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Authors: Jerry John Ouner, Agani Afaya, Jaffer Okiring, Sera Young, Rachel G. A. Thompson, Torsten B. Neilands, Tarik Benmarhnia, Isaac Yeboah, Raymond Aborigo, Monica Getahun, Sheri Weiser

Although recent literature increasingly recognizes HIV, food insecurity, water insecurity, and depression as interconnected syndemics, research simultaneously evaluating the role of all these factors is limited among people living with HIV. We assessed the associations between water insecurity and food insecurity and how they relate to depression among people living with HIV in Ghana. This was a cross-sectional analysis of the baseline data of an ongoing cohort in three regions of Ghana. PHQ-9 depression scale was used, summed up to generate a depression score, which was then recoded into 4 categories of ‘none-minimal’,’mild’,’moderate’, and ‘severe’. Multivariable ordered logistic regression analysis (controlling for a priori identified confounders) was used to quantify the association between water insecurity and depression. Overall average depression score was 5.88 (SD = 4.82), with 47.1% of the participants having ‘none-minimal’ depression, 32.2% having mild, 19.9% having moderate, and only 0.8% having severe depression. In the multivariate model, depression was more prevalent among participants experiencing low (aOR = 1.96; 95% CI: 1.30–2.95) or moderate water insecurity (aOR = 2.64; 95% CI: 1.45–4.82), and moderate (aOR = 2.22; 95% CI: 1.27–3.87) or high food insecurity (aOR = 3.32; 95% CI: 2.22–4.95). Higher odds of depression were also observed among females (aOR = 1.73; 95% CI: 1.23–2.44), and those reporting moderate (aOR = 6.22; 95% CI: 1.85–20.86) or high perceived stress (aOR = 21.07; 95% CI: 6.75–65.80). Lower odds of depression was observed among widowed women (aOR = 0.61; 95% CI: 0.41–0.86). The study demonstrates that both water insecurity and food insecurity are strongly associated with depression among people living with HIV. The substantially higher odds of depression among women and those experiencing moderate to high perceived stress highlight the importance of incorporating gender-responsive and stress-focused mental health interventions into HIV care.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000546. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Thuan Minh Tu, Quan Hong Nguyen, Phuong Ngoc-Duy Nguyen, Ho Hai Phan

Although sustainable management literature extensively addresses the link between organizational performance and sustainable practices, evidence on the mechanisms through which environmental regulations translate into firm performance remains inconsistent. Findings on whether circular practices mediate this relationship are mixed, particularly within SMEs, where these mediating pathways remain largely untested. The circular economy has arisen as a solution to address sustainability concerns. This study examines the influence of environmental regulations and circular supply chain management on sustainable firm performance. It emphasizes the mediating role of circular economy practices and the moderating impacts of top management green commitment. Employing Partial Least Squares Structural Equation Modeling on survey data from 482 Vietnamese SMEs, the results indicate that both environmental regulations and circular supply chain management positively influence business performance, with circular economy practices acting as a partial mediator. Moreover, top management green commitment moderates the relationships between environmental regulations and circular economy practices and between circular supply chain management and circular economy practices, showing that top management green commitment determines how effectively environmental regulations and supply chain practices lead to circular economy actions - a finding that adds new insight beyond the widely recognized direct effect of leadership on sustainability outcomes. The results have significant implications for researchers, government officials, and company executives by elucidating how SMEs should adhere to environmental regulations and leverage circular supply chain management to enhance circular economy practices for sustainable efficiency in the context of developing countries. By integrating Institutional Theory and the Natural Resource-Based View, this study clarifies the regulatory and supply-chain pathways through which circular economy practices emerge, and how these practices translate into sustainable firm performance under varying levels of top management green commitment.

Source: PLOS Sustainability and Transformation. DOI: 10.1371/journal.pstr.0000295. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Tong Lyu

Digital health governance increasingly relies on policy systems that coordinate data resources, information platforms, standards, service delivery, regulation, security, innovation, and implementation support. However, the structural composition and cross-policy heterogeneity of China’s national digital health policy system remain insufficiently quantified. This study develops a domain-specific Policy Modeling Consistency (PMC) framework to evaluate the structural coverage of national-level digital health management policies in China. Using a source-locked corpus covering 2016–2025, 42 eligible policies were identified, of which 39 with complete and auditable texts were included in the quantitative analysis. The framework comprises nine dimensions and 48 binary indicators, generating 1,872 policy-by-indicator coding decisions. An independently coded 11-policy subset yielded 96.78% agreement and a Cohen’s kappa of 0.914. The mean PMC score was 6.654 (SD = 1.456; median = 6.500; range = 3.467–9.000). Under the study’s structural-coverage thresholds, nine policies were classified as perfect, 11 as good, 16 as acceptable, and three as poor. Regulatory governance, standards and institutional arrangements, and data resources showed the highest average coverage, whereas data protection and industrial innovation showed the lowest coverage and the greatest cross-policy variation. Leave-one-policy-out and policy-family sensitivity analyses confirmed the stability of the principal structural pattern. These findings reveal a policy architecture with relatively extensive governance, institutional, and data-related provisions but more uneven protection- and innovation-related coverage. The proposed framework provides a reproducible basis for comparing policy-text structure while avoiding the interpretation of textual completeness as evidence of implementation quality or policy effectiveness.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0362220. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Amal Mubarak Alsuwaylim, Bandar A. Alsharif, Mohamed Sayed Abdellatif, Mohammed Rahmath, Ashraf Ragab Ibrahim, Mohamed Ali Nemtallah

Despite growing evidence linking academic entitlement to diminished student outcomes, the psychological mechanisms through which entitled academic expectations erode student well-being remain insufficiently understood. The present study examines the mediating role of the impostor phenomenon in the relationship between academic entitlement and well-being among university students. A cross-sectional correlational design was employed with a sample of 864 undergraduate students recruited from Al-Azhar University and Kafr El-Sheikh University in Egypt. Participants completed the Academic Entitlement Scale (AES-28), the Short Clance Impostor Phenomenon Scale (CIPS-10), and the BBC Well-Being Scale (BBC-WBS). Mediation analysis was conducted using the PROCESS macro with bootstrapping based on 5,000 resamples. Results revealed that academic entitlement significantly and positively predicted the impostor phenomenon, which in turn significantly and negatively predicted student well-being. The impostor phenomenon partially mediated the relationship between academic entitlement and well-being, accounting for approximately 23% of the total effect. These findings suggest that entitlement-driven expectations are associated with lower overall well-being (composite score), both directly and indirectly by fostering fraudulence-related self-doubt. Mediation was not tested separately for psychological, physical, and relational well-being. Universities, particularly in comparable Egyptian and collectivist contexts, may consider addressing both entitled academic attitudes and impostor-related cognitions through counseling interventions and pedagogical strategies.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0362076. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Solay Farhat, Zeinab Hammoud, Nadeen Zayour, Jinan Fahs, Tasneem Freijeh, Nada Moussaoui, Hawraa Al Rachiini, Bassam Matar

Background Cancer diagnosis is often accompanied by changes in nutritional needs and lifestyle habits, which may ultimately be associated with patients’ quality of life (QOL). Despite the high burden of cancer in Lebanon, limited data exist on how dietary intake and lifestyle behaviors change following diagnosis. This study aimed to assess self-reported retrospective changes in dietary and lifestyle behaviors following cancer diagnosis and examine factors associated with these changes and their relationship with QOL. Methods This single-center, cross-sectional study was conducted at Al Zahraa Hospital University Medical Center in Beirut, Lebanon. Adult cancer patients receiving active treatment were assessed regarding self-reported dietary and lifestyle behaviors before and after cancer diagnosis. QOL was assessed using the validated Functional Assessment of Cancer Therapy–General (FACT-G). Results This study included 145 participants, the majority of whom were Lebanese (93.79%) and female (69.7%). Most lacked health insurance (84.8%), and 91.0% reported a financial burden related to treatment. Compared with recalled pre-diagnosis behaviors, 47.6% of participants reported favorable changes in smoking behavior, while 34.5% reported decreased physical activity. The most frequently reported favorable dietary changes according to the prespecified framework were reduced sugar (60.0%), reduced red meat (49.6%), and reduced fast-food consumption (34.5%). Younger age and employment were associated with the favorable dietary-change score in bivariate analyses, while age and marital status were associated with tobacco-habit change in multivariable analysis; medical insurance was associated with physical-activity change in bivariate analysis. The mean FACT-G total score was 70.48 ± 20.79. Favorable dietary changes were associated with FACT-G scores, including changes in fruit, milk, and fast-food intake. Conclusions Self-reported retrospective changes in dietary and lifestyle behaviors were observed among patients receiving active cancer treatment, with substantial variation across behavioral domains. The favorable dietary-change score was associated with QOL; however, the cross-sectional design and retrospective assessment preclude causal or directional interpretation. These findings may inform future longitudinal and interventional studies evaluating structured, individualized nutritional and lifestyle support during cancer treatment in Lebanon.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0362053. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Salman Alzayani, Khaldoon Al-Roomi, Amer Almarabheh, Mohamed Alqahtani

Gulf Cooperation Council (GCC) countries face substantial burdens from noncommunicable diseases along with high public expectations of health services, yet little is known about whether health is visibly represented in candidates’ declared election programs in this region. This study examined publicly identifiable candidates’ programs from the Kingdom of Bahrain’s Council of Representatives 2022 elections and assessed among candidates with identifiable programs whether the presence of explicit visible health content and candidates’ characteristics are associated with positive election outcomes. A cross-sectional study was undertaken using the complete cohort of candidates in Bahrain’s 2022 elections (N = 336). Election programs were identified from publicly declared materials, and health visibility was coded as present when a program contained an explicit pledge, priority or proposal addressing health services, public health, prevention, health issues, or health related social support. Descriptive data analysis used full cohort of candidates (N = 336) where applicable, whereas analysis of health visibility was conditional on 108 candidates with identifiable programs. Of the 336 candidates, 262 (78.0%) were men and 40 (11.9%) were elected to the council. Among candidates with a publicly identifiable program (108), 88 (81.5%) candidates had visible health content in their identified programs. In Firth penalized-likelihood analysis, women had higher odds of visible health content than men (OR=3.826, 95% profile-likelihood CI 0.943–15.522, p = 0.060). Among program identified candidates (N = 108), the association between visible health content and electoral success was inconclusive (two-sided Fisher’s exact test p = 0.188). This study has systematically quantified the health content visibility in a full candidate cohort from Bahrain’s Council of Representatives 2022 elections. Although exploratory, these findings provide evidence on how health issues are represented in electoral discourse in this Arab Gulf setting and may inform future comparative studies across GCC countries.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361902. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Yanyu Lin, Zhiying Ma, Jinghua Zhang, Jie Zhuang

Background Mild cognitive impairment (MCI) is a prevalent complication of type 2 diabetes mellitus (T2DM). Cognitive impairment progressively impairs self-care abilities, thereby triggering a vicious cycle of poor glycemic control and further cognitive decline. Exercise has been widely recognized as an effective strategy to improve both glycemic control and cognitive function; however, an optimal time of day for exercise to mitigate this neurodegenerative trajectory has not been determined. This trial aims to determine the most effective exercise timing to maximize cognitive benefits in older T2DM patients with MCI (T2DM-MCI) and to investigate the underlying neurobiological mechanisms using multimodal magnetic resonance imaging. Methods In this randomized controlled trial, patients 60–75 years of age with T2DM‐MCI will be assigned to a morning exercise group (09:00–10:10), an evening exercise group (19:00–20:10), or a health education group. The exercise groups will complete a 12-week, home-based, remotely supervised exercise program comprising aerobic and resistance exercises. The health education group will receive a 12-week health education program. Cognitive function will be evaluated at baseline and post-intervention using the Montreal Cognitive Assessment, Color-Word Stroop Test, N-back task, Trail making Test, Attention Network Test, and Digit Symbol Substitution Test. Additionally, brain structure and function based on imaging, blood biomarkers, and physical fitness will also be assessed. Discussion In this study, we aim to identify the optimal time of day for exercise to maximize cognitive benefits in patients with T2DM‐MCI and to elucidate underlying neurocognitive mechanisms. We will examine whether glycemic control mediates the relationship between exercise and cognitive function improvement. This research is expected to provide “time-specific” evidence for exercise prescription to maximize the neurocognitive benefits and mitigate dementia risk in this population. Trial registration Chinese Clinical Trial Registry: [http://www.chictr.org.cn], identifier [ChiCTR2300073737].

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361868. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Mutharaju Arelingaiah, Arpitha Arun, Bangalore Sivilan Madhuri, Kibballi Madhukeshwar Akshaya, Huluvadi Shivalingaiah Anwith, Shivappa Usha, Ramesh Holla, Aravind Karinagannanavar, Malatesh Undi, Sharankumar Holyachi, Pradeep S. Banandur, Gautham Melur Sukumar, Banavaram Anniappan Arvind, Betagalli Mallappa Shivaraj, Khandiga Sharma Lakshmi, Thimappa Hegde, Komal Prasad, Lavanya Garady, Ankesh Ashwini, Upashana Medhi

Background onitoring the implementation of observational studies are rare, unlike experimental studies. This article aims to describe the development and implementation of a monitoring plan and framework for a large-scale cohort and quasi-experimental study: the NIMHANS-NH-SKAN Stroke project. Methods The monitoring framework was developed through a systematic, stepwise process involving expert consultation workshops conducted by an Independent Monitoring Team in collaboration with the study team. A logical framework approach was used to identify key processes throughout the study implementation. These processes were then disaggregated into critical activities (sub-processes) to generate an initial list of monitoring items. These items were prioritized using the Vital–Essential–Desirable (VED) strategy through consensus building. The shortlisted items were further refined using SMART criteria (Specific, Measurable, Achievable, Relevant, and Time-bound) to finalize checklist components. Key Performance Indicators were subsequently derived from the finalized checklist items. The framework emphasized usability, feasibility, and relevance to implementation, enabling systematic monitoring of critical study processes. Results A total of 89 activities were identified and consolidated into 10 checklists, from which 16 Key Performance Indicators (KPIs) were derived. The monitoring framework primarily emphasized indicator-based assessment of project outputs and outcomes while ensuring adherence to key processes and quality standards. KPIs were expressed as proportions to facilitate standardized performance assessment across sites and time periods. The checklists comprised a combination of in-person observations and record reviews. Monitoring findings were synthesized into periodic reports based on KPI proportions, enabling objective evaluation of implementation performance and identification of areas requiring corrective action. Conclusions Timely and systematic monitoring is critical to ensure rigor in large-scale projects, and the approach described in this study provides a replicable framework for the development of robust monitoring systems in similar community-based large-scale observational studies in India and similar countries.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361702. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Dennis Wambiri Waithaka, Angela Kairu, Jacob Kazungu, Stacey Orangi, Felix Masiye, Obinna Onwujekwe, Edwine Barasa

The EuroQol five-dimension five-level (EQ-5D-5L) instrument is increasingly used to develop health-state utility value sets for computing quality-adjusted life years (QALYs) in economic evaluations. However, little attention has been given to the practical realities of administering EQ-5D-5L valuation interviews in African settings. This study examined experiences of administering EQ-5D-5L valuation interviews in Kenya. We conducted an embedded qualitative study alongside the Kenyan EQ-5D-5L national valuation study. Data were collected through 23 post-valuation in-depth interviews with community participants and 16 debrief sessions with valuation interviewers and field supervisors. Post-valuation interviews were conducted in English or Kiswahili, audio-recorded, transcribed verbatim, translated where necessary, and analysed thematically. Health-state preferences were shaped by personal and contextual factors, including illness experience, household financial implications of ill health, beliefs about death, norms concerning independence and social worth, and local environmental conditions. Participants identified aspects of health they felt were not fully captured by the EQ-5D-5L descriptive system, namely vision, speech, broader aspects of mental health and social relationships. Pain/discomfort, mobility, and usual activities were often the most influential dimensions, while anxiety/ depression was generally given less weight. Tool-related linguistic and semantic challenges affected comprehension of some terms, while participant-related factors such as limited literacy, sensory difficulties and caregiving responsibilities also shaped administration. Valuation interviewers and field supervisors used strategies to preserve the intended logic of the valuation tasks, support participant comprehension, manage interruptions and protect data quality. Embedding qualitative methods within EQ-5D-5L valuation studies can complement standard quality-control procedures and quantitative valuation outputs by explaining how participants understood health states, what factors shaped their preferences, and whether administration challenges may have influenced responses. These insights can help researchers and decision-makers interpret final utility values by showing whether observed valuation patterns reflect locally meaningful preferences or challenges in understanding and completing valuation tasks.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007568. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.