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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: Wang Yizhang, Li Jing, Yang Mingxi, Ou Shiqiang, Liu Hao, Xie Peng, Zhu Kaimei

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361897. 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.

Authors: Yodying Kaolawanich, Methat Meechuen, Issarayus Laohabut, Thanawat Ruengchaisiwawaith, Thananya Boonyasirinant

Background Coronary artery calcium (CAC) scoring effectively stratifies cardiovascular risk, and stress perfusion cardiac magnetic resonance (CMR) accurately detects myocardial ischemia. We aimed to investigate the prevalence and factors associated with myocardial ischemia on CMR in patients with CAC, and to assess the clinical impact of myocardial ischemia following CMR. Methods This study included 215 patients aged ≥18 years who underwent CAC scoring for risk stratification, followed by stress CMR between 2013 and 2026. The prevalence and predictors of myocardial ischemia were investigated. Receiver operating characteristic (ROC) analysis was performed to assess the association between CAC scores and myocardial ischemia. Additionally, subsequent clinical management following CMR was determined. Results The mean age was 69.3 ± 9.1 years (60.9% male). The average 10-year PREVENT risk score was 18.6 ± 8.7%. Overall, myocardial ischemia was present in 26.0% of patients (56/215): 17.1% in the CAC 300–999 Agatston units (AU) group (14/82) and 41.6% in the CAC ≥ 1,000 AU group (42/101). CAC score was the only independent predictor of myocardial ischemia (adjusted OR 1.07, 95%CI 1.03 − 1.10; p < 0.001 per 100 AU). Across clinical risk score categories and diabetes status, CAC score was consistently associated with myocardial ischemia, with no significant interactions observed (all p for interaction >0.05).The number of ischemic segments increased with increasing CAC scores (p < 0.001). ROC analysis demonstrated an optimal cutoff threshold of CAC ≥ 1,093 AU for detecting myocardial ischemia (AUC 0.75, p < 0.001). The clinical impact of stress CMR included medication changes in 37.2% of patients, while 18.1% underwent invasive procedures. Conclusions In patients with CAC scores undergoing stress CMR, the prevalence of myocardial ischemia was approximately one-fourth and was associated with higher CAC scores. Stress CMR may influence clinical management in this population. Larger or prospective studies validating these findings and evaluating prognosis are warranted.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361659. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Isabella Garti, Awube Menlah, Emuejevoke Fuafugo, Evans Osei Appiah, Nadyen Jordan Shikpup, Ophelia Serwaa Tonto, Betty Osei Ntiamoah

Introduction Pre-eclampsia, a high-risk pregnancy complication, poses significant threats to maternal and fetal health. Globally, little is known about how women navigate a pre-eclampsia diagnosis or their perceptions of the pathology, unpredictable course, and treatment. Guided by the Health Belief model, this study explores pregnant women’s beliefs about pre-eclampsia in Ghana’s most populous region. Materials and methods A qualitative descriptive study was conducted at a district hospital in the Ashanti Region of Ghana to explore pregnant women’s narratives of their health beliefs and perceptions regarding pre-eclampsia. Sixteen participants were purposively selected, and one-on-one semi-structured interviews were conducted in October 2021. Data were analyzed using qualitative content analysis. Categories were developed inductively from participants’ accounts and subsequently interpreted in relation to the constructs of the Health Belief Model. Results Pregnant women’s risk perceptions of pre-eclampsia varied, with some not perceiving personal risk, while a few felt vulnerable based on community experiences and observations of other women. Pre-eclampsia was widely regarded as a serious condition, with many expressing fears of adverse maternal and fetal outcomes. Participants recognized the benefits of antenatal care and lifestyle modifications in reducing risk and empowering care-seeking, while previous experiences with pre-eclampsia and guidance from health providers served as key cues to action. However, several barriers to care were identified, including financial constraints, mistrust of the health system, and inadequate communication from health providers. Conclusion This study highlights the need for context-specific approaches to address health beliefs related to pre-eclampsia. Strengthening maternal health literacy, effective risk communication, and respectful care can improve early recognition, care-seeking, and outcomes for pre-eclampsia.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361626. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Cornelia Herbert

Academic performance involves achieving one’s goals and reaching one’s full potential while staying mentally, emotionally, and physically well. This can be challenging across all career paths. This article presents results from a new survey examining key psychological factors and how early-career researchers evaluate them in relation to their scientific performance and health as they pursue their career goals. A total of 475 participants (e.g., in Germany, Switzerland, or Austria) evaluated psychological factors that, according to previous research and psychological theories, influence academic success. The evaluations included participants’ assessments of their self-competence, motivation, and work effort; achievement emotions (including negative and positive experiences that influence well-being); perceptions of supervision; and views on reasons for staying or leaving academia. Gender differences and differences between PhDs and postdocs were also analyzed. Overall, PhD students and postdocs felt confident in and satisfied with their academic performance. They evaluated their competencies, effort, and motivation as key to achieving their career goals. Satisfaction, effort, and self-efficacy showed no gender differences, but women reported higher levels of worry and negative emotions, particularly among postdocs. Challenges such as time and financial constraints, as well as the benefits of working outside academia, influenced self-perceptions of career decisions. Most participants reported regular supervision; a few had experience with or were participating in early-career initiatives. The study emphasizes the need to consider young scientists’ beliefs, feelings, and expectations about their academic performance, achievement, and health when developing early-career strategies to reduce perceived barriers and reflect career decisions. The current approach and results are discussed in relation to previous studies, the observed challenges, and the gaps this research addresses.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361623. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Jin Wang, Xingwei Zhu, Linhui Jin, Yafei Liu, Man Tao, Zhijuan He, Xiaoxia Tang, Guilan Zhang, Hailin Zhu

Background Sepsis continues to be a major contributor to death among critically ill individuals and places a heavy strain on healthcare resources. In addition to causing systemic inflammation and affecting hemodynamics, sepsis has a significant effect on the gastrointestinal system, leading to complications like stress ulcers and notable gastrointestinal bleeding (GIB), which worsen patient outcomes. While stress ulcer prophylaxis (SUP) has traditionally been included in sepsis treatment protocols, the concept of applying it universally is being increasingly scrutinized due to the absence of definitive mortality advantages and the risk of adverse effects, such as hospital-acquired pneumonia. Nevertheless, there is a notable gap in synthesized research that specifically addresses the independent risk factors for stress ulcers in sepsis patients. Methods We carried out a systematic review in accordance with PRISMA standards, exploring eight databases (CNKI, Wanfang, VIP, Sinomed, PubMed, Web of Science, Embase, and Cochrane Library) from their inception until September 1, 2026. We included observational analytical studies (either cohort or case-control) that examined factors linked to stress ulcers or significant gastrointestinal bleeding in adult patients with sepsis. Two researchers independently handled the selection of studies, extraction of data, and evaluation of quality using the Newcastle-Ottawa Scale. Due to the limited number of studies for each association between associated factors and outcomes, a narrative synthesis was utilized. Results A total of six studies encompassing 131,568 individuals suffering from sepsis or septic shock were analyzed. The incidence rates of stress ulcers or gastrointestinal bleeding (GIB) varied between 2.0% and 32.3%. The identified associated factors were divided into three categories: patient-related (older age, history of GIB, cirrhosis, HIV, cancer/immunosuppression), disease-related (coagulopathy, kidney impairment, high BUN levels, severity of illness scores, source of infection), and treatment-related (mechanical ventilation, use of anticoagulants, corticosteroid therapy, duration of ICU stay). Specifically for stress ulcer, factors such as respiratory failure, high BUN levels, shock, and increased HMGB1/TLR2/TLR4 levels were found to be independently linked to a higher odds. Conclusions In summary, the likelihood of developing stress ulcers and gastrointestinal bleeding in patients with sepsis is shaped by a variety of factors related to the patient, their illness, and the treatments they receive. Key indicators that consistently emerge include issues with blood coagulation, the presence of shock, the need for mechanical ventilation, liver and kidney dysfunction, the severity of the disease, and any previous occurrences of gastrointestinal bleeding. These results advocate for tailored strategies for stress ulcer prophylaxis based on individual risk rather than a one-size-fits-all approach, offering crucial insights for precise clinical decision-making. Additional high-quality research is essential to confirm and enhance the understanding of these associated factors. Registration PROSPERO (CRD420251242849)

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361608. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.