PLOS ONE: [sortOrder=DATE_NEWEST_FIRST, sort=Date, newest first, q=subject:"Epidemiology"]PLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/search/feed/atom?sortOrder=DATE_NEWEST_FIRST&unformattedQuery=subject:%22Epidemiology%22&sort=Date,+newest+firstAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-29T06:41:28ZOlder women’s experience with COVID-19 pandemic: A study of risk perception and coping among culturally and linguistically diverse population in South AustraliaNoore Alam SiddiqueeMohammad HamiduzzamanHelen McLarenEmi Patmisari10.1371/journal.pone.03013662024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Noore Alam Siddiquee, Mohammad Hamiduzzaman, Helen McLaren, Emi Patmisari</p>
Background <p>A global catastrophe–the COVID-19 pandemic–appears to have two-dimensional health consequences for older adults: high risk of being infected and psychological distress. There is limited evidence on how the pandemic has impacted the life and coping of older adults who are culturally and linguistically diverse (CALD), women in particular. This study explored the COVID-19 risk perception and coping strategies of older CALD women in South Australia.</p> Methods <p>A mixed-methods research design was employed, involving a 31-items coping and emergency preparation scale for survey and semi-structured interviews with participants. The older CALD women were approached through 11 multicultural NGOs. One hundred and nine women participants from 28 CALD communities completed the online surveys; 25 of them agreed to a telephone interview and provided their contact details. 15 older CALD women ultimately participated in interviews.</p> Results <p>Mean sum-score of dread risk, unknown risk, and fear (M: 43.5; SD: 4.9) indicated that the participants were somewhat anxious and worried. Mean sum-score of coping (M: 79.8; SD: 9.3) reported their compliance with expert advice and disinfection practices but accessing health information (M: 2.8; SD 1.4) and tendency to minimize anxiety (M: 2.1; SD: 1.2) were below neutral. Significant variations were found in coping in terms of age, meaning that the women aged 75 years and older were less likely to cope with the pandemic (<i>P</i> = 0.01). Emergency preparation differed based on the participants’ residence and occupation status. The deductive-inductive thematic analysis of interview data was framed around three priori themes: risks of being affected, emotional and behavioral coping, and emergency preparation and access to services.</p> Conclusions <p>Evidence shows a fear among the older CALD women with an endeavor to cope and prepare for emergency situations. This suggests the requirements for interventions that improve coping and reduce the risk of stress among them.</p>Prevalence and associated factors of occupational injuries in an industrial city in GhanaMichael Tetteh AsieduDouglas Aninng OpokuNana Kwame Ayisi-BoatengJoseph OsarfoAlhassan SulemanaAliyu MohammedJohn AmissahJennifer AshileviAyongo Mate-KoleFelix Agyemang OpokuIsaac Kofi YanksonEmmanuel Kweku Nakua10.1371/journal.pone.03013392024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Michael Tetteh Asiedu, Douglas Aninng Opoku, Nana Kwame Ayisi-Boateng, Joseph Osarfo, Alhassan Sulemana, Aliyu Mohammed, John Amissah, Jennifer Ashilevi, Ayongo Mate-Kole, Felix Agyemang Opoku, Isaac Kofi Yankson, Emmanuel Kweku Nakua</p>
Background <p>Workers are exposed to workplace hazards which increase their risk of occupational injury. Data on occupational injuries and associated factors are important for planning and informing national policy regarding workplace health and safety. This study sought to estimate the prevalence and factors associated with occupational injuries among workers in an industrial city in Ghana.</p> Methods <p>A community-based cross-sectional survey was conducted among 459 workers in the Tema industrial enclave in Ghana from 22<sup>nd</sup> December 2020 to 27<sup>th</sup> February 2021. Participants were recruited using a two-stage sampling technique. Eight communities were randomly selected from twenty-five communities in the first stage while households in each community were randomly selected in the second stage. Data on socio-demographic characteristics, occupational health and safety and occupational injuries were collected. Logistic regression was used to examine the relationship between occupational injuries and associated factors.</p> Results <p>The mean age of the workers was 33.9 (±6.8) years with a range of 21–53 while over 18.1% of them were working at the Port and Harbour. The prevalence of occupational injury among the workers in the preceding twelve months was 64.7%. The mechanism of injury was mainly the use of working tools (45.8%) and hot surfaces, substances or chemicals (14.1%). Being a casual staff (AOR: 2.26, 95%CI: 1.04–4.92), working at Port and Harbour (AOR: 3.77, 95%CI: 1.70–8.39), no health and safety training (AOR: 2.18, 95%CI: 1.08–4.39), dissatisfaction with health and safety measures (AOR: 4.31, 95%CI: 2.12–8.78) and tertiary education (AOR: 0.03, 95%CI: 0.01–0.10) were significantly associated with occupational injuries.</p> Conclusion <p>The prevalence of occupational injuries in this study was high. Promoting machine tools’ safety, health and safety training, and satisfaction with health and safety measures through rewarding workers who do not sustain injuries could be key to employees’ health and safety.</p>Tobacco use among in-school young adolescents in Indonesia: Exploring availability, affordability, and accessibilityYeni RosilawatiZain RafiqueErwan Sudiwijaya10.1371/journal.pone.03012912024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Yeni Rosilawati, Zain Rafique, Erwan Sudiwijaya</p>
The research on Indonesian adolescents’ perception of tobacco control in schools is limited. This study aimed to explore the availability, affordability, and accessibility of tobacco among young adolescents in Yogyakarta Municipality, Indonesia, with a focus on advocating for school teenagers. Focus groups, comprising participants from diverse backgrounds and stakeholders, were conducted in Yogyakarta, Indonesia, to systematically collect varied data. The subsequent analysis employed a robust thematic approach, combining both inductive and deductive processes to ensure a nuanced exploration of emerging patterns and pre-existing frameworks. In addition to focus group data, the study incorporated insights from extensive field observations and research group discussions. The multifaceted approach enhanced the depth of analysis but also facilitated a comprehensive understanding of the complex dynamics. The findings of this study revealed that young adolescents found it extremely easy to purchase cigarettes from local markets. The smoking prevalence among young adolescents was relatively low, with only 10% of the respondents admitting to smoking. Although the Indonesian government has increased surveillance and regulations regarding smoking among young individuals, the actual implementation and effectiveness of these measures remain questionable. The existing anti-smoking approaches in Indonesia have been unsuccessful in curbing smoking among Indonesian school students. The study argues that it is crucial to recognize and value students’ perceptions of smoking, as their knowledge of smoking is actively constructed. To address this issue, future anti-smoking education in schools should incorporate interactive sessions rather than solely relying on didactic approaches that highlight the harms of smoking. By engaging students in interactive discussions, they can actively participate in constructing their understanding of the consequences of smoking. Additionally, efforts should be made to enhance the implementation of tobacco control measures within schools and extend the reach of these measures to off-campus environments.OXIDATIVE study: A pilot prospective observational cohort study protocol examining the influence of peri-reperfusion hyperoxemia and immune dysregulation on early allograft dysfunction after orthotopic liver transplantationElizabeth A. WilsonAnna WoodburyKirsten M. WilliamsCraig M. Coopersmith10.1371/journal.pone.03012812024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Elizabeth A. Wilson, Anna Woodbury, Kirsten M. Williams, Craig M. Coopersmith</p>
Early allograft dysfunction (EAD) is a functional hepatic insufficiency within a week of orthotopic liver transplantation (OLT) and is associated with morbidity and mortality. The etiology of EAD is multifactorial and largely driven by ischemia reperfusion injury (IRI), a phenomenon characterized by oxygen scarcity followed by paradoxical oxidative stress and inflammation. With the expanded use of marginal allografts more susceptible to IRI, the incidence of EAD may be increasing. This necessitates an in-depth understanding of the innate molecular mechanisms underlying EAD and interventions to mitigate its impact. Our central hypothesis is peri-reperfusion hyperoxemia and immune dysregulation exacerbate IRI and increase the risk of EAD. We will perform a pilot prospective single-center observational cohort study of 40 patients. The aims are to determine (1) the association between peri-reperfusion hyperoxemia and EAD and (2) whether peri-reperfusion perturbed cytokine, protein, and hypoxia inducible factor-1 alpha (HIF-1α) levels correlate with EAD after OLT. Inclusion criteria include age ≥ 18 years, liver failure, and donation after brain or circulatory death. Exclusion criteria include living donor donation, repeat OLT within a week of transplantation, multiple organ transplantation, and pregnancy. Partial pressure of arterial oxygen (PaO<sub>2</sub>) as the study measure allows for the examination of oxygen exposure within the confines of existing variability in anesthesiologist-administered fraction of inspired oxygen (FiO<sub>2</sub>) and the inclusion of patients with intrapulmonary shunting. The Olthoff et al. definition of EAD is the primary outcome. Secondary outcomes include postoperative acute kidney injury, pulmonary and biliary complications, surgical wound dehiscence and infection, and mortality. The goal of this study protocol is to identify EAD contributors that could be targeted to attenuate its impact and improve OLT outcomes. If validated, peri-reperfusion hyperoxemia and immune perturbations could be targeted via FiO<sub>2</sub> titration to a goal PaO<sub>2</sub> and/or administration of an immunomodulatory agent by the anesthesiologist intraoperatively.Factors associated with adolescent pregnancy among Chepang women and their health-seeking behavior in Ichchhakamana rural municipality of Chitwan districtSmriti PantSaugat KoiralaAnand Prasad AcharyaPranil Man Singh Pradhan10.1371/journal.pone.03012612024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Smriti Pant, Saugat Koirala, Anand Prasad Acharya, Pranil Man Singh Pradhan</p>
Adolescent pregnancy is a critical public health issue, particularly in developing regions like Nepal, where it poses significant risks to maternal and child health and perpetuates the cycle of poverty. This study focused on the marginalized Chepang community, which is endangered and faces unique challenges. The study aimed to explore the factors associated with adolescent pregnancy among Chepang women in Ichchhakamana Rural Municipality, Chitwan, Nepal, and also assessed their reproductive health-seeking behavior. A cross-sectional analytical study was conducted with 217 Chepang women aged 15–20 years, and data was collected through face-to-face interviews using a semi-structured questionnaire. The collected data was entered and analyzed using IBM SPSS version 20. Descriptive statistical tools like frequency, and percentage were used to express the results. Pearson chi-square test, Fisher exact test were used for bivariate analysis to determine the presence of association between the dependent and independent variables. Binary logistic regression was used for further analysis. The prevalence of current adolescent pregnancy was 8.3%(18), while one-fourth had experienced prior pregnancies during their adolescence. Factors significantly associated with adolescent pregnancy included lack of education among the women and their mothers, as well as living in joint families. Additionally, number of antenatal visits and consumption of iron tablets seemed to be lower among Chepang women in comparison to the national data. Chepang women had high adolescent pregnancy rates, with low education level and joint family structure being important risk factors for it. They also had inadequate reproductive health seeking behavior. Addressing these problems requires strategies that prioritize education and raise awareness about reproductive health.Impact of laws prohibiting domestic violence on wasting in early childhoodPragya BhuwaniaAmy RaubAleta SpragueAlfredo MartinBijetri BoseRachel KidmanArijit NandiJere R. BehrmanJody Heymann10.1371/journal.pone.03012242024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Pragya Bhuwania, Amy Raub, Aleta Sprague, Alfredo Martin, Bijetri Bose, Rachel Kidman, Arijit Nandi, Jere R. Behrman, Jody Heymann</p>
Intimate partner violence (IPV) affects an estimated 641 million women and girls globally with far-reaching consequences for the health of women and children. Yet, laws that prohibit domestic violence (DV) are not universal. Countries actively debate the effectiveness of DV laws in improving conditions given the inconclusive evidence on deterrent effects within households particularly in low- and middle-income countries that have limited infrastructure, and fewer resources to implement and enforce policy changes. This is the first study to rigorously examine the impact of DV laws on women’s health decision-making and the intergenerational impact on children’s wasting, a key predictor of mortality. We used the Demographic and Health Surveys (DHS) data collected between 2000–2020 across 23 African countries. Exploiting the staggered adoption of laws, we used a difference-in-differences study design to estimate the impact of DV laws in the treated countries compared to countries without such laws. We find that DV laws increased women’s decision-making autonomy in healthcare by 16.7% as well as other measures of women’s autonomy that matter for health such as financial autonomy by 6.3% and social mobility by 11.0%. The improvements in women’s autonomy translated into reductions in the probability of wasting among children aged 0–23 months by 5.4% points, a 30.9% reduction from the mean. DV laws also reduced wasting among older children aged 24–59 months by 3.6% points, a 38.7% reduction from the mean. The laws were effective in all 6 countries analyzed individually that criminalized DV. A civil prohibition in the seventh country was not found to be effective. The effect was positive and significant for all wealth and geographical categories. Our findings demonstrate the value of enacting criminal laws that prohibit domestic violence as one important tool to reducing the profound health impacts of IPV, a critical health and human rights issue.Short-term chemotherapy-related complications and undernutrition in children diagnosed with cancer at Korle Bu Teaching Hospital, Accra, Ghana: A prospective cohort studyNihad SalifuCatherine I. SegbefiaYakubu AlhassanLorna A. RennerEdem M. A. Tette10.1371/journal.pone.03012082024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Nihad Salifu, Catherine I. Segbefia, Yakubu Alhassan, Lorna A. Renner, Edem M. A. Tette</p>
Undernutrition in children with cancer is associated with complications during cancer therapy. The study objective was to determine the association between specific anthropometric parameters and short-term chemotherapy-related complications and mortality. This was a hospital-based, prospective cohort study of children, age ≤12 years, with a new cancer diagnosis at the Paediatric Oncology Unit, Korle Bu Teaching Hospital, Ghana. Socio-demographic information, cancer characteristics and anthropometric measurements were obtained at enrolment. Participants were followed up for twelve weeks from commencement of chemotherapy and selected treatment-related complications such as anaemia and thrombocytopenia requiring transfusions, prolonged neutropenia resulting in treatment delays, febrile neutropenia, mucositis and death were recorded. A total of 133 participants were recruited with a median age of 4.5 years. Eighty-one (60.9%) were diagnosed with solid tumours, 31 (23.3%) had leukaemias and 21 (15.8%) had lymphomas. Of the anthropometric parameters assessed, only arm anthropometry using upper arm muscle area (UAMA) and mid-upper arm circumference (MUAC) were associated with complications. Participants with wasting were more likely to develop anaemia and mucositis. However, the incidence of prolonged neutropenia was significantly higher among participants with average UAMA (p = 0.043) and low average UAMA (p = 0.049) compared to those with low UAMA. Risk of neutropenia was also significantly less among those with wasting by MUAC compared to those well-nourished (p = 0.045). Twenty-three participants (17.3%) died with a greater proportion (11/44; 25%) occurring in those who were wasted using MUAC. These findings underscore the need for nutritional surveillance at diagnosis and during chemotherapy, particularly where co-morbid disease is prevalent.Impact of COVID-19 vaccination on liver transplant recipients. Experience in a reference center in MexicoDaniel Azamar-LlamasJosealberto Sebastiano Arenas-MartinezAntonio Olivas-MartinezJose Victor JimenezEric Kauffman-OrtegaCristian J García-CarreraBruno Papacristofilou-RiebelingFabián E Rivera-LópezIgnacio García-Juárez10.1371/journal.pone.03011982024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Daniel Azamar-Llamas, Josealberto Sebastiano Arenas-Martinez, Antonio Olivas-Martinez, Jose Victor Jimenez, Eric Kauffman-Ortega, Cristian J García-Carrera, Bruno Papacristofilou-Riebeling, Fabián E Rivera-López, Ignacio García-Juárez</p>
Background and aims <p>COVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center.</p> Methods <p>A retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement.</p> Results <p>153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14–3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11–1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14–0.71, p = 0.005).</p> Conclusions <p>Vaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.</p>Diverging likelihood of colon and rectal cancer in Yogyakarta, Indonesia: A cross sectional studyHerindita PuspitaningtyasSusanna Hilda HutajuluJajah FachirohNungki AnggorowatiGuardian Yoki SanjayaLutfan LazuardiPatumrat Sripan10.1371/journal.pone.03011912024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Herindita Puspitaningtyas, Susanna Hilda Hutajulu, Jajah Fachiroh, Nungki Anggorowati, Guardian Yoki Sanjaya, Lutfan Lazuardi, Patumrat Sripan</p>
Objectives <p>Colon and rectal cancer are associated with different risk factors and prognostic. However, this discrepancy has not been widely explored in the local population. This study aimed to investigate the site-specific likelihood of colorectal cancer (CRC) incidence in the Yogyakarta province, Indonesia.</p> Methods <p>This cross-sectional study analyses 1,295 CRC cases diagnosed in 2008–2019 registered in the Yogyakarta population-based cancer registry (PBCR) database. Cases were grouped into colon and rectal cancer. Log-binomial regression was used to determine the relative risk of either colon or rectal cancer across different gender, age group, and rurality of residence. The age-specific rates were calculated by age group and temporal trend for each group were analyzed using joinpoint regression.</p> Results <p>Females displayed higher odds of colon cancer (relative risk/RR = 1.20, 95%CI = 1.02–1.41) and lower odds of rectal cancer (RR = 0.92, 95%CI = 0.85–0.99). Elevated odds of colon cancer were observed in younger age group, especially 30–39 (RR = 1.87, 95%CI = 1.10–3.19), while decreased odds of rectal cancer was apparent in age group 30–39 and 40–49 (RR = 0.75, 95%CI = 0.60–0.93 and RR = 0.82, 95%CI = 0.69–0.98, respectively). Living in urban or rural areas did not significantly influence the odds of either having colon (RR = 0.98, 95%CI = 0.82–1.17) or rectal cancer (RR = 1.01, 95%CI = 0.93–1.10). During 2008–2019, trends of colon cancer in age <50 increased by 8.15% annually while rectal cancer displayed a 9.71% increase annually prior to 2017, followed by a 17.23% decrease until 2019.</p> Conclusions <p>Yogyakarta population shows higher odds of young-onset colon cancer, especially between age 30–39 years old. Overall observation of trend shows increasing incidence in young-onset colon cancer, and non-significant decrease in rectal cancer.</p>Colorectal cancer survival disparities in the five regions of GeorgiaMeng-Han TsaiDaramola N. CabralCaitlyn GrunertJustin X. Moore10.1371/journal.pone.03010272024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Meng-Han Tsai, Daramola N. Cabral, Caitlyn Grunert, Justin X. Moore</p>
Background/objective <p>The objective of this study was to examine 5-year colorectal cancer survival rates. We also determined whether demographics, tumor characteristics, and treatment modality were associated with 5-year CRC survival in the Clayton, West Central, East Central, Southeast, and Northeast Georgia regions because the significant higher CRC mortality rates in these regions in comparison to the overall rates in the State of Georgia.</p> Methods <p>We conducted a retrospective cohort analysis using data from the 1975–2016 Surveillance, Epidemiology, and End Results program aggregated CRC patients to these five regions. Five-year CRC survival was calculated and stratified by the five regions of Georgia, using the Kaplan-Meier method with log-rank test. Cox proportional hazard regression was used to examine the mentioned association in these five regions.</p> Results <p>Among 11,023 CRC patients, 5-year CRC survival was lowest in Clayton (65.9%) compared to the West Central (69.0%), East Central (68.2%), Southeast (70.5%), and Northeast regions (69.5%) (p-value = 0.02). In multivariable analysis, greater risk of CRC death was found in the Clayton region compared to the West Central (HR, 1.12; 95%, 1.00–1.25) region when adjusting for demographics, tumor characteristics, and treatment modality. Among Clayton Georgians, age of 75+ years (HR, 2.13; 95%, 1.56–2.89), grade 3 & 4 tumors (HR, 2.22; 95%, 1.64–3.00), and distant stage (HR, 20.95; 95%, 15.99–27.45) were negatively associated with CRC survival.</p> Conclusion <p>We observed place-based differences in CRC survival with significantly lower survival rates in the Clayton region. Factors associated with higher risk of CRC death include older age at diagnosis, high-grade tumors, and distant stage CRC among Clayton Georgians. Our study provides important evidence to all relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection and improved outcomes.</p>Focused deterrence: A protocol for a realist multisite randomised controlled trial for evaluating a violence prevention intervention in the UKTia SimanovicPaul McFarlaneIain BrennanWilliam GrahamAlex Sutherland10.1371/journal.pone.03010232024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Tia Simanovic, Paul McFarlane, Iain Brennan, William Graham, Alex Sutherland</p>
Introduction <p>Focused deterrence (FD) is a frequently cited intervention for preventing violence, particularly against violent urban gangs. The Youth Endowment Fund (YEF) believes it could be effective in the UK, based primarily on research conducted in the US. However, we contend that these studies have inadequate methodological designs, lack of rigorous testing, and small sample sizes. Therefore, the evidence supporting focused deterrence as an effective method, particularly outside the US, is inconclusive. The aim of the protocol is to better understand the potential effects of FD in the context of the UK, using a multisite evaluation experimental design to more closely investigate the evidence of its likely impact.</p> Methods <p>We planned a realist randomised controlled trial. The design is focused on a multisite trial consisting of two-arm randomised experiments in five locations. Each trial location will test their implementation of a core programme specified by the funder. The multisite nature will allow us to understand differential impacts between locations, improving the external validity of the results. Participants will be randomly selected from a wider pool of eligible individuals for the intervention. We estimate a sample size of approximately <i>N</i> = 1,700 individuals is required. Based on this pooled sample size, a relative reduction of 26% would be detectable in 80% of trials. The trial is coupled with a formative process evaluation of delivery and fidelity. The formative evaluation will use a mixed methods design. The qualitative aspect will include semi-structured cross-sectional and longitudinal interviews with programme leads, programme delivery team, and programme participants, as well as observations of the meetings between the programme delivery team (i.e., community navigators/mentors) and programme participants. The quantitative data for the formative evaluation will be gathered by the sites themselves and consist of routine outcome performance monitoring using administrative data. Sampling for interviews and observations will vary, with the researchers aiming for a higher number of individuals included in the first round of cross-sectional interviews and retaining as many as possible for repeat interviews and observations.</p> Discussion <p>This protocol outlines the process and impact evaluation methodology for the most extensive multisite evaluation of focused deterrence to date in the UK. Spanning five distinct sites with seven trials, the evaluation includes a cohort of 2,000 individuals, marking it as the only multisite trial of focused deterrence. Employing an integrated realist evaluation framework, the study uses qualitative and quantitative research methods. The anticipated findings will offer pivotal insights for formulating future violence prevention policies in the UK. They are also expected to contribute significantly to the corpus of literature on violence prevention and intervention evaluation.</p> Trial registration <p>Protocol registration: ISRCTN: 11650008 4<sup>th</sup> June 2023.</p>Adherence to HEI-2010 and odds of breast cancer according to the menopause status: Evidence from Middle Eastern CountrySoraiya Ebrahimpour-KoujanSanaz Benisi-KohansalLeila AzadbakhtMaryam FallahAhmad Esmaillzadeh10.1371/journal.pone.03009862024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Soraiya Ebrahimpour-Koujan, Sanaz Benisi-Kohansal, Leila Azadbakht, Maryam Fallah, Ahmad Esmaillzadeh</p>
Background <p>Majority of earlier studies have assessed the association between individual healthy eating index-2010 (HEI-2010) and the odds of breast cancer (BC). However, no study has been conducted on the effect of compliance with HEI-2010 and the odds of BC in the Iranian population with a large sample size. Therefore, we aimed to investigate the relationship between the HEI-2010 and the odds of BC in the Iranian population.</p> Method <p>This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. HEI-2010 was examined using validated questionnaires. The adherence to HEI-2010 among the participants was divided into four categories. The general characteristics of the participants in the quartiles of the HEI score for categorical variables and continuous variables were evaluated using chi-square and one-way analysis of variance, respectively. Also, using logistic regression analysis, dietary intakes were evaluated in HEI score quartiles. Also, confounding variables were adjusted in different models.</p> Result <p>People with the highest HEI score had 60% lower odds of BC (OR: 0.40; 95% CI: 0.27, 0.57) than those with the lowest score among post-menopause women. After controlling for age and energy intake, individuals with the highest HEI score were 78% less likely to have BC compared with those with the lowest score (OR: 0.22; 95% CI: 0.14, 0.33). Adjustments for other potential confounders including demographic factors made the association stronger (OR: 0.21; 95% CI: 0.13, 0.32). This association remained significant even after taking BMI into model (OR: 0.27; 95% CI: 0.17, 0.43).</p> Conclusion <p>Finally, in this study we found an association between HEI-2010 and odds of breast cancer. This association was particularly seen in postmenopausal women. No significant association was found between adherence to HEI-2010 and odds of BC among pre-menopausal.</p>Clusters of longitudinal risk profile trajectories are associated with cardiometabolic diseases: Results from the population-based KORA cohortFiona NiedermayerGunther SchaubergerWolfgang RathmannStefanie J. KlugBarbara ThorandAnnette PetersSusanne Rospleszcz10.1371/journal.pone.03009662024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Fiona Niedermayer, Gunther Schauberger, Wolfgang Rathmann, Stefanie J. Klug, Barbara Thorand, Annette Peters, Susanne Rospleszcz</p>
Background <p>Multiple risk factors contribute jointly to the development and progression of cardiometabolic diseases. Therefore, joint longitudinal trajectories of multiple risk factors might represent different degrees of cardiometabolic risk.</p> Methods <p>We analyzed population-based data comprising three examinations (Exam 1: 1999–2001, Exam 2: 2006–2008, Exam 3: 2013–2014) of 976 male and 1004 female participants of the KORA cohort (Southern Germany). Participants were followed up for cardiometabolic diseases, including cardiovascular mortality, myocardial infarction and stroke, or a diagnosis of type 2 diabetes, until 2016. Longitudinal multivariate k-means clustering identified sex-specific trajectory clusters based on nine cardiometabolic risk factors (age, systolic and diastolic blood pressure, body-mass-index, waist circumference, Hemoglobin-A1c, total cholesterol, high- and low-density lipoprotein cholesterol). Associations between clusters and cardiometabolic events were assessed by logistic regression models.</p> Results <p>We identified three trajectory clusters for men and women, respectively. Trajectory clusters reflected a distinct distribution of cardiometabolic risk burden and were associated with prevalent cardiometabolic disease at Exam 3 (men: odds ratio (OR)<sub>ClusterII</sub> = 2.0, 95% confidence interval: (0.9–4.5); OR<sub>ClusterIII</sub> = 10.5 (4.8–22.9); women: OR<sub>ClusterII</sub> = 1.7 (0.6–4.7); OR<sub>ClusterIII</sub> = 5.8 (2.6–12.9)). Trajectory clusters were furthermore associated with incident cardiometabolic cases after Exam 3 (men: OR<sub>ClusterII</sub> = 3.5 (1.1–15.6); OR<sub>ClusterIII</sub> = 7.5 (2.4–32.7); women: OR<sub>ClusterII</sub> = 5.0 (1.1–34.1); OR<sub>ClusterIII</sub> = 8.0 (2.2–51.7)). Associations remained significant after adjusting for a single time point cardiovascular risk score (Framingham).</p> Conclusions <p>On a population-based level, distinct longitudinal risk profiles over a 14-year time period are differentially associated with cardiometabolic events. Our results suggest that longitudinal data may provide additional information beyond single time-point measures. Their inclusion in cardiometabolic risk assessment might improve early identification of individuals at risk.</p>The Impacts of COVID-19 Restrictions on Quality Adjusted Life Years (QALY): Heterogeneous effects and post-pandemic recoveryRaimundo AtalPaula BedregalJosé A. CarrascoFelipe GonzálezRodrigo HarrisonCecilia Vizcaya10.1371/journal.pone.03008912024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Raimundo Atal, Paula Bedregal, José A. Carrasco, Felipe González, Rodrigo Harrison, Cecilia Vizcaya</p>
Objectives <p>Estimate the effects of non-pharmacological interventions used to prevent the spread of COVID-19 on the quality of life, measured by Quality Adjusted Life Years (QALYs).</p> Methods <p>A survey on 1,506 heads of households from Chile in May of 2022. Respondents were asked basic socioeconomic questions and a version of the EQ-5D-5L questionnaire that was used to calculate the evolution of HRQoLs. Comparisons of means in HRQoLs measures before the pandemic, at the peak of restrictions, and at the moment of the survey were performed.</p> Results <p>The average HRQoL of the population before the pandemic was similar to other countries in the region (0.96). At the peak of restrictions (June 2020–August 2021), the average HRQoL decreased to 0.87 (-9%). At the time of survey (May 2022), the average HQRoL was 0.91 (4%). Assuming the recovery trend continued, pre-pandemic HRQoLs would be reached by January 2024. Altogether, the pandemic would have reduced QALYs by 0.2 in average. The effect is larger and the recovery slower among women. Our estimates imply that the restrictions to manage the pandemic came at a cost of 2.4 months of life years for the average (surviving) person, 1.8 months for men and 3.4 for women.</p> Conclusions <p>Our results suggest that COVID-19 had worse effects on life quality than previously thought. These effects are more significant among women than among men. Efforts to improve life quality and speed up its recovery could have large positive consequences for the population.</p>Does attitude importance moderate the effects of person-first language? A registered reportSandy SchumannHazem Zohny10.1371/journal.pone.03008792024-03-28T14:00:00Z2024-03-28T14:00:00Z<p>by Sandy Schumann, Hazem Zohny</p>
Previous research has demonstrated that exposure to outgroup descriptions that use person-first, as compared to identity-first, language can attenuate negative stereotypes or prejudice and enhance support for policies that seek to advance outgroup rights. However, those benefits of person-first language may not apply to all social groups equally. The present study examines a boundary condition of the effects of person-first language. Specifically, we postulate that person-first language reduces the stigmatization of outgroups to a lesser degree if individuals hold more important negative attitudes towards the respective communities. We will test this hypothesis in a two-factorial 2 (target group) x 2 (descriptor) online experiment that includes a control group and for which we will recruit a general-population sample (<i>N</i> = 681). Stereotyping, dehumanization, as well as negative affect and behavioral intentions towards two outgroups will be compared: people with a physical disability/the physically disabled (i.e., negative attitudes are expected to be less important) and people who have committed a violent crime/violent criminals (i.e., negative attitudes are expected to be more important). Our findings will bear implications for understanding when language use could influence public opinion of different social groups. Additionally, the research can inform the development of more effective communication policies to promote inclusion and reduce stigma.