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Authors: Efrén Martínez-Quintana, Marta Isabel García-Suárez, María Alcántara-Castellano, Jesús María González-Martín, Fayna Rodríguez-González

Background Adults with congenital heart disease (CHD) may experience substantial psychological distress. This study evaluated whether a documented history of anxiety disorders is associated with a distinct psychosocial profile in adults with CHD. Methods In this cross-sectional study, 45 adults with CHD were included: 21 with a documented history of anxiety disorders and 24 without. Psychosocial assessment included the EuroQol-5D-3L (EQ-5D-3L), Rosenberg Self-Esteem Scale (RSES), State–Trait Anxiety Inventory (STAI), and Beck Depression Inventory-II (BDI-II). Associations between psychosocial measures and documented anxiety history were assessed using multivariable logistic regression adjusted for sex, NYHA functional class, and CHD complexity. Moderate depression was additionally assessed using univariable logistic regression. Results Mean age was 35 ± 9 years in participants with a documented history of anxiety disorders and 31 ± 11 years in those without (P = 0.230); males accounted for 33% and 62%, respectively (P = 0.052). NYHA functional class II–IV was more frequent among participants with a documented history of anxiety disorders (67% vs. 25%; P = 0.018). Compared with those without a documented anxiety history, participants with anxiety history reported greater limitations in usual activities (P = 0.021), higher anxiety/depression scores on the EQ-5D-3L (P = 0.023), poorer self-rated health (P = 0.038), higher trait anxiety (31.2 ± 5.8 vs. 26.5 ± 5.2; P = 0.008), and greater depressive symptom severity (BDI-II median 19 vs. 3; P = 0.001). Self-esteem was also higher (RSES median 27 vs. 25; P = 0.006). After adjustment, BDI-II scores were positively associated with a documented history of anxiety disorders (OR 1.14, 95% CI 1.05–1.28; P = 0.011), while EQ-5D VAS scores were inversely associated (OR 0.64, 95% CI 0.38–0.97; P = 0.048). STAI-State, STAI-Trait, and RSES scores were not significantly associated with anxiety history. None of the variables assessed in the univariable analysis was significantly associated with moderate depression. Conclusions In adults with CHD, a documented history of anxiety disorders was associated with greater depressive symptom severity and poorer self-rated health after adjustment for relevant clinical factors.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360616. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Abdulmohsen Saud Albesher

National digital health platforms are becoming fundamental components of modern healthcare delivery; however, patient experience is commonly assessed using overall ratings or sentiment analysis, providing limited understanding of the specific dimensions that influence digital healthcare quality and service improvement. This study aimed to develop a multidimensional framework for understanding patient experience in a national digital health platform, examine variation across healthcare services, investigate changes over time, and identify evidence-based improvement priorities. A qualitative analysis was conducted using 97,034 Google Play reviews of Sehhaty, the Saudi national digital health platform, posted between 2019 and 2026. Reviews were analyzed using an inductive coding approach to develop a patient experience framework, followed by comparative analyses across healthcare services and longitudinal analyses across successive stages of platform development. Nine patient experience dimensions were identified. Patient experience differed considerably across healthcare services, indicating that improvement priorities were service-specific rather than uniform across the platform. Longitudinal analyses showed a shift from predominantly technical concerns during early deployment toward challenges involving service accessibility, integration, continuity of care, as the platform matured. These findings enabled the identification of service-specific priorities for improving digital healthcare delivery. Patient experience in national digital health platforms is multidimensional, service-dependent, and evolves alongside platform maturity. The proposed framework extends approaches based primarily on ratings or sentiment by transforming large-scale patient-generated feedback into actionable evidence for healthcare quality improvement and continuous evaluation of patient-centered digital health services.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360416. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Şeyma Sünbül, Perim Fatma Türker

Shift work is associated with irregular eating behaviors, increased energy intake, and impaired sleep quality. Poor dietary patterns may elevate systemic inflammation, contributing to long-term metabolic and cardiovascular risks. The aim of this study was to investigate differences in the Dietary Inflammatory Index (DII), sleep quality, dietary intake, and anthropometric and body composition measures between fixed daytime workers and rotating shift workers and to examine the associations among these parameters. This cross-sectional study included 52 male workers employed at a defense industry factory in Ankara, Türkiye, who worked either fixed daytime or rotating shifts. Dietary intake was assessed using 24-h dietary recalls for three non-consecutive days, from which macronutrient and micronutrient intakes were calculated. DII scores were computed to assess the inflammatory potential of the diet. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Anthropometric measurements, body composition, blood pressure, and biochemical parameters, including fasting plasma glucose, lipid profile (total cholesterol, HDL-C, LDL-C, and triglycerides), C-reactive protein, and homocysteine, were measured using standardised protocols. Rotating shift workers had significantly higher total energy intake and higher daily intakes of fructose, total fat, saturated and monounsaturated fatty acids, cholesterol, and several micronutrients, including vitamin A, folate, iron, calcium, and phosphorus compared with fixed daytime workers (p < 0.05). Mean DII scores did not differ significantly between the groups (Fixed daytime: 0.2 ± 1.86; rotating shift: −0.2 ± 2.25). DII scores were positively correlated with global PSQI score (r = 0.278, p = 0.046), the PSQI sleep duration component score (r = 0.319, p = 0.021), and daytime dysfunction component score (r = 0.287, p = 0.039); however, the association between DII and overall sleep quality was no longer statistically significant after adjustment for potential confounding factors (age, BMI, smoking status, physical activity, and work schedule). These findings suggest that dietary habits, pro-inflammatory dietary patterns, and poor sleep quality may represent co-existing factors associated with metabolic risk, and addressing these factors may contribute to better overall metabolic health.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360075. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Onja Gabrielle Ravololohanitra, Alphonsine Razanamiarana, Michel Tiaray Harison, Justine Nafeno, Lydia Raveloarisoa, Harizaka Emmanuel Andriamasy, Haingotiana Razafimanantsoa, Anne Neumann, Nadine Muller

Community health workers (CHWs) are central to primary health care delivery in Madagascar, yet their perspectives on what enables effective work are rarely centered in program design and implementation. This study aims to examine the lived experiences of Malagasy CHWs engaged in tuberculosis (TB) program activities and to develop context-specific recommendations to strengthen their effectiveness in Madagascar’s TB response. We conducted a qualitative study nested within the formative phase of a participatory action research initiative aimed at strengthening Madagascar’s community health workforce. TB program support was used as a tracer condition for universal health coverage-relevant service delivery. Five focus group discussions were held with 26 CHWs in August-September 2024 in two contrasting regions (Analamanga and Atsimo-Andrefana). Discussions were conducted in Malagasy and its dialects, audio-recorded, transcribed, translated into French, and analyzed using inductive reflexive thematic analysis. CHWs articulated five interlinked priorities for effectiveness in the TB response: (1) stable and equitable socio-economic protection; (2) standardized, continuous, and practical training; (3) formative and collaborative supervision; (4) reliable provision of tools, equipment, transport, and personal protective equipment; and (5) recognition and integration within communities and the health system. CHWs emphasized reliability and fulfillment of promised entitlements and described fragmentation across implementing partners as a key source of inequity, uncertainty, and demotivation. CHWs’ accounts point to a persistent implementation gap between policy commitments and the reliability of day-to-day support. Addressing fragmentation and strengthening coordinated national stewardship and partner accountability will be essential to ensure predictable, equitable support for CHWs - a prerequisite for advancing equitable progress toward universal health coverage in Madagascar.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005797. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Muhammed Abdul Odud, Omar I. Abdul-Aziz

Objective This scoping review examines how climate-related stressors and infectious-disease conditions, including pandemic-related workplace disruptions, interact to influence worker health, vulnerability, and occupational resilience. The review focuses on shared exposure pathways, vulnerable worker populations, methodological patterns, policy gaps, and strategies for strengthening worker safety under compound hazards. Rather than treating pandemics as isolated events, the review uses pandemic conditions as a lens to understand broader, recurring occupational risks and to inform strategies for building safer and more resilient workplaces under compound hazards. Methods Following PRISMA-ScR guidelines, a structured literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language peer-reviewed and formally structured evidence sources published primarily between January 2020 and April 2025, with one pre-2020 policy study retained for foundational context. Out of 612 records initially identified, 10 studies or sources met the inclusion criteria across healthcare, agriculture, construction, emergency response, and other high-exposure sectors after systematic screening and eligibility assessment. Data were charted and synthesized by occupational sector, geographic region, exposure type, worker vulnerability, and methodological approach. Results The evidence indicates that climate-related and infectious-disease stressors frequently converge, amplifying physical, environmental, and psychosocial pressures on workers. Disproportionate risks were observed among migrant workers, informal laborers, low-income populations, older adults, women, and seasonal or cross-border agricultural workers, particularly where access to healthcare, legal protections, or adaptive infrastructure was limited. Most studies relied on descriptive, qualitative, cross-sectional, conceptual, or review-based designs, with limited use of predictive modeling, geospatial analysis, longitudinal evidence, or integrated datasets. Policy responses were often fragmented, with climate adaptation and infection-control measures addressed separately despite overlapping benefits. Conclusions Climate-related and infectious-disease stressors interact to reinforce occupational health inequities and expose persistent gaps in worker protection. The findings highlight the need for integrated, multi-hazard occupational health strategies that align climate adaptation, infection prevention, and psychosocial support. Embedding data-driven early-warning systems, equitable protections for vulnerable workers, and cross-sector coordination into occupational policies may help strengthen workforce resilience during routine operations as well as future climate extremes and public health crises. However, the findings should be interpreted with caution because of the limited number of available studies combining climate-related and infectious-disease occupational risks, heterogeneous study designs, and the emerging nature of the evidence base. Furthermore, since this scoping review maps evidence rather than formally grading evidence strength or testing causal relationships, recommendations should be interpreted as evidence-informed directions for future occupational-health planning and research.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361296. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Rie Kudoh, Taiga Shibayama

Educational support for nurses is essential to promote oral health management education for patients with diabetes. However, few studies have focused on supporting nurses in this context. This study explored the effects of an audiovisual material designed to support nurses’ patient education on oral health management in diabetes care. Semi-structured interviews were conducted with eight certified diabetes nurse educators. Data were analyzed using content analysis. Four main themes emerged: (1) enhancement of nurses’ individual learning (8/8 participants), including improved knowledge of the connection between oral health and diabetes; (2) promotion of professional development and reflection (5/8); (3) provision of new insights into patient care (7/8), particularly regarding patient motivation strategies; and (4) identification of implementation considerations in diabetes outpatient settings. The findings suggest that the audiovisual material, designed to complement an existing evidence-based educational guide, was perceived as useful and may support nurses’ learning and educational practices related to oral health education for patients with diabetes.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361280. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Tippawan Boonyaporn, Piyanun Limruangrong, Ameporn Ratinthorn, Thitipong Tankumpuan

Background Preeclampsia (PE) with severe features threatens maternal and neonatal health. This study examined maternal and health–service factors associated with severe features and compared maternal and neonatal outcomes in Thailand. Methods This case–control study enrolled 156 postpartum women with PE (52 with and 104 without severe features) and 111 nurse–midwives in antenatal care, labor, and postpartum units across four Thai tertiary hospitals. Data were collected using postpartum and nurse–midwife questionnaires, and a maternal–neonatal health record form. Group differences were assessed using independent t–test, chi–square or Fisher’s exact tests. Multivariable binary logistic regression examined factors associated with severe features, adjusting for antenatal care visits and gravidity. Results Women with severe features more often had a history of PE (32.7% vs. 13.5%, p = 0.006) and differed in BMI distribution (p = 0.007). Three maternal factors were independently associated with severe features: history of PE (aOR = 5.99, 95% CI 2.13–16.83), BMI (aOR = 0.92 per kg/m2, 95% CI 0.86–0.98), and moderate versus low PE knowledge (aOR = 0.13, 95% CI 0.04–0.50). No health–service variable, including nurse training, was independently associated with severe features after adjustment (all p > 0.05). The model explained 29.4% (Nagelkerke R2) of the variance in PE severity and correctly classified 75.8% of cases. Infant birth weight was lower among women with severe features (p < 0.05); delivery mode, hospital stay, birth asphyxia, and NICU admission did not differ significantly. Conclusion A history of PE was associated with higher odds, and moderate (versus low) PE knowledge and higher BMI with lower odds, of severe features. These findings support prioritizing screening for prior PE history and structured antenatal knowledge counseling, together with adequately powered, multilevel studies to clarify the role of health–service factors in PE severity.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361195. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Nahin Shakurun, Fernanda André, Nazeem Muhajarine

Introduction Nutritional challenges are a global public health concern, especially among children under five in sub-Saharan African countries. The coexistence of an overweight/obese mother and an underweight child in the same household is recognized as a dual burden of malnutrition (DBM). This study estimated the prevalence, identified associated factors, and assessed socioeconomic inequalities in DBM among mother-child dyads in Mozambique. Methods We used nationally representative, cross-sectional data from the Mozambique Demographic and Health Survey 2022–2023 (n = 3,605 mother-child dyads). Child undernutrition and maternal BMI status were calculated using the World Health Organisation (WHO) standard guidelines. The outcome variable, DBM, was defined as the presence of child undernutrition condition (stunting, wasting or underweight) with corresponding maternal overweight/obesity. Multivariable binary logistic regression, Erreygers’s concentration index, and concentration curve analyses were performed, accounting for the complex survey design, to determine associated factors and social inequalities. Results The prevalence of DBM was 5.5% [95% CI: 4.6, 6.6]. Mothers aged ≥ 34 years [aOR (95% CI): 4.01(1.44, 11.14); p < 0.05] and mothers with four or more children [aOR (95% CI): 2.68(1.29, 5.57); p < 0.05] had higher odds of DBM. Rural residence and using unimproved toilet facilities (latter an indicator) were also significantly associated with DBM. Additionally, maternal age modified the association between women’s empowerment and mother-child DBM. Women aged 15–19 years at the lowest and highest empowerment levels were more likely to experience DBM than women 20 years or older. A positive and statistically significant concentration index indicates that wealth-related inequalities exist, with DBM more concentrated among wealthier mother-child dyads. Conclusion Our study highlights the occurrence of household-level DBM in Mozambique. These findings emphasize the need for targeted interventions addressing social and economic inequalities, including poor sanitation, a marker of broader household deprivation. Prioritizing integrated maternal-child nutrition interventions within national strategies is essential to improving equity in nutrition and health outcomes.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361129. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Changhong Huang, Xiu-Mei Chen, Feten Fekih-Romdhane, Sahar Obeid, I-Hua Chen, Xiao-Ling Liao, Ping Xu, Zeng-Han Lee, Souheil Hallit, Olga Malas

Background The Depression, Anxiety and Stress Scale for Youth (DASS-Y) has been validated in several countries, but its measurement equivalence between Middle Eastern and East Asian adolescents remains untested, and prior validations primarily relied on single analytic approaches without examining complex factor structures or brief screening forms. This study evaluated the DASS-Y in Lebanese adolescents enduring sociopolitical strain and Chinese adolescents under comparatively stable conditions. Methods The sample comprised 758 Lebanese (M age = 15.95, SD = 1.78; 63.2% female) and 1,062 Chinese adolescents (M age = 16.83, SD = 0.59; 47.5% female). Psychometric properties were examined using confirmatory factor analysis, exploratory structural equation modeling (ESEM), and bifactor variants of both. Differential item functioning was assessed using Rasch analysis. Reliability was indexed by composite reliability (CR), average variance extracted (AVE), and person separation reliability. Results Lebanese adolescents showed a largely unidimensional pattern, whereas an ESEM solution better represented the Chinese data. Reliability was strong in both samples (subscale CR = 0.91 to 0.95, AVE = 0.58 to 0.71, person separation reliability = 0.79 to 0.85; total CR = 0.97 in both samples; total AVE = 0.63 for the Lebanese and 0.61 for the Chinese sample). Several items, mainly in the stress subscale, functioned non-equivalently across samples. The 12-item short form performed comparably (subscale CR = 0.88 to 0.92, AVE = 0.65 to 0.73; total CR = 0.96 and 0.94; total AVE = 0.64 and 0.57, respectively). Conclusions Lebanese adolescents’ responses reflected a unitary distress construct, whereas Chinese adolescents’ responses showed greater differentiation among depression, anxiety, and stress, though a general distress factor remained dominant in both samples. Reliability was high throughout, so this divergence is structural rather than a matter of measurement precision. The 12-item form offers a practical screening option pending further cross-national confirmation.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360807. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Benjamin P. Rigby, Anne Martin, Colin B. Shore, Xueqi Wu, Carolyn Blake, Dawn Haughton, Holly Scott, Heather Cleland Woods, Rhiannon Evans, Sharon A. Simpson

Background Adolescent night-time use of interactive electronic devices (IEDs) is increasingly linked to poor sleep, mental health challenges, and reduced academic performance. However, existing interventions often overlook the complex systems shaping these behaviours. This study presents a first-of-its-kind systems-based programme theory for CLOCK OFF – a peer influence intervention aimed at reducing night-time IED use and improving adolescent sleep – created through novel participatory mapping activities and analyses, which involved adolescents, parents and teachers. Methods We conducted five online participatory workshops with adolescents (aged 11–14 years), parents, and teachers across four United Kingdom schools, supported by desk-based research. Workshop activities were facilitated using StickyStudio software. Causal loop diagramming was used to identify system components and feedback loops influencing adolescent IED use and sleep. Causal loop diagrams (CLDs) were iteratively built using Kumu software, refined and validated through stakeholder input and network analysis. The final CLD informed the development of a systems-based programme theory. Results Thirty participants (23 adolescents, 7 adults) contributed to the systems mapping process. The final CLD comprised 68 factors (i.e., causal influences of night-time IED use) and 131 connections between these factors, spanning behavioural, educational, psychological, physiological, social, and technological domains. CLOCK OFF-related mechanisms were represented across a large proportion of the system’s identified feedback structures. The programme theory diagram included 72 factors and 147 feedback loops, grouped into five subsystems. These subsystems highlighted the dynamic interplay between enjoyment, overstimulation, fear of missing out (FOMO), emotional regulation, and educational stress. Conclusions Participatory systems mapping with adolescents is a feasible and valuable method for surfacing complex behavioural drivers and informing intervention design. CLOCK OFF’s systems-based programme theory offers a novel approach for understanding and addressing adolescent night-time IED use and sleep disruption. Findings support the need for multi-actor and peer-led, multi-level interventions embedded within broader systemic strategies.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0359723. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Philip Baiden, Batholomew Chireh, Judith S. Anagbonu

Depression is highly prevalent among cancer survivors and contributes to poorer quality of life, reduced treatment adherence, and increased morbidity. Functional limitations, loneliness, and inadequate social and emotional support are important psychosocial factors associated with self-reported lifetime diagnosis of major depressive disorder among cancer survivors. Using a cross-sectional study design, this study examined the independent associations of functional limitations, loneliness, and social/emotional support with a self-reported lifetime diagnosis of major depressive disorder among a large sample of U.S. cancer survivors. Data were drawn from the 2023 and 2024 Behavioral Risk Factor Surveillance System. The analytic sample included 70,620 adult cancer survivors (56.3% female) with depression as the outcome variable. Functional limitations, loneliness, and social/emotional support were primary explanatory variables. Multivariable logistic regression models estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs), controlling for demographic, socioeconomic, and health-related covariates. Overall, 21.8% of cancer survivors reported depression. In the fully adjusted models, loneliness (AOR = 2.72, 95% CI: 2.44–3.03), functional limitations (AOR = 2.05, 95% CI: 1.81–2.31), and lack of social/emotional support (AOR = 1.43, 95% CI: 1.27–1.62) were independently associated with higher odds of depression. Female sex, low income, cost-related forgone medical care, poor self-rated health, obesity, and current/former smoking were also significantly negatively associated with depression, while physical activity was protective. We found that functional limitations, loneliness, and inadequate social support are robust and independent associated factors of depression among cancer survivors. Screening and interventions targeting these psychosocial factors may improve mental health outcomes and enhance overall survivorship care.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0359599. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.