PLoS Medicine[JOURNAL]
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200 papers
Social contact patterns in the United Kingdom following the COVID-19 pandemic: The Reconnect cross-sectional survey.
Goodfellow L, Quilty BJ, van Zandvoort K … +1 more , Edmunds WJ
PLoS Med · 2026 May · PMID 42118714 · Full text
BACKGROUND: Close-contact and respiratory infectious diseases are spread through social interactions. Measuring these interactions has transformed our ability to understand transmission and control these infections. Soci...
BACKGROUND: Close-contact and respiratory infectious diseases are spread through social interactions. Measuring these interactions has transformed our ability to understand transmission and control these infections. Social contact patterns were disrupted during the COVID-19 pandemic and have been affected by wider demographic, cultural, and workplace changes since then. METHODS AND FINDINGS: To estimate post-pandemic social contact patterns in the United Kingdom, we conducted a cross-sectional social contact survey from November 2024 to March 2025 on a nationally representative sample of participants. Interactions were captured by age, gender, and across socioeconomic status (SES) and ethnic groups. We calculated the mean number of daily contacts and contact matrices, stratified by variables of interest, using a negative binomial regression model weighted by age, gender, ethnic group, and weekday/weekend. 13,238 participants were recruited, 3,019 of whom were aged under 18 years old; survey response rates were 36% and 27% for adults and children, respectively. The mean number of daily contacts was 9.1 (95% confidence interval (CI): 8.7, 9.5); this figure was 13.8 (95% CI: 12.8, 14.9) for children, and 7.8 (95% CI: 7.4, 8.2) for adults. Higher numbers of contacts were positively associated with employment, household income, and educational qualifications held. Contact matrices showed high levels of age-assortativity, as well as inter-generational contacts in the home. Contacts were assortative between ethnic groups and SES in all settings; this effect was strongest between ethnic groups in the home, and between SES in the workplace. We constructed socially-stratified next-generation matrices for a novel respiratory pathogen, projecting that the majority White ethnic group would account for the largest share of new infections (76.7% (95% CI: 75.5, 77.9) of cases), but that per-capita infection risk would disproportionately affect minority ethnic groups, with the risk for the Black population being 2.27 (95% CI: 2.06, 2.51) times that of the White population. This study may be limited by the inherent recall biases and reporting fatigue involved with self-reporting contacts. CONCLUSIONS: This study provides crucial data to inform post-pandemic mathematical models of infectious disease transmission, and allows ethnicity and SES to be incorporated in such models.
Connected or chained by social media? Child and adolescent mental health in a digital era.
Kosola S
PLoS Med · 2026 May · PMID 42113790 · Full text
Social media has evolved from connection to compulsion, disproportionately harming children and adolescents. Addictive designs together with developmental vulnerability fuel mental health risks and highlight the urgent n...
Social media has evolved from connection to compulsion, disproportionately harming children and adolescents. Addictive designs together with developmental vulnerability fuel mental health risks and highlight the urgent need for stricter age limits and stronger protections.
Optimal minimal residual disease threshold in pediatric acute myeloid leukemia: A retrospective cohort study based on the TARGET database.
Liao XY, Zheng H, Fang JP … +2 more , Zhou DH, Qiu KY
PLoS Med · 2026 May · PMID 42102025 · Full text
BACKGROUND: Minimal residual disease (MRD) monitoring is a cornerstone of risk stratification in pediatric acute myeloid leukemia (AML), with a threshold of 0.1% conventionally defining positivity by flow cytometry. Adva...
BACKGROUND: Minimal residual disease (MRD) monitoring is a cornerstone of risk stratification in pediatric acute myeloid leukemia (AML), with a threshold of 0.1% conventionally defining positivity by flow cytometry. Advances in flow cytometric technologies, enabling detection of leukemic cells with higher sensitivity and specificity, warrant a reevaluation of whether a lower threshold improves prognostic accuracy. METHODS AND FINDINGS: We conducted a retrospective cohort study using data from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET)-AML initiative. The study population comprised 1,205 pediatric patients with de novo AML treated across Children's Oncology Group (COG) clinical trial centers. Patients were enrolled between September 1996 and December 2016, with a median follow-up of 6.2 years (range: 0.5-20.1 years). The primary objective was to compare the prognostic performance of the traditional MRD threshold (≥0.1%) with a lower threshold (≥0.05%) after induction courses 1 and 2. The main outcome measure was 5-year event-free survival (EFS). Analyses included Kaplan-Meier survival estimates, Cox proportional hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI), receiver operating characteristic (ROC) curves, and net reclassification improvement (NRI). The optimal threshold for predicting 5-year EFS, determined by ROC analysis, was 0.05% after both induction course 1 (AUC: 0.840, 95%CI[0.76,0.88]) and course 2 (AUC: 0.854, 95%CI[0.78,0.89]). The 0.05% threshold demonstrated higher HR for the first event than the 0.1% threshold (after course 1: HR = 2.8, 95%CI[2.3,3.3]; P < 0.001; after course 2: HR = 3.7, 95%CI[3.0,4.6]; P < 0.001). NRI analysis confirmed significant improvement in risk classification with the 0.05% threshold (overall NRI: 0.15 after course 1, 0.18 after course 2). The main limitation of this study is its retrospective design using historical data from trials conducted over 20 years, which may limit generalizability to contemporary treatments. CONCLUSIONS: A lower MRD threshold of 0.05% provides superior prognostic discrimination compared to the conventional 0.1% threshold in pediatric AML treated in previous COG trials. These findings support testing this more sensitive threshold in future clinical trial designs for improved risk-adapted therapy.
Climate change and non-communicable diseases: An invisible syndemic.
Parameswaran G, Al-Kindi S, Rajagopalan S
PLoS Med · 2026 May · PMID 42101971 · Full text
Climate change accelerates non-communicable diseases (NCDs) through cascading environmental disruptions and is attributed to driving increased NCD-related mortality. Yet this syndemic remains invisible and underfunded. W...
Climate change accelerates non-communicable diseases (NCDs) through cascading environmental disruptions and is attributed to driving increased NCD-related mortality. Yet this syndemic remains invisible and underfunded. We detail why addressing the climate-NCD intersection is critical for improving health.
Conditional cash transfer and mortality among interpersonal violence victims: A cohort study.
Bonfim C, Alves F, Barreto ML … +2 more , Patel V, Machado DB
PLoS Med · 2026 May · PMID 42090627 · Full text
BACKGROUND: Interpersonal violence is a significant public health issue, increasing mortality risks for those affected. While Cash Transfer Programs offer health benefits, their role in addressing the needs of interperso...
BACKGROUND: Interpersonal violence is a significant public health issue, increasing mortality risks for those affected. While Cash Transfer Programs offer health benefits, their role in addressing the needs of interpersonal violence victims remains unclear. This study aims to examine the association between Brazil's Bolsa Família Program (BFP) participation and reduced mortality rates among interpersonal violence victims. METHODS AND FINDINGS: This cohort study was conducted using data from 100 Million Brazilian Cohort, which were linked with interpersonal violence registries (2011-2015). All individuals with a record of interpersonal violence following their registration in Brazil's primary social assistance system during the study period were included. The primary outcome was overall mortality, while secondary outcomes comprised deaths due to natural and unnatural causes, as recorded in the Mortality Information System (SIM) and classified according to the International Classification of Diseases, 10th Revision (ICD-10). We used Cox proportional hazards models with propensity score-based method to analyze overall mortality and competing risk models to assess specific causes of death, estimating the association between BFP participation and mortality rates. A total of 29,075 individuals who were victims of interpersonal violence were followed throughout the five-year period. A total of 990 individuals died from overall causes. BFP participation was associated with an 18% reduction in overall mortality rate (hazard ratio, HR 0.82, 95% CI [0.70,0.95]; p = 0.011) and a 66% reduction in mortality rate from natural causes (HR 0.34 [95% CI 0.28, 0.41]; p < 0.001). This sample includes only individuals who seek healthcare services, which may overrepresent more severe cases of interpersonal violence. CONCLUSIONS: The association between BFP participation and lower mortality rates, especially from natural causes, among interpersonal violence victims highlights that such programs may be associated with reductions in poverty, improvements in health outcomes, and increased survival in vulnerable populations.
Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study.
Subhi R, Sogbesan A, Muramuzi D … +10 more , Burhin M, Bakare AA, Falade AG, Kitutu FE, Ssengooba F, King C, Kane S, Dawson-McClaren B, Graham HR, MOXY-Implementation Research Collaboration
PLoS Med · 2026 May · PMID 42090433 · Full text
BACKGROUND: Child mortality remains high in countries with weak emergency care systems. Facility organisation for paediatric emergency care is heterogeneous and under-described. We examined how hospitals in Uganda and Ni...
BACKGROUND: Child mortality remains high in countries with weak emergency care systems. Facility organisation for paediatric emergency care is heterogeneous and under-described. We examined how hospitals in Uganda and Nigeria are organised to deliver emergency care for neonates and children. METHODS AND FINDINGS: We conducted a qualitative, multi-method study in 26 purposively selected secondary and tertiary facilities in Uganda and Nigeria from October 2023 to December 2024. Embedded researchers documented patient pathways, resources for care, and care processes for severely ill children (<15 years). We used inductive content analysis to generate organisational archetypes and describe different facets of the patient journey. We identified 4 recurring patterns of facility organisation and patient flow ('archetypes'): outpatient department (OPD) 'screen and treat'; OPD 'screen and send'; emergency department (ED) 'receive and treat'; and inpatient department (IPD) 'receive and treat'. Across sites, formal triage systems were generally absent or rarely used. First contact and early sorting of children into these pathways frequently involved guards, lay bystanders, students, and caregivers. Duplication in assessment and treatment steps and misrouting from intended pathways occurred especially when initial care was spread across multiple locations. After-hours closure of OPDs shifted the place of entry to EDs or IPDs and could result in caregiver confusion. Administrative procedures (registration and payment) and recurrent stock-outs of medications and consumables could delay initiation of clinical processes. Referral pathways were inconsistent and some referrals were informal, undocumented, and enacted prior to patient stabilisation. Our findings are based on a purposive sample of facilities from Nigeria and Uganda, which may not be representative of other low-resource settings. CONCLUSIONS: Process mapping can help understand context and identify opportunities for intervention to improve facility care of severely ill children. We define organisational archetypes as heuristic tools for facility leaders and policymakers that can help facilities locate their configuration and recognise context-specific priorities. Potential low-cost opportunities for improvement include: building on existing adaptations (e.g., involving non-clinical staff and families in triage), formalising triage, streamlining non-clinical care processes that can delay clinical care (e.g., clearer signage and expedited administration), and strengthening referral systems.
Point-of-care early infant HIV diagnosis at birth in a pragmatic cluster-randomized trial in Mozambique and Tanzania: A comparative cost and cost-effectiveness study.
Elsbernd K, Sabi I, Jani IV … +16 more , Mudenyanga C, Boniface S, Mahumane A, Lequechane J, Chale F, Meggi B, Pereira K, Edom R, Lwilla AF, Buck WC, Ntinyinya NE, Hoelscher M, Baernighausen T, Kroidl A, Kohler S, LIFE Study Consortium
PLoS Med · 2026 May · PMID 42090430 · Full text
BACKGROUND: Timely access to early infant diagnosis (EID) is crucial for newborns with HIV, as late diagnosis can delay lifesaving antiretroviral treatment (ART). We assessed the comparative cost and cost-effectiveness o...
BACKGROUND: Timely access to early infant diagnosis (EID) is crucial for newborns with HIV, as late diagnosis can delay lifesaving antiretroviral treatment (ART). We assessed the comparative cost and cost-effectiveness of integrating point-of-care EID at birth into routine care in primary healthcare settings. METHODS AND FINDINGS: This pre-specified secondary analysis was nested in the cluster-randomized LIFE study conducted at 28 primary healthcare facilities in Mozambique and Tanzania from October 2019 to September 2021. We estimated the health system cost of point-of-care birth plus 4-8-week HIV testing (very early infant diagnosis; VEID) compared to standard-of-care (SoC) testing at 4-8 weeks only, both with immediate ART initiation. We assessed the cost-effectiveness of VEID relative to SoC with respect to ART initiation within one week of life using Bayesian hierarchical models. As this is an intermediate outcome, incremental cost-effectiveness ratios (ICERs) cannot be directly compared to available life-year-based cost-effectiveness thresholds. To contextualize results, we derived the minimum life-years gained per early ART initiation required for VEID to meet standard thresholds in a break-even analysis. VEID was associated with a higher cost and resulted in earlier ART initiation than SoC in both countries. In Mozambique, VEID increased the proportion of infants initiating ART within one week of life by 90.0 (95% CrI [67.5, 98.5]) percentage points at an incremental cost of $2,632 (95% CrI [$2,249, $3,062]) per infant with HIV. In Tanzania, VEID increased early ART initiation by 59.9 (95% CrI [20.9, 89.5]) percentage points at an incremental cost of $6,263 (95% CrI [$5,394, $7,243]) per infant with HIV. The ICER was $2,924 and $10,458 in Mozambique and Tanzania, respectively and was sensitive to intrauterine transmission rate. These findings were limited by the lack of long-term health outcome data and reliance on an intermediate outcome. Based on the break-even analysis, we estimated that VEID would need to yield 6-32 life-years gained per additional early ART initiation to meet standard thresholds. CONCLUSIONS: Adding birth testing improved early ART initiation but was unlikely to be cost-effective relative to standard thresholds given current prices, vertical transmission rates, and knowledge of long-term health benefits. Cost-effectiveness could be achieved at current costs if early ART translates to substantial long-term health benefits or if targeted to infants at high risk of vertical transmission.
Multimorbidity, health service use, and health insurance by socioeconomic groups in 31 countries: A multi-cohort study.
Wang Y, Cai C, Shi Z … +6 more , Gao Q, Bottle A, Sharabiani MTA, Stott J, Hayhoe B, He P
PLoS Med · 2026 May · PMID 42085482 · Full text
BACKGROUND: The prevalence of physical, psychological, and cognitive multimorbidity is characterised by marked socioeconomic status (SES) inequalities. However, the relationships between multimorbidity patterns-particula...
BACKGROUND: The prevalence of physical, psychological, and cognitive multimorbidity is characterised by marked socioeconomic status (SES) inequalities. However, the relationships between multimorbidity patterns-particularly those involving cognitive conditions-and healthcare utilisation, as well as the role of health insurance, remain poorly understood. This study aims to explore healthcare-seeking behaviour among individuals with multimorbidity and assess whether these associations vary by SES and health insurance coverage. METHODS AND FINDINGS: This multicohort study analysed harmonised data from six longitudinal studies across 31 countries, including participants aged 50 years and older. Multimorbidity was defined as the coexistence of two or more disorders across physical, psychological, or cognitive disorders. Outpatient and inpatient healthcare utilisation were measured. Random-effects logistic regression models were used to estimate associations with healthcare utilisation, and random-effects negative binomial models were applied to analyse visit frequencies. All models were adjusted for age, gender, educational attainment, work status, marital status, and SES, as well as lifestyle factors. Country-specific estimates were pooled using multinational meta-analysis to generate overall effect sizes. Compared with individuals without any conditions, those with the most complex multimorbidity pattern (physical-psychological-cognitive multimorbidity) were more likely to use outpatient care (OR 3.21, 95% CI [2.39, 4.03]; p < 0.001) but not as high as those with physical-psychological multimorbidity (OR 7.84, 95% CI [6.59, 9.10]; p < 0.001). Additionally, the association varied across socioeconomic groups, individuals of lower SES experiencing more pronounced disparities in healthcare use. For inpatient care, adding a cognitive disorder to an existing physical or psychological condition was not associated with increased inpatient utilisation. Among individuals with health insurance coverage, the association between multimorbidity and outpatient care utilisation was generally attenuated. This was especially evident for those with physical-psychological-cognitive multimorbidity: insured individuals had an OR of 6.22 (95% CI [5.33, 7.25]; p < 0.001), compared with 3.40 (95% CI [3.03, 3.82]; p < 0.001) among uninsured individuals. A limitation of this study is that healthcare utilisation measures differed across cohorts and were harmonised retrospectively. CONCLUSIONS: Cognitive disorders further complicate the relationship between multimorbidity and health service use, indicating potential unmet healthcare needs, especially among individuals with lower SES. Our study highlights the potential role of health insurance in reducing socioeconomic disparities in healthcare utilisation associated with multimorbidity.
Trends in HIV self-testing uptake in Africa: A modeling study of population-based surveys and HIV testing program data.
Aratrika A, Doyle CM, Johnson CC … +8 more , Edun O, Mbope B, Adoko A, Tlhomola M, Yansouni CP, Choko AT, Imai-Eaton JW, Maheu-Giroux M
PLoS Med · 2026 May · PMID 42085474 · Full text
BACKGROUND: HIV self-testing (HIVST) can increase access to and uptake of HIV testing among people underserved by other HIV testing approaches. Several countries in Africa, the region most affected by HIV, have scaled-up...
BACKGROUND: HIV self-testing (HIVST) can increase access to and uptake of HIV testing among people underserved by other HIV testing approaches. Several countries in Africa, the region most affected by HIV, have scaled-up HIVST. However, no comprehensive analysis has yet quantified HIVST uptake trends and how HIVST kits are used. We aimed to estimate 1) country-level and regional trends in HIVST uptake among adults by sex and age and 2) the proportion of distributed HIVST kits that are used and re-testing rates with HIVST. METHODS AND FINDINGS: Across African countries, we analyzed 1) data from national population-based surveys that included questions on previous HIVST use and 2) the number of HIVST kits distributed from nationally reported program data (2012-2024). We developed a hierarchical Bayesian compartmental model to estimate HIVST rates by triangulating surveys and program data. Random effects were used to pool information across countries. Data were available from 40 surveys in 27 countries and from 99 country-years of HIVST program data. The proportion of adults aged ≥15 years in Africa who have ever used an HIVST (HIVST uptake) steadily increased, from <1% in 2012 to almost 7% (6.8%; 95% credible interval [95%CrI] [5.8, 8.2]) in 2024. HIVST uptake was higher in eastern and southern Africa (10.2% in 2024, 95%CrI [8.5, 12.7]) compared to western and central Africa (2% in 2024; 95%CrI [1.7, 2.5]). The proportion of people who ever self-tested varied substantially across countries, reaching a maximum in 2024 of 45.4% (95%CrI [41.8, 51.5]) in Lesotho. Men (7.2% in 2024, 95%CrI [6.1, 8.8]) were slightly more likely than women to have ever used an HIVST (6.4% in 2024; 95%CrI [5.4, 7.8]). Compared to younger individuals (15-24 years), those aged 25-34 years had higher rates of self-testing (men: rate ratio [RR]=1.8, 95%CrI [1.5, 2.3]; women: RR = 1.4, 95%CrI [1.1, 1.6]). Individuals who previously self-tested may be more likely to self-test again (RR = 1.1, 95%CrI [0.8, 1.5]), although with substantial uncertainty. We estimated that 70% (95%CrI [60, 80]) of all HIVST distributed were used. Limitations of the study include challenges in precisely estimating some parameters, exclusion of countries without any HIVST distribution data and inability to model HIVST positivity. CONCLUSIONS: HIVST uptake has increased in Africa, with wide variation between countries. HIVST is more likely to engage 25-34-year-olds and men, who have historically been less likely to be aware of their HIV status. Our results can help understand patterns of use and support countries in optimizing their HIV testing services.
Investment in preventive health needs to be seen as a driver of economic development.
Colombo F, Vuik S, Devaux M … +1 more , Cecchini M
PLoS Med · 2026 May · PMID 42085422 · Full text
Prevention delivers major gains in health and productivity but remains underfunded due to governance and technical barriers. Strategic investment in prevention is critical to reduce health system costs, boost productivit...
Prevention delivers major gains in health and productivity but remains underfunded due to governance and technical barriers. Strategic investment in prevention is critical to reduce health system costs, boost productivity and sustain long-term prosperity.
Health system use and experience among people with poor mental health: A cross-sectional analysis of the People's Voice Survey in 18 countries.
Kruk ME, Kapoor NR, Arsenault C … +20 more , Carai S, Daray FM, Doubova SV, Ettman CK, Garcia PJ, Getachew T, Garcia-Elorrio E, Lenze EJ, Lewis TP, Mazzoni A, Medina-Ranilla J, Mohan S, Naidoo I, Oh J, Okiro EA, Pate M, Rondon MB, Tarricone R, Wang X, Cavazos-Rehg P
PLoS Med · 2026 May · PMID 42085346 · Full text
BACKGROUND: Across the globe, rates of depression and anxiety have risen substantially since the COVID pandemic. Consequently, poor mental health is now a top health policy priority in many countries and more people than...
BACKGROUND: Across the globe, rates of depression and anxiety have risen substantially since the COVID pandemic. Consequently, poor mental health is now a top health policy priority in many countries and more people than ever are seeking treatment. While the segment of people with poor mental health is large and growing, there is a dearth of data about their demographics and health needs and their use of and experience in the health system. Health systems require this information to effectively organize and provide services. METHODS AND FINDINGS: We investigated population prevalence of fair or poor mental health and compared health system experience and quality of care among adults with poor versus good mental health in 18 high-, middle-, and low-income countries using data from the People's Voice Survey (n = 32,419). Data were collected in 2022 and 2023 through a combination of nationally representative telephone, online, and in-person surveys. Prevalence of self-reported poor mental health ranged from 4.7% in Nigeria to 39.6% in China and was unrelated to national income per capita. More women than men reported poor mental health in most countries. Across all countries, people with poor mental health had worse self-rated overall health and more chronic illness. Between 0.9% (Lao PDR) and 52.4% (UK) of those with poor mental health had received mental healthcare in the past year. People with poor mental health reported lower patient activation, worse care quality, and lower confidence in the health system. A study limitation is that results are based on self-reported mental health rather than clinical diagnoses. CONCLUSIONS: People with poor mental health have markedly different health profiles and health system experience. These findings should prompt health systems to re-assess their services to better serve this growing patient group. Comparison of user experience and quality over time and across countries with similar health systems may assist in benchmarking performance.
Adherence to voluntary UK sugar, salt, and calorie reduction targets in the highest-grossing restaurant chains: A cross-sectional study.
O'Hagan A, Pechey R, Forde H … +1 more , Bandy L
PLoS Med · 2026 May · PMID 42085343 · Full text
BACKGROUND: To address high rates of diet-related disease, the UK Government has a series of voluntary targets for retailers, manufacturers, and the out-of-home sector (e.g., restaurants), to reduce the sugar, salt, and...
BACKGROUND: To address high rates of diet-related disease, the UK Government has a series of voluntary targets for retailers, manufacturers, and the out-of-home sector (e.g., restaurants), to reduce the sugar, salt, and calorie content of food products. The sugar targets were intended to be met in 2020, the salt targets in 2024, and the calorie targets in 2025 (extended from 2024 due to Covid-19). There is limited evidence for how the out-of-home sector is performing against these targets, and individual company responses have not been evaluated. This study aimed to assess adherence to UK Government's sugar, salt, and calorie reduction targets for menu items offered by the 21 highest-grossing restaurant chains in 2024. METHODS AND FINDINGS: Nutritional information was collected from restaurants' online menus. Mean/median sugar, salt, and calorie content, per 100 g and per serving, was calculated for each restaurant and food subcategory. Sugar, salt, and calorie content for each menu item was compared against the UK Government's targets, and the proportion of menu items meeting (i) each and (ii) every applicable target, was calculated for each restaurant and food subcategory. Three thousand ninety-nine menu items were included. Across all restaurants, 61% of menu items met their calorie targets, 58% met their salt targets, 36% met their sugar targets, and 43% met all of their applicable targets. Six of the 12 food subcategories, and nine of the 21 restaurants, had over 50% of menu items meeting all of their applicable targets. Menu items from Papa John's were the lowest adhering for the calorie (35%) and salt (8%) targets, and menu items from Burger King, KFC, Nando's, and Vintage Inns were the lowest adhering for the sugar targets (0%). Menu items from pizza restaurants had the lowest adherence to all applicable targets (32% overall) out of all the restaurant types, but items offered by restaurants with similar menu foci were also found to vary in their adherence. We were unable to account for heterogeneity in item-level sales due to the lack of accessible sales data from the out-of-home food sector, and therefore we could only assess performance against the targets for available items as opposed to purchased items. CONCLUSIONS: Our findings suggest that while menu items from certain restaurant types appear to perform worse than others against the sugar, salt, and calorie targets, items from restaurants with similar menu portfolios also vary in their adherence, highlighting the potential for restaurants to improve the nutritional quality of their products without changing their menu focus. Our study demonstrates that there is low adherence to voluntary schemes across the out-of-home sector, and therefore mandatory regulations may be a more effective approach to improving the nutritional quality of out-of-home food.
Correction: Reassessing BMI-based access to joint replacement surgery.
PLOS Medicine Staff
PLoS Med · 2026 Apr · PMID 42054354 · Full text
[This corrects the article DOI: 10.1371/journal.pmed.1005003.].
[This corrects the article DOI: 10.1371/journal.pmed.1005003.].
The principles of Population-Level Approaches to Dementia Risk Reduction (PLADRR).
Walsh S, Röhr S, Mígeot J … +28 more , Bodryzlova Y, Ma'u E, Salemme S, Marshall CR, Daly T, Cheung G, Stephan BCM, Kalaria R, Langa KM, Mukadam N, Grasset L, Cullum S, Govia I, Wilson NA, Urso D, Peters R, Wang J, Richard E, Logroscino G, Giannoni-Luza S, Lautenschlager NT, Prynn JE, Ferri CP, Yates S, Wolters FJ, Wallace L, Brayne C, Anstey KJ
PLoS Med · 2026 Apr · PMID 42048404 · Full text
Dementia is a leading health policy challenge, with cases expected to triple by 2050, particularly in low- and middle-income countries. Epidemiological evidence demonstrates falling age-specific incidence rates in high-i...
Dementia is a leading health policy challenge, with cases expected to triple by 2050, particularly in low- and middle-income countries. Epidemiological evidence demonstrates falling age-specific incidence rates in high-income countries, suggesting risk can be lowered at the population level.The Population-Level Approaches to Dementia Risk Reduction (PLADRR) Research Group is a diverse, international network of researchers committed to investigating how structural, social, and environmental conditions can promote life course brain health and reduce dementia risk across the population.This Policy Forum article sets out the guiding principles of our approach, the building blocks required, our research priorities, and how PLADRR research can inform and translate into policy changes.
Subsequent primary cancer incidence among cancer survivors in the United States, 1975-2019: An age-period-cohort analysis.
Cheng HG, Aduse-Poku L, McGill C … +2 more , Palesh O, Hong S
PLoS Med · 2026 Apr · PMID 42048284 · Full text
BACKGROUND: The growing population of cancer survivors faces elevated risks of subsequent primary cancers (SPCs), yet temporal patterns in SPC incidence remain poorly understood. This study aims to characterize age-, per...
BACKGROUND: The growing population of cancer survivors faces elevated risks of subsequent primary cancers (SPCs), yet temporal patterns in SPC incidence remain poorly understood. This study aims to characterize age-, period-, and cohort-specific patterns in SPC incidence among US cancer survivors using population-based data. METHODS AND FINDINGS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) 8 registries, identifying 3.36 million individuals diagnosed with a first primary cancer between 1975 and 2019. Survivors were followed through 2022 to estimate the incidence of SPCs. We used age-period-cohort analysis to estimate longitudinal age curves, cohort and period rate ratios, and annual percent changes in SPC incidence. Analyses were stratified by sex and the five most common index cancer sites. During 29.5 million person‑years of follow‑up, 510,340 SPCs were observed. SPC incidence increased with age at index cancer diagnosis, rising among females from 915 per 100,000 person‑years at ages 35-39 years to 1,980 per 100,000 at ages 75-79 years, and among males from 1,228 per 100,000 to 2,945 per 100,000 across the same age groups, demonstrating steeper rises in men. Cohort-specific SPC risk peaked in the 1935-1945 birth cohorts and declined in later cohorts, except among female survivors of lung cancer and male survivors of bladder cancer, where risks continued to rise. Period patterns showed overall declines in SPC incidence, particularly among survivors diagnosed at a younger age, but increasing risks among survivors diagnosed at an older age and survivors of specific index cancer sites. Notably, SPC incidence rose by 60% among female lung cancer survivors between 1975-1979 and 2015-2019 (incidence rate ratio = 1.60, 95% CI [1.22, 2.09]; p < 0.001). Main limitations include the descriptive nature of age-period-cohort analyses and the absence of treatment, genetic, and lifestyle data in SEER. CONCLUSIONS: SPC risk is shaped by complex, site- and sex-specific temporal patterns. These findings underscore the need for tailored survivorship care strategies that incorporate age, cohort, and index cancer site to mitigate future SPC burden.
Identifying novel prodromal symptoms of eclampsia: A two-country, case-control study.
Hastie R, Ahmed F, Mehdipour P … +10 more , Yan B, Walker SP, Visser J, Bashir A, Gurrin L, Lindquist A, Atkinson JA, Cluver C, Bergman L, Tong S
PLoS Med · 2026 Apr · PMID 42048280 · Full text
BACKGROUND: Magnesium sulphate halves the risk of eclampsia. There is no consensus on who to give magnesium sulphate prophylaxis because clinical tools are poor at identifying those at risk. Known prodromal symptoms such...
BACKGROUND: Magnesium sulphate halves the risk of eclampsia. There is no consensus on who to give magnesium sulphate prophylaxis because clinical tools are poor at identifying those at risk. Known prodromal symptoms such as headache, visual disturbance, or epigastric pain have modest associations with eclampsia. We set out to identify new prodromal symptoms of eclampsia. METHODS AND FINDINGS: This case-control study prospectively recruited participants in South Africa and Pakistan who had eclampsia, preeclampsia, or normotensive pregnancies. We asked whether they experienced 20 neurological symptoms, within 7 days of the seizure for those who had eclampsia. The primary analysis was the likelihood of symptoms occurring before eclampsia, compared to being present with preeclampsia. 341 participants were recruited with eclampsia, 1,355 with preeclampsia and 389 with normotensive pregnancies. When comparing symptoms among those who had eclampsia versus preeclampsia, the odds ratios (OR) were 2.56 (95% confidence interval (CI) [1.81,3.62]; p < 0.001) for headache, 5.73 (95% CI [4.44,7.39]; p < 0.001) for visual disturbances and 2.25 (95% CI [1.76,2.89]; p < 0.001) for epigastric pain. We identified 10 symptoms with odds ratios over 10 for eclampsia. Odds ratios were 42.03 (95% CI [23.66,74.68]; p < 0.001) for twitching/jerking limbs (30.5% eclampsia versus 1% preeclampsia); 36.00 (95% CI [18.34,70.65]; p < 0.001) for affected hearing (21.1% versus 0.7%)' 33.60 (95% CI [21.39,52.78]; p < 0.001) for affected mind state (38.7% versus 1.8%); 33.12 (95% CI [19.46, 54.37]; p < 0.001) for impaired speech; 23.71 (95% CI [16.49,34.10]; p < 0.001) for feelings of doom; 26.59 (95% CI [7.82,90.41]; p < 0.001) for severe vertigo; 20.52 (95% CI [14.22,29.63]; p < 0.001) for confusion; 18.16 (95% CI [10.76,30.66]; p < 0.001) for jitters; 15.18 (95% CI [11.34,20.33]; p < 0.001) for difficulty concentrating; and 10.49 (95% CI [6.76,16.27]; p < 0.001) for weakness/paralysis. These symptoms were rare among normotensive pregnancies. Only 2.4% of women with eclampsia did not experience any prodromal symptoms. This study is limited by the fact that we asked about prodromal symptoms after the seizure happened, and the potential for recall bias. CONCLUSIONS: Ten prodromal symptoms exhibit far stronger associations with eclampsia than headache, visual disturbances, or epigastric pain. Eclampsia is uncommon without any prodromal symptoms. It may be useful to screen these symptoms among women with preeclampsia as part of clinical history taking to guide management. They could help direct magnesium sulphate prophylaxis to those with a higher risk of eclampsia.
Optimizing dengue vaccination strategies.
Wilder-Smith A
PLoS Med · 2026 Apr · PMID 42044179 · Full text
Dengue is a rapidly expanding global health threat driven by urbanization, climate change, and complex transmission dynamics. Modeling and tailored vaccination programs will be critical to developing effective, context-s...
Dengue is a rapidly expanding global health threat driven by urbanization, climate change, and complex transmission dynamics. Modeling and tailored vaccination programs will be critical to developing effective, context-specific strategies to reducing disease burden.
Obesity and cancer: Methodological frontiers for mechanistic discoveries.
Moore SC, Ryan PJ
PLoS Med · 2026 Apr · PMID 42030412 · Full text
It has long been a biological mystery why obesity increases cancer risk. Rapid advances in statistical and analytical methods are now opening the door to mechanistic discoveries that may finally resolve this question.
It has long been a biological mystery why obesity increases cancer risk. Rapid advances in statistical and analytical methods are now opening the door to mechanistic discoveries that may finally resolve this question.
Tobacco control policies on cancer prevention in the Eastern Mediterranean Region, 2025-2050: A modeling study.
Nemati S, Vand Rajabpour M, Feng X … +7 more , Taheri N, Rumgay H, Heidari F, Karimi E, Abdi S, Johansson M, Sheikh M
PLoS Med · 2026 Apr · PMID 42030293 · Full text
BACKGROUND: Despite the implementation of control policies, smoking prevalence remains high in Eastern Mediterranean Region (EMR), and the impact of tobacco control efforts on cancer prevention is unclear. We assessed th...
BACKGROUND: Despite the implementation of control policies, smoking prevalence remains high in Eastern Mediterranean Region (EMR), and the impact of tobacco control efforts on cancer prevention is unclear. We assessed the potential impact of key policy interventions on tobacco-related cancer incidence in EMR countries from 2025 to 2050. METHODS AND FINDINGS: We conducted a modeling study using a country-level historical data to project tobacco smoking prevalence in EMR countries under four scenarios: (i) full implementation of the MPOWER (Monitor, Protection, Offer, Warn, Enforce, and Raise) policy package, (ii) a 10-unit increase in the cigarette affordability index (Higher values of the affordability index indicate that cigarettes are less affordable) (iii) maximized literacy rates (100% adult literacy), and (iv) combined implementation of all three policies. For each scenario, we estimated the Population Attributable Fraction (PAF) of tobacco smoking for 13 cancer types causally linked to tobacco use. The number of preventable cancer cases was calculated using the difference in PAFs between the current and alternative scenarios, referred to as the Potential Impact Fraction (PIF). An estimated 14.3 million tobacco-related cancer cases will occur in the EMR between 2025 and 2050, with over 3 million attributable to current smoking prevalence (PAF = 21.3%; [95% CI: 18.4, 24.6]). Combined implementation of all assessed policies could prevent 442,292 cases (95% CI: 226,987, 660,045) (3.1% of all projected cases; [95% CI: 1.6, 4.6]). The greatest impact was observed in low HDI (Human Development Index) countries, where up to 291,425 (95% CI: 198,186, 388,546) cases could be averted. Maximizing literacy showed the highest preventive potential in low (n = 224,463; [95% CI: 149,521, 307,386]) and medium HDI (n = 84,569; [95% CI: [2,801, 177,317]) countries, while full implementation of MPOWER had the greatest effect in high HDI countries (n = 11,890; [95% CI: 8,397, 15,378]). As our main limitation, we assumed a causal relationship between previously implemented policies and concurrent changes, while other potential causes of these changes have not been considered in the current study. CONCLUSION: Strengthening tobacco control policies particularly improving literacy in low HDI countries may potentially contribute to reductions in future cancer burden in EMR.
Identification of lipid quantitative trait loci linked with cardiometabolic disease in Asian Indians and Europeans: A genome-wide association study and Mendelian randomization.
Rout M, Aston CE, Duggirala R … +3 more , Goring HH, Fiehn O, Sanghera DK
PLoS Med · 2026 Apr · PMID 42024661 · Full text
BACKGROUND: Genetic mechanisms that predispose people to type 2 diabetes (T2D) and cardiovascular disease (CVD) remain poorly understood, partly because of a lack of sufficient data on non-European ethnic groups. Extendi...
BACKGROUND: Genetic mechanisms that predispose people to type 2 diabetes (T2D) and cardiovascular disease (CVD) remain poorly understood, partly because of a lack of sufficient data on non-European ethnic groups. Extending these evaluations to diverse cohorts is essential for gaining insights into the molecular pathways involved in disease development among human populations. In this study, we aimed to evaluate the genetic connection between the human lipidome and cardiometabolic disorders. We conducted a metabolite genome-wide association study (mGWAS) in a Punjabi population from India, along with multi-layer replication studies using the UK Biobank and other independent European and non-European cohorts. METHODS AND FINDINGS: We performed mGWAS using 516 lipid metabolites in 3,000 Punjabi Sikh individuals, and validation was performed in 1.13M Europeans and 15K individuals from Asian Indian ancestry using independent cohorts of the UK Biobank, GeneRISK, DIAMANT, PROMIS, and other studies. We identified 609 SNP-metabolite associations representing 236 SNP-metabolite pairs that attained genome-wide significance (p </= 5 × 10-8). Of the 36 SNP-lipid metabolite signals that survived multiple testing correction (p </= 1.92 × 10-10), 33 associations were not reported before, and 3 associations were confirmed to be ancestry-specific. Using colocalization analysis, polygenic risk scores, and Mendelian randomization approaches, we identified a causal association of LPC O-16:0 with T2D, represented by a lead variant in CD45, a key regulator of T- and B-cell antigen receptor signaling, and is already used as a therapeutic target. Another possible causal relationship of PC 38:4 (C) in protecting against coronary artery disease risk in Asian Indians, attributed to a variant in the untranslated region in the FADS1/2 genes, may be specific to ancestry and/or could not be confirmed in Europeans because of extensive pleiotropy in this region. The main limitation of this study was the absence of an independent validation cohort of Asian Indians from India. CONCLUSIONS: The mGWAS of Asian Indians offers new insights into the diverse molecular origins of cardiometabolic diseases and suggests potential pathways for innovative treatments. Our findings highlight the need for additional research on human lipidomics to better understand the downstream effects of the genome and its impact on cardiometabolic health.
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