PLoS ONE最新文献

{"title":"Children's preferences for features and designs of KN95-style respirators: A comparative study between Indonesia and Nepal.","authors":"Sarah Nila, Chandika Shrestha, Hastin M Maharti, Claire J Horwell, Dicky C Pelupessy, Rachel L Kendal, Meghnath Dhimal, Judith Covey","doi":"10.1371/journal.pone.0334116","DOIUrl":"10.1371/journal.pone.0334116","url":null,"abstract":"<p><p>Air pollution is a global crisis, posing significant health risks to humans. Children are particularly vulnerable to the effects of particulate air pollution, and the use of respiratory protection could reduce their exposure. Certified, well-fitting respirators have been shown to effectively filter airborne particles and are increasingly available for children in non-occupational settings. However, their effectiveness relies on proper fit and consistent use. Understanding children's perspectives on wearing respiratory protection, specifically their preferences for different types and styles of respirators, is crucial. To explore these issues, 12 focus group discussions were conducted in January 2023 with 116 children aged 6-12 years living in Kathmandu, Nepal (N = 67) and Bandung, Indonesia (N = 49). Participants were recruited from public and private schools in each city using purposive sampling to ensure diversity in age, gender and socio-economic background. Focus groups were held in school settings and facilitated by local researchers in the children's native languages. Children were shown seven different respirators and asked questions about their preferred styles and features. Statistical analyses using Wilcoxon one-sample tests and ordinal regression showed the most popular types of respirators had ear-loops rather than head-straps and some features (e.g., patterned rather than plain masks) were more popular with certain groups (e.g., younger children). These results suggest that respirator manufacturers should ideally offer a variety of styles or designs.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334116"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that influence an individual's decision to undergo bariatric surgery: A qualitative systematic review.","authors":"Natasha Keogh, Dawn Horsom, Geraldine Lee, Mohamad M Saab","doi":"10.1371/journal.pone.0334837","DOIUrl":"10.1371/journal.pone.0334837","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is a significant health issue associated with chronic conditions such as cardiovascular disease and type 2 diabetes. Bariatric surgery is the most effective weight loss treatment for obesity. This systematic review aimed to examine factors influencing individuals' decisions to undergo bariatric surgery.</p><p><strong>Methods: </strong>This systematic review was guided by the JBI Manual for Evidence Synthesis for Qualitative Reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Literature searches were conducted in CINAHL, PubMed, Cochrane Library, APA PsycINFO, and APA PsycArticles. Results were analysed using a meta-aggregative approach. Quality appraisal was conducted using the JBI Checklist for Qualitative Research.</p><p><strong>Results: </strong>Thirteen studies were included. Health concerns, fears of obesity-related comorbidities, and a desire to improve physical health and quality of life emerged as key motivators to undergoing bariatric surgery. Support from healthcare professionals and family played a crucial role in motivating individuals to consider surgery. Women particularly noted concerns about fertility as a motivator to undergo bariatric surgery. Disclosure of surgery, financial concerns, transport, family and work commitments, and perceived risks of surgery were identified as barriers to undergoing bariatric surgery.</p><p><strong>Conclusion: </strong>Findings highlight the need for healthcare professionals to adopt empathetic, patient-centred approaches when discussing bariatric surgery. Addressing financial, insurance, and logistical barriers, alongside stigma and family resistance, is essential. Improving patient education, strengthening provider relationships, and offering tailored support can enhance decision-making, access, and long-term outcomes for those considering bariatric surgery.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334837"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin therapy and mortality in critically ill heart failure patients: Insights from a triangulated real-world design study.","authors":"Li Wang, Yibing Wang","doi":"10.1371/journal.pone.0334822","DOIUrl":"10.1371/journal.pone.0334822","url":null,"abstract":"<p><p>This study is aimed to evaluate the association between statin therapy and intermediate-term survival in critically ill patients with heart failure (HF). Using a real-world retrospective cohort from the MIMIC-IV database, we assessed all-cause mortality at 90 and 180 days following ICU admission. To reduce confounding factors, we applied a triangulated analytic framework incorporating propensity score matching, inverse probability of treatment weighting and standardized mortality ratio weighting. Survival outcomes were additionally examined across different statin types, including atorvastatin, rosuvastatin, simvastatin and pitavastatin, using stratified Kaplan-Meier analysis. Among over 8,000 eligible patients, statin use during hospitalization was consistently associated with reduced mortality at both time points across all models. Stratified survival curves showed comparable trends among the different statin types. These findings suggest a potential class-wide survival benefit of statin therapy in the ICU setting for HF patients and highlight the need for further studies to determine whether specific statin selection offers additional clinical advantages.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334822"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-market volatility spillovers between China and the United States: A DCC-EGARCH-t-Copula framework with out-of-sample forecasting.","authors":"Jin Zeng, Jingwen Wu","doi":"10.1371/journal.pone.0333794","DOIUrl":"10.1371/journal.pone.0333794","url":null,"abstract":"<p><p>This study examines volatility spillovers between Chinese and U.S. equity markets by developing a comprehensive framework that captures asymmetric volatility, extreme co-movements, and dynamic correlations. We propose an integrated methodology combining EGARCH models with Student-t innovations, a Student-t copula, and a Dynamic Conditional Correlation (DCC) structure. Using daily returns of the Hang Seng Index (HSI) and the S&P 500, our analysis reveals three principal findings. First, the EGARCH model effectively captures the pronounced leverage effect and fat-tailed distributions characteristic of both markets. Second, the Student-t copula demonstrates the best fit among competing specifications, indicating significant symmetric tail dependence between the two markets. Third, time-varying correlations exhibit high persistence, rising during crises yet remaining within a moderate range. Crucially, out-of-sample forecasting shows that our unified framework achieves superior predictive accuracy relative to standard benchmarks. These findings provide valuable insights for investors designing hedging strategies, exchanges determining margin requirements, and policymakers monitoring financial contagion. Our approach offers a robust tool for analyzing volatility transmission between developed and emerging markets.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0333794"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced heart disease diagnosis and management: A multi-phase framework leveraging deep learning and personalized nutrition.","authors":"Ritika Ritika, Rajender Singh Chhillar, Sandeep Dalal, Surjeet Dalal, Iyyappan Moorthi, Mitiku Dubale, Arshad Hashmi","doi":"10.1371/journal.pone.0334217","DOIUrl":"10.1371/journal.pone.0334217","url":null,"abstract":"<p><p>In health care, an accurate diagnosis with the help of a data-driven forecasting framework takes the risk factors associated with heart disease. However, building such an effective model using deep learning (DL) methods requires high-quality data, i.e., data free of outliers or anomalies. The current paper proposes a new approach to diagnosing and controlling heart diseases by utilizing a multi-tiered data acquisition model, data pre-processing, feature extraction, and DL. The framework encompasses four types of datasets. The first phase of the proposed methodology consists of data acquisition, while the second phase includes advanced data preprocessing for each data type. In phase three, multi-feature extraction methods are used to extract the features from the dataset. In phase four, a combined feature selection technique of ReliefF and Pearson correlation is used to select the best features. Phase five of the study is the formulation of the CILAD-Net DL model that integrates CNN, Inception Net, LSTM, and Angle DetectNet to accurately detect heart disease. The sixth phase implements Deep Reinforcement Learning (DRL) for nutrition recommendations based on the detected disease, thus improving the treatment individualization. The developed model's experimental outcomes are validated with other prevailing models in terms of accuracy, recall, hamming loss, and so on. Finally, the outcomes of the proposed model attain the higher accuracy of 0. 998 for the CILAD-Net model, which is significantly better than DenseNet-201 with 0. 988, ANN with 0. 987, KNN with 0. 977, and CL-Net with 0. 984.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334217"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbonizing technology enables Sanguisorbae Radix to inhibit yeast-to-hypha differentiation and biofilm formation in Candida albicans.","authors":"Xuxi Cheng, Jinyun Song, Qinglian Hu, Hongdan Wu, Bohui Song, Ruixiao Ma, Jinghan Gao, Yiwei Wang, Huangjin Tong, Wei Gu, Hongyu Zhao","doi":"10.1371/journal.pone.0334659","DOIUrl":"10.1371/journal.pone.0334659","url":null,"abstract":"<p><p>Sanguisorbae Radix (SR) has been employed as an herbal medicine over centuries. Charred SR (CSR), acquired via carbonization after the charred stir-frying of SR, demonstrates superior antimicrobial activity compared to SR. The aim of the study was to identify how carbonizing technology enhanced the ability of SR to inhibit the transformation from yeast to hypha and biofilm formation in C. albicans. In this paper, a vulvovaginal candidiasis (VVC) mouse model was used to evaluate the therapeutic effects. After CSR treatment, VVC mouse models nearly eliminated hyphal C. albicans adhering to the vaginal mucosa. The inhibitory activities of CSR on C. albicans biofilm formation and hyphal growth were assessed through quantitative biofilm analysis, morphological observations, and gene expression studies in vitro. Since the hyphal form signifies the initiation of biofilm development, this study confirmed CSR's remarkable inhibitory effect on C. albicans biofilm formation and hyphal growth. These effects were significantly weaker with SR. Additionally, the impact of carbonization on the composition of active compounds was analyzed. Carbonization significantly increased the content of ellagic acid (EA) and pyrogallic acid (PYG) by 7.44-fold and 28.09-fold, respectively. Both EA and PYG inhibited C. albicans biofilms and hyphal growth, with EA showing a more pronounced inhibitory effect. Finally, we concluded that carbonization technology enables SR to inhibit the yeast-to-hypha transition and biofilm formation in C. albicans by increase the levels of EA and PYG. EA was identified as the primary bioactive compound responsible for CSR's anti-biofilm effects.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334659"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How migrants' transcultural perceptions shape their children's bilingual language development: Insights from a cross-sectional multicultural study.","authors":"Caroline Barry, Charlène Mafuta, Hawa Camara, Bruno Falissard, Muriel Bossuroy, Marie Rose Moro, Amalini Simon, Dalila Rezzoug","doi":"10.1371/journal.pone.0317645","DOIUrl":"10.1371/journal.pone.0317645","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the factors affecting children's language acquisition in transcultural situations and how clinicians can take these children's specific needs into account.</p><p><strong>Objectives: </strong>To better understand the acquisition of bilingualism by migrant parents' children, our aim was to study the relations between parental transcultural perceptions and their children's language skills in both the heritage language and the host country's majority language.</p><p><strong>Methods: </strong>This cross-sectional study included 114 kindergarten children, born in France to migrant parents speaking Arabic, Tamil, or Soninke. Children's expressive language and comprehension skills were assessed with the ELAL and the N-EEL scales. In semistructured interviews, parents answered questions about perceptions of migration-related changes, extended-family relationships, and transgenerational transmission. Quantitizing methods and regression models were used to assess these factors' potential associations with children's language skills after adjustment for background characteristics and languages used at home.</p><p><strong>Results: </strong>Children of parents with a strongly positive perception of transgenerational transmission had better expressive skills in their heritage language. However, strongly positive parental perceptions of extended-family relationships and of migration-related changes were independently associated with some poorer skills in the heritage language. None of these transcultural/familial factors was significantly associated with any of the majority language skills assessed.</p><p><strong>Conclusion: </strong>This research suggests that parental perceptions of migration, extended-family relationships, and transgenerational transmission are closely related to their children's heritage language skills regardless of the choice of languages spoken at home. Further research on transcultural factors is necessary to illuminate the mechanisms underlying bilingual learning and inform evidence-based practices for clinicians.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0317645"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression, anxiety, and stress levels during the COVID-19 pandemic: A longitudinal study among Indonesian psychologists.","authors":"Fitri Ariyanti Abidin, Ahmad Gimmy Prathama, Efi Fitriana, Anggi Mayangsari, Rahmi Salsabila Putri Syam, Sophia Amira Latifa Hakim, Joeri K Tijdink","doi":"10.1371/journal.pone.0315584","DOIUrl":"10.1371/journal.pone.0315584","url":null,"abstract":"<p><p>During the COVID-19 pandemic, while clinical psychologists played a crucial role in supporting mental health, their well-being was overlooked compared to other healthcare professionals. Therefore, this study aimed to examine the trend levels of depressive symptoms, anxiety, and stress among psychologists during the pandemic and explore how these levels are related to demographic characteristics, personality traits, and self-compassion. One hundred and ten psychologists who provided online counseling during the pandemic participated in all three-time points of the study conducted from January to October 2021 in the midst of the pandemic. The validated Indonesian versions of the DASS-21, Big Five Personality, and Self-Compassion Scale were surveyed. The results indicated that despite no significant longitudinal changes in stress, anxiety, and depression levels (p > 0.05) over nine months, the prevalence of moderate-to-severe depressive symptoms, anxiety, and stress was noted in 10.9%-14.5%; 22.7%-30.9%; and 11.8%-14.5%; respectively. In terms of protective and risk factors, being married, older age, higher openness to experience, higher extraversion, and higher conscientiousness emerged as potential protective factors against mental health issues. Additionally, self-compassion was linked to depression, anxiety, and stress at corresponding time points; however, its impact diminished over time. Meanwhile, stress emerged as a significant predictor of both depression and anxiety. These findings demonstrate that the mental health of psychologists during the pandemic was not severely affected over time. Compared with other populations, the levels of depressive symptoms, anxiety, and stress are lower. The results may indicate that Indonesian psychologists are able to cope with very stressful situations, like a global pandemic. Future studies should focus on protective factors.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0315584"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the HIV epidemic among Black gay and bisexual men in the Southern United States: Results of the HPTN 096 pilot cross-sectional assessment.","authors":"Chris Beyrer, Robert H Remien, Susan H Eshleman, Theresa R Gamble, Jean De Dieu Tapsoba, Rita L Labbett, Philip A Sullivan, Oliver Laeyendecker, Peter L Anderson, Devang Agravat, James P Hughes, Daniel D Driffin, Craig S Hutchinson, Christopher Hucks-Ortiz, Maurice Adair, Melissa Curry, Shakita Brooks Jones, Ian L Haddock, Donte Boyd, Dale R Burwen, Anna Satcher Johnson, LaRon E Nelson","doi":"10.1371/journal.pone.0334031","DOIUrl":"10.1371/journal.pone.0334031","url":null,"abstract":"<p><strong>Background: </strong>The HIV Prevention Trials Network (HPTN) 096 study was designed to address the markedly higher rates of HIV incidence among Black men who have sex with men (MSM) in the Southern United States (US). A cross-sectional assessment was conducted during the pilot phase of the study to determine its feasibility and collect key HIV-related metrics for the study population.</p><p><strong>Methods and findings: </strong>Four hundred and twenty-two Black MSM, ≥ 15 years old and living in the four pilot communities (Dallas, TX; Houston, TX; Montgomery, AL; Greenville, SC), were enrolled via starfish sampling into the cross-sectional assessment. Each participant completed two questionnaires and had blood samples collected at a single study visit. Laboratory testing was performed to determine HIV status and use of oral pre-exposure prophylaxis (PrEP). HIV drug resistance and viral suppression were also assessed for two of the four pilot communities (Dallas and Houston). Categorical variables were summarized using frequency and percentage. Continuous variables were summarized using mean, standard deviation, median and interquartile range. Univariable and multivariable logistic regression models were used to assess various associations. HIV status was determined for 403 of the 422 participants (95.5%); 212 (52.6%) men were living with HIV, including one with acute HIV. For these participants, 163 (76.9%) reported that they were in HIV care. In Dallas and Houston, 71 of the 101 living with HIV (70.3%) were virally suppressed. Of the 191 not living with HIV, 57 (29.8%) reported ever taking PrEP, 41 (21.5%) reported being currently on PrEP, and eight (4.2%) reported never having heard of PrEP. PrEP use was documented through laboratory testing in 36 (19.1%) of 188 participants tested; of the 41 participants reporting current PrEP use, five did not have laboratory evidence of PrEP use.</p><p><strong>Conclusion: </strong>During the pilot, we successfully recruited Black MSM using starfish sampling and demonstrated the feasibility of collecting primary study outcomes using a cross-sectional assessment. We found a high burden of HIV and those living with HIV had only a moderate rate of viral suppression. In addition, PrEP use was uncommon among the men living without HIV. Reducing HIV incidence in Black MSM remains a key element to addressing the HIV epidemic in the US.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334031"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of implementation climate in shaping early essential newborn care practice: Insights from a multi-center cross-sectional study in China.","authors":"Hongxiao He, Jiahe Li, Junying Li, Hong Lu, Jie Lu, Linlin Cao, Luxia Gong, Ruyan Pang, Xiu Zhu","doi":"10.1371/journal.pone.0334855","DOIUrl":"10.1371/journal.pone.0334855","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) recommends Early Essential Newborn Care (EENC) to improve newborn outcomes. However, uptake remains suboptimal in many low-resource settings. Organisational factors, such as implementation climate, are crucial but understudied in relation to EENC implementation.</p><p><strong>Objective: </strong>To explore how implementation climate mediates the relationship between knowledge, attitudes, and EENC practices.</p><p><strong>Design: </strong>Multi-site, cross-sectional study.</p><p><strong>Setting: </strong>Twelve tertiary maternity hospitals in China (December 2022-April 2023).</p><p><strong>Participants: </strong>433 nurse-midwives.</p><p><strong>Methods: </strong>Validated questionnaires were use to assess knowledge, attitudes, practices, and perceived implementation climate related to EENC. Path analysis and logistic regression were employed to explore direct and indirect relationships.</p><p><strong>Results: </strong>A total of 69.3% participants reported good EENC practice. Significant predictors included good knowledge (adjusted odds ratio [AOR] = 2.75; 95% confidence interval [CI]: 1.76-4.31), positive attitudes (AOR = 2.00; 95% CI: 1.17-3.41), in-service training (AOR = 1.88; 95% CI: 1.17-3.02), holding a middle leadership role (AOR = 2.24; 95% CI: 1.20-4.17), and perceived workload. Nurse-midwives who reported heavier workloads were 48% less likely to hold positive attitudes towards EENC (AOR = 0.52; 95% CI: 0.28-0.94), which subsequently affected their EENC practice. The mean score of implementation climate was moderately favorable (3.30 ± 0.77), with the lowest in the rewards domain (3.02 ± 1.11). A one-point increase in climate score was associated with significantly higher odds of a positive attitude (AOR = 4.56; 95% CI: 2.98-6.99). Implementation climate influenced EENC practice indirectly through attitudes (RMSEA = 0.039).</p><p><strong>Conclusions: </strong>This study highlights the importance of both individual factors and organizational climate in shaping EENC practices. To improve EENC implementation, healthcare systems should prioritize enhancing the implementation climate through leadership support, establishing appropriate reward systems, and addressing workload challenges. Additionally, integrating EENC training into continuous professional development programs and strengthening support for mid-level leadership are key strategies.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 10","pages":"e0334855"},"PeriodicalIF":2.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}