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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: 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: 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.

Authors: Chunxia He, Lingli Yan, Jia Yin, Qian Yao, Jiali Zhang, Jimei Zhang, Xiuying Hu

Background Public health nurses play a pivotal role in primary public health services, yet China lacks a systematic, context-specific competency framework to support workforce development. This study aimed to develop a competency framework for public health nurses in China to guide capacity-building initiatives. Methods A preliminary competency framework was constructed based on a literature review, job analysis, and semi-structured interviews with 22 frontline practitioners and comprised six domains, 16 subdomains, and 52 competencies. A two-round Delphi survey was then conducted with 21 experts from multiple regions with expertise in community nursing, public health, primary care medicine, and nursing education and related specialties. Consensus was defined as a mean importance rating ≥4.0 (5-point Likert scale) and a coefficient of variation ≤0.25. The Delphi consultation process was characterized by expert engagement, the expert authority coefficient, and the coordination of expert opinions. Finally, the Analytic Hierarchy Process was applied to determine the relative weights of the agreed-upon items at each level. Results Across the two Delphi rounds, the response rates were 95.45% and 100%, the expert authority coefficient was 0.90, and Kendall’s coefficients of concordance were 0.156 and 0.171, respectively (both P < 0.001). The final competency framework comprised six domains, 16 subdomains, and 46 competencies. All Analytic Hierarchy Process judgment matrices showed acceptable consistency (CR < 0.10). Health education and health promotion was assigned the highest weight (0.280) among the domains. Conclusion The resulting competency framework demonstrates methodological rigor, a comprehensive structure, and contextual relevance. It provides theoretical and practical implications for competency-based education, workforce development, and the professionalization of public health nursing in China.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361940. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jui-Kun Chiang, Po-Chen Chiang, Malcolm Koo

Electronic health record-based oncology studies depend on computable case definitions, but different operational definitions may identify different patient populations and change downstream estimates. This retrospective benchmarking cohort study evaluated three definitions of incident invasive breast cancer in the TriNetX Global Collaborative Network: at least one malignant breast cancer diagnosis code (Dx1), a repeated diagnosis-code definition within 90 days (Dx2), and a diagnosis code plus breast cancer-directed treatment evidence (DxTx). Female patients aged 20 years or older were identified after a 12-month washout period and exclusion of patients with carcinoma in situ only. Pairwise one-to-one propensity-score matching was performed using 13 baseline covariates. Outcomes were all-cause mortality and time to the first emergency department visits, assessed from day 180 after the index date to 1, 3, and 5 years after the original index date. Appendicitis and femoral neck fracture were included as negative-control outcomes. Dx1, Dx2, and DxTx identified 1,450,233, 678,739, and 578,576 patients, respectively. After matching, more restrictive definitions were consistently associated with higher hazards of mortality and emergency department visits. For mortality, hazard ratios ranged from 1.26 to 1.32 for DxTx versus Dx1, 1.13 to 1.14 for Dx2 versus Dx1, and 1.13 to 1.17 for DxTx versus Dx2 across assessment windows. Emergency department visit estimates showed a similar but attenuating pattern. These associations should be interpreted as differences between phenotype-defined populations arising from selection and ascertainment mechanisms rather than as treatment effects. Negative-control outcomes were generally close to the null; small appendicitis associations observed in comparisons involving Dx1 did not remain statistically significant after correction for multiple testing. These findings indicate that plausible electronic health record-based breast cancer definitions are not analytically interchangeable. Phenotype specification should therefore be treated as a core analytic decision and evaluated through transparent reporting and sensitivity analyses.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361883. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Lu Zhang, Bianca Ton, Louise Mewton, Susanne Schweizer

Background While the COVID-19 pandemic caused major disruptions to social connections and lifestyles, many countries continued the sale of alcohol as an essential commodity. Evidence on change in alcohol use, and its association with mental health and wellbeing during the pandemic is, however, mixed and limited to initial periods of the pandemic. This study aimed to address these research gaps. Methods Data were drawn from the COVID-19 Risks Across the Lifespan (CORAL) Study, a three-wave longitudinal study conducted between May 2020 and April 2021. The present sample included 2,369 participants (ageM = 38.81 ± 16.94 years, range = 11–100; 90% females) from the United Kingdom, United States, and Australia. Measures included pre-pandemic alcohol use and changes in consumption frequency, quantity, drinking behaviours (e.g., drinking earlier in the day), and motivations (e.g., drinking for enjoyment) during the pandemic. General perceived stress, COVID-19-related stress, loneliness, and symptoms of depression and anxiety were also assessed. Findings Drinking frequency and quantity remained stable across the first year of the pandemic; however, non-linear age associations were found. Young individuals aged between 11 to 20 years, and mid-aged individuals aged between 50 to 70 years, had the highest probability of increased alcohol use frequency and quantity. Drinking behaviours and motivations also remained largely stable, although age- and country-specific differences emerged, potentially reflecting policy differences such as alcohol access restrictions and lockdown measures. Finally, loneliness unidirectionally predicted subsequent alcohol use quantity. Conclusions These findings highlight the heterogeneous alcohol use patterns across age groups and countries during the pandemic, and underscore loneliness as an important public health issue with implications for alcohol misuse.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361854. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Eivind Andersen, Fredrik Lie Haugen, Heidi Lindsverk, Oda Eline Aasland, Anne Sæther, Bjørn Bjorvatn

Background Insomnia and poor sleep are highly prevalent among university students and are linked to impaired mental and physical health, reduced cognitive functioning, and lower academic performance. Existing interventions for insomnia include cognitive behavioural therapy for insomnia (CBT-I), mindfulness, and sleep hygiene. CBT-I is widely recognised as effective but remains difficult to access for the general population and lack scalability, long-term follow-up, and feasibility in non-clinical settings. Pragmatic, group-based approaches that can be delivered within the university and are tailored to help students develop self-endorsed routines and competencies for better sleep, creating sustainable changes that extend beyond the program period, is needed. Methods This study is a pragmatic, two-arm randomised controlled trial evaluating the effectiveness of a group-based sleep program for university students with insomnia symptoms. A total of 118 full-time students aged 18–30 meeting diagnostic criteria for chronic insomnia disorder will be randomized (1:1) to either the intervention or a wait-list control group. The intervention comprises 12 weekly 90-minute group sessions followed by nine monthly follow-up meetings, facilitated by trained coaches. The program integrates core elements of CBT-I with motivational and coping strategies, delivered in an interactive and peer-supported format. The primary outcome is change in insomnia severity measured by the Bergen Insomnia Scale. Secondary outcomes include subjective and objective sleep measures, mental health, cognitive performance, academic attainment, health behaviours, physical fitness, and biological markers. Assessments will be conducted at baseline, post-program (12 weeks), and 12 months. A mixed methods process evaluation will assess fidelity, acceptability, mechanisms of impact, and contextual influences. Discussion This trial will be among the first pragmatic evaluations of a structured, group-based sleep intervention tailored to university students with insomnia. Key strengths include the randomised controlled design, comprehensive outcome assessment, 12-month follow-up, and embedded process evaluation. If effective, the program could provide a feasible, scalable, and cost-effective model to improve sleep and therein health, and academic performance in young adults in higher education.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361815. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Yuanzhang Feng, Zhenwei Wu

Background Post-exercise metabolomic changes are difficult to interpret without reference to the pre-exercise state. A baseline-referenced approach may help distinguish transient exercise responses from residual metabolic deviation during early recovery. Methods We performed a secondary analysis of two public human plasma metabolomics datasets. ST001789 was used as the primary discovery dataset and included 57 paired plasma samples from 19 participants collected before exercise, immediately after a 90-min endurance run, and after 60 min of recovery. ST004303 was used as an external support dataset and included moderate-intensity and sprint-interval exercise conditions. We assessed paired baseline-referenced contrasts, recovery-pattern classes, residual baseline deviation, cross-dataset support, intensity-related behavior, and threshold sensitivity to prioritize candidate metabolites for future validation. Results In ST001789, 198 metabolites differed from baseline immediately after exercise, 140 differed after 60 min of recovery, and 116 changed between the immediate post-exercise and recovery samples. Recovery-pattern classification showed heterogeneous early responses. Of 77 discovery features matched in ST004303, 74 had at least one direction-consistent external comparison and 66 had at least one FDR-supported external change. Staged prioritization identified 54 primary candidates. Corrected sensitivity schemes retained 136, 25, and 11 features, with 11 retained across all three schemes. These candidates spanned fatty-acid transport and oxidation, amino acid metabolism, lipid remodeling or signaling, and purine/nucleoside turnover. Conclusions Baseline return, residual deviation, external support, and intensity-related behavior help organize early post-exercise metabolomic responses. The identified metabolites should be interpreted as hypothesis-generating candidates for future validation, not as validated recovery biomarkers.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361757. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Sijing Peng, Min Wang, Peili Xu, Xiang Wang, Ting Zheng, Min You, Jiejie Ge

Introduction Concept analysis is widely used in nursing and health-related disciplines to clarify ambiguous constructs, refine disciplinary language and support theory development, instrument construction, education and practice. However, concept analysis is methodologically plural rather than a single uniform method. Different approaches vary in their assumptions, data sources, analytic steps and expected outputs. Aims This scoping review will identify methodological lineages of concept analysis and map reporting elements across nursing and health-related disciplines. It will examine both the cross-lineage applicability and the empirical distribution of candidate reporting elements. Methods The review will follow Joanna Briggs Institute guidance for scoping reviews and will be reported according to the PRISMA extension for Scoping Reviews. Ten English- and Chinese-language databases will be searched from inception to the final search date, supplemented by targeted citation searching for foundational methodological sources. Two reviewers will independently screen records after calibration on a purposively enriched set of 25 records containing likely inclusions, likely exclusions and borderline records. Formal screening will begin after both overall raw agreement and positive agreement for the include/uncertain decision reach at least 75%; raw agreement and Cohen’s kappa will be reported before consensus. Data will be charted using a piloted form and synthesised descriptively through deductive-inductive framework analysis. Reporting elements will be mapped by both methodological applicability and empirical distribution. Conclusion The review will provide a structured account of concept analysis methods and reporting elements. It represents an evidence-mapping and candidate-item generation stage and will not itself produce a formal reporting guideline. The protocol is registered on the Open Science Framework: https://osf.io/xru7f.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361727. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.