Background China’s healthcare system is confronting a rising burden of antimicrobial resistance, chronic complex diseases, and an aging population requiring long-term, post-acute care. As a value-based care model in the USA for over 50 years, home infusion therapy (HIT), combined with home health services (HHS), presents a sustainable alternative to prolonged hospitalization for intravenous medication administration. In this two-part narrative review, Part 1 provides a needs assessment describing the demographic, clinical, and public health factors driving the demand for HIT and HHS in China. Methods We conducted a literature search up to January 2026 using MEDLINE, EMBASE, PubMed, Web of Science, and China National Knowledge Infrastructure. Results In Part 1, we present the impact of the aging population and chronic conditions requiring prolonged infusion therapy (including cancer, malnutrition and infections like osteomyelitis, endocarditis, and bacteremia) on the rising antimicrobial resistance, hospital burden and healthcare expenditures. Through the patient-centric solution of HIT and HHS, patients can receive intravenous medications and nutrition in the comfort of their homes, enabling the continuity of care beyond the hospital. Services include outpatient parenteral antibiotic therapy, hospice and palliative care in patients with cancer, and management of nutritional needs through total parenteral nutrition. Under this care model, reimbursement is tied to success in improved patient outcomes and reduced hospital readmissions. A detailed reimbursement and cost-effectiveness considerations are addressed in Part 2 of this review. Conclusion With proper infrastructure development and reimbursement mechanisms that align payment with value, HIT and HHS could mitigate antimicrobial resistance, and transform and sustain affordable care delivery in China, especially for older adults and those with chronic conditions. Part 2 is available at https://doi.org/10.3389/fpubh.2026.1761870 .

Background The extension of survival in patients with pneumoconiosis has led to a shifting mortality spectrum where non-pneumoconiosis causes increasingly act as competing risks. Traditional survival analyses frequently ignore these competing events, potentially biasing prognostic estimates. Methods We conducted a retrospective study of 18,064 patients with pneumoconiosis diagnosed between 1960 and 2024 in Jiangsu Province. The Fine–Gray model was used to identify independent predictors of pneumoconiosis-related death while accounting for competing mortality. We compared this evidence with the standard Cox proportional hazards model and established a prognostic nomogram. Results The cumulative incidence of non-pneumoconiosis-related death progressively surpassed that of pneumoconiosis-related death during long-term follow-up. Older age at diagnosis, silicosis, an earlier era of diagnosis, and advanced baseline stage were identified as independent risk factors. The traditional Cox model overestimated risk effects for variables with differential impacts on competing outcomes. Subgroup analyses showed a significant interaction between disease type and stage regarding competing mortality risk. Specifically, patients with Stage II silicosis exhibited higher systemic vulnerability compared with those with coal workers’ pneumoconiosis. The constructed nomogram demonstrated high discrimination and calibration. Conclusion Non-pneumoconiosis-related death constitutes a critical competing risk that substantially affects the long-term survival outcomes of patients with pneumoconiosis. The Fine–Gray model provides accurate risk stratification by correcting for potential overestimation bias. Clinical management strategies must shift from singular pulmonary care to comprehensive health management that addresses comorbidities to improve overall survival outcomes.

Background For people living with HIV (PLWH), CD4 count serves as an effective indicator of response to antiretroviral therapy (ART) and a predictor of morbidity and mortality before and after ART initiation. In PLWH on ART, changes in CD4 count reflect immunological response to treatment. CD4 count recovery after ART initiation is defined as achieving a CD4 cell count of ≥500 cells/mm 3 . This study utilised survival analysis techniques to determine time to CD4 count recovery and to identify determinants among PLWH with severe immunosuppression who were initiated on ART in KwaZulu-Natal, South Africa. Materials and methods Secondary data were collected by CAPRISA from June 2004 to August 2013, with monthly hospital visits. Time to CD4 recovery was calculated from ART initiation to the first CD4 count ≥500 cells/mm 3 . Participants were followed until recovery; those who did not recover, were lost to follow-up, or died were censored. Kaplan–Meier curves estimated median survival time, while Cox and Weibull regression models identified risk factors associated with CD4 recovery. Results Among 2,528 participants (median age 32 years), 1,803 had viral load <400 copies/mL, 1,589 were females, and 524 had TB. By the end of the study, 727 achieved CD4 recovery. Kaplan–Meier estimates showed median time to recovery of nearly 40 months for females and 59 months for males. The Weibull model outperformed the Cox model. Male participants had a 41% lower hazard of recovery than females [HR: 0.589, 95% CI: 0.497–0.698], while rural care was associated with a 49% higher hazard of recovery than urban settings [HR: 1.494, 95% CI: 1.228–1.818]. TB-coinfected participants had a 39.5% lower hazard [HR: 0.605, 95% CI: 0.489–0.748], whereas those with viral suppression had a 49% higher hazard of recovery [HR: 1.489, 95% CI: 1.213–1.826]. Conclusion Delayed CD4 recovery among males, urban residents, TB-coinfected participants, and those with unsuppressed viral load (>400 copies/mL) underscores the need for targeted, differentiated HIV care strategies to accelerate immunological recovery and reduce HIV-related morbidity. Policymakers should prioritise male-focused interventions, strengthened TB–HIV integrated services, intensified adherence and viral load monitoring, and context-specific interventions in urban settings to accelerate immunological recovery and reduce HIV-related morbidity.

Introduction In Philadelphia there are racial disparities in health outcomes during the perinatal period, such that Black infants and their parents experience a disproportionately higher burden of poor outcomes compared to their White counterparts. These excess risks are driven at least in part by high rates of poverty and other manifestations of structural racism. The provision of guaranteed income (GI) or unconditional cash payments during and after pregnancy, is a bold and evidence-based approach to advancing equity in financial security and health. The objective of this protocol paper is to describe the community-centered approach to the design of (a) the Philly Joy Bank (PJB), a perinatal GI program in Philadelphia, and (b) the evaluation of PJB’s impact. Methods PJB was conceived by an established coalition of community partners through a collective impact model. Decisions related to the design and implementation of PJB are made through a consensus building process that centers the voices of Lived Experience Experts (i.e., Black birthing people in Philadelphia). Congruent with the community-driven design of PJB, the evaluation of the impact of PJB is grounded in the principles of community-based participatory research and is co-designed by the community. Results The study purpose is to assess the feasibility and acceptability of PJB (Aim 1); to examine whether and how GI affects ability to meet basic needs and parental stress (Aim 2); and to explore the impact of PJB on parental mental health and the preliminary impact on infant prematurity (low birthweight and preterm birth) (Aim 3). Descriptive statistics, mixed effects regression analyses, and participatory qualitative analysis approaches will be used to achieve study aims. Discussion GI is a promising upstream structural intervention to address persistent health inequities during the perinatal period: a critical period of the life course. Understanding if and how GI improves health for birthing people and their infants can inform implementation and policy to advance health equity.

Objectives This large-scale cross-sectional study utilized electronic health records (EHRs) to determine the prevalence, sonographic characteristics, and independent correlates of thyroid nodules in a Chinese health examination cohort, with comprehensive adjustment for iodine status, thyroid function, and autoantibodies. Methods We analyzed data from 12,468 adults undergoing routine check-ups in 2024. Thyroid nodules were assessed via ultrasonography and classified using TI-RADS. Multivariable logistic regression identified factors independently associated with nodule presence. Results The prevalence of thyroid nodules was 35.36%, with the vast majority (96.01%) being benign or probably benign (TI-RADS 2–3). Independent correlates included female sex (OR = 1.65, 95% CI:1.51–1.80), older age (per 10-year increment, OR = 1.55, 95% CI:1.47–1.64), family history of thyroid disease (OR = 2.31, 95% CI:2.04–2.61), insufficient iodine intake (OR = 1.38, 95% CI:1.23–1.55), obesity (OR = 1.35, 95% CI:1.21–1.50), abnormal TSH (OR = 1.32, 95% CI:1.19–1.46), and TPOAb positivity (OR = 1.28, 95% CI:1.13–1.45). Regular moderate-to-vigorous physical activity was protective (OR = 0.73, 95% CI:0.66–0.81). Conclusion Thyroid nodules are highly prevalent in this population. We identified a profile of both non-modifiable (e.g., sex, age) and modifiable (e.g., iodine nutrition, obesity, physical activity) correlates. These findings highlight targets for preventive health strategies, though future prospective studies in the general population are warranted to confirm causality.

Background Hepatitis C virus (HCV) infection is prevalent worldwide. The genotype (GT) distribution characteristics and transmission patterns of HCV show regional differences. Currently, the research on HCV genotype characteristics, molecular transmission networks, and associated risk factors in key areas of the southeast coast of China remains limited. This district lacks accurate molecular epidemiological data on HCV, hindering the implementation of prevention and control efforts. This study aims to investigate the epidemiological characteristics and molecular network transmission features of hepatitis C genotypes in key areas of the southeastern coast of China, to provide a reference basis for prevention and control strategies. Methods The HCV RNA-positive serum samples (88 cases) were collected from sentinel surveillance subjects with hepatitis C in Xiuyu District, Putian City, Fujian Province, China, from October 2022 to April 2023. The Core and NS5b fragments of the HCV genome were amplified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). The PCR products were sent to Sangon Biotech (Shanghai, China) Co., Ltd. for purification and Sanger sequencing. The sequences were assembled and aligned using biological software. The processed sequences were used to construct phylogenetic trees and molecular transmission networks. The Fisher–Freeman–Halton exact test was used to evaluate the significance of differences in demographic characteristics between HCV genotype groups. Results A total of 59 sequence samples were obtained from October 2022 to April 2023 (53 in the Core fragment and 45 in the NS5B fragment). Phylogenetic tree analysis showed that the major HCV genotypes were 1b (36/59, 61.02%) and 2a (22/59, 37.29%). One sample showed inconsistent genotyping results between the two genomic fragments. Most HCV strains had similar genetic evolutionary relationships in the Xiuyu District. There was a statistically significant difference in the distribution of HCV genotypes across occupations ( p < 0.05), whereas no other factors showed significant differences. At genetic distance thresholds of 0.018 and 0.043, Core and NS5B sequences formed the highest number of transmission clusters. A total of 40 sequences formed the molecular transmission network, with an overall clustering rate of 67.80%. The Core fragment contained 6 clusters, and the NS5b fragment contained 5 clusters. The connection between samples in the GT 1b transmission cluster was closer than in GT 2a. The network transmission figures reflected the potential connections between samples. Conclusion In this study, the HCV genotypes in the key areas were predominantly 1b and 2a. Most hepatitis C strains shared a similar evolutionary relationship. It suggested that there might be cluster transmission in this area. However, we still need more detailed epidemiological case investigations and experimental data in the future to obtain an accurate estimate of hepatitis C prevalence. Providing targeted treatment for HCV-infected individuals and intensifying screening among farmers are crucial measures to prevent and control hepatitis C in Xiuyu District.

Background Informal caregiving plays a vital role in supporting dependent individuals; however, prolonged caregiving is associated with significant physical and psychological strain. Understanding factors associated with caregiver burden is essential for designing effective interventions to protect caregiver health and sustain long-term care systems. Objective To examine the associations between psychological, physical, and contextual factors on caregiver burden and to identify variables independently associated with caregiver burden. Methods A cross-sectional study was conducted with 73 informal caregivers of people living with dementia or cerebral palsy who required substantial assistance in daily living. Standardized instruments were used to assess caregiver burden (Zarit Burden Interview), anxiety and depression (HADS), mental health and quality of life (SF-36), pain (VAS), and physical activity (IPAQ). Hierarchical multiple regression, mediation, and moderation analyses were performed. Results Mental health and anxiety showed the strongest independent associations of caregiver burden ( β = −0.396, p = 0.002; β = 0.243, p = 0.049, respectively), followed by musculoskeletal pain in the back and lower limbs. Patient-related variables, such as functional dependence or disability, were not directly associated with burden. Mediation analysis showed that mental health did not mediate the dependence-burden link. Moderation analysis did not reveal a statistically significant interaction effect. The final model explained over 60% of the variance in caregiver burden. Conclusion Caregiver mental health is a key determinant of perceived burden of caring for people with dementia and cerebral palsy, exerting a stronger influence than patient dependence or physical demands. Interventions should integrate psychological screening and mental health support to prevent caregiver distress and ensure a sustainable informal care.

Background With the increasing global aging population, depression in older adults has become an increasingly prominent issue. As a traditional mind–body exercise, Tai Chi Exercise (TCE) may have the potential to alleviate depression in older adults. However, its underlying mechanisms, particularly the mediating role of Psychological Resilience (PR) and the complex relationships between variables, require systematic exploration. Methods This study employed an integrated research design and surveyed 1,143 older adults through questionnaires. Mediation analysis was used to test the mediating effect of PR between TCE and depression (Dep). Additionally, network analysis was used to construct a cross-sectional network model of TCE, PR, and Dep symptoms to reveal the systemic associations between the variables. Results Mediation analysis showed that TCE not only negatively predicted Dep directly ( β = −0.068, p < 0.001) but also indirectly alleviated Dep symptoms through improving PR. The indirect effect (−0.192) accounted for 73.88% of the total effect. Network analysis further revealed the complex structure between variables: internal connections within constructs were strong, while direct connections between constructs were weaker. The item “I can achieve my goals” (PR1) was the most influential core node in the network. Conclusion This study revealed the dual pathways through which TCE alleviates depression in older adults: the direct effect and the indirect effect through enhancing PR. Network analysis provided systemic-level evidence for this mediating mechanism and identified the key intervention target of “goal achievement.” This suggests that future efforts to promote TCE for enhancing older adults’ mental health should focus on strengthening its role in improving PR, particularly in fostering a sense of personal control and goal achievement, thereby enabling more precise and effective interventions.

Objective Effective health communication is a cornerstone of public health promotion. This study aimed to develop and evaluate a pedagogical model to equip future physicians with essential skills in audience-tailored science communication, thereby contributing to the public health workforce. Methods The study involved 79 undergraduate students enrolled in the elective science communication course. The newly proposed A-SPIRE model (Anchoring, Searching, Processing, Integrating, Realizing, Evaluating) was applied in a teaching unit on “Precision Science Communication.” A pre-post design was used, with data collected via questionnaires, knowledge tests, and analysis of student-created communication works. Results Students’ understanding of precision science communication concepts and recognition of its importance significantly improved post-course ( P < 0.05). The overall distribution of knowledge test scores shifted upward ( P < 0.05). The student-created works effectively addressed the needs and characteristics of different target populations, demonstrating strong relevance, targeting, and effectiveness. The student-created works demonstrated a strong ability to address the specific needs and characteristics of different target populations (adolescents, young/middle-aged adults, older adults). 92.6% of students were satisfied with the model, and 96.3% reported improved communication abilities. Conclusion The A-SPIRE model effectively enhances medical students’ competency in precision health communication. It represents a feasible and scalable educational strategy to bridge medical training and public health needs by cultivating a future workforce capable of designing and delivering effective, audience-specific health promotion interventions.