IntroductionThe availability of digital care services does not ensure their adoption by older adults.MethodsThis study develops a tripartite evolutionary game involving government, platform enterprises, and older adults to examine how legal governance, enterprise investment, and user-side benefits jointly shape the adoption of smart care services by older adults in China. The payoff structure applies penalties and reputational losses only to passive enterprise investment and makes age-friendly design, data protection, and support measures improve the relative payoff of adoption. Official procurement records, enterprise disclosures, administrative performance data, subsidy standards, and survey estimates provide direct observable anchors, proxy-informed ranges, or scenario bounds according to parameter identifiability.ResultsUnder a coordinated baseline and an initial utilization share of 0.116, the system reached (0.908, 0.919, 0.965) at t = 80. A low government-and-enterprise initial state recovered much more slowly but approached the same high-inclusion equilibrium by t = 300. Across 2,000 seeded draws, the share with all three strategies above 0.9 increased from 1.95% at t = 80 to 6.1% at t = 1,000; the high-inclusion corner was locally stable in 6.2% of the drawn parameter sets.DiscussionThese are conditional simulation results, not population probabilities. High inclusion requires the public value of intervention to exceed implementation cost, sanctions and reputation to offset the short-run advantage of underinvestment, and user benefits and support to overcome the outside option.
ObjectivePesticide self-poisoning is a major global public health issue, yet the post-discharge mental health of survivors remains poorly characterized. To investigate the physical and mental health among survivors of diquat self-poisoning after returning to the community, which informs the effective prevention and intervention measures of repeated suicide.MethodsA follow-up study of 25 patients with acute diquat self-poisoning was enrolled from Guangzhou twelfth people’s hospital during 2017 to 2023. The health-related quality of life (HRQoL) was evaluated using the MOS 36-item short-form health survey (SF-36), and anxiety and depression were, respectively, assessed using Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales.ResultsTwenty-five (25) diquat self-poisoning patients were enrolled in a follow-up study, with a median follow-up of 1.58 person-years. Most participants had low scores in mental health of the HRQoL survey, with a median score was 108.15. In SF-36 domains, only Role Physical (RP) scored significantly lower in the high-dose group (p = 0.04). Persistent neurological issues (fatigue, forgetfulness, headache) were the primary physical complaints. HRQoL total scores were significantly shaped by sleep duration, history of major trauma, left-behind child status, and psychological symptoms (p < 0.05). Anxiety and depression symptoms had high prevalent rates of 56 and 68%, respectively. Stratified analysis by toxic dose [low-dose (≤ 50 mL, n = 12) vs. high-dose (> 50 mL, n = 13)] revealed no statistically significant differences in anxiety or depression rates.ConclusionDiquat self-poisoning survivors may experience persistent physical and psychological health difficulties after returning to the community, warranting further attention. The findings highlighted that prevention of repeated self-harm is still necessary among at-risk populations after returning to the community, particularly adolescents and young adults.
PurposeThis study evaluated the association of combined cognitive behavioral therapy (CBT) and rehabilitation training with improvements in vestibular dysfunction and negative emotions based on real-world clinical practice.MethodsThis single-center, real-world, retrospective cohort study recruited 100 patients with vestibular dysfunction and negative emotions from a tertiary hospital in China between August 2020 and October 2024. Patients were divided into two groups based on actual treatment received: the conventional care group (n = 50) received standard medication and health education, while the combined intervention group (n = 50) additionally underwent a 3-month program of CBT combined with rehabilitation training. Primary outcomes included Visual Analog Scale (VAS), Dizziness Handicap Inventory (DHI), and Somatic Symptom Scale (SSS) scores at 3 months. Secondary outcomes included the above scales at 1 month, along with Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores.ResultsAt 3 months, the combined intervention group showed significantly greater improvement in VAS, DHI, and SSS scores compared to the conventional care group (all p < 0.05). At 1 month, the combined group demonstrated early superiority in the emotional and functional dimensions of the DHI. GAD-7 and PHQ-9 scores showed significantly greater psychological improvement in the combined group at both 1 and 3 months (p < 0.01).ConclusionIn real-world settings, CBT combined with rehabilitation training was associated with greater improvements in dizziness, somatic symptoms, and anxiety/depression in vestibular dysfunction patients with negative emotions compared with conventional care. Most outcomes improved early, whereas the physical component of dizziness-related disability showed a later between-group separation, which supports the potential value of integrated psychosomatic care models.
BackgroundRegular physical activity is known to benefit emotion and cognition, and acute moderate-intensity aerobic exercise has been shown to improve executive function, particularly inhibitory control, in healthy populations. However, whether these effects generalize across individuals with different levels of trait anxiety remains unclear. The present study investigated the effects of acute moderate-intensity aerobic exercise on state anxiety and inhibitory control in young adults with low and high trait anxiety using the Stroop task, with a particular focus on the temporal neural processes associated with Stroop performance.MethodsBased on trait anxiety scores, participants were assigned to either the low trait anxiety (LTA, n = 21) or high trait anxiety (HTA, n = 21) group. All participants completed both a 30-min moderate-intensity aerobic exercise session and a resting control session. Following each session, participants completed a state-anxiety assessment and performed a color-word Stroop task while stimulus-locked event-related potentials (ERPs) were recorded.ResultsAcute moderate-intensity aerobic exercise reduced state anxiety in the HTA group but not in the LTA group. Exercise also shortened response times and reduced error rates across both congruent and incongruent Stroop conditions in both groups. At the neural level, acute aerobic exercise was associated with less negative N400 amplitudes and larger sustained positive potential (SP) amplitudes during the Stroop task in both groups.ConclusionA single bout of moderate-intensity aerobic exercise selectively reduced state anxiety in individuals with HTA and broadly improved Stroop performance across both trait anxiety groups. These behavioral changes were accompanied by exercise-related modulation of N400 and SP amplitudes, suggesting alterations in neural processes associated with conflict-related cognitive control.
BackgroundPopulation aging requires community-based approaches to identify multidomain risk patterns before severe disability or clinical cognitive impairment develops. Although social interaction, physical frailty, and subjective cognitive decline are relevant to healthy aging, their parallel longitudinal trajectories remain insufficiently characterized in community-dwelling older adults.ObjectiveThis study examined the six-year co-development of social interaction, screening-defined physical frailty, and screening-defined subjective cognitive decline among community-dwelling older adults in Japan.MethodsThis longitudinal cohort study analyzed 307 older adults (34.6% of 887 baseline-eligible participants) with valid measurements of all three focal variables in 2014, 2017, and 2020. Social interaction was measured using the Index of Social Interaction. Physical frailty (PF) was operationalized using the five-item motor domain of the Kihon Checklist (KCL), and screening-defined subjective cognitive decline (SCD) was operationalized using the three-item KCL Cognitive Function domain (KCL-CF). A Bayesian parallel-process latent-basis growth model was fitted, adjusting for baseline sociodemographic, lifestyle, and chronic disease factors.ResultsThe model showed acceptable posterior predictive fit. Social interaction scores decreased from 16.82 to 16.09, PF prevalence increased from 8.8 to 19.5%, and screening-defined SCD prevalence increased from 31.3 to 62.9%. A higher social-interaction intercept factor was associated with lower PF intercept liability (standardized estimate −0.282, 95% credible interval (CrI) −0.503 to −0.044) and lower SCD intercept liability (−0.433, −0.651 to −0.179). The social-interaction and PF slope factors were inversely associated (−0.490, −0.809 to −0.026), whereas slope associations involving SCD were imprecisely estimated.ConclusionSocial, physical, and subjective cognitive indicators showed distinct but interrelated longitudinal patterns. Repeated multidomain assessment may support community-based risk characterization and follow-up for healthy aging.
IntroductionSuicide prevention research has increasingly emphasized protective factors in addition to risk factors. Reasons for living represent a protective construct in suicidology, reflecting beliefs and commitments that may discourage suicidal behavior. However, less is known about how self-rated functioning in family, social, and social-life domains is associated with reasons for living among young adults.MethodsAn anonymous cross-sectional online survey using non-probability convenience sampling was conducted between March and June 2025 among 546 young adults aged 18–35 years in Poland. Reasons for living were assessed using the Polish adaptation of the Reasons for Living Inventory. Life satisfaction and general self-efficacy were measured using the Satisfaction With Life Scale and General Self-Efficacy Scale. Participants rated family, social, and social-life functioning on five-point scales. Hierarchical multiple linear regression examined associations with reasons for living after accounting for selected sociodemographic and family-related factors, life satisfaction, and general self-efficacy.ResultsReasons for living were positively correlated with life satisfaction, general self-efficacy, and self-rated functioning in all three domains. Selected sociodemographic and family-related variables explained 8.2% of the variance. Adding life satisfaction and general self-efficacy increased explained variance by 16.0%, and adding family, social, and social-life functioning contributed a further 1.4% (p = 0.022). The fully adjusted model explained 25.6% of the variance. Life satisfaction showed the strongest positive standardized association, followed by parenthood and general self-efficacy. Family functioning was also positively associated with reasons for living, whereas social and social-life functioning were not independently associated. In a sensitivity analysis excluding Responsibility to Family and Child-Related Concerns items, the association with family functioning was attenuated and no longer statistically significant, whereas parenthood remained positively associated with the non-family-content outcome.ConclusionIn this convenience sample, reasons for living were cross-sectionally associated with psychological resources and family-related factors. The family-functioning association was sensitive to family-related RFL-48 content, whereas the parenthood association persisted after this content was excluded. Given the non-probability sampling strategy and predominance of women, the findings should not be interpreted as population estimates for Polish young adults. Causal interpretations require longitudinal research, and intervention-related implications require intervention studies.
BackgroundType 2 diabetes mellitus (T2DM) is a major global public health challenge, with many individuals remaining undiagnosed until complications develop. Machine learning (ML)-based risk prediction models have the potential to support early identification of individuals at increased risk using primary care data. However, the characteristics and applicability of these models within primary care settings have not been comprehensively mapped.ObjectiveTo systematically map the available evidence on machine learning (ML)-based models for risk prediction, early detection, and case-finding of type 2 diabetes in primary care, and to summarize their characteristics, including predictors, modeling approaches, validation strategies, and model performance.MethodsA scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed/MEDLINE, Scopus, and Ovid MEDLINE were searched for English-language studies published between January 2011 and December 2025. Primary research describing ML-based risk prediction models developed, validated, evaluated, or intended for implementation in primary care was eligible. Data were extracted using a structured charting form and synthesized descriptively.ResultsThe search identified 186 records, of which four studies met the inclusion criteria. The included studies were conducted in Sweden, Canada, Saudi Arabia, and Hong Kong between 2024 and 2025. Three studies focused on model development and internal validation, while one externally validated previously developed non-laboratory prediction models. A range of ML approaches was identified, including stochastic gradient boosting, federated learning, multilayer perceptron, random forest, support vector classification, naïve Bayes, and decision tree algorithms, with logistic regression commonly used as a comparator. Models primarily utilized routinely collected demographic, anthropometric, lifestyle, and electronic health record-derived variables. Most studies reported moderate-to-good predictive performance; however, evidence regarding external validation, calibration, and prospective implementation within routine primary care remained limited.ConclusionEvidence on ML-based risk prediction models for T2DM applicable to primary care remains limited despite growing interest in AI for diabetes prediction. Existing models demonstrate promising predictive performance using routinely available clinical information, but greater emphasis is needed on external validation, calibration, prospective implementation, and evaluation across diverse primary care populations before widespread clinical adoption.Review registrationOpen Science Framework https://osf.io/mbfrz.
ObjectiveTo comprehensively synthesize the objective clinical determinants and subjective experiences shaping long-term health-related quality of life (HRQOL) among Intensive Care Unit (ICU) survivors.MethodsSeven databases were searched through May 1, 2026. Eligible studies examined HRQOL and its determinants in adult ICU survivors. Outcomes assessed at ≥3 months after discharge were used for the primary long-term interpretation, whereas assessments before 3 months were retained as early-recovery evidence. Two reviewers independently screened studies, extracted data, and appraised individual studies using the Mixed Methods Appraisal Tool (MMAT). Quantitative evidence was synthesized by effect direction and major determinant, HRQOL bodies of evidence were assessed using an adapted GRADE approach. Quantitative and qualitative evidence was synthesized separately and subsequently integrated using a convergent segregated approach.ResultsFifty-three eligible studies were included in the final synthesis. Long-term HRQOL was associated with pre-existing health status, acute illness severity, post-intensive care physical, psychological, and cognitive impairments, functional limitation, rehabilitation, and social support. Pre-ICU chronic disease, frailty, disability, and baseline HRQOL emerged as important contextual determinants and potential confounders of apparent ICU-related associations.ConclusionsLong-term HRQOL impairment is a multi-layered outcome of biomedical, symptomatic, functional, and environmental interactions. Post-ICU rehabilitation should transition toward multidisciplinary, continuous care that combines physical therapy with cognitive-psychological support and robust transitional care networks to foster successful societal reintegration.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261398874, identifier: CRD420261398874.
BackgroundSchools are an important setting for developing movement competence and supporting physical activity PA). Teachers provide feedback on how learners move, but individualized observation is difficult to sustain and document in large classes. Existing artificial intelligence (AI) systems typically classify an action or predict one competitive-sport score. These outputs do not identify the specific movement feature that a learner might adjust during practice.MethodsUsing three public human action datasets (NTU RGB+D, Penn Action, and a FineGym subset), we benchmarked five representative skeleton-sequence models—recurrent (LSTM, GRU), graph-based (ST-GCN, CTR-GCN), and a Transformer—under a unified setting, and constructed four interpretable movement-profile indicators from joint coordinates and trajectories: movement amplitude, postural stability, left–right coordination, and temporal consistency. Each indicator was normalized against the same-class reference distribution, providing a relative, interpretable description rather than an expert-certified score.ResultsOver five random seeds per dataset, independent-test macro-F1 ranged from 0.76 to 0.97; CTR-GCN obtained the highest mean on every dataset (NTU RGB+D 0.970 ± 0.003). Paired tests supported its advantage over all four comparators on NTU RGB+D and FineGym, whereas on Penn Action only the comparison with LSTM remained significant after correction. In the feature ablation, the full kinematic input increased macro-F1 from 0.925 to 0.936 on 3D skeletons (Holm-adjusted p = 0.022); the corresponding 2D change from 0.893 to 0.905 was not significant after correction (p = 0.079). Per-action profiles and a same-action case analysis showed that the indicators capture interpretable kinematic structure. The resulting percentiles describe relative tendencies within these datasets; a low percentile does not by itself identify an incorrect movement or constitute an age-appropriate standard for children.ConclusionSkeleton-only movement profiles offer a privacy-reducing, teacher-in-the-loop approach to formative feedback that could support digital PA education and health promotion in schools. As a computational proof-of-concept evaluated on public datasets, the study does not include health or learning outcomes, age-specific K–12 reference distributions, or authentic-classroom validation. Calibration on curriculum-relevant data from children and validation against teacher or movement-expert ratings are required before the profiles can be interpreted as movement-quality feedback or used to support public-health claims.
Public service for nationwide fitness serves as a key pillar for advancing the Healthy China initiative and reducing health inequities. However, regional development disparities and supply–demand mismatches remain prominent, and empirical research from a public health perspective on the long-term spatiotemporal evolution and spatial spillover effects of such services is still lacking. Using panel data from 30 Chinese provinces from 2013 to 2022, this study measures the supply level of public services for nationwide fitness using the CRITIC-entropy weight method, and employs spatial trend surface analysis, spatial autocorrelation, and a spatial lag model (SAR) to investigate its spatiotemporal patterns and spatial spillover effects. The results show that the supply level of China’s nationwide fitness public services exhibits a three-stage upward trend, with an average annual growth rate of 7.18%, and an overall spatial pattern characterized by higher levels in the east than in the west, and higher in the south than in the north. The disparity between the eastern and western regions has narrowed, whereas the north–south gap has continued to widen. Economic development level and urbanization level demonstrate bidirectional positive spatial spillover effects; population density, government support, and educational structure only affect local supply levels; transportation accessibility shows no significant effect. Therefore, differentiated regional policies and strengthened interprovincial cooperation are needed to optimize resource allocation with a focus on health equity. These findings provide a reference for formulating public health strategies, alleviating health inequities, and improving the overall health status of residents.
BackgroundAlthough long-term exposure to ambient fine particulate matter (PM2.5) is an established risk factor for stroke, evidence on the detrimental effects of its specific constituents remains limited. This study aimed to investigate the associations between long-term exposure to PM2.5 constituents and incident stroke, and to identify the key contributor.MethodsWe conducted a nationwide prospective cohort study using data from the China Health and Retirement Longitudinal Study (CHARLS) between 2013 and 2018. Incident stroke cases were identified from CHARLS self-reported physician diagnoses during follow-up interviews. PM2.5 constituent concentration data were derived from the Tracking Air Pollution in China (TAP) dataset, while temperature and relative humidity data were obtained from the European Center for Medium-Range Weather Forecasts Reanalysis v5 (ERA5). Individual records were matched with environmental exposure data to quantify the associations between specific PM2.5 constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) and the incident stroke. Multivariate Cox models and quantile-based g-computation were applied to assess the associations of PM2.5 constituents with incident stroke and to identify the key contributor.ResultsOver a median follow-up of 5.0 years, 610 incident stroke cases occurred among 8,724 participants. All five constituents were significantly associated with stroke onset, the adjusted hazard ratios (95% confidence interval [CI]) for each interquartile range increase were 1.55 (95% CI: 1.35–1.79) for PM2.5, 1.55 (95% CI: 1.34–1.79) for sulfate, 1.37 (95% CI: 1.18–1.59) for nitrate, 1.42 (95% CI: 1.24–1.63) for ammonium, 1.59 (95% CI: 1.40–1.80) for organic matter, and 1.77 (95% CI: 1.54–2.03) for black carbon, respectively. In the joint effect analysis, black carbon (28.6%) exhibited the largest weight within the mixture. Stratified analyses revealed that individuals aged over 65 years and residents of southern China were more susceptible.ConclusionLong-term exposure to PM2.5 constituents is associated with an elevated risk of incident stroke, with black carbon showing the strongest association among the five constituents. Older adults and residents of southern China were found to exhibit heightened susceptibility. These findings highlight the importance of mitigating the growing stroke burden through tailored clinical approaches and targeted regulation of carbonaceous emissions, accounting for demographic and regional vulnerabilities.
IntroductionSport is often understood as a health behavior associated with happiness through physical activity and psychological regulation. However, less is known about the social pathways connecting different forms of sport involvement with happiness. This study examined the associations of structured exercise participation (SEP) and live sports spectatorship (LSS) with happiness and investigated the mediating role of neighborhood social capital (NSC).MethodsData were drawn from 5,451 respondents in the 2023 Chinese General Social Survey. OLS regression was used as the main analytical approach, ordered logistic regression was conducted as a robustness check, and bootstrap mediation analysis was used to estimate the indirect, direct, and total associations of SEP and LSS with happiness through NSC.ResultsBoth SEP and LSS were positively associated with happiness after adjustment for demographic, socioeconomic, health-related, and residential characteristics. The ordered logistic models produced substantively consistent results. Bootstrap analysis showed significant positive indirect associations through NSC for both SEP and LSS. For SEP, the direct association remained statistically significant after NSC was included. For LSS, the direct association was not statistically significant, whereas the indirect and total associations remained significant.DiscussionThe findings suggest that sport involvement is associated with happiness not only through active physical participation or spectator-based leisure, but also through neighborhood social connections and everyday social embeddedness. SEP appears to be linked to happiness through both direct and socially mediated pathways, whereas the association of LSS with happiness appears to operate primarily through NSC. Given the cross-sectional design, these findings should be interpreted as associations rather than causal effects.
BackgroundTinnitus-related disability among older adults in long-term care facilities may reflect not only auditory symptoms but also functional and psychosocial vulnerability. This study examined the association between perceived social support and Tinnitus Handicap Inventory (THI)-defined tinnitus-related disability among older long-term care residents with chronic subjective tinnitus.MethodsWe conducted a cross-sectional study between July and November 2025 among 390 residents aged 60 years or older with chronic subjective tinnitus in long-term care facilities in urban Wuhan, China. Perceived social support was measured using the 13-item Short-form Social Support Appraisals Scale for older adults, and tinnitus-related disability was assessed using the THI. The primary outcome was continuous THI score; severe/catastrophic THI was additionally analyzed as a binary outcome. Ordinal THI severity and moderate-or-worse THI were examined in sensitivity analyses. Multivariable linear, logistic, ordinal logistic, quartile-based, restricted cubic spline, subgroup, and sensitivity analyses were performed with adjustment for demographic, socioeconomic, lifestyle, institutional, clinical, and tinnitus-related covariates.ResultsThe mean age was 79.85 years (SD 8.32), and 237 participants (60.8%) were female. Among the covariates included in the fully adjusted model, hypertension was associated with a higher THI score (adjusted β = 23.82, 95% CI 19.00 to 28.65; p < 0.001). Per 1-SD higher SSA-13 score, the fully adjusted THI total was 5.24 points lower (β = −5.24, 95% CI −7.34 to −3.14; p < 0.001), and the odds of severe/catastrophic THI were lower (OR = 0.60, 95% CI 0.45 to 0.80; p < 0.001). The highest SSA-13 quartile had a lower adjusted THI score than the lowest quartile (β = −12.11, 95% CI −17.39 to −6.84), but intermediate-quartile estimates were non-monotonic; the spline nonlinearity test was significant (p < 0.001).ConclusionAmong older adults with chronic subjective tinnitus living in long-term care facilities, higher perceived social support was associated with lower tinnitus-related disability. Because of the cross-sectional design, these findings should be interpreted as evidence of association rather than causation. Brief assessment of perceived social support may help identify residents who need additional psychosocial attention within long-term care settings.
ObjectiveTo systematically evaluate existing risk prediction models for enteral feeding intolerance (EFI) in critically ill patients, with the aim of providing evidence-based references for clinical practice.MethodsPubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biology Medicine Disc (CBM), and VIP Database were systematically searched from database inception to November 20, 2025. Studies that developed or validated risk prediction models for enteral feeding intolerance in adult critically ill patients were included. Data extraction was conducted using the CHARMS checklist, and the risk of bias and applicability of the included studies were assessed using the PROBAST tool.ResultsA total of 25 studies were included, involving 25 risk prediction models for enteral feeding intolerance. Sample sizes ranged from 118 to 1,584 patients, and the incidence of EFI ranged from 26.25 to 61.3%. APACHE II score, blood glucose, mechanical ventilation, age, albumin, and intra-abdominal pressure were relatively frequently reported predictors, but no single predictor was consistently identified across all models.ConclusionExisting risk prediction models for enteral feeding intolerance in critically ill patients demonstrate certain predictive value; however, the methodological quality varies considerably, and external validation is insufficient. Future studies should conduct large-scale, multicenter, prospective research and adopt standardized methodological procedures to develop and validate prediction models, thereby improving their clinical applicability and generalizability.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261281618, identifier (CRD420261281618).
IntroductionFor the public to adopt health promoting behaviors widely, there has to be sufficient trust in the institutions that disseminate information on protective behaviors. However, when members of the public lose trust in formal information sources, many seek information from informal information sources. Identifying trusted informal messengers is key to restore trust and effectively promote public health.MethodsWe conducted repeat surveys with young adults and older adults living in New York City public housing to assess who they consider a trusted source of COVID-19 information, as well as their protective behavior practices across a period of five weeks. We then examined the association between trusted sources and participant behavior.ResultsParticipants in both age groups showed the highest trust in doctors or healthcare providers. Associations with protective behavior existed across multiple information sources, but strongest associations for both age groups were seen in relation to trusting one’s faith leader for information.DiscussionAlthough other sources of information were more frequently cited as trustworthy by participants, trust in one’s faith leader was the strongest predictor of protective behavior practices.
ObjectiveTo investigate patients’ willingness and needs for ICU virtual reality visits prior to elective surgery, so as to provide a reference for developing VR-based preoperative ICU visits tools that meet actual clinical user requirements.MethodsA descriptive qualitative study was conducted. A total of 18 patients undergoing elective surgery in surgical departments collaborating with the intensive care unit of a tertiary Grade A hospital in Jinan, Shandong Province, between March 2025 and August 2025 were selected for semi-structured in-depth interviews. Data were analyzed using thematic analysis.ResultsFive themes were extracted: current cognitive status of patients regarding the ICU and core information gaps; patients’ cognition and expectations of preoperative visits; patients’ acceptance and cognition of applying VR technology to ICU preoperative visits; core needs for VR-based preoperative ICU visits; and Potential Barriers and Optimization Suggestions for the Implementation of VR-based preoperative ICU visits.ConclusionThis qualitative study explored patients’ willingness and needs for VR-based preoperative ICU visits. Patients expressed positive attitudes toward the potential application of VR technology in ICU preoperative visits, reflecting anticipated rather than actual use of this intervention. Based on the results of this study, future research can collaborate with technology development teams to construct a VR-based preoperative ICU visits system, conduct longitudinal in-depth studies from the aspects of clinical verification, technical iteration, and long-term promotion, so as to facilitate the translation of this technology from demand-oriented design to clinical application.
BackgroundCommunity oral health practice increasingly requires dental hygienists to perform prevention-oriented, population-based, and interprofessional roles beyond traditional chairside clinical care. However, existing competency frameworks primarily emphasize clinical practice or general professional competencies, and an integrated competency framework specifically designed for community oral health practice remains unavailable. This study aimed to identify core competencies for community oral health practice among dental hygienists through a scoping review.MethodsA scoping review was conducted in accordance with the JBI methodology and reported following the PRISMA-ScR guidelines. Literature published between 2005 and 2025 was identified through PubMed, Scopus, Google Scholar, and targeted searches of official organizational websites. Following predefined eligibility criteria, 38 sources were synthesized across three analytical layers: (1) seven cross-professional competency frameworks represented by 12 source documents, (2) five national or regional dental hygiene competency frameworks represented by nine source documents, and (3) 17 community oral health practice literature sources. Competency domains were identified through iterative qualitative coding and retained when supported by convergent evidence across at least two of the three analytical layers.ResultsEight integrated competency domains were identified: Health Equity Practice (based on social determinants of health, SDOH); Population-Based Program Planning, Implementation & Evaluation; Professionalism & Social Responsibility; Policy & Health System Literacy; Community Problem-Solving; Interprofessional Collaboration & Leadership; Evidence-Based Practice & Data Literacy; and Cultural Competence & Public Communication. The resulting framework integrates competencies derived from international healthcare professional frameworks, national dental hygiene competency frameworks, and community oral health practice literature, reflecting the expanding public health role of dental hygienists.ConclusionThis study proposes an integrated competency framework for community oral health practice that may support competency-based curriculum development, workforce preparation, and professional development for dental hygienists. The framework provides a structured foundation for strengthening prevention-focused community oral health practice and may be adapted and validated across diverse educational, sociocultural, and healthcare settings.
BackgroundWeChat group consultations extend pediatric advice into everyday messaging, but their interactional organization is not well described.ObjectiveTo identify recurring interactional stages, and clarification practices in asynchronous caregiver-physician exchanges.MethodsWe analyzed 5,938 messages nested within 347 manually identified complete consultation episodes from one private pediatric WeChat group in Chengdu, China, collected from January to December 2024. A qualitatively led mixed-methods design combined manual sequence segmentation, descriptive analysis of message distribution and length, and targeted qualitative analysis of clarification sequences.ResultsFour recurrent stages were identified: problem initiation, clinical data collection, diagnostic advice, and closure. Opening and illness presentation were combined in 69.45% of episodes (241/347), and diagnosis with treatment recommendation in 85.88% (298/347). Caregivers produced more messages overall than physicians (3,273 vs. 2,665), with substantially longer and more variable messages during problem initiation (median = 9 vs. 3; M = 17.91 vs. 3.50; IQR = 14.75 vs. 3) and clinical data collection (median = 10 vs. 7; M = 14.22 vs. 9.29; IQR = 11 vs. 7). Message-length distributions became more comparable during diagnostic advice (median = 10 for both; IQR = 12 vs. 13). Clarification sequences were identified in both directions: 293 physician-led sequences during clinical data collection and 686 caregiver-initiated sequences during diagnostic advice, progressively transforming underspecified symptom reports into more specified clinical accounts.ConclusionThe findings demonstrate how asynchronous messaging redistributes communicative activities between caregivers and physicians, with clarification as a recurrent mechanism for specifying clinically relevant information. Structured symptom prompts, clearer message threading, and explicit escalation guidance warrant testing in future intervention research. This study provides an empirical basis for understanding the sequential organization of asynchronous pediatric consultations and offers actionable directions for communication design in digital health services.
AimsHealing workplaces require evidence on how personal resources are experienced under demanding clinical conditions and what forms of support nurses perceive as useful. This study examined burnout, psychological capital, and empathy among pediatric nurses in a Chinese tertiary hospital and used qualitative findings from nurses with extreme burnout profiles to clarify burnout-related support and training needs.MethodsAn explanatory sequential mixed methods design was used. In the quantitative phase, 218 pediatric nurses completed an online survey including the Maslach Burnout Inventory–Human Services Survey, the Chinese Revised Nurses’ Psychological Capital Scale, and the Jefferson Scale of Empathy–Health Professionals. In the qualitative phase, 11 nurses with extreme burnout profiles participated in one 120-min focus group. Quantitative data were analyzed using descriptive statistics, unadjusted Pearson correlations, and 95% confidence intervals. Qualitative data were analyzed using inductive thematic analysis and integrated with quantitative findings through a joint display.ResultsReduced personal accomplishment was the most prevalent burnout dimension (54.6%), whereas emotional exhaustion and depersonalization were low in most participants (75.0% and 84.0%, respectively). Psychological capital was low in 76.0% of nurses and was not significantly correlated with any burnout dimension. Empathy was high in 62.0% of participants and was positively correlated with personal accomplishment (r = 0.405) and negatively correlated with emotional exhaustion (r = −0.184) and depersonalization (r = −0.313). Qualitative findings identified perceived support needs related to burnout recognition, psychological guidance, career development, professional enhancement, case-based learning, confidentiality, and follow-up evaluation.ConclusionPediatric nurses showed a burnout profile dominated by diminished personal accomplishment. The non-significant psychological capital–burnout associations suggest that personal resources alone may not fully explain burnout patterns in this single-center context. Burnout support in high-acuity pediatric settings may need to combine psychological support with career-development pathways, team learning, and reflective practice.
BackgroundSouth Africa has seen a rise in gender-based violence (GBV), which now ranks as a top contributor to years of life lost for women. GBV is a significant public health challenge. Physicians and other medical professionals need targeted knowledge and skills for an adequate response. This study assessed South African physicians’ understanding and opinions on GBV care. It also explored the effects on physicians treating survivors.MethodsTo assess the understanding and opinions of practicing physicians in South Africa, the study used a qualitative method. One mini focus group discussion (mini-FGD) included four physicians from four provinces. This was followed by one in-depth interview (IDI). Researchers conducted thematic analysis using Atlas.ti. They organized themes based on guided prompts.ResultsPhysicians identified structural and social barriers like societal issues, inefficient systems, lack of collaborative efforts for GBV, community factors affecting the care, personal financing for GBV care that block survivor access to GBV care. Survivors often return to unsafe environments because of poor support services. Physicians reported stress, fatigue, and helplessness while responding to GBV survivors. While physicians are motivated by empathy to help survivors, they also experience trauma due to the growing number of GBV cases.ConclusionThe high incidence of GBV in South Africa demands comprehensive attention. Physicians recognized GBV care as a complex socioeconomic and public health issue. They reported that enhanced cooperation between the government and the private sector, with a focus on funding prevention and strengthening infrastructure, would improve care for survivors of GBV.
