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전체arXiv CS.AI6,535arXiv Math6,523arXiv Physics2,314arXiv Stat1,122PLOS ONE453arXiv Q-Bio318arXiv Econ316PLOS Global Public Health64PLOS Biology29PLOS Medicine14
PLOS ONE

Research on an islanding detection method suitable for distributed generation grid-connection complex system

by Wen Sun, Sihan Yu, Zhengye Jiang With the increase in penetration rate of distributed generation under dual-carbon goals, hazards of unplanned islanding caused by grid-connection of distributed generation systems have attracted attention. Due to the dilution effect of characteristic parameters in multi-machine grid-connected systems, active and passive hybrid islanding detection is prone to have islanding detection blind zones. Therefore, an islanding detection method suitable for complex multi-machine grid-connected systems of distributed generation is proposed. To verify the feasibility of the proposed islanding detection method, a simulation model of the distributed generation grid-connected system was built in MATLAB/Simulink based on IEC 61850-7-420 standard. Two different operating conditions of islanding and grid-connection, were simulated to obtain voltage and current waveforms of each node, which were converted into time series. Then, time-frequency spectrum analysis and calculation were performed based on Short-Time Fourier Transform (STFT) to generate time-frequency spectrum. After feature extraction, training iterations were carried out using Convolutional Neural Network (CNN) algorithm to obtain the optimal islanding detection model. Simulation results show that the proposed method achieves a detection accuracy of 99.84% on the independent test set, with a missed detection rate of 3.4% under five-fold cross-validation, which significantly reduces the non-detection zone.

PLOS ONE

‘The world is just so fast, and I’m not fast… it’s just really, really difficult to keep up’: A qualitative exploration of the lived experience of adults with Developmental Coordination Disorder

by Rebecca Murray, Cara E. Staniforth, Lucy H. Eddy Background Developmental Coordination Disorder (DCD) is an under-recognised neurodevelopmental condition impacting 5–6% of the population. There is a growing evidence base showing the deleterious impacts of poor motor skill development, however there is a distinct lack of research gathering in-depth insights which explore the impact of DCD within both childhood and adulthood. Methods Ten online lived experience interviews were undertaken with adults who have a diagnosis of DCD/ Dyspraxia (8 females, 2 males), lasting between 30 minutes and one hour. Participants were recruited both nationally and internationally. Lived experience interviews focused on experiences in primary care, education, friendships, wellbeing, employment and romantic relationships. Data were transcribed and analysed using inductive thematic analysis. Results Emergent themes highlighted a major lack of societal awareness in all life domains, which often led to participants facing difficulties navigating health, education and workplace systems for support, resulting in relative abandonment and a lack of validation within their lived experience of DCD. Conclusion Individuals with DCD often report feeling alone, isolated and misunderstood in a world which presents challenges for them across all aspects of life. There is an urgent need for the profile of DCD to be raised by insider voices as for many, DCD often transcends diagnostic criteria to wider challenges, for example executive functioning. Fundamentally, more needs to be done to ensure a lifespan approach to DCD, to allow greater opportunities for adults with a diagnosis to thrive alongside their ‘neurotypical’ peers.

PLOS ONE

Physical activity and depressive symptoms among Chinese university students: Grit as a mediator

by Yizhou Chen, Jie Zhang Background While physical activity is widely recognized for its protective role against depressive symptoms, the specific psychological mechanisms that explain this relationship, particularly among Chinese university students, require further exploration. The present study seeks to clarify whether grit as a hypothesized mediator explaining how physical activity is linked to depressive symptoms severity within this population. Methods In this cross-sectional investigation, 3,140 Chinese university students were recruited to complete an online survey. Assessments included demographic variables, physical activity levels, grit, and depressive symptoms, each measured with validated instruments. The hypothesized mediation pathway—wherein grit serves as the mediating variable—was tested via the PROCESS macro for SPSS, with bias-corrected bootstrapping (5,000 resamples) used to assess the indirect effect. Results Analyses demonstrated a significant negative association between physical activity and depressive symptoms. Crucially, grit was found to completely mediate this association. The indirect pathway through grit was statistically significant (ab = −0.013, 95% CI [−0.016, −0.010]), whereas the direct effect of physical activity was non-significant (c’ = −0.002, p > 0.05, 95% CI [−0.011, 0.007]). Conclusions These findings indicate that the beneficial effect of physical activity on depressive symptoms is primarily channeled through grit. Intervention strategies aimed at improving mental well-being in this population may be more effective if they combine physical activity promotion with grit-fostering components.

PLOS ONE

A preliminary cost-utility analysis of routine myasthenia gravis and thyroid dysfunction screening in acquired comitant Esotropia

by Worapot Srimanan, Phawasutthi Keokajee, Sunita Sawangsribanterng This study evaluated the cost-effectiveness of routine screening for acetylcholine receptor antibody (AChR-Ab) and thyroid function tests (TFT) in patients with acquired comitant esotropia (ACE) without overt signs of myasthenia gravis (MG) or thyroid eye disease (TED). A retrospective cost–utility analysis was conducted in 110 patients at a Thai tertiary hospital between 2014 and 2024. A decision tree combined with a 10-year Markov model compared two strategies: no routine screening (symptom-triggered testing) and universal baseline screening with AChR-Ab and TFT. Costs were expressed in 2024 Thai Baht (THB) from a healthcare sector perspective, and outcomes were measured in quality-adjusted life years (QALYs). Model uncertainty was assessed using one-way sensitivity analyses and probabilistic sensitivity analysis with 10,000 simulations, incorporating downstream costs of follow-up, confirmatory evaluation, and treatment. In the base-case analysis incorporating real-world diagnostic accuracy, universal screening yielded higher QALYs (109.56 vs. 105.45) but also higher costs (฿2,826,680 vs. ฿1,653,500), resulting in an incremental cost-effectiveness ratio (ICER) of ฿285,360 per QALY gained. This exceeded Thailand’s willingness-to-pay threshold of ฿160,000–200,000 per QALY, indicating that universal screening was not cost-effective. Probabilistic sensitivity analysis showed that most simulations were located in the northeast quadrant of the cost-effectiveness plane, reflecting greater effectiveness with higher cost, with many exceeding the willingness-to-pay threshold. Key drivers included MG prevalence, utility loss from undiagnosed MG, and AChR-Ab test cost. TFT screening contributed minimal benefit due to the very low prevalence of thyroid dysfunction. Universal AChR-Ab screening may improve early detection of MG in ACE, but it was not cost-effective under current assumptions. Exploratory targeted screening appeared relatively more efficient, and symptom-triggered thyroid testing may be a more appropriate approach. These findings are preliminary and require validation in larger studies.

PLOS ONE

System immunoinformatics–based design of a multi-epitope vaccine candidate against La Crosse virus

by Md. Habib Ullah Masum, Homaira Pervin Heema, Ahmad Abdullah Mahdeen, Syed Mohammad Lokman, Zarin Tasnim, Md. Rakibul Hasan, Sanjida Hossain Arpa, Rehana Parvin, Jannatul Ferdous, Mohammad Sharif Uddin The emergence of La Crosse virus (LACV) infection has been attributed to the global expansion of mosquito habitats and climate change. This pressing issue underscores the urgency of preemptive actions to combat the infection. Currently, no vaccines or targeted antivirals are available for LACV infection. The present study utilizes advanced immunoinformatics approaches for the design of a multiepitope vaccine (LACV-mVax01) targeting the viral proteins G1, G2, and N. The structural assessment suggested favorable stability characteristics, reflected by an instability score of 17.12 and an aliphatic index of 81.88. Based on the two-dimensional structure, the LACV-mVax01 had an alpha-helical content of ~45%, with favorable beta sheets and coils. The refinement of the LACV-mVax01 resulted in an accurate model (TM-score 0.49, C-score −1.86), supported by high-quality metrics (RMSD 0.489, MolProbity 2.230, ERRAT 85.539). Docking analyses indicated potential binding interactions with TLR4, showing a binding energy of −1000.0 compared to −939.2 for TLR2. Molecular dynamics simulations were consistent with these observations, suggesting relatively stable interactions and maintenance of structural integrity in both complexes. Codon optimization yielded a codon adaptation index of 0.9848, and the predicted mRNA structure had a free energy of −342.16 kcal/mol, consistent with a stable conformation. Subsequent in silico immunological analyses suggested humoral and cellular responses, including probable memory B- and T-cell responses. However, sustained immunity was also supported by consecutive cytokine and antibody synthesis. The comprehensive structural, molecular, and immunological evaluations suggest that LACV-mVax01 is a promising vaccine candidate capable of eliciting sustained protective immunity against LACV infection. Though future in vitro, in vivo, and clinical validations are required to perceive its effectiveness and safety.

PLOS ONE

Temporal and spatial patterns and determinants of traditional villages in Henan Province

by Man Zhang, Jiabin Wu, Yu Liu Traditional villages are important carriers of China’s cultural heritage and reflect long-term interactions among history, environment, and human settlement. This study examines 1,035 officially recognized traditional villages in Henan Province to identify their spatiotemporal distribution patterns and associated factors. Using ArcGIS-based spatial analysis, GeoDetector, the spatial lag model, and historical literature review, we find that traditional villages show significant spatial clustering and clear regional inequality. High-density clusters occur in northern Henan (Anyang–Hebi), central Henan (Pingdingshan), and southern Henan (Xinyang), whereas eastern Henan remains sparsely distributed, partly due to the long-term impacts of Yellow River flooding. The evolution of village distribution can be divided into four major historical stages, and the dominant spatial orientation shifted from a southwest–northeast trend before the Ming period to a southwest–northeast trend thereafter. Descriptively, village concentration is associated with moderate elevation, proximity to water, lower GDP levels, and intermediate distance from county-level central cities. However, after spatial autocorrelation was controlled for, these variables were not statistically significant as independent predictors in the spatial lag model, suggesting that village distribution is shaped more by combined effects and spatial spillover than by single factors alone. These findings provide evidence for cluster-based heritage protection in Henan and offer broader lessons for historically layered inland regions facing rural transformation and urbanization pressures.

PLOS ONE

Cost-effectiveness of inclisiran in patients with atherosclerotic cardiovascular disease from Chinese healthcare perspective

by Mochou Liu, Xinyue Zhang, Mengwen Feng, Qingfeng He, Zhen Feng Background Atherosclerotic cardiovascular disease (ASCVD) imposes a substantial clinical and economic burden in China. Despite maximally tolerated statin therapy, many patients fail to achieve recommended low-density lipoprotein cholesterol (LDL-C) targets. Inclisiran, a novel small interfering ribonucleic acid (siRNA) therapy, provides sustained LDL-C reduction, but its economic value under the Chinese healthcare system remains uncertain. Objective To evaluate the cost-effectiveness of inclisiran when added to standard lipid-lowering therapy for patients with ASCVD in China. Methods A Markov cohort multistate-transition model was developed from the perspective of the Chinese healthcare system, using a one-year cycle length and a lifetime horizon. Clinical inputs, costs, and utilities were derived from published literature and clinical trials. Both costs and outcomes were discounted at 4.5% annually. The primary result of the economic evaluation was the incremental cost-effectiveness ratio (ICER), with inclisiran considered cost-effective if the ICER was below the willingness-to-pay (WTP) threshold of CNY 191,498 per quality-adjusted life year (QALY), equivalent to two times China’s per capita gross domestic product in 2024. One-way and probabilistic sensitivity analyses were conducted to assess model uncertainty. Results Compared with statin therapy alone, inclisiran added to statin therapy yielded an additional 0.41 QALYs and incurred incremental costs of CNY 58,321.35, resulting in an ICER of CNY 143,044.57/QALY, which is well below the WTP threshold. One-way sensitivity analyses showed that the mortality reduction effect, discount rate, and inclisiran price were the main drivers of model outcomes; however, inclisiran remained cost-effective across all tested scenarios. Probabilistic sensitivity analysis showed a 95.1% probability that inclisiran is cost-effective at the current price. Conclusions At its current negotiated price of CNY 2,790 per dose, inclisiran added to standard therapy is cost-effective for patients with ASCVD in China.

PLOS ONE

Correction: Soil microbial communities in the face of changing farming practices: A case study in an agricultural landscape in France

by Laurie Dunn, Christophe Lang, Nicolas Marilleau, Sébastien Terrat, Luc Biju-Duval, Mélanie Lelièvre, Solène Perrin, Nicolas Chemidlin Prévost-Bouré

PLOS ONE

Retraction: Optimum 3D Matrix Stiffness for Maintenance of Cancer Stem Cells Is Dependent on Tissue Origin of Cancer Cells

by The PLOS One Editors

PLOS ONE

Expression of Concern: Soft computing models to predict the compressive strength of GGBS/FA- geopolymer concrete

by The PLOS One Editors

PLOS ONE

Correction: Translation, cross-cultural adaptation, validity and reliability of the inaugural Albanian Roland-Morris Disability Questionnaire in Albanian population with low back pain

by The PLOS One Editors

PLOS ONE

Correction: Clay minerals evidences for cold-warm fluctuations in the early Silurian

by The PLOS One Staff

PLOS ONE

From image to trust: Cross-national pathways to brand evangelism in hospitality sector

by Ngo Cao Nghia, Phan Khanh Duy, Bao Quoc Truong-Dinh This study investigates how frontline employee attributes foster customer brand evangelism in ASEAN hospitality, addressing whether symbolic brand image or relational trust better explains advocacy and under what conditions these mechanisms vary across cultures. A two-wave survey design was implemented with 428 hotel guests in Vietnam and Thailand. Using PLS-SEM and multi-group analysis, the model tested digital competence, proactive assistance, and relationship-building as antecedents of brand evangelism, mediated by brand image and customer trust, and moderated by loyalty program participation and visit frequency. Results reveal dual pathways: brand image and trust both mediate employee behaviors, with symbolic cues dominating in Vietnam and relational credibility prevailing in Thailand. Loyalty programs strengthened trust-based evangelism in Thailand, while visit frequency shaped image-based evangelism differently across contexts. These mechanisms explained substantial variance in evangelism, underscoring cultural contingencies in advocacy formation. This research advances brand evangelism theory by integrating symbolic and relational mediators, identifying boundary conditions, and demonstrating cultural contrasts. It provides a novel dual-process, cross-national framework that refines relationship marketing and social identity perspectives while offering actionable guidance for culturally adaptive hospitality strategies.

PLOS ONE

Distribution of refractive errors and horizontal concomitant strabismus in Iraqi children

by Hassan A. Aljaberi, Saeed Rahmani, Humam H. Alrikabi Horizontal concomitant strabismus is a common pediatric ocular disorder influenced by underlying refractive error patterns, yet evidence from Iraq remains limited. This study characterized refractive profiles in esotropia and exotropia and identified refractive predictors of each subtype. In this retrospective multicenter clinic-based case-comparison study, medical records of 2,256 children aged 4–15 years evaluated at three tertiary pediatric ophthalmology centers in Iraq were reviewed; 1,012 met the criteria for horizontal concomitant strabismus (642 esotropia and 370 exotropia), while 1,244 non-strabismic children served as controls. All participants underwent standardized cycloplegic refraction, visual acuity assessment, and ocular alignment testing. Group differences were examined using Chi-square tests, and logistic regression was used to identify refractive predictors. Children with esotropia were younger (mean age 8.24 ± 2.89 years) and exhibited a marked hyperopic profile, with 78% having spherical equivalent hyperopia ≥ +2.00 D; clinically significant anisometropia (≥2.50 D) was present in 33.8% of cases. Exotropia occurred at a slightly older age (8.75 ± 2.89 years) and was associated with higher proportions of myopia (53.5%) and astigmatism ≥1.00 D (55.7%). Across the full cohort, myopic refractive error (SE <−0.50 D) was present in 310 children (13.7%), hyperopic refractive error (SE ≥ +2.00 D) in 1,002 (44.4%), astigmatism ≥1.00 D in 555 (24.6%), and anisometropia ≥0.50 D in 1,489 (66.0%). In multivariable analysis, moderate-to-high hyperopia strongly predicted esotropia, whereas myopia and clinically significant astigmatism independently predicted exotropia. These findings show contrasting refractive profiles in Iraqi children with esotropia and exotropia and support the clinical value of early cycloplegic refraction in children with suspected ocular misalignment.

PLOS ONE

Exploring the contribution of straw utilization to carbon emission reduction in Anhui Province (China)

by Zhou Ye, Xiaohang Yu, Ruoyun Yao, Youzhi Yao Taking various prefecture-level cities in Anhui Province as the subject of this study, this research draws on data from the ‘Anhui Statistical Yearbook’ to analyze crop straw resources’ potential full utilization, and spatial distribution characteristics, in Anhui Province for the year 2023. The carbon neutralizing effect of straw full utilization was also evaluated using life cycle assessment. Results indicate that the total theoretical straw resources from major crops in Anhui Province in 2023 amounted to 5.213 × 107 tons (t), dominated by wheat, rice, and corn straw; which collectively accounted for 89.72% of the total. The carbon emission reductions from straw utilization through fertilization, animal feed, energy generation, substrate application, and raw material processing were approximately 4 × 106, 1.07 × 106, 5.8 × 105, 9.8 × 104, and 1.67 × 105 t of CO₂, respectively. Clarifying the total amount, types, potential utilization, and spatial distribution of straw resources at the city level is essential for promoting rational resource allocation and facilitating logicall regional planning for the utilization of those resources. These findings are of paramount importance towards efforts to achieve the goals of “Carbon peaking and carbon neutrality” (Dual-carbon) and fostering coordinated economic and social development in China. Under the framework of “dual carbon” national strategy and the overall layout of agricultural carbon emission reduction, the data analysis results of straw resource utilization in Anhui Province can serve as a reference for other regions to carry out relevant work.

PLOS ONE

mRNA splicing in turkey muscle satellite cells is dynamically altered upon thermal challenge

by Ashley A. Powell, Gale M. Strasburg, Sandra G. Velleman, Kent M. Reed Regulation of gene expression at the transcriptional and post-transcriptional levels is essential for proper development and growth, with tightly coordinated cellular processes supporting key biological functions. While transcription determines the available mRNA pool, post-transcriptional modifications such as alternative splicing (AS) increase transcriptome complexity and enable the production of diverse protein isoforms. In muscle, AS is critical in generating muscle-specific proteins required for normal development and function and may be particularly susceptible to disruption by thermal stress. This study examines how thermal challenges—both cold and heat—affect muscle biology by analyzing AS events during the proliferation and differentiation of skeletal muscle satellite cells (SCs). Isoform identification and AS analyses were performed on RNA-seq data from a prior study of skeletal muscle SCs derived from commercial turkeys and exposed to three temperature conditions (33°C, 38°C, or 43°C) during proliferation or differentiation. Analyses revealed 61,266 predicted splicing events across 5,202 annotated genes. Significant differential splicing was observed in all temperature comparisons, and between proliferating and differentiating cells at each temperature. Additionally, there was a strong association between differentially spliced genes (DASs) and differentially expressed genes (DEGs). This study provides a comprehensive catalog of splice isoforms for future functional analyses, many of which are likely to result in protein variants that influence SC proliferation, differentiation, and ultimately, muscle development and performance.

PLOS ONE

A blockchain-based multi-authority hierarchical attribute encrypted data sharing scheme in the Internet of Medical Things

by Hao Yuan, Guofang Dong, Leilei Zhao With the rapid development of the Internet of Medical Things (IoMT), the secure and efficient sharing of massive amounts of sensitive medical data has become a core challenge. Addressing the limitations of existing Ciphertext-Policy Attribute-Based Encryption (CP-ABE) schemes, such as the lack of data source authentication, computational redundancy, and single-point-of-failure risks when handling hierarchical data, this paper proposes a blockchain-based multi-authority hierarchical attribute-based encryption scheme. First, the scheme integrates a Distributed Key Generation (DKG) protocol and combines threshold BLS signature technology to establish a collaborative authentication mechanism, thereby enhancing the verification of data source authenticity. Additionally, a dynamic update mechanism ensures the long-term security of collaborative key management. Second, the scheme optimizes the encryption logic for structured data by constructing a hierarchical access tree, and introduces a multi-authority collaboration mechanism and proxy re-encryption (PRE) technology to mitigate single-point-of-failure risks and enable efficient user permission revocation. Security analysis demonstrates that the scheme is resistant to chosen-plaintext attacks (IND-CPA) and collusion attacks by authorities under standard models. Meanwhile, the DKG protocol has been proven to satisfy validity, robustness, confidentiality, and resistance to Sybil attacks. Performance evaluation indicates that the CP-ABE algorithm in this scheme outperforms existing solutions in terms of computational and storage overhead. In large-scale testing on a 100-node Hyperledger Fabric environment, the system achieved a consensus latency of approximately 280 ms and a key update propagation delay of 1.52 s, validating the feasibility of deploying this solution in real-world IoMT environments with limited resources and certain real-time requirements.

PLOS ONE

Decreased expression of Ly-1 antibody reactive clone (Lyar) triggers enhanced adipogenesis of bone marrow mesenchymal stromal cells in aged bone marrow

by Yu Shinyashiki, Yuta Onodera, Yusuke Kawashima, Natsumi Iwawaki, Toshiyuki Takehara, Koji Goto, Takeshi Teramura Accumulation of adipocytes within the bone marrow is a frequently observed during aging. However, the molecular mechanisms underlying aberrant adipocyte differentiation in aged bone marrow remain largely unclear. In this study, we identified Ly-1 antibody reactive clone (Lyar) as an interacting partner of TGF-β activated kinase 1 (Tak1), a key molecule of non-canonical TGF-β signaling, through a proteomics approach, and demonstrated its involvement in the regulation of aging-related enhancement of adipogenesis. Lyar was not only implicated in the regulation of BMMSC proliferation but also may partly mediate the inhibitory effects of Bromodomain-containing protein 2 (Brd2). An age-associated decline in Lyar expression was associated with a reduction in FGF2–PI3K–Akt1 signaling activity in aged bone marrow. These findings suggest that Lyar may act as a context-dependent modulator of TGF-β signaling and may be involved in regulating proliferation and differentiation in BMMSCs. The age-related loss of Lyar may contribute to the complex mechanisms underlying enhanced adipogenesis in aged bone marrow, providing new insights into the regulation of mesenchymal stem cell fate during aging.

PLOS ONE

Lived experiences of postpartum hypertensive women in Accra, Ghana

by Kennedy Dodam Konlan, Hellen Akosua Asante, Cecilia Eliason Background Hypertension is a leading cause of adult mortality globally with postpartum hypertension posing distinct risk to women. In Ghana, particularly within the Accra Metropolis, there is a limited understanding of the lived experiences of women managing hypertension after childbirth. Aim We described the lived experiences of postpartum women diagnosed with hypertension receiving care in a resource-constrained setting in Accra, Ghana. Methods The study employed a qualitative, descriptive-phenomenological design. We purposively selected 16 postpartum women diagnosed with hypertension and receiving care. They were recruited from the postnatal clinic of the Greater Accra Regional Hospital. The data was collected via in-depth, semi-structured interviews using a pre-tested interview guide. The interviews were audio-taped and transcribed verbatim. We then conducted thematic analysis with the aid of NVivo 11.0. Results The analysis yielded three major themes; expectations about living with hypertension, self-efficacy in managing hypertension and environmental factors on the management of hypertension. On the expectation about living with hypertension, we identified the following sub-themes: optimism and hope for recovery as well as fear and uncertainty about complications. Regarding self-efficacy, the following sub-themes were identified: Confidence in adhering to treatment and challenges with lifestyle modification and monitoring. On the environmental factors influencing management of hypertension among the participants, we found the following sub-themes, spousal and family support, role of healthcare providers, social perceptions and stigma. Conclusion and recommendations Postpartum women diagnosed with hypertension face social stigma and have mixed feelings of hope, fear and uncertainty about developing complications. We recommend that midwives/nurses should design and implement targeted postpartum hypertension education programmes to promote confidence in the treatment, improve knowledge on the condition and enhance emotional resilience. Also, managers of antenatal and postnatal clinics must integrate spouses and faith-based organizations in the management of postpartum hypertension to reduce the associated social stigma.

PLOS ONE

Ethnic differences in healthcare trust and patient satisfaction in England: A cross-sectional survey

by Steven David Pickering, Martin Ejnar Hansen, Han Dorussen, Jason Reifler, Thomas Scotto, Yosuke Sunahara, Dorothy Yen Trust in healthcare is an important component of patient experience, yet ethnic minority patients in England often report lower trust and satisfaction with the NHS than White patients. We examine these differences using data from a cross-sectional survey of 1,111 adults living in England, conducted in April–May 2023. Respondents rated their agreement with 18 statements covering five domains of healthcare experience: communication, ethical treatment, perceived competence, trust in providers, and perceived discrimination. We estimate a series of linear regression models comparing responses between ethnic minority and White participants, both before and after adjustment for demographic and attitudinal factors. Ethnic minority respondents reported significantly less positive perceptions on several items, particularly those relating to ethical behaviour, personal care, trust in front-line providers and perceived discrimination. They were less likely than White respondents to agree that the NHS behaves ethically, cares for patients, or goes out of its way to help people, and reported lower trust in GPs and hospital doctors and nurses. The largest differences were observed for perceptions that NHS care quality depends on ethnic background or country of origin. By contrast, we found no ethnic differences in perceptions of NHS honesty, promise-keeping, overall competence, or trust in NHS leadership or management. Overall, the findings indicate that ethnic differences in trust and satisfaction with the NHS are concentrated in relational and experiential aspects of care rather than in assessments of technical competence. Addressing these disparities may be important for improving equity and strengthening trust in healthcare services.

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