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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.

Authors: Action Amos, Sandra Jumbe, Thiyara Bandara, Sadiya Begum, Charlotte Hanlon, Sumeet Jain, Martyn Pickersgill, Eric Umar, Robert C. Stewart

Inclusive healthcare decision-making is a cornerstone of recovery-oriented mental health services, contributing to improved outcomes, enhanced autonomy, and reduced stigma. While substantial research on mental healthcare decision-making has been conducted in high-income countries, there is limited evidence from low- and middle-income countries (LMICs), where sociocultural norms, family structures, and health system constraints may shape decision-making differently. This review sought to synthesise evidence on service user and caregiver involvement in mental healthcare decision-making in LMICs and identify contextual factors influencing these processes. A scoping review was conducted following Arksey and O’Malley’s five-stage framework. English-language studies from 2008 to 2025 were identified through databases and grey literature searches. Eligible studies extracted examined the involvement of people with mental health conditions and/or caregivers in mental healthcare decision-making within LMICs. Two reviewers independently coded descriptions of involvement using an inductive content analysis approach. Three overarching themes emerged: (1) active user involvement, reflecting service users’ participation in and co-creation of decisions about their care; (2) family dominance, where family members significantly influenced or controlled decision-making processes; and (3) drivers of decision-making, including cultural norms, stigma, economic hardship, social relationships, and health system constraints. Overall, decision-making was predominantly shaped by family authority and contextual factors, with relatively limited evidence of shared or supported decision-making approaches. The search yielded 21,830 records, with an additional 46 studies identified through grey literature searches. Following screening, 36 studies were included. Studies were conducted across Africa (n = 12), Asia (n = 22), and the Middle East (n = 2). Mental healthcare decision-making in LMICs is embedded within complex family, cultural, and structural contexts that both enable and constrain service user participation. This review contributes to promoting a contextualised understanding of mental healthcare decision-making in LMICs.

Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000712. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Henry B. Perry, Abhay Bang, Steve Hodgins, Madeleine Ballard, Jeffrey D. Sachs, Abnet Z. Muluneh, Mushtaque Chowdhury, Mark Mwenda, Raj Panjabi

Many health systems, particularly in low- and lower middle-income countries (LMICs), are lagging in their progress in achieving Universal Health Coverage and delivering on the promise of Health for All, constrained by workforce shortages, fiscal ceilings, and inadequate outreach to those lacking basic and essential services. Stark inequities in coverage of services and in health status persist. Strengthening community health worker (CHW) programs provides the fastest and most cost-effective route for health systems to achieve their full potential. CHWs should become the backbone of primary health care (PHC) and the foundation of health systems. Evidence from more than a decade of national-scale experience demonstrates that CHWs who are appropriately trained, paid, equipped, and supervised can extend high-quality essential services to the last mile while improving the overall efficiency of the health system. We are at a point in time when donor strategies and private investment are captivated by the promise of digital health and artificial intelligence. The most reliable approach to saving more lives is still a paid, supported CHW empowered with digital tools. At the same time, the contraction of Official Development Assistance (ODA) creates both risk and opportunity. ODA must pivot from supporting services to catalytic capital: time-bound, matching investments that accelerate governments’ own proCHW policy. A “next generation” of CHW programs in LMICs would enable CHWs to visit every home monthly and provide a broad array of PHC services as a result of adequate remuneration and appropriate training, supervision, logistical support, and integration into the health system. This could yield a highly favorable economic return—through productivity gains from better health, reduced health-care expenditures, and pandemic-risk mitigation. A “next generation” of CHW programs is our best bet for accelerating progress in achieving Universal Health Coverage and Health for All sooner rather than later.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007545. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Madura Nanthakumaran, Charles Orjiakor, Dina Balabanova

Corruption in healthcare is a pervasive global challenge that undermines equity, efficiency, and trust in health systems. Whilst its economic and governance impacts are well documented, the psychological consequences for patients, providers, and those involved in anti-corruption reform remain under-explored. Understanding these mental health effects is critical for designing anti-corruption strategies that safeguard wellbeing and strengthen health systems. An exploratory mixed-methods study was conducted to map an emerging evidence base. A scoping review of 25 peer-reviewed and grey literature sources was complemented by four key informant interviews, which were used to interpret and contextualise the review findings. Findings were synthesised into a conceptual framework mapping pathways between corruption and mental health outcomes. Corruption was reported to be associated with psychological distress among patients, providers, and anti-corruption actors. This included stress, anxiety, depressive symptoms, and moral injury. At a community level, corruption eroded trust and collective agency, whilst institutional effects included normalisation of unethical practices. Structural determinants were found to perpetuate corruption’s harms. Anti-corruption efforts produced mixed outcomes: reform targeting high-level officials improved public mental health modestly, whereas punitive measures against frontline workers exacerbated fear and demoralisation in the workforce. Protective factors such as moral agency, and robust reporting systems were found to buffer harm but were context dependent. Policy recommendations are made for practice, research and capacity building. These include framing corruption as a public mental health issue, strengthening whistleblower protections, commissioning further research, and adapting reform to local political economy and social norms. These findings indicate that corruption is a plausible but under-recognised social determinant of mental health requiring further research. Integrating mental health considerations into anti-corruption policy and health system reforms is essential to mitigate harm and strengthen resilience.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007509. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Moses Mwale, Peter Jay Chipimo, Andrew Phiri, Patrick Sakubita, Penelope Masumbu, Bryson Musonda, Chipo Mwela, Kelvin Mwangilwa, Musole Chipoya, Priscilla Nkonde Gardner, Francis Dien Mwansa, Azmach Gebregiorgis, Muziya Chika, Kennedy Matanda, Freddie Masaninga, Jacob Sakala, Peter Clement Lugala

Despite progress in childhood immunization, Zambia retains pockets of zero-dose children (those who have not received the first dose of diphtheria-tetanus-pertussis-containing vaccine, DTP1) and under-immunised children (those missing one or more vaccines in the recommended schedule), sustaining vulnerability to vaccine-preventable diseases. Understanding the factors associated with missed vaccination is essential for achieving Immunization Agenda 2030 targets. We analysed cross-sectional data from 1,738 children aged 12–23 months identified through the 2024 Zambia Demographic and Health Survey, a nationally representative survey using a stratified two-stage cluster sampling design. Three outcomes were assessed: zero-dose status (no DTP1), under-immunization by the basic schedule (BCG, DTP1–3, OPV1–3, measles-1), and under-immunization by the national expanded schedule (basic plus PCV1–3 and rotavirus1–2). Survey-weighted multivariable regression identified associated factors. Nationally, 3.2% (95% CI: 2.1–4.3%) of children were zero-dose, 36.1% (95% CI: 33.0–39.2%) were under-immunised by the basic schedule, and 69.9% (95% CI: 67.0–72.8%) by the national schedule. Zero-dose prevalence ranged tenfold across provinces, from 0.6% in Lusaka to 6.9% in North Western. In adjusted models, children in the richest households had 93% lower odds of zero-dose than the poorest (aOR 0.07, 95% CI: 0.02–0.29). Facility delivery reduced zero-dose by 68% (aOR 0.32, 95% CI: 0.15–0.69). For basic-schedule under-immunization, secondary education (aOR 0.50, 95% CI: 0.30–0.82; prevalence ratio 0.68) and vaccination card possession (aOR 0.24, 95% CI: 0.14–0.40; prevalence ratio 0.53) were associated with lower odds. Wealth effects differed significantly by residence for all outcomes (p < 0.001). Zero-dose and under-immunization in Zambia are profoundly socioeconomically and geographically patterned. Reaching zero-dose children requires targeting the poorest households and those with home deliveries, particularly in North Western and Northern provinces. Improving vaccination card coverage may reduce broader under-immunization. Gaps in national schedule coverage are consistent with supply-side constraints requiring structural health system responses, though direct supply-side measurement was beyond the scope of this analysis.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006618. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Sameera Mahomedy, Nosiphiwo Nzimande, Susan Goldstein

The prevalence of overweight and obesity among South African children is increasing. Unhealthy food and beverage marketing is a major contributor to this burden and has been associated with an increased risk of diet-related non-communicable diseases (DR-NCDs), unhealthy food preferences among children, and changes in household purchasing patterns. Despite these risks, South Africa primarily relies on industry self-regulation to govern advertising, raising questions about the effectiveness of existing complaint mechanisms. This study evaluated the procedural and substantive effectiveness of advertising complaint mechanisms for child-directed marketing across South African regulatory bodies. A ‘mystery shopper’ methodology was used to assess the complaint mechanisms under real-world conditions. Nine adverts were purposively selected from a broader observational sample, resulting in eleven complaints submitted to the relevant regulatory bodies. Complaints related to alcohol adverts, unhealthy food and beverage adverts, and promotional adverts across television, radio, YouTube and outdoor platforms. Complaint mechanisms were evaluated for timeliness, accessibility, jurisdictional clarity, and procedural and substantive adjudication. The current advertising framework is largely self-regulatory through the Advertising Regulatory Board (ARB), limiting the scope of enforceable oversight. Complaint procedures were frequently characterised by delays, incorrect referrals, inconsistent procedural requirements, and fragmented jurisdiction. Procedurally, nine of the eleven complaints were not satisfactorily resolved. Substantively, none were satisfactorily resolved. The ARB applied a narrow “specifically directed to children” test, despite broader evidence that children’s exposure to unhealthy product marketing can influence behaviour, particularly among adolescents. Comparison with relevant ARB decisions involving public health messaging further suggested asymmetries in evidentiary standards between commercial advertising and public health communications. These findings highlight important procedural and substantive limitations within South Africa’s current advertising complaints framework. They further support consideration of stronger statutory or co-regulatory approaches with independent oversight to better protect children from harmful commercial marketing.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005223. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Shiferaw Birhanu, Getu Degu Alene, Yeshalem Mulugeta Demilew

Background Appropriate complementary feeding is essential for children’s growth and cognitive development. However, these practices remain inadequate in the study area. Therefore, this study aimed to evaluate the effect of nutrition counseling on complementary feeding practices among mothers with children aged 6–23 months in West Gojjam Zone, Northwest Ethiopia. Methods A two-arm, parallel, cluster-randomized controlled trial was conducted from June 2023 to December 2024 in rural districts of West Gojjam Zone. Thirty clusters (15 per arm) were assigned to either an intervention group (n = 401), which received Health Belief Model-based nutrition counseling by Women’s Development Army leaders, or to a control group (n = 401), which received routine education. The intervention was delivered monthly for nine months from infant age 6–8 months. The primary outcome was appropriate complementary feeding practices. Secondary outcomes included minimum dietary diversity, meal frequency, acceptable diet, and egg/flesh food consumption. Data were collected via interviewer-administered questionnaires. The intervention effect was analyzed using Generalized Estimating Equations with adjustment for potential confounders. Statistical significance was set at p < 0.05. Results The difference-in-differences in appropriate complementary feeding practices between groups was 13.2 percentage points. After adjustment, mothers in the intervention group were nearly 2.5 times more likely to practice appropriate complementary feeding than controls [AOR = 2.49, 95% CI: (1.40, 4.42)]. Children of counseled mothers were also more likely to achieve minimum dietary diversity [AOR = 1.75, 95% CI: (1.04, 2.93)], minimum meal frequency [AOR = 1.62, 95% CI: (1.01, 2.61)], and minimum acceptable diet [AOR = 2.13, 95% CI: (1.26, 3.59)] compared with controls. Conclusion Health Belief Model-based nutrition counseling was positively associated with improvements in appropriate complementary feeding practices, minimum dietary diversity, meal frequency, and acceptable diet. Integrating such counseling into routine maternal and child health services may strengthen child nutrition programs in similar rural settings. Trial registration ClinicalTrials.gov (NCT05871346).

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361976. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Gwangsu Lee

Rising health insurance expenditure (HIE) poses fiscal risks and challenges to the sustainability of public insurance systems. Despite growing interest in data-driven analysis, empirical evidence on the associations between macroeconomic, social, and financial conditions and national HIE remains limited, particularly across provider types. This study introduces an explainable machine-learning framework with temporal predictive validation to analyze and forecast HIE using 60 macro-financial and socioeconomic indicators. The framework is applied to three monthly expenditure series from Korea’s National Health Insurance system (2000–2023). Predictive performance and interpretability are assessed using two univariate autoregressive baselines, three regularized linear indicator-based benchmarks, and six nonlinear indicator-based ensemble models. LightGBM serves as the primary explanatory model, and SHapley Additive exPlanations (SHAP) quantifies indicator contributions and captures autoregressive persistence. Beyond associational insights, temporal predictive validation using lagged regression and Granger-type temporal predictive tests examines, within a prespecified exploratory lag window, whether SHAP-identified indicators show statistically supported exploratory lagged monitoring relevance. These results are interpreted as hypothesis-generating temporal monitoring evidence rather than as evidence of structural causal effects. Although persistence-based baselines achieved the strongest short-term forecasting accuracy, indicator-based models provided model-conditional explanatory information beyond autoregressive controls. The results indicate that shared macroeconomic pressures and provider-specific factors are associated with HIE predictions. The cost-of-living index is consistently associated with expenditure patterns across categories, whereas domestic demand and external conditions indicate provider-specific associations for medical institutions and pharmacies. Only a subset of predictors retained exploratory lagged monitoring support, underscoring the distinction between model-based predictive importance and hypothesis-generating monitoring signals. This integrated framework may inform transparent fiscal risk monitoring hypotheses and contextual review of public HIE.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361904. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.