PLOS MEDICINE

A latent class assessment of healthcare access factors and disparities in breast cancer care timeliness
Dunn MR, Li D, Emerson MA, Thompson CA, Nichols HB, Van Alsten SC, Roberson ML, Wheeler SB, Carey LA, Hyslop T, Elston Lafata J and Troester MA
Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing).
Conditional cash transfers and mortality in people hospitalised with psychiatric disorders: A cohort study of the Brazilian Bolsa Família Programme
Bonfim C, Alves F, Fialho É, Naslund JA, Barreto ML, Patel V and Machado DB
Psychiatric patients experience lower life expectancy compared to the general population. Conditional cash transfer programmes (CCTPs) have shown promise in reducing mortality rates, but their impact on psychiatric patients has been unclear. This study tests the association between being a Brazilian Bolsa Família Programme (BFP) recipient and the risk of mortality among people previously hospitalised with any psychiatric disorders.
The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry
Whitehouse MR, Patel R, French JMR, Beswick AD, Navvuga P, Marques EMR, Blom AW and Lenguerrand E
The risk of re-operation, otherwise known as revision, following primary hip replacement depends in part on the prosthesis implant materials used. Current performance evidences are based on a broad categorisation grouping together different materials with potentially varying revision risks. We investigated the revision rate of primary total hip replacement (THR) reported in the National Joint Registry by specific types of bearing surfaces used.
Identification and outcomes of acute kidney disease in patients presenting in Bolivia, Brazil, South Africa, and Nepal
Evans RDR, Sharma SK, Claure-Del Granado R, Cullis B, Burdmann EA, Franca F, Aguiar J, Fredlund M, Hendricks K, Iturricha-Caceres MF, Rai M, Shah B, Kafle S, Harris DC and Rocco MV
The International Society of Nephrology proposes an acute kidney disease (AKD) management strategy that includes a risk score to aid AKD identification in low- and low-middle-income countries (LLMICs). We investigated the performance of the risk score and determined kidney and patient outcomes from AKD at multiple LLMIC sites.
The NOVA system can be used to address harmful foods and harmful food systems
Adams J
The critical need for a robust research agenda on ultra-processed food consumption and cancer risk
Loftfield E, Moore SC and Mayne ST
Ultra-processed food consumption has increased worldwide, but associations with cancer risk remain unclear and potential underlying mechanisms are speculative. A robust, multidisciplinary, research agenda is needed to address current research limitations and gaps.
Economic, cultural, and social inequalities in potentially inappropriate medication: A nationwide survey- and register-based study in Denmark
Paust A, Vestergaard C, Smith SM, Friis K, Schramm S, Bro F, Mygind A, Bech Utoft N, Larkin J and Prior A
Potentially inappropriate medication (PIM) is associated with negative health outcomes and can serve as an indicator of treatment quality. Previous studies have identified social inequality in treatment but often relied on narrow understandings of social position or failed to account for mediation by differential disease risk among social groups. Understanding how social position influences PIM exposure is crucial for improving the targeting of treatment quality and addressing health disparities. This study investigates the association between social position and PIM, considering the mediation effect of long-term conditions.
Long-term cognitive effects of menopausal hormone therapy: Findings from the KEEPS Continuation Study
Gleason CE, Dowling NM, Kara F, James TT, Salazar H, Ferrer Simo CA, Harman SM, Manson JE, Hammers DB, Naftolin FN, Pal L, Miller VM, Cedars MI, Lobo RA, Malek-Ahmadi M and Kantarci K
Findings from Kronos Early Estrogen Prevention Study (KEEPS)-Cog trial suggested no cognitive benefit or harm after 48 months of menopausal hormone therapy (mHT) initiated within 3 years of final menstrual period. To clarify the long-term effects of mHT initiated in early postmenopause, the observational KEEPS Continuation Study reevaluated cognition, mood, and neuroimaging effects in participants enrolled in the KEEPS-Cog and its parent study the KEEPS approximately 10 years after trial completion. We hypothesized that women randomized to transdermal estradiol (tE2) during early postmenopause would show cognitive benefits, while oral conjugated equine estrogens (oCEE) would show no effect, compared to placebo over the 10 years following randomization in the KEEPS trial.
Routine measurement of cardiometabolic disease risk factors in primary care in England before, during, and after the COVID-19 pandemic: A population-based cohort study
Ho FK, Dale C, Mizani MA, Bolton T, Pearson ER, Valabhji J, Delles C, Welsh P, Nakada S, Mackay D, Pell JP, Tomlinson C, Petersen SE, Bray B, Ashworth M, Rahimi K, Mamas M, Halcox J, Sudlow C, Sofat R, Sattar N and
This study estimated to what extent the number of measurements of cardiometabolic risk factors (e.g., blood pressure, cholesterol, glycated haemoglobin) were impacted by the COVID-19 pandemic and whether these have recovered to expected levels.
Determining optimal timing of birth for women with chronic or gestational hypertension at term: The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) randomised trial
Magee LA, Kirkham K, Tohill S, Gkini E, Moakes CA, Dorling J, Green M, Hutcheon JA, Javed M, Kigozi J, Mol BWM, Singer J, Hardy P, Stubbs C, Thornton JG, von Dadelszen P and
Chronic or gestational hypertension complicates approximately 7% of pregnancies, half of which reach 37 weeks' gestation. Early term birth (at 37 to 38 weeks) may reduce maternal complications, cesareans, stillbirths, and costs but may increase neonatal morbidity. In the WILL Trial (When to Induce Labour to Limit risk in pregnancy hypertension), we aimed to establish optimal timing of birth for women with chronic or gestational hypertension who reach term and remain well.
Impact of active case finding for tuberculosis with mass chest X-ray screening in Glasgow, Scotland, 1950-1963: An epidemiological analysis of historical data
MacPherson P, Stagg HR, Schwalb A, Henderson H, Taylor AE, Burke RM, Rickman HM, Miller C, Houben RMGJ, Dodd PJ and Corbett EL
Community active case finding (ACF) for tuberculosis was widely implemented in Europe and North America between 1940 and 1970, when incidence was comparable to many present-day high-burden countries. Using an interrupted time series analysis, we analysed the effect of the 1957 Glasgow mass chest X-ray campaign to inform contemporary approaches to screening.
Manufactured meals: The challenges of ultraprocessed foods
Tosun A and
In this Editorial on behalf of the PLOS Medicine Editors, Alexandra Tosun discusses how ultra-processed food has found itself at the center of a growing storm of criticism, the complexities of the ongoing nutrition debate and why stakeholders must be held to higher standards.
Risk of common psychiatric disorders, suicidal behaviours, and premature mortality following violent victimisation: A matched cohort and sibling-comparison study of 127,628 people who experienced violence in Finland and Sweden
Sariaslan A, Pitkänen J, Forsman J, Kuja-Halkola R, Brikell I, D'Onofrio BM, Aaltonen M, Larsson H, Martikainen P, Lichtenstein P and Fazel S
Associations between violent victimisation and psychiatric disorders are hypothesised to be bidirectional, but the role of violent victimisation in the aetiologies of psychiatric disorders and other adverse outcomes remains unclear. We aimed to estimate associations between violent victimisation and subsequent common psychiatric disorders, suicidal behaviours, and premature mortality while accounting for unmeasured familial confounders.
Ultraprocessed food (UPF), health, and mechanistic uncertainty: What should we be advising the public to do about UPFs?
Robinson E and Johnstone AM
In this perspective, we discuss why current mechanistic uncertainty on ultraprocessed foods (UPFs) and health acts as a major challenge to providing informed dietary guidelines and public advice on UPFs. Based on the balance of current evidence, we do not believe it is appropriate to be advising consumers to avoid all UPFs and we await further evidence to inform consumer guidance on the need to limit consumption of specifics foods based on their degree or type of processing.
Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study
Di Giuseppe G, Sutradhar R, Pequeno P, Kwan ML, Miglioretti DL, Smith-Bindman R and Pole JD
Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown.
Safety of single-dose bedaquiline combined with rifampicin for leprosy post-exposure prophylaxis: A Phase 2 randomized non-inferiority trial in the Comoros Islands
de Jong BC, Nourdine S, Bergeman AT, Salim Z, Grillone SH, Braet SM, Wirdane Abdou M, Snijders R, Ronse M, Hoof C, Tsoumanis A, Ortuño-Gutiérrez N, der Werf CV, Piubello A, Mzembaba A, Assoumani Y and Hasker E
To reduce leprosy risk in contacts of patients with leprosy by around 50%, the World Health Organization (WHO) recommends leprosy post-exposure prophylaxis (PEP) using single-dose rifampicin (SDR). Results from a cluster randomized trial in the Comoros and Madagascar suggest that PEP with a double dose of rifampicin led to a similar reduction in incident leprosy, prompting the need for stronger PEP. The objective of this Phase 2 trial was to assess safety of a bedaquiline-enhanced PEP regimen (intervention arm, bedaquiline 800 mg with rifampicin 600 mg, BE-PEP), relative to the WHO recommended PEP with rifampicin 600 mg alone (control arm, SDR-PEP).
Adverse health outcomes in offspring of parents with alcohol-related liver disease: Nationwide Danish cohort study
Jepsen P, West J, Larsen AKK, Kann AE, Kraglund F, Morling JR, Crooks C and Askgaard G
Parental drinking can cause harm to the offspring. A parent's diagnosis of alcohol-related liver disease (ALD) might be an opportunity to reach offspring with preventive interventions. We investigated offspring risk of adverse health outcomes throughout life, their association with their parent's educational level and diagnosis of ALD.
Leveraging behavioral economics strategies to close gaps in biomedical HIV prevention
Heitner J, Mwenda V, Umutesi G and Barnabas RV
Adolescent girls and young women (AGYW) in southern Africa face triple the HIV incidence of their male peers due to multiple factors, including economic deprivation and age-disparate relationships. A new study by Aurélia Lépine and colleagues has demonstrated that addressing healthcare costs among AGYW has the potential to reduce HIV incidence.
The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial
Lépine A, Szawlowski S, Nitcheu E, Cust H, Defo Tamgno E, Noo J, Procureur F, Mfochive I, Billong S and Tamoufe U
Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence.
Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study
Lai R, Barnett S, Zhang X, Kam LY, Cheung R, Xie Q and Nguyen MH
Detailed subgroup incidence rates for steatotic liver disease (SLD)-related hepatocellular carcinoma (HCC) are critical to inform practice and public health interventions but remain sparse. We aimed to fill in this gap.
Safety and tolerability of tegoprubart in patients with amyotrophic lateral sclerosis: A Phase 2A clinical trial
Perrin S, Ladha S, Maragakis N, Rivner MH, Katz J, Genge A, Olney N, Lange D, Heitzman D, Bodkin C, Jawdat O, Goyal NA, Bornstein JD, Mak C, Appel SH and Paganoni S
The interaction of CD40L and its receptor CD40 on activated T cells and B cells respectively control pro-inflammatory activation in the pathophysiology of autoimmunity and transplant rejection. Previous studies have implicated signaling pathways involving CD40L (interchangeably referred to as CD154), as well as adaptive and innate immune cell activation, in the induction of neuroinflammation in neurodegenerative diseases. This study aimed to assess the safety, tolerability, and impact on pro-inflammatory biomarker profiles of an anti CD40L antibody, tegoprubart, in individuals with amyotrophic lateral sclerosis (ALS).