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Authors: Jenna Bennett, Smita Pakhale, Nicola Desmond

Moral distress has been studied across many health arenas; however, public health has often been overlooked. Canada is facing a healthcare crisis with a significant number of staff leaving the healthcare field. This study explores the experiences of moral distress in public healthcare practitioners across Canada. Better understanding these experiences can provide insights into how to support staff and prevent attrition in public health across the globe. This is a qualitative study using in-depth semi-structured interviews. Fifteen in-depth interviews were conducted between May and July 2023, through remote and in person methods. Recruitment material was distributed across Canada and participants self-identified. Participants were from nursing, social work, medicine, and dietetics, all working in public health across Canada. Data-driven, inductive thematic analysis was used. Iterative analysis as interviews occurred supported the development of a codebook. Themes were compared within and across data sets and by participant age and years of experience. Experiences that contributed to moral distress included systemic powerlessness, political and ideological overreach, unethical work environments and undervalued expertise. Years of experience and diversity in gender and ethnicity impacted how practitioners navigated moral distress. Experiences where practitioners felt actions went against their values increased during the pandemic, contributing to moral injury. This study situates the unique position of public health within the health system and explores experiences of moral distress both during and outside the COVID-19 pandemic. While the pandemic brought the concept of moral distress to the forefront of many people’s minds, these experiences existed prior. Addressing the underlying causes will contribute to establishing approaches to support public health practitioners suffering from moral distress and injury.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006673. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Md. Farid Reza Mashfi, Sumiya Sharmin Mou, Monalisa Riya, Nasiba Binte Bahar, Tasnuha Islam, Fayek Rafi Ahmad, Fabliha Fatima, Md. Elias Al-Mamun

Cardiovascular disease causes more deaths than any other condition worldwide, and four in five of these deaths occur in low- and middle-income countries (LMICs). Pharmacogenomics (PGx) uses genetic testing to guide drug selection and administration, which can reduce adverse drug reactions and enhance treatment response; however, LMIC groups are significantly underrepresented in the evidence base, limiting equitable clinical translation. A systematic review was conducted, following PRISMA 2020 guidance, mapping PGx-guided cardiovascular therapy, implementation barriers, and equity gaps in LMICs. PubMed and Scopus were searched for studies published between January 2020 and December 2025 and included 24 studies (one randomized controlled trial, 19 observational studies, and four economic models); because of substantial clinical and methodological heterogeneity, findings were combined through SWIM guidelines, and certainty of evidence was assessed using GRADE. Genotype-guided warfarin dosing nearly quintupled the time patients spent in the therapeutic INR range compared with standard care, and decision-analytic models supported the cost-effectiveness of genotype-guided antiplatelet therapy. Ancestry-specific genetic variants relevant to heart-failure drug response, statin-induced myotoxicity, and resistant hypertension were identified, yet African-ancestry individuals made up less than 1% of global PGx study participants. The certainty of evidence varied from very low to moderate across outcomes, indicating a near-total dependence on observational designs and small sample sizes. High testing prices, workforce shortages, low physician genetic knowledge, and the lack of locally appropriate prescribing recommendations all remain obstacles to implementation. Based on these findings, a four-tiered, health-system-focused implementation approach is proposed that spans primary care to national policy. To create regionally calibrated prescribing guidelines in LMICs, multi-site randomized trials, ancestry-informed genomic data, and coordinated policy investment are required.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006591. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Ana Maria Loboguerrero, Jon Hellin, Michelle Bonatti, Bruce Campbell, Ciniro Costa Junior, Eleanor Fisher, Jamie Males, Patti Petesch, Philip Thornton, Sonja Vermeulen

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001094. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Soheil Hataminia, Nazi Mohammadzadeh Asl

Ecological sustainability depends on the compatibility of demand arising from human activities with ecosystems’ biological regenerative capacity. The consumption-based load capacity factor (LCF) represents this balance as the ratio of domestic biocapacity per capita to the ecological footprint of consumption per capita. This study examines how income, capital formation, and energy use are associated with LCF in Iran and whether the energy–LCF association differs across levels of sanctions intensity. Annual data for 1965–2024 were analyzed within an autoregressive distributed lag framework and its error-correction representation, with lag selection based on the Bayesian information criterion and conditional bootstrap inference. LCF declined from 1.362 to 0.188, and Iran transitioned from an ecological reserve to an ecological deficit; the ecological sustainability gap also widened in relative terms. In the primary model’s conditional long-run estimates, higher real gross domestic product (GDP) per capita was associated with higher LCF, whereas greater primary energy use per capita and a higher gross fixed capital formation share of GDP were associated with lower LCF. In the primary model, the negative energy–LCF association was stronger at higher levels of sanctions intensity, but this finding was sensitive to model specifications and sanctions coding. The bootstrap supF test also rejected coefficient constancy in the primary model. The estimated relationships are conditional associations, and the study does not identify the causal contribution of sanctions to the decline in LCF. The findings support considering energy and resource requirements in investment appraisal and monitoring LCF alongside economic indicators.

Source: PLOS Sustainability and Transformation. DOI: 10.1371/journal.pstr.0000192. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Rasha Aziz Attia Salama, Naveen Kumar, Mohamedanas Patni, Shadha Nasser Mohammed Bahutair, Sufyan Mohammed, Saiha Khan, Minha Shehed, Omar Khalid

Background Healthcare students serve as frontline ambassadors in promoting public awareness and shaping attitudes toward organ donation. This study assessed knowledge, attitudes, and organ donor registration among university students in Ras Al Khaimah, UAE, and identified factors associated with organ donor registration. Methods A cross-sectional study was conducted among undergraduate health sciences students using a structured self-administered questionnaire to collect data on sociodemographic characteristics, knowledge of organ donation and transplantation, attitudes, and donor registration status. Results The study included 428 students. The mean knowledge score was 7.77 ± 2.85 out of 19, indicating gaps in understanding of the definition of brain death, donor eligibility, and legal requirements. The mean attitude score was 41.58 ± 6.61 out of 65, suggesting generally positive attitudes towards organ donation, although concerns regarding organ misuse, body disfigurement, lack of trust, and fear of reduced quality of medical care were reported. Only 28.0% of participants were registered as organ donors, with a lack of awareness (39.0%) being the most frequently reported barrier among non-registered students. In multivariable logistic regression analysis, non-Arab students had lower adjusted odds of registration than Arab students, including Emiratis (aOR = 0.149, 95% CI: 0.072–0.310, p < 0.001). Compared with medical students, pharmacy (aOR = 0.050), dentistry (aOR = 0.032), and nursing students (aOR = 0.024) had significantly lower adjusted odds of registration (all p < 0.001). Students with a medical parental educational background also had lower adjusted odds of registration than those with a non-medical parental background (aOR = 0.129, 95% CI: 0.063–0.264, p < 0.001). Knowledge and attitude scores were not significantly associated with registration. Conclusion Despite generally positive reported attitudes toward organ donation, self-reported donor registration remained low, highlighting a discrepancy between stated willingness and registration behavior. Educational and awareness initiatives should address knowledge gaps, misconceptions, trust-related concerns, and perceived barriers to registration.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0362203. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Susana López-Gutiérrez, Laura A. Espinosa-Barrera, Arianna Soto-Hernández, Holber Zuleta-Prada, Celia Bustos-Brito, César S. Cardona-Félix, José Utrilla, Beatriz Velazquez-Cruz, Yair Cárdenas-Conejo, Jesus Alfredo Araujo-León, Victor Aguilar-Hernández, Juan A. Osuna-Castro, Baldomero Esquivel, Hugo Serrano-Posada, Sara Centeno-Leija

Marine microorganisms are a prolific source of novel polyketide synthases (PKSs) that generate structurally diverse and functional polyketides. Here, we identify a novel type III PKS, ArsMB, from Pontimonas sp. via metagenomic mining of a Baltic Sea microbiome. Heterologous expression of arsMB synthetic gene in an Escherichia coli host that lacks a native type III PKS, combined with a two-step strategy to boost acyl-CoA precursor availability in a glucose-mineral medium, enabled the in vivo synthesis of two cell-associated alkylresorcinols, identified by GC-MS as 5-pentadecyl-1,3-benzenediol (ars1) and 5-tridecyl-1,3-benzenediol (ars2). The product profile is consistent with a tetraketide alkylresorcinol biosynthetic pathway utilizing C16 and C14 acyl starter units, drawn from the host acyl-CoA pool. In agreement, AlphaFold2-based structural modeling predicts a Cys139/His275/Asn308 catalytic triad and a long hydrophobic substrate tunnel compatible with long-chain acyl starter units. E. coli producing the amphipathic cell-associated alkylresorcinols ars1/ars2 exhibited increased resistance to muralytic digestion by endolysins and to hydrogen peroxide. These findings expand the known repertoire of marine-derived type III PKSs and highlight the biotechnological potential of ArsMB-derived alkylresorcinols.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361965. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Mélina Maureen Houndolo, Fifali Sam Ulrich Bodjrenou, Waliou Amoussa Hounkpatin, Fadilatou Chabi Yorouba, Hessede Mondoukpe Gbahougbola, Deo Grathias Yevedo Kossa, Irene Mitchodigni, Teresa Borelli, Celine Termote

Background The food environment within and around schools plays a critical role in shaping secondary school students’ current and future eating behavior, food choices, and perceptions of healthy diets. However, little is known about how secondary school students in low-income settings perceive these environments and how such perceptions may influence their food practices. Methods A qualitative study was conducted in the municipalities of Natitingou (urban) and Boukombe (rural), Northern Benin, to explore secondary school students’ perceptions of their school food environments. In each municipality, two focus group discussions were held: one with lower-secondary students (11–15 years), and one with upper-secondary students (14–19 years), ensuring equal gender representation. Discussions addressed the types of foods available within and around schools, students’ food preferences and perceptions, and suggestions for improving their food environments. Data were analyzed thematically. Results Students reported access to a wide variety of foods within and near their schools, particularly in urban settings. However, most of these foods were energy-dense and high in sugar, while fruit and vegetables were rarely available. Participants perceived their school food environments as largely unhealthy, citing inadequate food hygiene practices and poor vendor sanitation as major concerns. Conclusion Findings highlight the need to integrate secondary school students’ perspectives into efforts to improve school food environments in Benin. Policies promoting the availability of nutritious foods and strengthening hygiene standards in and around schools could support healthier dietary behaviors among students. Future research should examine how these environments and perceptions influence secondary school students’ long-term nutrition and health outcomes.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361942. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Hairu Zhang, Baoqi Zhou, Jiaxin Wang, Yue Li

This study surveyed 270 college students from seven major geographic regions of China and, using multiple ordinal logistic regression, structural equation modeling (SEM), importance–performance analysis (IPA), and K-means clustering, examined their light meal consumption behavior, its determinants, and service optimization pathways. Results show that light meal consumption is characterized by diversified demands, regular-meal-oriented timing, rigid price sensitivity, and functionalized categories; specific dietary needs are the core driver of consumption frequency (B = −1.985, p < 0.001), whereas grade, gender, monthly living expenses, and campus supply conditions are not significant. In universities without a light meal supply, consumption intention follows an “attitude–norm/control–intention” multiple mediation pathway, with subjective norm showing the strongest direct effect (β = 0.392). In universities with a light meal supply, supply–demand gaps across all six service dimensions are highly significant (p < 0.001), with taste and variety falling into the IPA improvement quadrant as core shortcomings. K-means clustering identifies three student groups in supplied universities (high-satisfaction loyal, differentiated rational, and low-satisfaction wait-and-see) and two in non-supplied universities (high-demand expectant and low-demand wait-and-see). The findings confirm that intrinsic health demands, rather than external supply conditions, are the core driver; peer effects are a key lever; taste and variety are the primary bottlenecks to repeat purchases; and student heterogeneity necessitates stratified strategies.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361891. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Faith Magut, Elizabeth Kemigisha, Moses Otieno, Stephen Gakuo, Vivienne Kamire, Jane Osindo, Thomas Gachie, Sarah Mulwa, Annabelle Gourlay, Isolde Birdthistle, Daniel Grint, Daniel Kwaro, Abdhalah Ziraba, Sian Floyd

Common mental disorders (CMD) are increasing globally among young people. The DREAMS (Determined-Resilient-Empowered-AIDS-free-Mentored-Safe) multi-component intervention package, delivered during 2016–2023, aims to reduce HIV incidence among adolescent girls and young women (AGYW). We hypothesised that social, health and economic benefits of DREAMS would reduce CMD, though this was not the program’s goal. In each of two Kenyan settings (Gem and Nairobi) a randomly selected cohort of around 1000 AGYW aged 13–22 years was enrolled during 2017–2018 and followed up during 2019–2022. CMD was measured using the Shona-Symptom-Questionnaire; a score of ≥7 was classified as `experiencing CMD’. We used inverse-probability-of-treatment-weighting to control for confounding and compared 3 groups of AGYW: those invited to DREAMS by 2018 (early invitees), during 2020–2022 (later invitees), or not invited to DREAMS (non-invitees). In 2022, the proportion experiencing CMD was 45% (463/1023) in Gem, and 46% (410/889) in Nairobi. In Gem, the estimated proportions with CMD were 49%, 45%, and 38% for the counterfactual scenarios in which all AGYW were early invitees, all were later invitees, or all were non-invitees, respectively. There was evidence of an increase in CMD prevalence when comparing early invitees with non-invitees (11%; 95% CI:2%,21%). In Nairobi, the estimated proportions with CMD were 46%, 55%, and 32% for the scenarios in which all were early invitees, all were later invitees, or all were non-invitees, respectively. There was evidence of an increase in CMD prevalence when comparing early invitees to non-invitees (14.4; 95% CI:2.1%, 26.4%) and when comparing later invitees to non-invitees (23.3%; 95% CI:5.8%,41.2%). CMD was common among AGYW in both settings. The higher CMD prevalence among DREAMS invitees compared with non-invitees might be due to increased recognition of, and willingness to disclose, symptoms of mental ill-health. Specific interventions to address CMD among AGYW should be incorporated within health and HIV prevention programmes.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000765. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Matthew Aviso, Youming Ng, James Chan, Panqin Cai, Kelvin Lim, Natasha Howard

The 2025 establishment of Singapore’s Communicable Diseases Agency (CDA) included creation of a One Health Office (OHO), supporting an existing whole-of-government approach involving five agencies spanning human, animal, and environmental health. Singapore’s approach incorporates distinctive features intended to strengthen preparedness, prevention, and mitigation during non-emergency periods. We examined how this approach developed and implemented multisectoral governance of national One Health priorities. This nine-month ethnographic study (2024–2025) involved observations of three inter-agency One Health meetings and eight partner agency engagements, semi-structured interviews with 26 public servants across five partner agencies, and review of eight internal government documents. Data were analysed thematically using abductive coding. We found that Singapore’s One Health governance was supported by participant-driven socialisation through ‘semi-informal’ inter-agency relations among public servants. These were reinforced by a rotational governance structure, Singapore’s small size, regular bilateral and multilateral communication, and OHO-led engagement. These interactions enabled workable inter-agency arrangements while progressively strengthening multisectoral governance. Importantly, socialisation processes appeared structurally supported rather than emerging incidentally from formal governance arrangements, challenging conventional assumptions about the relationship between formal structures and informal networks. Singapore’s One Health approach demonstrates how multisectoral governance can be deliberately strengthened through interpersonal socialisation. Formal institutional arrangements, including those established through CDA, can cultivate ‘semi-informal’ networks that foster trust, shared ownership, and consensus across government agencies. For national public health agencies elsewhere, embedding opportunities for sustained socialisation within governance structures may strengthen intersectoral collaboration and collective ownership of One Health priorities. The Singapore experience suggests that informal social processes need not be incidental outcomes of formal governance but can be intentionally enabled through institutional design, with implications for the development and assessment of One Health governance internationally.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005871. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Roisin McCafferty, Angela Carlin, Róisín Carney, Marie H. Murphy, Alison M. Gallagher, Ciara Fitzpatrick, S. Maria O’Kane

Physical activity (PA) in childhood and adolescence has established health benefits. Despite this many children worldwide do not meet PA guidelines, with implications for future health. Cost is a recognised barrier to participation and may exacerbate socioeconomic inequalities, particularly during the ongoing cost-of-living crisis. Free/low-cost PA opportunities may help promote equitable access to PA for children, but less is known about how families experience and access these opportunities and the factors influencing engagement. This study explored parental perspectives on children’s participation in free/low-cost PA opportunities, local provision, and future needs. Differences in participation by indicators of socioeconomic status (SES) were also examined. A cross-sectional questionnaire (n = 855) and semi-structured interviews (n = 29) were conducted with parents/guardians of children aged 4–16 years in Northern Ireland. Quantitative data were analysed descriptively and using between-group comparisons, while qualitative data were analysed thematically. Almost all parents/guardians (99%) reported weekly participation in at least one free/low-cost PA opportunity, most commonly informal activities such as walking and outdoor play. However, 76% perceived insufficient local opportunities, and only 10% considered provision adequate. Since the cost-of-living crisis began in 2021, 29% reported increased engagement in free activities, including walking and running. Qualitative findings highlighted barriers beyond cost, including limited awareness, location, transport, and the quality and suitability of provision. Although free/low-cost PA opportunities were widely used, parents identified gaps in local provision and access. Participation did not differ across most SES indicators, but this does not necessarily indicate equitable access, particularly for adolescents, girls, and children with additional needs. Findings suggest that removing cost barriers alone may be insufficient as financial, environmental, social and individual factors influence access and engagement with free/low cost opportunities. A coordinated approach encompassing increased availability, improved facilities, better promotion, and targeted support for low-income families is needed to ensure equitable opportunities for children’s PA.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005770. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.