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Authors: Suman Ranjitkar, Ingrid Kvestad, Ram K. Chandyo, Kjersti S. Bakken, Manjeswori Ulak, Tor A. Strand, Sandra Huber, Maria Averina, Mari Hysing

Background Adequate selenium (Se) status is important for biological mechanisms involved in cognitive functioning and mental health. However, there are few studies that have examined the association between prenatal maternal Se and mental health of preschool children in low-and middle-income countries. The primary aim of this study was to measure associations between maternal plasma Se concentration during pregnancy and child mental health at four years. The secondary aim was to assess the psychometric properties of the parent reported Nepalese version of the Strengths and Difficulties Questionnaire (SDQ-P). Method A total of 720 mother-infant dyads were included in the study from a cohort from Bhaktapur, Nepal, with prenatal maternal plasma Se concentration measured in early pregnancy. Child mental health was assessed at 4 years of age by the SDQ-P. The fit of the original five-factor structure of the SDQ-P was examined using Confirmatory Factor Analysis (CFA). Generalized linear models were used to analyze the association between maternal plasma Se concentration (continuous, dichotomized or tertiles) and child’s SDQ-P scores using the five-factor model. Results The mean (SD) maternal plasma Se concentration was 74.7 µg/L (± 10.2 µg/L). The original five-factor structure of the SDQ-P was confirmed with some modifications (Comparative fit index (CFI)=0.967, Root mean square error of approximation (RMSEA)=0.059). Children with mothers with the lowest tertile of maternal plasma Se concentration had higher Hyperactivity-Inattention scores than those in the middle tertile (adjusted β = 0.329, 95% CI 0.023 to 0.636). No associations were observed between maternal plasma Se concentration and the other SDQ-P subscale scores. Conclusion We observed limited evidence of an association between maternal plasma Se concentration and mental health outcomes in children at 4 years of age. The observed association between maternal plasma Se concentrations and Hyperactivity-Inattention was only present when comparing the lowest to middle tertile, however no clear exposure-response pattern was observed. This isolated finding requires confirmation in further studies.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360527. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Nicolas Tugui, Shahinur S. Islam, Daniel D. Heath

Osmoregulatory stress is a critical factor in the welfare and performance of salmonids under captive rearing for aquaculture and conservation, and characterizing cellular responses to that stress may foster better husbandry. One approach for early detection of osmotic stress is gene transcriptional profiling, where a suite of qPCR assays designed for related-function genes is used to determine patterns of transcriptional responses to stress. This study describes the development, assessment and application of 28 Taqman qPCR assays for use on the OpenArray® platform as an osmoregulatory stress transcriptional profiling (OSTP) chip. The assays include key genes involved in osmoregulation (twelve), stress response (four), immune function (five), growth/metabolism (four) and endogenous controls (three). Here, using gill and liver tissues from eight salmonid species across four genera, the OSTP chip’s performance was evaluated. While results showed both tissue- and species-specific transcriptional differences, the OSTP chip has considerable utility for characterizing molecular stress responses. As a test application of the OSTP chip, we performed a 24-hour saltwater challenge with Chinook salmon and applied the chip to control and challenged fish. This test confirmed the OSTP chip’s capacity to detect acute osmotic stress-induced molecular genetic signatures. This OSTP chip will be useful for aquaculture practices by fostering better husbandry as well as providing a valuable tool for future studies of the osmoregulatory response of salmonid fishes to environmental stress.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360513. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shiwei Wu, Dongxing Zhang, Yizhang Zhu, Ning Li, Daobin Wang, Jiayue Zou, Xiaoyuan Hu, Jiawei Jin, Jun He, Xiaofeng Xue, Lei Qin

Objective To investigate the associations of preoperative C-reactive protein-to-albumin ratio (CAR), inflammatory burden index (IBI), and C-reactive protein-albumin-lymphocyte (CALLY) index with clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP), and to compare their predictive value, providing a reference for preoperative risk assessment. Methods We retrospectively included 300 patients who underwent DP between June 2022 and June 2024. CR-POPF was defined according to the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria as Grade B or Grade C POPF. Multivariable logistic regression was used to evaluate the associations of CAR, IBI, and CALLY with CR-POPF, and restricted cubic splines were used to assess dose-response relationships. Predictive performance of the preoperative baseline model and models incorporating each index was compared using receiver operating characteristic (ROC) analysis with DeLong tests, calibration assessment, Brier scores, decision curve analysis, and 1,000-resample bootstrap internal validation. Results CR-POPF occurred in 84 of 300 patients (28.0%); among these events, 81 (96.4%) were Grade B and 3 (3.6%) were Grade C. In preoperative-adjusted analyses, higher CAR (odds ratio [OR] 230.244, 95% confidence interval [CI] 45.053–1176.652; P < 0.001) and IBI (OR 1.015, 95% CI 1.006–1.024; P < 0.001) were associated with higher odds of CR-POPF, whereas higher CALLY was associated with lower odds (OR 0.979, 95% CI 0.967–0.991; P = 0.001). The baseline model had an area under the ROC curve (AUC) of 0.786 (95% CI 0.726–0.845). Adding CAR increased the AUC to 0.894 (95% CI 0.857–0.931; P < 0.001 vs baseline), compared with 0.821 for IBI (P = 0.004) and 0.827 for CALLY (P = 0.016). Bootstrap-corrected AUCs were 0.763 for the baseline model, 0.879 for baseline+CAR, 0.796 for baseline+IBI, and 0.805 for baseline+CALLY. The CAR-extended model also had the lowest Brier score (0.120) and showed the greatest net benefit across much of the examined threshold range. Conclusions Preoperative CAR, IBI, and CALLY were associated with CR-POPF after DP. Among the three indices, CAR showed the strongest predictive performance when added to the preoperative clinical model. These findings may provide a reference for preoperative risk assessment, although external validation is needed.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360418. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jhon A. Zabaleta-Santisteban, Angel J. Medina-Medina, Katerin M. Tuesta-Trauco, Abner S. Rivera-Fernandez, Teodoro B. Silva-Melendez, Marlen A. Grandez-Alberca, Julio Puscan-Rojas, Rolando Salas López, Manuel Oliva-Cruz, Alexander Cotrina-Sanchez, Nilton B. Rojas-Briceño, Jhonsy O. Silva-López, Darwin Gómez-Fernández, Santos Triunfo Leiva-Espinoza, Angel F. Huaman-Pilco, Elgar Barboza

Identifying climatically suitable areas for cacao cultivation (Theobroma cacao L.) is essential to guide sustainable intensification, territorial planning, and compliance with emerging environmental standards in tropical regions. This study assessed the current climatic suitability of cacao in the Amazonas department (northwestern Peru) using an ensemble modeling approach implemented in biomod2, integrating bioclimatic, topographic, and edaphic predictors with spatial biophysical exclusion criteria, legal conservation constraints, regulatory eligibility associated with the European Union Deforestation-Free Products Regulation (EUDR), and local phytosanitary evidence. A total of 403 quality-controlled presence records were used to calibrate multiple machine-learning algorithms under cross-validation, retaining only those with high predictive performance (AUC > 0.9; TSS > 0.7). Decision tree–based models, particularly Random Forest and XGBoost, showed the best individual performance, while the consensus model exhibited greater spatial stability and overall accuracy. Results indicate that approximately 14.8% of the regional territory presents high climatic suitability under current conditions, concentrated in inter-Andean valleys and low- to mid-elevation zones, with thermal seasonality identified as the main environmental predictor. However, the incorporation of territorial and regulatory constraints substantially reduced the effectively available area, especially under the EUDR scenario, demonstrating that cacao expansion potential is strongly conditioned by conservation and regulatory frameworks. High-priority degraded areas emerged as focal opportunities for productive restoration through agroforestry systems. Phytosanitary validation (2021–2024) revealed high spatial concordance between areas of greatest climatic suitability and the prevalence and incidence of major cacao pathogens and pests, particularly Moniliophthora roreri and M. perniciosa, confirming that optimal climatic niches for cultivation also favor biotic pressure. Overall, this study provides an integrative framework combining climatic modeling, territorial management, and phytosanitary risk, delivering robust scientific inputs to inform public policy, land-use planning, and sustainable cacao production strategies in the Amazon.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360376. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Charllote Boateng, Isaiah Osei Duah Junior, Brandy Swati Bonnah, Bikram Adhikari, Kwadwo Owusu Akuffo, Rhodalene Asantewaa Buabeng, Engmann Yorgen Carl Nii Lomotey, Xinhua Yu

Mental health care (MHC) utilization remains uneven among middle-aged and older adults in the United States, yet the role of comorbidity burden and other sociodemographic, socioeconomic, behavioral, and clinical domain predictors remains incompletely characterized. We analyzed pooled data from six waves (2019–2024) of the National Health Interview Survey (NHIS), comprising 128,261 adults aged ≥40 years. Comorbidity burden was the primary predictor, categorized as none, one, or ≥2 chronic conditions, while together with additional predictors was organized according to the predisposing, enabling, and need domains of Andersen’s Behavioral Model of Health Services Use. MHC utilization, the outcome, was defined as counseling or psychotherapy, mental health medication use, or visits to a mental health specialist within the previous 12 months. Survey-weighted multivariable logistic regression accounted for the complex survey design and sampling weights. Overall, approximately one in five adults utilized MHC services. Utilization was higher among females, non-Hispanic White adults, unmarried adults, smokers, overweight or obese adults, those with lower income, those with health insurance coverage, or residence in the Midwest, and those with one or ≥2 comorbidities, depression, or anxiety. In contrast, utilization was lower among adults aged 50–64, 65–74, and ≥75 years, non-Hispanic Black and Asian adults, and those with higher educational attainment. Taken together, these findings indicate that MHC utilization is shaped by comorbidity burden alongside predisposing, enabling, and need-related factors, underscoring the need for targeted and culturally responsive strategies to improve equitable access to MHC among this ageing population.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000744. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Alex Olateju Adjagba, Jacob Novignon, Justice Nonvignon, Richmond Owusu, Ephrem Lemango, Helga Fogstad, Ngashi Ngongo, Jean Kaseya, George Laryea-Adjei

In 2001, African Union (AU) member states committed to allocating 15% of their annual budget to health under the Abuja Declaration (AD). However, after more than two decades, health allocations across many countries still fall short of the target. This study uses an expenditure-based proxy for the AD to examine the likelihood and timing of attainment of the benchmark under historical fiscal trajectories.We compiled a 2002–2023 panel for 54 African countries using WHO and World Bank data. We distinguished observed, first and sustained attainment. Kaplan-Meier and Weibull models characterised time to first attainment, country-specific linear trends projected benchmark-crossing years through 2063, system GMM assessed expenditure-share persistence, and country and year fixed-effects models examined associations with primary health care (PHC) and immunisation expenditure per capita.In 2023, South Africa was the only one of 54 countries at or above the expenditure-based 15% benchmark. Five countries had attained it at least once during 2002–2023, and three sustained it for at least three consecutive years. Under the primary trend specification, which included the 51 countries with complete series, 42 (82.4%) were off track to attain the benchmark by 2063. Among the 48 countries without previous attainment, the median adjusted conditional probability of first attainment during 2023–2063 was 7.9% (IQR 4.6%–13.3%). The primary system-GMM lag coefficient was 0.821 (95% CI 0.635 to 1.006), indicating strong expenditure-share persistence. Higher government health prioritisation was associated with higher domestic government PHC expenditure per capita, while the association with total immunisation expenditure per capita was not statistically significant.Attainment of the expenditure-based Abuja benchmark remains uncommon and is unlikely to become widespread by 2063 if historical trends continue. While the 15% target remains politically useful as an accountability signal, efforts should target improving public health expenditure per capita, fiscal capacity, budget execution, financial protection and service coverage.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007423. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Karin Gallandat, Jaime Mufitini Saidi, Baron Bashige Rumedeka, Damien Machuel, Audrey Seon, Espoir Bwenge Malembaka, Patrick Musole Bugeme, Esther German, Didier Bompangue, Chloe Hutchins, Jackie Knee, Andrew Azman, Oliver Cumming

Climate change is straining water and sanitation services (WSS), leading to disruptions that threaten public health. In low-income and fragile contexts, there is an urgent need to increase investments in WSS, as well as to enhance efficiency in the utilisation of available financial resources. Operational research can help optimise future investments in WSS. In this perspective, we share our experience carrying out research embedded within a large-scale water supply infrastructure improvement programme in an urban, cholera-endemic area in South Kivu (Democratic Republic of the Congo). Through the lens of this concrete example, we highlight the need for rigorous research on higher quality drinking water services in low-income and fragile countries, discuss how multi-stakeholder research partnerships and pragmatic methods can contribute to the generation of rigorous evidence where it is most needed, and illustrate the role of research in strengthening capacities for both science and practice.

Source: PLOS Water. DOI: 10.1371/journal.pwat.0000646. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Mohamed El-Tanani, Shakta Mani Satyam, Sainath Prabhakar, Yahia El-Tanani, Ebrahim Safaii, Syed Arman Rabbani, Mark Sutherland

Acquired resistance to epidermal growth factor receptor (EGFR)-targeted therapy remains a major obstacle in the treatment of EGFR-mutant non-small cell lung cancer (NSCLC). This study investigated whether repurposing mebendazole (MBZ), a microtubule-disrupting agent, could restore sensitivity to gefitinib in gefitinib-resistant HCC827 GR5 cells. Gefitinib monotherapy showed minimal cytotoxicity, reducing cell viability only marginally (92.7 ± 1.5%), whereas MBZ significantly decreased viability to 79.7 ± 0.6% at 0.1 µM and 29.7 ± 0.6% at 0.5 µM (p < 0.001). Combination treatment (gefitinib 1 µM + MBZ 0.1 µM) further reduced viability to 37.7 ± 0.6% (p < 0.001). Mechanistically, alkaline comet assay revealed significantly increased single-strand DNA damage in the combination group (tail intensity 22.33 ± 0.56%, p < 0.001), while neutral comet assay confirmed elevated double-strand DNA breaks. MBZ also induced dose-dependent γ-H2AX activation (p < 0.001), supporting replication stress-associated DNA damage signaling. In vivo, combination therapy significantly suppressed tumor growth, prolonging tumor doubling time from 6.2 days in controls to 25 days and increasing growth delay to 18.8 days (p < 0.01), without substantial systemic toxicity. Collectively, these findings identify replication stress vulnerability as a therapeutically exploitable axis and support MBZ repurposing as an adjuvant strategy to overcome gefitinib resistance.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360164. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Dikshya Adhikari, Hari Prasad Kaphle, Ramesh Ojha, Chiranjivi Adhikari

Background Health workers’ burnout compromises patient safety and satisfaction, in addition to their own health. Over the last three decades or more, burnout syndrome has been getting more attention. High levels of burnout have been reported by health workers globally, and Nepal is no exception, including those mainly in hospital settings. Despite this, burnout issues have not been given enough attention in the literature. Hence, this study aims to assess the prevalence of burnout among health workers in hospital settings in Pokhara and to assess its’ associated factors (personal, job-related, and work-life balance). Materials and methods A hospital-based cross-sectional observational study was carried out among 242 health workers from selected hospitals of Pokhara, Kaski, over a period of one month from Sep to Oct, 2024. Data were collected using a self-administered questionnaire to assess the prevalence of burnout and its’ associated factors. The Oldenburg Burnout Inventory scale was used for assessing the prevalence of burnout. Frequency, percentage, and median were calculated to describe the sample characteristics, whereas, chi-square tests and logistic regression were used to determine the factors associated with burnout. Results The prevalence of burnout was 61.6%. When subscales were evaluated separately, slightly more than and nearly three-fourths were found to have both high disengagement (76.4%) and high exhaustion (71.9%). Multivariate logistic regression showed that the insufficient sleeping hours at night (aOR: 2.292, 95% CI: 1.193–4.404), poor job satisfaction (aOR: 3.391, 95% CI: 1.286–8.943), and poor work-life balance (aOR: 5.187, 95% CI: 2.600–10.350) were associated with burnout status. Conclusions Nearly two-thirds of the hospital health workers experienced burnout in Pokhara. Insufficient sleeping duration at night, poor job satisfaction, and poor work-life balance determined the burnout status of health workers. Hospital administrators, policymakers, and health system leaders should prioritize interventions targeting burnout among health workers, which protect work-life balance and improve job satisfaction.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360067. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Zacharie Tsala Dimbuene, Hugues Sampasa-Kanyinga

Background Child stunting remains a major public health challenge in the Democratic Republic of the Congo (DRC), reflecting persistent inequalities in child nutrition and health outcomes. This study examines the distribution and spatial variation of height-for-age z-scores (HAZ) among children under five, while also assessing the influence of selected demographic and socioeconomic factors. Methods Data were obtained from the 2023–2024 Demographic and Health Survey (DHS-8). A structured additive regression model was then applied to assess the effects of child age and maternal education, allowing for nonlinear relationships through smooth functions. To capture geographic heterogeneity, spatial effects were decomposed into structured (spatially correlated) and unstructured (area-specific random) components, enabling the identification of regional clustering and residual province-level variation in stunting. Results Geographic analysis reveals substantial regional disparities in stunting prevalence across the 26 provinces of the DRC. The province of Kwilu emerges as a major hotspot with very high levels of stunting, while several provinces fall within medium to high prevalence categories, indicating that stunting is a widespread issue across the country. Model results highlight important nonlinear relationships for certain predictors. Child’s age shows a strong negative trend with stunting risk: younger children have higher log-odds of stunting, and the risk decreases sharply with age. Maternal education displays a weaker and nonlinear association, with generally small effects across most education levels and greater uncertainty at higher levels of schooling. Spatial modeling further demonstrates that geographic factors significantly contribute to variation in stunting outcomes. Both structured spatial effects, indicating regional clustering, and unstructured spatial effects, reflecting province-specific deviations, contribute to the observed patterns. The combined spatial effect suggests persistent geographic disparities even after adjusting for covariates, although uncertainty varies across regions. Conclusions The findings underscore the importance of geographic context and early childhood factors in shaping stunting outcomes in the DRC, highlighting the need for targeted, context-specific interventions to address persistent nutritional inequalities.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360056. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shashika Bandara, Muriel Mac Seing, Charity Oga-Omenka, Michelle Amri, Zahid A. Butt, Amelia Dinh, Karina Dubois-Nguyen, Marie Dorey, Joelle Ducharme, Saad El-Din Hassan, Janet Hatcher-Roberts, Justus Holben, Tina Lines, Nihad Mahmalat, Margaret Mutumba-Nakalembe, Hannah Neufeld, Nitika Pant Pai, Sanskruti Patel, Claudia Ximena Robayo-Gonzalez, Bukola Salami, Lauren Smith, Sarah Stecko, Eric Tchouaket Nguemeleu, Kathryn E. Tiedje, Bilkis Vissandjée

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007441. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Alexandre Dukundane, Rachel Murekatete, Jimmy Opiyo, Laura Keyser, Jessica McKinney, Rashidah Nambaziira, Robert Ojiambo

Urinary incontinence (UI), an involuntary loss of urine, is a widespread pelvic floor disorder affecting 20–50% of women worldwide, with a 21% prevalence in Sub-Saharan Africa. Contributing factors include genetics, childbirth, and chronic conditions, leading to significant physical, social, and emotional challenges such as fear of leakage and isolation. Despite its impact, many affected women lack awareness of UI and available treatments, which include medication, surgery, and pelvic floor muscle training (PFMT). Knowledge gaps and misconceptions persist, hindering timely diagnosis and management. In response to these challenges, healthcare systems in Africa are adopting digital technologies (DTs), including WhatsApp and social media, to facilitate patient education and professional collaboration. Studies indicate that digital platforms can support women in managing UI, particularly through PFMT. However, little is known about women’s digital health education needs, barriers, and platform preferences. This study explored these aspects among women with UI in Kigali through a phenomenological qualitative approach across four hospitals: Masaka, Rwanda Military, Kibagabaga, and King Faisal. Using purposive sampling, 20 women aged 20–70 were selected. Data analysis was conducted through thematic analysis using deductive and inductive coding. The findings revealed four key themes. First, there are significant knowledge gaps about UI, necessitating multimodal education to address misinformation and misconceptions. Second, participants regularly use digital devices and the internet, recognizing their benefits and affordability for accessing health information. Third, barriers to digital health education included distrust in the accuracy of online information and financial constraints in maintaining digital devices and internet services. Lastly, participants expressed a strong interest in multimodal digital health education platforms to receive UI-related information. Many women misunderstood UI, often confusing it with aging or other conditions, leading to delayed diagnosis, emotional distress, social withdrawal, financial strain, and reduced quality of life. Although digitally literate, they rarely sought digital health information on UI due to knowledge gaps, financial limitations, and skepticism about online sources. The study underscores the urgent need for accessible and trustworthy digital health education to bridge knowledge gaps, provide support, and enhance UI management among affected women.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006703. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.