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Authors: Dana Waltzman, Juliet Haarbauer-Krupa, Samuel R. Walton, Amani Jridi, Angela P. Presson, William C. Walker, David X. Cifu, Jessie R. Oldham, Landon B. Lempke

Mild traumatic brain injury (mTBI) is a common injury across all age groups and populations, with a high prevalence among military service members and Veterans. The purpose of this cross-sectional study was to use a large, prospective cohort of Veterans to examine the association between childhood mTBI and multimodal mental and behavioral health outcomes, and among those with childhood mTBI, evaluate sociodemographic characteristics associated with worse outcomes. Data came from the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) prospective longitudinal study. This cohort included 1,286 Veterans, 61.3% of whom sustained a childhood mTBI. After adjustment for demographic, behavioral, and military history factors, Veterans with childhood mTBI had higher PTSD symptom scores (Mean Ratio[MR] = 1.36, 95%CI: 1.22–1.51), higher anger scores (MR = 1.08, 95%CI: 1.05–1.10), higher depression scores (MR = 1.31, 95% CI: 1.17–1.46), higher anxiety scores (mean difference [MD]= 4.3, 95% CI: 2.9-5.6), emotional-behavioral dyscontrol scores (MD = 3.2, 95% CI: 2.2–4.3), worse sleep quality (MD = 1.6, 95% CI: 1.1-2.2), worse neurobehavioral symptoms (MD = 6.8, 95% CI: 5.2-8.5), lower satisfaction with life (MD = -1.2, 95% CI: -2.1 to -0.27), and lower resilience scores (MR = 0.96, 95% CI: 0.94–0.99). There were no significant differences after adjustment for alcohol or drug use scores. Among individuals with a history of childhood mTBI, several mental and behavioral health outcomes were worse among those who sustained multiple mTBIs and better among those who were physically active and had higher education. These findings suggest markers of increased riskpresent before military enlistment that may warrant targeted prevention, screening, and treatment strategies. Increased awareness among healthcare providers may help identify Veterans with childhood mTBI history who would benefit from evidence-based treatment and support.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000679. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Yuanqing Cao, Huihui Wang, Xuan Chen, Li Zhu

Soil salinization threatens agricultural productivity in arid gravity irrigation systems worldwide, yet the depth-stratified relationships between soil water and salt content remain poorly characterized. We monitored soil moisture and electrical conductivity (EC) at six depths (0–100 cm) across 15 sites in the Hetao Irrigation District, China, during the 2025 growing season. Our results indicate a depth-dependent divergence in water–salt associations. The EC-derived salinity index varied from 0.08 to 42.91 g/kg, exhibiting extreme spatial heterogeneity (coefficient of variation (CV) = 185.2%) across the salinity gradient. However, moisture-salinity relationships showed marked depth dependency. Surface soils (0–20 cm) exhibited non-statistically significant correlations (r = 0.07), whereas deep layers (60–100 cm) showed a statistically significant but weak positive correlation (r = 0.25, p < 0.01, R2 = 0.06), indicating limited explanatory power. This pattern is consistent with a subtle tendency of downward salt redistribution. The EC-derived salinity index showed a 42% increase in deep layers (from 1.59 to 2.26 g/kg) over the season, compared to a 136% fluctuation in surface layers. These results highlight limitations of surface-focused monitoring approaches and indicate patterns consistent with subsurface salt redistribution. Compared with previous studies, this work provides a depth-resolved, multi-site observational dataset combined with a stratified analytical approach, offering additional evidence for interpreting soil salinity dynamics under heterogeneous field conditions.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360976. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Sven-Erik Bursell, Stephanie J. Fonda, Kaitlynn Borik, Jeff Stainback, Dara Shahon

Diabetic retinopathy (DR) regression is not regularly reported; yet understanding of its prevalence in early-stage DR may impact strategies for eye care management. This study’s primary aim was to examine DR regression in patients initially diagnosed with very mild or mild nonproliferative DR (NPDR). A secondary aim was to assess the association between retinopathy regression and diabetes therapy, diabetes duration, and Hemoglobin A1c (HbA1c). This was a retrospective, longitudinal cohort study using medical record data from the United States’s Indian Health Service’s teleophthalmology program for DR evaluation. Baseline exams occurred in 2015–2017 and follow-up (FU) exams occurred within 3 years of baseline. There were 2,348 patients included in this cohort with very mild NPDR at baseline and 705 patients with mild NPDR. For the whole sample, mean age was 56 ± 12.8 years, 55% were female, diabetes duration was 13.0 ± 9.1 years, and HbA1c was 8.8 ± 2.1%. Proportions for DR regression were 0.47 (CI = .45 − .50) (from very mild NPDR) and 0.36 (CI = 0.33–0.40) (from mild NPDR). Proportions for any DR progression were 0.27 (CI = 0.25–0.29) (from very mild NPDR) and 0.34 (CI = 0.30–0.38) (from mild NPDR). Multivariable analyses showed that lower HbA1c levels were associated with greater odds of diabetic retinopathy regression in patients with either very mild or mild baseline NPDR, whereas insulin use was associated with lower odds of regression. Shorter diabetes duration was associated with greater odds of regression only among patients with very mild NPDR at baseline. DR regression was more frequent than DR progression particularly for patients initially with very mild NPDR. DR reversal was more likely in early-stage DR. Behavioral modifications such as increased physical activity and weight loss that lower HbA1c and subsequent risks for DR progression are important to emphasize in diabetic eye care.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361052. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Xiaoxue Sun, Qinqin Wang, Wei Zheng

Objective To address the occupational exposure risks caused by instantaneous steam overflow when opening the top cover of hatch-type boiling disinfectors in the central sterile supply department, this study developed an interlocked centrifugal exhaust system (ICES) characterized by operational simplicity and high adaptability. Methods The ICES was assembled using a centrifugal fan, Hall effect switch, instant relay, time-delay relay, solid-state relay, and piping. The system achieved automatic start/stop of the fan based on the open‑or‑closed status of the top cover. A self-controlled design was adopted on one hatch-type boiling disinfector. Temperature was measured at the chamber edge (T1) and at the technician’s facial position (T2). Airborne particle counts were also measured at the technician’s facial position. Measurements were performed under conditions with and without the ICES enabled. Data were analyzed using the Wilcoxon signed-rank test. Results After enabling the ICES, T1 and T2 decreased by 20.89% and 31.31%, respectively. The median temperature at T2 was 21.5 °C, which was close to the ambient temperature. The reduction ratios for airborne particle counts of six different sizes at the technician’s facial position ranged from 53.09% to 67.83%. All differences between groups were statistically significant (all P < 0.001). Conclusion The ICES effectively reduces steam overflow upon the top-cover opening of hatch-type boiling disinfectors and lowers the risk of occupational injury. With advantages such as wide installation adaptability, imperceptible operation, and convenient maintenance, it provides a stable and reliable solution for the safety retrofitting of existing hatch-type boiling disinfectors.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360909. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Virginia Zweigenthal, Nicola Christofides, Thembelihle Dlungwane, Sogo France Matlala, Mathildah Mpata Mokgatle, Abraham Opare, Sean Mark Patrick, Nikki Schaay, Maylene Shung-King, Takalani Tshitangano, Laetitia Rispel

The Master of Public Health (MPH) degree is a key qualification for public health practice in low- and middle-income countries. Graduates entering practice should possess a range of competencies to address complex health issues in managerial, technical or research positions. As competencies of graduates exiting South African MPH programs are unknown, a consortium of academics from South African universities conducted an on-line survey of alumni exiting between 2012−2016, to determine their self-reported public health competencies and their recommendations for improving academic programs. Competencies were explored in 11 domains, through three lenses – their reported usefulness at work; perceptions whether they were obtained through MPH programs; and graduates’ confidence in their application. Over 80% of this cohort of 221 graduates, mostly in their mid-30’s, largely from South Africa and sub-Saharan Africa, needed the competencies in all 11 domains at work, which were felt to be largely obtained from the MPH, and most were confident using them. However, one fifth were not confident in crisis management and 13% were not confident in health promotion. On average 30% reported they did not obtain either crisis management or leadership skills from the MPH. Respondents recommended changes to course content and organization included more experiential learning, mentorship and faculty advocacy for graduate employment. In the absence of country-wide governance for public health education, the study is a first step towards developing core-competencies for South African programs. Findings can be factored into MPH program reviews with attention given to enhancing leadership, crisis management and monitoring and evaluation training into existing courses. Additionally, more experiential learning could fill identified gaps in problem-solving and project management skills. Producing a ‘fit for purpose’ public health workforce requires alignment of education objectives with health workforce systems in country contexts to ensure a seamless transition between learning and working.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360789. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Elhaitham Yasir Awad Musa, Amar Yasir Awad Musa

Cardiovascular disease (CVD) remains the leading cause of death worldwide. While clinical scores provide modest predictive accuracy, the electrocardiogram (ECG) is rarely leveraged for prognosis. Artificial intelligence (AI) and deep learning now enable extraction of high-dimensional features from ECG waveforms for predicting cardiovascular outcomes. Our objective was to systematically evaluate the prognostic performance of AI-enabled ECG models for predicting all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). We searched PubMed, Cochrane CENTRAL, IEEE Xplore, and Google Scholar through November 2025 for studies using AI/ML models with 12-lead or single-lead ECGs to predict all-cause mortality, cardiovascular mortality, or MACE in adults (≥18 years old). Eligible studies included adults (≥18 years) using ECG as primary input. Two reviewers independently screened and extracted data. Narrative synthesis was conducted due to heterogeneity. Thirteen studies were included (~5.9 million patients). Eleven reported all-cause mortality (8 short-term: 30-day to 1-year), four reported cardiovascular mortality, and eight assessed MACE (4 composite MACE, 4 individual components). Models predominantly used convolutional neural networks [CNNs] on raw ECG waveforms. C-statistics ranged 0.70–0.89 for mortality prediction. Definitions and follow-up durations varied, limiting direct comparison. AI-ECG models demonstrate strong potential for predicting mortality and cardiovascular events with consistent performance and scalability. However, prospective validation and standardization are essential before clinical implementation.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360756. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jeong-Eun Yang, SeolHwa Moon

Background Frailty in older adults is a critical public health concern associated with increased morbidity, disability, and healthcare utilization. Although systemic health and socioeconomic factors are well-established determinants of frailty, the multidimensional nature of oral health has received relatively limited attention in previous research. The aim of this study was to examine the associations between general characteristics, health-related factors, oral health factors, and frailty among community-dwelling older adults, and to identify sex differences in frailty. Methods This cross-sectional study used data from the 2022 Korean Longitudinal Study of Aging (KLoSA) and included 3,729 individuals aged 65 years and older. Frailty was categorized as robust, pre-frail, or frail using the Frailty Instrument developed for older Korean adults. General characteristics, health-related factors, and oral health-related factors (structural, behavioral, and subjective) were assessed through structured questionnaires. Hierarchical logistic regression analysis was performed in three steps to identify factors associated with frailty. Results Of the participants, 16.0% were frail and 84.0% were non-frail (31.5% pre-frail and 52.5% robust). Sex-stratified analyses also showed that structural oral health factors were most strongly associated with frailty in both sexes. Edentulous status without denture use was associated with the highest odds of frailty in both women (OR = 3.76, 95% CI = 3.72–3.80) and men (OR = 2.95, 95% CI = 2.91–2.98). In contrast, sex differences were observed for some subjective oral health factors: tooth sensitivity was associated with higher odds of frailty in women (OR = 1.82, 95% CI = 1.80–1.84) but lower odds in men (OR = 0.85, 95% CI = 0.84–0.86). Conclusions Oral health conditions, including untreated tooth loss, difficulty in chewing or swallowing, and oral pain, were significantly associated with frailty. These findings suggest that oral health may be an important factor to consider in relation to frailty among community-dwelling older adults.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360682. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shuaib Hafid, Lawrence Mbuagbaw, Bruce Newbold, Andrew Costa, Ana Gayowsky, Peter Gozdyra, Aaron Jones, Sarina R. Isenberg, Erin Gallagher, Michelle Howard

Background Family physicians provide most outpatient care in patients’ last year of life, but it remains unclear how geographic distance between patients and their physicians affects continuity of care. Patients living farther from care providers may experience reduced access and more fragmented care. This study examined whether geographic proximity to a family physician is associated with relational continuity of outpatient care in the last year of life. Methods We conducted a population‑level retrospective cohort study of adults who died in Ontario, Canada, from 2021 to 2024, using linked health administrative data. Geographic proximity was measured using quartiles of the shortest driving distance (km) between each patient’s residence and their family physician’s practice location. Relational continuity was assessed using established measures capturing the concentration of visits, dispersion of care across physicians, and the temporal regularity of visits. Associations were estimated using proportional‑odds regression models adjusted for demographic, socioeconomic, and clinical factors. Results Among 400,499 patients, the mean age at death was 76.0 years, 52.2% were male, the mean (SD) distance to their family physician was 25.5 (92.0) km, with the highest quartile residing more than 14.2 km away from their family physician. Greater distance was associated with modestly lower relational continuity: each one-quartile increase in distance was linked to lower odds of higher continuity with the usual family physician (cOR: 0.88, 95%CI: 0.87, 0.88). Sensitivity analyses using travel time and Euclidean distance produced consistent findings. Discussion Geographic proximity is a significant determinant of outpatient continuity near the end of life. Patients living farther from their family physicians experience more fragmented care, underscoring the need for system-level strategies to reduce geographic barriers, including improved local access to primary care and enhanced virtual-care models.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360638. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Himal Gaire, Ganesh Bhandari, Rima Mishra, Ram Lal Shrestha, Aishwarya Prasad Dhakal, Pashupati Mahat

Mental health and psychosocial wellbeing among migrant workers and their families are important public health concerns in Nepal. The PARBARDHAN project used a community-based approach to strengthen mental health and psychosocial support, community participation, and local service capacity in migration-affected communities. This study describes psychosocial wellbeing at endline evaluation and compares findings descriptively with baseline and midline. A cross-sectional, mixed-methods endline evaluation was conducted in Salyan and Kailali districts of Nepal. The quantitative component included 245 project beneficiaries aged 16–80 yearsincluding20 (8.2%) migrant/returnee workers and 225 (91.8%) family/community respondents; 216 (88.2%) reported having a family member currently abroad. Psychological distress was assessed using the General Health Questionnaire (GHQ-12), and anxiety and depression the Hopkins Symptom Checklist (HSCL-25). Life satisfaction and subjective happiness were assessed. Qualitative interviews and focus group discussions provided contextual information on project implementation and perceived effects. Quantitative data were analysed using descriptive statistics while qualitative data were analysed using framework analysis. Data were collected from3-26 February, 2026. At endline, 34.7% screened positive for psychological distress, while 8.2% screened positive for anxiety and 5.3% for depression (5.3%). Compared with baseline and midline assessment rounds, anxiety and depression screening positivity was lower at endline, whereas probable psychological distress was higher. Qualitative findings indicated increased mental health awareness, greater willingness to seek support, perceived reductions in stigma, and support through self-help groups, peer groups counselling, and community activities. However, substantial dissatisfaction with life was also reported. Because the evaluation rounds used independent cross-sectional samples, the observed differences cannot be interpreted as within-person changes or attributed causally to the PARBARDHAN intervention. The findings indicate the perceived value of community-based mental health and psychosocial support while highlighting continuing economic insecurity, family separation, and other structural factors affecting psychosocial wellbeing.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006666. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Cairina Frank, Hadi Tehfe, Charles Ghanem, Jade Choo-Foo, Ramtin Hakimjavadi, Hawre Jalal, Risa Shorr, Daniel Kobewka

Purpose Cardiovascular disease remains a leading cause of morbidity and mortality in women. Cardiovascular risk prediction models are widely used to guide preventative management, although many do not incorporate female-specific risk factors. The aim of this review is to identify published cardiovascular risk prediction models for women or those which include female-specific predictors and to summarize the predictors and model performance. Methods The protocol was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines. The protocol has been registered in PROSPERO (CRD420261420766). An update of the systematic review by Baart et al. will be performed by searching MEDLINE and EMBASE from July 27 2017 to May 2026 to identify primary articles reporting on the development and/or validation of models predicting incident cardiovascular disease in women. Data on model predictors, performance, validation and clinical usability will be extracted. Risk of bias will be assessed using PROBAST+AI. Findings will be synthesized descriptively although quantitative synthesis will be considered when sufficiently comparable studies are available. Conclusions This systematic review will provide an updated synthesis of cardiovascular risk prediction models in women and summarize how female-specific risk factors are incorporated into contemporary risk assessment.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360860. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Thanat Nakaphan, Monthaka Teerachaisakul, Chatchai Chaotham, Krit Pongpirul

Introduction Despite the growing use of herbal medicinal products (HMPs) in Thailand, factors relevant to their availability and consumption in pharmacies remain insufficiently characterized. Pharmacies and healthcare professionals may play important roles in improving the availability and promoting their appropriate use. Methods A three-round e-Delphi study was conducted among 30 multidisciplinary experts to identify and establish consensus on factors considered relevant to the availability and consumption of HMPs in pharmacies across Thailand. Experts rated the relevance and impact of each factor using a 7-point Likert scale. Consensus was defined as a Quality of the Lower Approximation (QL) score ≥ 0.75. Results Of the 34 factors assessed, 25 reached consensus across four domains: (1) herbal medicinal products, (2) product information, (3) professional responsibilities, and (4) pharmacy operations. The National List of Essential Herbal Drugs received the highest consensus score (QL = 1.00). All nine product information factors reached consensus. Professional factors reaching consensus included product recommendation, knowledge of HMP categories, and knowledge of evidence-based efficacy and safety. Pharmacy-related factors reaching consensus included pharmacy type, business model, participation in national health programs, and location. Conclusion Expert consensus identified a set of factors considered relevant to HMP availability and consumption in Thai pharmacies. These findings provided a framework for future empirical studies and may inform policies and interventions related to product information, professional competency, and pharmacy operations.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360797. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.