low participation in support groups signals a gap in caregiver support that requires further exploration.
DOI: 10.3389/fpubh.2026.17676042026-04-01
Tang Ying, Wang Yuanqing
BackgroundHealthcare professionals, particularly anesthesiologists, nurses, and dental staff, are routinely exposed to inhalational anesthetic agents such as nitrous oxide and halogenated gases. Although scavenging and ventilation systems have reduced ambient levels, concerns remain regarding reproductive risks associated with chronic exposure. Previous studies have yielded inconsistent results. A systematic review and meta-analysis of published observational studies was conducted to clarify the relationship, assessing reproductive outcomes among healthcare workers who were exposed.ObjectiveThis systematic review and meta-analysis aimed to clarify the association between occupational exposure to anesthetic gases and the risk of spontaneous abortion among healthcare workers.MethodsA systematic search was performed in PubMed, Scopus, and Web of Science up from inception until the end of July 2025. Observational studies assessing spontaneous abortion among female healthcare workers exposed to inhalational anesthetics were included. Two reviewers independently screened and extracted data and assessed study quality using the Newcastle–Ottawa Scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was evaluated using the I2 statistic, and potential moderators were explored via subgroup and meta-regression analyses.ResultsSeventeen studies were included. The pooled analysis showed 1.29-fold higher odds of spontaneous abortion among exposed workers compared with unexposed controls (OR = 1.29; 95% CI: 0.96–1.75; I2 = 87%). Subgroup analyses indicated stronger associations in North American studies and among high-exposure occupations. Meta-regression analysis indicated that exposure duration is a significant predictor (p = 0.010), accounting for 73.6% of the heterogeneity. Sensitivity and Egger’s tests revealed robust findings without evidence of publication bias.ConclusionOccupational exposure to anesthetic gases may increase the risk of spontaneous abortion, particularly in those who are at high exposure, emphasizing the need for stringent exposure control and improved workplace safety standards.
DOI: 10.3389/fpubh.2026.17669122026-04-01
Peter Mac Asaga, Axel Kroeger, Sunday Omilabu, Philomena E. Airiohuodion, Arthur Oragwa, Deborah Buba, Chukwuma Anyaike
BackgroundDespite antiretroviral therapy (ART) scale-up in sub-Saharan Africa, treatment failure remains a significant challenge. We characterised virological and immunological outcomes among people living with HIV (PLHIV) attending tertiary care facilities in Nigeria, with exploratory analysis of potential mechanistic factors.MethodsThis multi-centre cross-sectional study enrolled 517 HIV-positive adults from four Nigerian tertiary facilities between January 2019 and December 2021. Primary outcomes included viral load suppression (<1,000 copies/mL) and CD4 count. Exploratory mechanistic analyses examined drug resistance mutations (n = 50), immune activation markers (n = 40), and inflammatory biomarkers (n = 35) in pilot subsets.ResultsAmong 412 participants with viral load data, only 111 (26.9%; 95% CI 22.7–31.5) achieved viral suppression, substantially below the UNAIDS 95% target. Of 387 with CD4 data, 149 (38.5%; 95% CI 33.6–43.6) had severe immunodeficiency (<200 cells/μL). Among 346 participants with complete data, discordant responses were common: 25.7% showed virological failure with preserved immunity, while 6.6% had immunological failure despite viral suppression. In pilot mechanistic subsets, 86% of viraemic participants harboured drug resistance mutations, with M184V (62%) and K103N (54%) predominating. CD8 T-cell activation (CD38+HLA-DR+) was significantly elevated in viraemic versus suppressed participants (median 28.6% vs. 12.4%; p < 0.001), correlating inversely with CD4 count (ρ = −0.46; p < 0.01).ConclusionHIV treatment outcomes at Nigerian tertiary facilities fall substantially short of global targets. The high prevalence of discordant immune-virological responses and preliminary evidence of drug resistance and immune activation suggest multiple interacting pathways to treatment failure. Larger mechanistic studies are warranted to inform targeted interventions.
DOI: 10.3389/fpubh.2026.17775882026-04-01
Deepa Tiwari, Sirimavo Nair
IntroductionStaple food fortification is a globally recognized method for reducing micronutrient deficiencies. India started its food fortification journey in the 1950’s with the fortification of Vanaspati. Over the years, several food vehicles, such as double fortified salt, oil, wheat flour, and rice, have been studied. Based on the mixed results observed, the Government of India launched the Central pilot scheme on “Fortification of rice and its distribution under the public distribution system” in 2019. This scheme was launched across 15 districts of India. The major aim of this study was to assess the impact of routine consumption of fortified rice distributed via the Targeted Public Distribution System (TPDS) on haemoglobin, ferritin, folate and vitamin B12 levels.MethodsA simple random sampling method was used to enroll 452 women of reproductive age. Using a purposive sampling technique and inclusion and exclusion criteria, a total of 167 WRA were enrolled for the intervention phase. Fortified rice procured from the Targeted public distribution system was monitored for a period of 6 months and 1 year. Micronutrient level was found to be as per the FSSAI, 2018 regulations (Iron, 40.13 mg; Folate, 93.66 µg; and Vitamin B12, 0.89 µg per kg of fortified rice).ResultsIt was found that fortified rice intervention helped in improving hemoglobin levels (capillary group: 0.52 g/dL; p = 0.005 and venous group: 0.55 g/dL; p = 0.001); however, no significant improvements were observed in serum ferritin, folate, and vitamin B12.ConclusionRoutine consumption of fortified rice significantly improved haemoglobin levels; however, no significant improvements were observed in ferritin, folate, and vitamin B12 levels.
DOI: 10.3389/fpubh.2026.17574082026-04-01
Raquel Prieto-García, Joan Pau Millet, Claudia Broto, Elisa Lara, María Espiau, Antoni Soriano-Arandes, Maria-Luiza de Souza-Galvão, Ma Angeles Jiménez-Fuentes, Cristina Domingo, Rosa Mercè Vileu Vallverdú, Verónica Saludes, Antoni E. Bordoy, Poppy J. Hesketh-Best, David Panisello Yagüe, Elisa Martró, Laura Gavaldà Mestre, Elisabet Sicart Torres, Helena Martínez Alguacil, Mar López Espinilla, Pere-Joan Cardona, Pere Simón, Cristina Rius
BackgroundIn June 2022, a case of non-bacillary pulmonary tuberculosis (TB) was reported in a 10-year-old girl attending a primary school in Barcelona. A second pediatric case from the same school was identified in October 2022, prompting the declaration of a TB outbreak and the initiation of an epidemiological investigation.MethodsContact tracing was conducted using the concentric circles approach, targeting household contacts, classmates, and school staff. Tuberculin skin tests were administered and read 72 h later. Whole genome sequencing of Mycobacterium tuberculosis isolates was performed to identify potential source cases and transmission chains.ResultsAmong 218 individuals screened, 30 TB infections and 4 TB disease cases were diagnosed. The highest prevalence occurred in grades EP4 and EP5 (ages 9–10), with a significantly higher risk compared to other grades. No adult cases linked to the school were identified. Later, a genomic cluster of 15 cases was detected across Catalonia, suggesting a super-spreading event. However, no direct epidemiological link to the school was established.ConclusionsThis outbreak highlights the challenges of TB detection in pediatric populations and the importance of genomic surveillance in tracing transmission. Despite extensive investigation, the source remains unidentified, underscoring the complexity of TB dynamics in urban settings.
DOI: 10.3389/fpubh.2026.17894252026-04-01
Lauren Hamill, Anna Kearns, Amy Rogers, Naome Reid, Limin Buchanan, Jahidur Rahman Khan, Natalie Munro, Alison Purcell, Katarina Ostojic, Rachel Walker, Sue Woolfenden
BackgroundThe social determinants of health (SDH) drive child health inequities. Adverse SDH are experienced at an individual level as unmet social needs. In a paediatric Allied Healthcare system, these unmet social needs are barriers to service access.EvidenceSocial prescribing offers a promising solution. However, this practice is not routinely implemented in Australia.ObjectiveTo determine whether the Routine Identification of Unmet Social Needs to Unlock Potential (RISE UP) social prescribing model of care is needed, feasible, and acceptable within a paediatric Allied Healthcare intake context.MethodsA pilot study using mixed-methods approach to design, implement, and evaluate the RISE UP model of care.ResultsMost parent/carers, 114 of 144 (79.2%), agreed to participate in RISE UP, with 74 of 114 (64.9%), reporting one or more unmet social needs. Childcare (n = 54, 47.4%) and employment (n = 52, 45.6%) were the most common needs. Multivariable analysis showed that each additional year of child age increased the risk of unmet needs by 7% [adjusted relative risk (RR) 1.07, 95% CI 1.03–1.10, p < 0.001], and families speaking only non-English at home had a 40% higher risk compared to English-only speakers (adjusted RR 1.40, 95% CI 1.01–1.94, p < 0.05). RISE UP was acceptable to parents/carers (97.2%). Staff reported mixed acceptability (55.8%) and feasibility (64.3%).ConclusionUnmet social needs identification and referrals pathways in paediatric Allied Healthcare intake services are needed and acceptable to parents/carers. However, further action is required to overcome challenges in integrating these models within existing Allied Healthcare systems in Australia.
DOI: 10.3389/fpubh.2026.17620352026-04-01
Shuwei Zhao, Rui Su, Zhenghui Yang, Yuye Li, Yi-Qun Kuang, Hongbin Li
BackgroundDeep fungal infections (DFIs) represent a significant and growing threat to hospitalized patients, contributing to substantial morbidity and mortality worldwide. The healthcare landscape has undergone notable changes in recent years, particularly with the impact of the COVID-19 pandemic, which has altered host immunity and care pathways, potentially influencing the epidemiology of DFIs.ObjectiveThis study aimed to delineate the clinical characteristics, mycological profiles, risk factors of deep fungal infections, and to evaluate factors associated with mortality among inpatients in a general hospital in southwestern China from 2020 to 2024.MethodsThis was a retrospective analysis of 886,056 patients in the hospital from 2020 to 2024, including the epidemiological characteristics, treatment, and prognosis of deep fungal infections.ResultsA total of 462 cases (0.052%) with deep fungal infections were identified, accounting for 0.052% of the total number of hospitalizations. The incidence of deep fungal infections in the hospital showed an increasing trend from 2020 to 2024. Compared with previous studies, Candida remained the predominant pathogen (84.20%), with increased proportions of Aspergillus (13.90%) and Cryptococcus (6.71%). A new case of Mucor infection (0.22%) was reported. The respiratory tract remains the most common site of infection (88.60%). In terms of treatment, most patients received azole therapy (88.30%), with those treated with echinocandins showing significantly higher survival rates (P = 0.033). Multiple logistic regression analyses revealed that mixed infections, hematologic diseases, and biological agents were significant risk factors for poor prognosis (all P < 0.05).ConclusionsCompared with earlier research (2015–2019), the number of deep fungal infection cases from 2020 to 2024 has shown a significant and sustained increase. Moreover, the threat posed by Aspergillus and Cryptococcus has increased. Although clinical data remain limited, these findings provide valuable insights for the prevention, diagnosis, and treatment of deep fungal infections. Compared with earlier research (2015–2019), the number of deep fungal infection cases from 2020 to 2024 has shown a significant and sustained increase. Moreover, the threat posed by Aspergillus and Cryptococcus has increased. Although clinical data remain limited, these findings provide valuable insights for the prevention, diagnosis, and treatment of deep fungal infections.
DOI: 10.3389/fpubh.2026.1766256