The core competencies of public health students represent the essential character and key capabilities they must possess to adapt to lifelong development and meet societal needs. These competencies directly influence the effectiveness of public health work, such as emergency response and health promotion. Therefore, this study aims to assess the core competency scores of public health students and identify their influencing factors. An online cross-sectional study was conducted in January 2026. Data on demographic characteristics, core competencies, and learning environment perception were collected through questionnaires. Independent samples t-tests and one-way ANOVA were used to compare internal differences among students with different characteristics, and multiple linear regression was employed to explore the influence of different dimensions of learning environment perception on core competencies. A total of 271 valid questionnaires were collected. The core competency score of public health students was 4.06 ± 0.49. Awareness of core competencies was positively correlated with core competency scores. No significant differences in core competency scores were observed by gender, ethnicity, household registration, major, grade level, or student leadership experience. Multiple linear regression showed that peer relationships (β = 0.52, P < 0.01), project practice (β = 0.33, P < 0.01), and learning atmosphere (β = 0.16, P < 0.01) had significant positive predictive effects on core competencies, collectively explaining 76.5% of the variance. The overall core competencies of public health students are at a relatively good level, and their awareness of core competencies is closely related to their actual performance. Key factors influencing core competencies include peer relationships, project practice, and learning atmosphere within the learning environment. It is recommended to enhance publicity and education on core competencies, optimize the design of the learning environment, and emphasize the integration of humanistic education with professional practice, in order to systematically improve the comprehensive competencies of public health talents.
Internet healthcare has become a key part of China's hospital-centered health system. Driven by "Internet Plus Healthcare", Healthy China 2030, and public-hospital high-quality development policies, it has evolved from remote consultation experiments into regulated online-offline care pathways. This review traces its development from the first documented remote medical practice in 1986 to the present, focusing on policy, institutional models, clinical evidence, governance challenges, and reform. We conducted a structured narrative review of English- and Chinese-language sources on internet healthcare in Chinese public hospitals. PubMed/MEDLINE, Web of Science Core Collection, China National Knowledge Infrastructure (CNKI), and official policy sources were searched. Eligible sources addressed internet hospitals, telemedicine, online follow-ups, remote monitoring, e-prescriptions, insurance payments, digital governance, clinical outcomes, patient safety, equity, or implementation barriers in mainland China. Internet healthcare progressed through early telemedicine, institutional network expansion, internet-hospital development, and pandemic-driven normalization. The 2018 regulatory framework positioned internet hospitals as extensions of licensed physical medical institutions, thereby permitting online follow-ups for common and chronic diseases while preserving offline accountability. During COVID-19, online consultation, e-prescriptions, drug delivery, and insurance payments rapidly expanded. Evidence suggests benefits for chronic disease management, medication adherence, cardiovascular secondary prevention, and reduced travel burden. However, evidence remains limited for diagnostic accuracy, adverse events, emergency escalation, and long-term outcomes. Persistent barriers include quality variation, workload, cybersecurity, data fragmentation, artificial intelligence (AI) accountability, reimbursement design, regional inequity, and digital exclusion among older adults. China's model may be understood as a hospital-centered extension of public-hospital functions rather than a stand-alone virtual-care system. Future development should prioritize outcome-based evaluations, safety governance, equitable access, data interoperability, and accountability for internet-based and AI-assisted care.
Workplace violence has emerged as a global problem that affects all nations, workplaces, and occupational categories. The health sector accounts for more than one-third of all workplace violence worldwide. There is very little information available in Ethiopia about workplace violence affecting healthcare professionals. This study aims to identify key associated factors of workplace violence to inform future evidence-based interventions and policy development. Therefore, the objective of this study was to assess the prevalence of workplace violence and associated factors among healthcare professionals working in selected public hospitals in Addis Ababa, Ethiopia. An analytic cross-sectional study was conducted from May 1 to June 30, 2023, among 599 randomly selected healthcare professionals working at four referral hospitals in Addis Ababa, Ethiopia via a multistage sampling technique. Data was collected via a pretested, structured, self-administered questionnaire adapted from a standard questionnaire. The data were coded and entered into EPI Information version 7 and exported to SPSS V.20.0 software for analysis. A frequency table was used to summarize the data. To identify factors associated with workplace violence, a binary logistic regression model in which the degree of association for variables was assessed via adjusted odds ratios (AORs) with 95% CIs and p values ≤ 0.05 was used. The prevalence of experiencing at least one type of workplace violence (physical, verbal, bullying, or sexual) in the previous year was 59.4% (95% CI = 55.6-63.1). The study revealed a statistically significant relationship between workplace violence and female sex (AOR = 1.56, 95% CI = 1.04-2.34, p = 0.033), pharmacist profession (AOR = 2.9, 95% CI = 1.15-7.33, p = 0.025), routine direct physical contact with patients (AOR = 2.19, 95% CI = 1.12-4.29, p = 0.022), emergency work starting (AOR = 2.50, 95% CI = 1.02-6.15, p = 0.045), and witnessing incidents of physical violence (AOR = 10.1, 95% CI = 5.75-17.59, p < 0.0001). This study revealed a high prevalence of workplace violence among health care professionals working in government hospitals in Addis Ababa, Ethiopia. Healthcare facilities should prioritize the establishment of comprehensive health and safety programs focused on the prevention and management of workplace violence, with particular attention given to the most vulnerable groups. Not applicable.
Several new school-located nurse models have recently been established in Australia. These services aim to improve health and education outcomes for children in less advantaged communities; however, data describing their activities and impact are limited. The School-Based Primary Health Care Service (SB-PHCS) was implemented in Broken Hill, a rural community in Far West New South Wales, Australia. The service aims to improve the health and educational outcomes of local children by facilitating access to health care. This study describes the referrals to other services supported by the SB-PHCS and the subsequent use of treatment and therapy services by the primary school children. We conducted a review of the community health electronic medical records of public primary school children referred to the SB-PHCS in 2019. Data extracted included demographics, presenting problems, referrals to other services that were supported by the SB-PHCS, type of SB-PHCS support provided, and client use of the services they were referred to. Cases were followed until 30 June 2020. This substudy examines the records of children who had referrals to other services that were supported by the SB-PHCS. In 2019, 270 public primary school children were referred to the SB-PHCS, representing 20% of local enrolments. Of these, 146 children received support from the SB-PHCS for a referral to another service (11% of enrolments). The services most referred to were speech pathology (23% of referrals to other services) and occupational therapy (20% of referrals to other services). Service use data were available for 160 referrals. Service use within the study period was highest for medical and mental health services (75-100% of referrals with available service use data) and lowest for allied health services (41-63% of referrals with available service use data). Forty-one percent of speech therapy referrals and 48% of occupational therapy referrals were still on a waitlist at end of follow-up. Actively supporting less advantaged families to access services to address health and developmental issues has potential for long-term health, educational and social benefits. However, for services like the SB-PHCS to facilitate access to other services, those services must be available, accessible, and adequately resourced. In rural communities and other underserved settings, alternative service models using school-based allied health services, telehealth, and/or paraprofessionals are needed to address these service gaps.
In the context of Global Health, massive administrative datasets have become indispensable tools for health surveillance. However, the sheer scale of Big Data can mask systemic selection biases that standard mathematical adjustments may not fully mitigate. In this study, I propose a methodological audit of a recent large-scale cohort (N = 2,975,035) concerning COVID-19 vaccination and oncological outcomes. By benchmarking the cohort's architecture against national demographic and epidemiological gold standards through single-proportion Z-tests, we identified notable structural divergences. The first inferential test yielded a Z-score of -260.39 (p < 10⁻⁵⁰), suggesting a structural under-sampling of the elderly population (32.2% deficit) relative to the reference population. The second test identified a statistically inconsistent cancer incidence deficit in the non-vaccinated control group (Z = -15.23, p < 10⁻⁵⁰). These findings indicate that the reported statistical signals may emerge as a computational consequence of structural selection bias, where an artificially deflated baseline in the control group potentially inflates Hazard Ratios. Within a One Health approach, ensuring the structural integrity of data is crucial for effective prevention and control measures. We conclude that large-scale surveillance studies could be inferentially validated against demographic benchmarks to ensure that public health conclusions are grounded in baseline equivalence, thereby safeguarding the reliability of global health monitoring.
Online marketing by the food and beverage industry has proliferated in recent years, but regulation to protect children has not kept pace. To support the uptake of WHO recommendations, this article defines key terms, concepts and techniques used in digital marketing. The article first explains the evolution and technical process of using personal data to target online advertising to users. It then describes specific approaches to food and beverage advertising in the digital space, drawing on real-world examples of digital advertising from food and beverage companies. The article aims to deepen understanding of digital marketing processes and concepts necessary for the design of effective regulation to counteract such marketing. Public health researchers, lawyers and policy makers must have an up-to-date understanding of digital marketing techniques to effectively regulate digital advertising to improve public health.
The purpose of the current study was to evaluate the possible role of multi-user video gamepads in spreading microbial populations among users and understand how to reduce this risk. The study design involved 10 public locations in Al-Kharj city and 10 semi-public locations inside the campus of Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. Air samples were collected from all selected places once during the study using a passive air sampling technique. Semi-public places with a good aeration system and a regular cleaning routine showed much less airborne organisms than public places with less care. Samples from the multi-user video gamepads were taken from each gamepad three times during a period of two weeks. Each time, one sample was taken before any intervention, and another sample was collected after disinfection with commercial alcohol swab pads containing 70% isopropyl alcohol. All samples were examined for the number of viable organisms. The mean microbial count ranged from 98 to 270 CFU in public locations and from 18 to 34 CFU in semi-public locations. Samples collected from semi-public places showed 3 bacterial genera and were free from fungi, while samples from public places showed 9 bacterial and 4 fungal genera. After disinfection of the multi-user video gamepads in the public places, the number of colonies reached a maximum of 8 CFU (approximately 97% reduction), while the semi-public places expressed a 91% reduction in the number of organisms. The results obtained demonstrate the importance of following hygiene measures in multi-user objects to reduce the risk of infection transmission.
To investigate the barriers and facilitators to adopting healthy lifestyle habits among patients with type 2 diabetes mellitus (T2DM) in the Brazilian Amazon, using the Environmental Factors domain of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework. A qualitative study was conducted with 47 patients with T2DM and 17 community health workers (CHWs) from primary health care services in the Brazilian Amazon. Data were collected through two World Café group discussion sessions (one involving patients and one involving CHWs) and 15 semi-structured interviews conducted in patients' homes. Data were analysed using thematic analysis supported by Atlas.ti 24 software. Three major categories emerged: attitudinal, social and physical factors. Attitudinal barriers included resistance to behaviour change, denial of disease severity and physical limitations, whereas fear of complications and valuing life motivated healthier behaviours. Social barriers comprised lack of family support, insecurity and transportation difficulties, while family involvement, professional guidance and trust in CHWs facilitated treatment adherence and lifestyle modification. Physical barriers included inadequate infrastructure, adverse weather conditions and the absence of safe public spaces for physical activity. Conversely, proximity to local markets and fairs facilitated access to healthy foods and supported dietary improvements. Barriers and facilitators to healthy lifestyle adoption among people with T2DM in the Brazilian Amazon are strongly influenced by attitudinal, social and environmental factors. Effective diabetes management in this context requires culturally sensitive interventions, improved urban infrastructure, strengthened community support networks and continued engagement of multidisciplinary healthcare teams, particularly CHWs. These findings provide important insights for developing context-specific strategies to promote sustainable lifestyle changes, enhance patient autonomy and improve quality of life in remote Amazonian communities.
Burnout, anxiety, and depression among healthcare workers are associated with long-term sickness absence, reduced quality of care, and impaired patient safety. In Sweden and other Scandinavian countries, common mental disorders account for a substantial share of sickness absence, with costs borne by employers and national insurance systems (the "payee side"). Early identification of workers at elevated risk, followed by proportionate preventive support, is therefore central to sustainable hospital management and occupational health. The Empowerment for Participation (EFP) assessment is a 110-item web-based system that maps everyday participation, demands, and self-expectations and derives validated risk indices for burnout, anxiety, and depression, together with constructs such as motivation, stress, and defence routines. The EFP battery has been used as a triage tool and an outcome framework in web-based psychotherapy trials targeting burnout risk and as a component in AI-driven digital triage concepts within the My-E-Health ecosystem. Prior Swedish evidence also links burnout and stress symptoms in healthcare workers to subsequent long-term sickness absence, supporting the relevance of risk indices for occupational prevention. Empowerment-related constructs have further been shown to be responsive to interventions such as mindfulness-based treatment. To integrate empirical data from a cohort of healthcare personnel assessed with the EFP battery into a broader preventive model linking early risk identification, digital and therapist-delivered support, and the Scandinavian sick-pay context, while clarifying the methodological limits of non-randomised, real-world data. I analysed EFP data from 325 healthcare workers with baseline (T1) and follow-up (T2) assessments who, in routine practice, either (1) received no structured treatment or AI support (no structured support/control), (2) engaged in human-delivered psychotherapy (human therapy), or (3) used an AI-supported, web-based intervention grounded in the EFP architecture (AI-only support). Outcomes included the EFP Empowerment index and EFP-derived risk indices for burnout, anxiety, and depression, plus stress burden, motivation, and defence routines. Change over time was examined within groups (paired t-tests; Cohen's d_z) and explored between groups using change-score ANOVAs (η²). Because groups were not randomised and differed at baseline, between-group comparisons were interpreted cautiously as descriptive. At baseline, participants who went on to use human therapy or AI-only support showed higher EFP-derived risk for burnout, anxiety, and depression and lower empowerment than those who did not engage in structured support, consistent with risk-driven help-seeking. Under naturalistic conditions, human therapy and AI-only support were associated with large within-group improvements in empowerment and substantial reductions in EFP-derived risk indices, whereas the no-structured-support group showed only small changes. Defence routines decreased far more in the human therapy group than in the AI-only group, suggesting potentially distinct mechanisms. Improvements in empowerment were strongly associated with reductions in risk indices; however, the observational design did not support causal inference. The EFP battery functions as a practical framework for early risk identification and change-sensitive outcome monitoring that can support scalable digital triage and stepped-care pathways. However, because allocation to support was non-randomised and sickness absence was not measured in this cohort, claims about prevention of sick leave should be treated as hypotheses to be tested in prospective studies that include baseline-balanced comparisons and registry-based sick-leave endpoints.
Antibiotics are crucial for treating bacterial illnesses; however, overuse and abuse of these drugs, together with improper consumption, have led to selection pressure and the rise of resistant bacteria. To investigate the knowledge and attitudes of outpatients in a healthcare setting regarding antibiotic consumption and antimicrobial resistance. This exploratory survey was conducted among 120 outpatients visiting a public primary healthcare setting in Greece, from February to March 2024. Data were collected via a 38-item self-administered questionnaire covering three domains: antimicrobial resistance (AMR) knowledge, antibiotic knowledge, and consumption practices. Statistical analysis was performed using SPSS (ver.29), employing Mann-Whitney and Kruskal-Wallis tests to identify demographic correlates (p < 0.05). A total of 120 individuals participated in the study, 72 of whom were women (60.0%); 37.5% resided in an urban center, and 30.8% were lyceum graduates. Most of the sample knew that AMR signifies resistance of microbes to antibiotics (75.0%), that it constitutes a significant public health problem in the country (70.0%), and that it is due to the inappropriate use of antibiotics in humans (67.5%). 74.2% disagreed with stopping antibiotic treatment earlier, while 40.0% of respondents stated that taking antibiotics is only useful for fighting bacterial infections. 27.5% thought antibiotics were necessary for viral illnesses with fever, and 35.8% thought they speed up recovery from a cold. Remarkably, 52.5% of respondents acknowledged keeping antibiotics for later use, and 56.7% reported using non-prescription antibiotics in the past. Antibiotic knowledge scores were statistically significantly higher for women and people living in urban and semi-urban areas (p < 0.05). People with less education knew less about antibiotics, antimicrobial resistance, and antibiotic consumption practices (p < 0.005). Although primary health care recipients demonstrate a generally satisfactory awareness of antimicrobial resistance, significant knowledge gaps and misconceptions about antibiotics persist, leading to inappropriate antibiotic use practices.
Self-management empowers non-communicable disease (NCDs) patients to improve health, enhance quality of life (QoL), and reduce adverse outcomes. This study aims to synthesize empirical evidence on the effectiveness of self-management interventions in improving QoL and health outcomes among patients with NCDs. Following the PRISMA guidelines, a systematic search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, ScienceDirect, and OVID databases was conducted to identify relevant studies published between 2019 and 2024. Studies were included if they evaluated the impact of self-management interventions on QoL among adults with NCDs using randomized controlled trials or experimental designs. Risk of bias was assessed using the RoB 2 and ROBINS-I tools. A random-effects meta-analysis was performed to calculate pooled standardized mean differences using Hedges' g. Heterogeneity was assessed using Cochran's Q test and the I² statistic. Sensitivity analyses and publication bias assessments were also conducted. Eleven studies involving 1,591 participants were included in the systematic review, and 10 studies were eligible for the meta-analysis. The pooled analysis demonstrated that self-management interventions significantly improved QoL compared with standard care (Hedges' g = 0.58; 95% CI: 0.34-0.81). Moderate-to-substantial heterogeneity was observed across studies (I² = 69.3%). Subgroup analysis indicated that intervention effects varied by country income level, with larger effect sizes observed in upper-middle-income countries. Sensitivity analysis confirmed the robustness of the findings. Funnel plot inspection and Egger's test indicated no statistically significant evidence of publication bias. Self-management interventions are associated with significant improvements in QoL among individuals with NCDs. These findings highlight the importance of integrating structured self-management programs into chronic disease care. Given the observed heterogeneity across studies, future research should focus on standardized intervention components, rigorous study designs, and evaluation across diverse healthcare settings to better understand the long-term effectiveness of self-management strategies. Not applicable.
In this study, an assessor-blinded randomized trial with concealed allocation was conducted. Thirty women aged 25-35 years with chronic ankle instability (CAIT score ≤ 24 on the affected ankle) were randomly assigned (1:1) to perceptual balance (PB) training with floss bands (FB group, n = 15) or PB training alone (n = 15). Both groups completed a 6-week program (3 sessions/week), progressing from static to dynamic and plyometric tasks. FBs were applied at perceived occlusion pressure of 5-7/10 (0-10 scale); no adverse events occurred. Outcomes (assessed on the affected limb only) included static balance (single-leg stance time), dynamic balance (Y-balance test-normalized reaches in anterior, posteromedial, and posterolateral directions and composite score), ankle proprioception [joint position sense (JPS) error at 20° plantarflexion], and functional performance (single-leg hop and triple-hop for distance). A 2 × 2 mixed ANOVA (time × group) was used, with Bonferroni post hoc tests. Effect sizes were partial η² (ANOVA interactions) and Cohen's dz (repeated-measures within-group changes with 95% CI). Both groups improved significantly (p < 0.01). The FB group showed greater improvements in static balance (25.7 ± 2.9 s vs. 22.3 ± 2.8 s, p = 0.015), dynamic balance (composite and all directions, p < 0.015), JPS (4.2 ± 1.1° vs. 6.1 ± 1.3°, p = 0.022), single-leg hop (1.80 ± 0.15 m vs. 1.65 ± 0.18 m, p = 0.032), and triple-hop (5.10 ± 0.30 m vs. 4.70 ± 0.35 m, p = 0.039). Interaction effect sizes (dz) ranged from 0.143 to 0.234 (large). These findings suggest that floss band augmentation may provide additional short-term benefit to PB training in women with CAI, although mechanisms remain speculative, and larger, longitudinal trials are needed.
Mesoamerican nephropathy (MeN) has emerged as a critical yet often overlooked occupational and environmental health crisis. Primarily affecting young, otherwise healthy agricultural workers in Central America, this disease leads to rapid progression to kidney failure without traditional causes like diabetes or hypertension. While the central drivers are recurrent heat stress and chronic dehydration, emerging research reveals a multifactorial pathogenesis. This includes synergistic nephrotoxic insults from agrochemicals, heavy metals, chronic endotoxin exposure, and mycotoxins (e.g., ochratoxin A). Morphologic studies point to shared pathways of tubular injury, characterized by mitochondrial dysfunction and lysosomal abnormalities. Furthermore, gut-kidney crosstalk and genetic susceptibility, particularly among individuals with Native American ancestry, may amplify renal inflammation and injury. Although targeted interventions, such as enhanced hydration, rest, and access to shade, show promise, their efficacy in halting disease progression remains limited. As global temperatures rise, similar disease patterns are now being reported among outdoor laborers in other hot regions, signaling a broader climate-linked public health threat. Addressing MeN demands a concerted, multidisciplinary effort encompassing rigorous pathogenesis research, enforceable occupational protections, and global recognition of heat-associated kidney disease as a growing epidemic. This perspective synthesizes recent insights into MeN and calls for urgent, actionable measures to confront this silent crisis.
Social phobia is prevalent in adolescence and may be shaped by early adversity and family context; Southeast Asian evidence remains limited. This study aimed to examine whether childhood trauma, bullying experiences, and parental bonding predict adolescent social phobia. Demographic variables (age and gender) were also examined descriptively. We hypothesized that higher levels of trauma and bullying, as well as non-optimal parental bonding, would be associated with greater social phobia. Quantitative Exploratory. We surveyed 252 students (aged 15-18) from a public senior high school in Yogyakarta, Indonesia. Inclusion: active enrollment and assent; parental consent for minors. Exclusion: current clinician-diagnosed psychiatric disorder under treatment. Instruments included the Childhood trauma was assessed using the 28-item Childhood Trauma Questionnaire - Short Form (CTQ-SF), Parental Bonding Instrument, Bullying Experience Scale, and Liebowitz Social Anxiety Scale - Self Report. Data were analyzed in SPSS using descriptive statistics and multiple linear regression (α = 0.05). Participants were mostly aged 16 years (40.5%) and female (61.1%). Trauma was commonly mild to moderate; non-optimal bonding was present in a sizable minority; bullying ranged from low to moderate for many. Social phobia was predominantly mild to moderate. Regression showed the model was significant (R = 0.652; R2 = 0.425; Adjusted R2 = 0.416; F (3,248) = 61.820, p < .001). Childhood trauma (B = 0.285, p < .001) and bullying (B = 0.312, p = .001) positively predicted social phobia, while optimal parental bonding was protective (B =  -0.204, p = .002). Future research could explore the effectiveness of nurse-led screening, school based anti-bullying, and family psychoeducation interventions to minimize social phobia among adolescents. Childhood trauma, bullying, and parental bonding predict adolescent social phobia, highlighting the importance of family and school-based mental health interventions. Social phobia makes teenagers afraid of social situations and can harm their learning and well-being. We studied 252 high-school students in Yogyakarta, Indonesia, to see whether three experiences childhood trauma, bullying, and the quality of parental relationships are linked to social phobia. Students completed standard questionnaires. We found that many reported some level of trauma and bullying, and not all experienced optimal parenting. Social phobia was common, often at mild to moderate levels. When we analyzed the data together, trauma, bullying, and parental bonding significantly predicted social phobia. Bullying and trauma were the strongest risk factors, while more optimal parenting was related to lower symptoms. These results suggest that nurses can make a real difference by screening early at schools, supporting anti-bullying efforts, and providing family education to build warm, supportive parenting. By focusing on prevention and early help, schools and families can work with nurses to reduce social fears and support healthier adolescent development.
Obesity has been associated with reduced cognitive function, potentially through inflammatory and neuroinflammatory mechanisms. The weight-adjusted waist index (WWI) is a novel anthropometric measure capturing central adiposity. However, its association with cognitive performance has been scarcely studied, and it remains unclear whether inflammation influences this relationship. This study aims to examine the association between WWI and cognitive performance, and whether this association is explained by inflammatory markers. WWI was calculated as waist circumference divided by the square root of body weight (cm/√kg). Cognitive performance was assessed using a test battery comprising the Controlled Oral Word Association test (COWAT; verbal fluency), the Kendrick Object Learning Test (KOLT; memory), and a modified Digit Symbol Test (m-DST; processing speed). Inflammatory markers included C-reactive protein and the kynurenine-to-tryptophan ratio. Multivariable linear regression analyses were used to assess associations between WWI and cognitive test scores per standard deviation, and to evaluate potential attenuation by inflammatory markers. A total of 2,066 community-dwelling older adults (55% women; median age 71 years [IQR 70-72]) from the Hordaland Health Study (1997-99) with complete data on WWI and cognitive tests were included in the cross-sectional analyses. Higher WWI was associated with lower cognitive performance across all tests: COWAT (ß -0.06 [95% CI -0.10, -0.02]), KOLT (ß -0.06 [95% CI -0.11, -0.02]), and m-DST (ß -0.09 [95% CI -0.12, -0.04]). Adjustment for inflammatory markers did not attenuate these associations. Body mass index, waist circumference, body fat percentage, and lean mass index were not significantly associated with cognitive performance. Higher WWI, reflecting greater central adiposity, was associated with lower performance across multiple cognitive domains. Inflammatory markers did not attenuate this relationship. Other anthropometric and body composition measures were not associated with cognitive performance. These findings suggest that central adiposity relative to body weight may be more relevant for cognitive health than overall body adiposity in older adults.
To estimate the prevalence of long COVID identified through hospital registry data and examine associated occupational and demographic factors among healthcare workers (HCWs) in Spain. A multicentre study was conducted between 2020 and 2023 in three Spanish hospitals (Madrid, n = 1; Barcelona, n = 2). Long COVID prevalence and 95% confidence intervals (CIs) were estimated overall and by sex, age group, and occupational category. Associations between long COVID and occupational category were assessed using Poisson regression models with robust variance, stratified by sex and hospital, and adjusted by age and occupation. Registry data included 8,439 HCWs. Long COVID prevalence ranged from 3.0% to 5.0% and increased with age, with an adjusted prevalence ratio (PR) increase of 3-9% per year. Occupational differences were more pronounced among men. In University Hospital Ramon y Cajal, male nurses (PR 2.56; 95% CI 1.13-5.81) and other HCWs (PR 3.67; 95% CI 1.12-12.08) had higher prevalence compared with physicians. In Hospital Parc Tauli, male nurse assistants (PR 20.33; 95% CI 3.64-113.42) and support staff (PR 8.30; 95% CI 1.46-47.19) showed markedly elevated prevalence, although confidence intervals were wide. Among women, occupational associations were weaker and less consistent. Overall sex differences were modest, but sex modified the association between occupational role and long COVID prevalence. Long COVID affected approximately 3-5% of HCWs across participating hospitals. Occupational differences in long COVID prevalence were observed, although estimates varied across centres. These findings highlight the importance of occupational health surveillance and follow-up strategies that consider both occupational role and potential sex-specific patterns.
Generating real-world evidence (RWE) approaches across federated evidence networks based on real-world data requires learning new methodological skills. However, standardized frameworks for defining and assessing competencies for large-scale RWE research remain limited. This study aims to develop an assessment framework for RWE studies and evaluate the competencies of RWE research professionals. We adapted the Joint Task Force (JTF) Core Competency Framework for RWE research using the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Through iterative expert review, 4 new domains were created, including Ethics and Governance, Protocol Development, Study Operations, and Data Analysis and Informatics, and 4 original JTF domains were adapted. Participants completed pre- and post-training self-assessments on a 10-point scale. Paired t-tests with effect sizes were used to evaluate changes in competency scores. Seventeen participants from academic, data, and clinical roles completed the assessment. Mean self-reported competency scores increased by 2.5 points across the 8 competency domains, with statistically significant changes observed in all domains. The largest gain was observed in Leadership and Professionalism (mean increase 3.66; 95% CI, 2.69-4.62). The RWE research competency assessment tool captured changes in self-reported skill proficiency, perceived readiness to conduct RWE studies, and methodological knowledge gaps. These findings suggest the potential to identify competency gaps, tailor educational interventions, and inform quality benchmarks for RWE research training programs. This study developed and evaluated a competency assessment framework specifically designed for RWE research using standardized healthcare data, providing a tool for training program evaluation and workforce development support.
Gastrointestinal infections are an important Public Health problem. International institutions suggest supporting traditional epidemiologic surveillance with syndromic surveillance, including the use of drug sales data monitoring. This review aims to investigate the usefulness of drug sales data as a tool for gastrointestinal infections surveillance by addressing the question "could drug sales data be a complementary contribution to traditional epidemiological GI infections surveillance?". The bibliographic search was carried out in December 2025 using a specific string across 4 scientific literature databases (PubMed, Embase, CINAHL, Cochrane Library), according to PRISMA guidelines. Out of 5.905 publications screened, 15 met the inclusion criteria and were included in the review. The selected studies were published between 1983 and 2021, mostly conducted in Europe. Despite the wide variety of study designs, 73% (n = 11) of the publications emphasized the usefulness and effectiveness of drug sales data for surveillance. In contrast, 20% (n = 3) reported no utility, and 7% (n = 1) found it to be less useful compared to other data sources. Many authors underlined the importance of considering the variables impacting the use and interpretation of drug sales data, and the importance of cooperation between healthcare providers to establish a virtuous surveillance system. In the present systematic review, most selected publications seem to define drug sales data as potentially useful complementary source of information for gastrointestinal infections detection. However, heterogeneity of studies, publication bias and limitations on search strategy do not allow for a definitive qualitative conclusion. The limited number of recent studies highlights the need for further research that also considers the analysis of behavioural factors. Moreover, to optimize the use of new drug sales data collection systems for gastroenteritis surveillance, the application of new computational methods appears promising. This systematic review was recorded in the register PROSPERO (ID number CRD42023492791).
Workplace gaslighting is an alarming issue. However, the negative consequences of workplace gaslighting in nurses are unknown. In this context, our aim was to examine the association between workplace gaslighting and nurses' mental health and work life. We conducted an online cross-sectional study in Greece during December 2024. We employed a convenience sample of nurses. We used the Gaslighting at Work Scale (GWS) to measure levels of workplace gaslighting among our nurses. We used the Patient Health Questionnaire-4, the Quiet Quitting Scale, and the Utrecht Work Engagement Scale-3 to measure anxiety-like symptoms, depressive-like symptoms, quiet quitting, and work engagement, respectively. The study population included 369 nurses with a mean age of 37.86 years. We found a positive association between workplace gaslighting, anxiety-like symptoms, and depressive-like symptoms in our nurses. After adjustment for confounders, we found a positive association between GWS scores and anxiety-like symptoms (adjusted b = 0.758, 95% CI = 0.606 to 0.909, p < 0.001), and depressive-like symptoms (adjusted b = 0.720, 95% CI = 0.555 to 0.885, p < 0.001). Moreover, our multivariable models showed a positive association between GWS scores and quiet quitting (adjusted b = 0.258, 95% CI = 0.186 to 0.330, p < 0.001). Also, we found a negative association between GWS scores and work engagement (adjusted b = -0.353, 95% CI = -0.512 to -0.195, p < 0.001). Our findings suggest that nurses who experience higher levels of gaslighting from their supervisors have more anxiety-like symptoms and depressive-like symptoms. Moreover, workplace gaslighting is associated with quiet quitting and work engagement. However, considering the cross-sectional nature of our study and the study limitations, further research should be conducted to extract more valid results.
Digital Social Prescribing (DSP) represents an innovative paradigm that integrates digital technologies into traditional social prescribing frameworks to address the social determinants of health (SDOH). However, persistent conceptual inconsistencies and a paucity of theoretical clarity have constrained its systematic application and evaluation within public health and nursing practices. This study aims to clarify the definition of digital social prescribing, distinguish it from traditional social prescribing, and identify its core characteristics through a systematic concept analysis. The Walker and Avant concept analysis framework was adopted. A comprehensive literature searches was conducted across multiple databases, including PubMed, CINAHL (EBSCOhost), APA PsycArticles, Scopus, Web of Science, Embase, IEEE Xplore, ACM Digital Library. A total of 30 relevant articles were included in the analysis. The analysis followed eight steps proposed by Walker and Avant: selecting concept, determining purposes of the analysis, identifying all uses of concept, determining defining attributes, constructing model and related cases, identifying antecedents and consequences, and defining empirical referents. Digital social prescribing (DSP) is not merely a technological tool but a multidimensional public health model. Its five defining attributes are the uses of technology, non-clinical services, make personal plans based on needs, likes and location, community-based resources, and organizations from different sectors. The antecedents of DSP include contextual and population health drivers, medical systems and structural limitations, technological enabling factors, practice and implementation gaps and catalytic events and social development trends. The consequences of DSP encompass health and well-being outcomes, care and service delivery, system and implementation outcomes, equity and ethical considerations. Despite its potential benefits, DSP also faces challenges, including digital exclusion, data governance issues, gender imbalances and structural ethnic disparities. This study provides a comprehensive conceptual framework for digital social prescribing (DSP), addressing existing conceptual ambiguities and clarifying its theoretical boundaries. The study also highlights the need to critically address potential challenges associated with DSP implementation, including digital exclusion, data governance concerns, gender imbalances and structural ethnic disparities. These findings support the development of standardized evaluation frameworks and provide guidance for future research, practice and policy aimed at facilitating the sustainable and equitable implementation of DSP.