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PLoS Medicine

Cody Cichowitz, Leonard Rubenstein, Chris Beyrer
In an essay, Cody Cichowitz and colleagues discuss approaches to preventing the practice of inappropriate anal examination.
March 2018: PLoS Medicine
(no author information available yet)
PLOS and the PLOS Medicine team would like to express our appreciation to the academic editors, guest editors, and reviewers who contributed to the peer-review process in 2017.
March 2018: PLoS Medicine
Tammy Hoffmann, Jesse Jansen, Paul Glasziou
In a Perspective, Tammy Hoffmann and colleagues discuss medical decision making for elderly patients with multimorbidity.
March 2018: PLoS Medicine
Xiaolin Xu, Gita D Mishra, Annette J Dobson, Mark Jones
BACKGROUND: The prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three of these conditions) has increased rapidly. Little is known about how the three conditions progress from one to another sequentially through the life course. We aimed to delineate this progression in middle-aged women and to determine the roles of common risk factors in the accumulation of diabetes, heart disease, and stroke multimorbidity. METHODS AND FINDINGS: We used data from 13,714 women aged 45-50 years without a history of any of the three conditions...
March 2018: PLoS Medicine
Evan D Muse, Nathan E Wineinger, Emily G Spencer, Melissa Peters, Riley Henderson, Yunyue Zhang, Paddy M Barrett, Steven P Rivera, Jay G Wohlgemuth, James J Devlin, Dov Shiffman, Eric J Topol
BACKGROUND: Atrial fibrillation (AF) is the most commonly encountered arrhythmia and is associated with an elevated risk of stroke. Improving the identification of patients with the highest risk for AF to enable appropriate surveillance and treatment, if necessary, is critical to reducing AF-associated morbidity and mortality. Multiple common single nucleotide polymorphisms (SNPs) are unequivocally associated with the lifetime risk of AF. In the current study we aimed to prospectively validate an AF genetic risk score (GRS) in previously undiagnosed patients at risk for AF...
March 2018: PLoS Medicine
Lars O Karlsson, Staffan Nilsson, Magnus Bång, Lennart Nilsson, Emmanouil Charitakis, Magnus Janzon
BACKGROUND: Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains significant undertreatment. The main aim of the current study was to investigate whether a clinical decision support tool (CDS) for stroke prevention integrated in the electronic health record could improve adherence to guidelines for stroke prevention in patients with AF. METHODS AND FINDINGS: We conducted a cluster-randomized trial where all 43 primary care clinics in the county of Östergötland, Sweden (population 444,347), were randomized to be part of the CDS intervention or to serve as controls...
March 2018: PLoS Medicine
Tess Harris, Sally M Kerry, Elizabeth S Limb, Cheryl Furness, Charlotte Wahlich, Christina R Victor, Steve Iliffe, Peter H Whincup, Michael Ussher, Ulf Ekelund, Julia Fox-Rushby, Judith Ibison, Stephen DeWilde, Cathy McKay, Derek G Cook
BACKGROUND: Physical inactivity is an important cause of noncommunicable diseases. Interventions can increase short-term physical activity (PA), but health benefits require maintenance. Few interventions have evaluated PA objectively beyond 12 months. We followed up two pedometer interventions with positive 12-month effects to examine objective PA levels at 3-4 years. METHODS AND FINDINGS: Long-term follow-up of two completed trials: Pedometer And Consultation Evaluation-UP (PACE-UP) 3-arm (postal, nurse support, control) at 3 years and Pedometer Accelerometer Consultation Evaluation-Lift (PACE-Lift) 2-arm (nurse support, control) at 4 years post-baseline...
March 2018: PLoS Medicine
Brant M Wagener, Parker J Hu, Joo-Yeun Oh, Cilina A Evans, Jillian R Richter, Jaideep Honavar, Angela P Brandon, Judy Creighton, Shannon W Stephens, Charity Morgan, Randal O Dull, Marisa B Marques, Jeffrey D Kerby, Jean-Francois Pittet, Rakesh P Patel
BACKGROUND: Trauma is the leading cause of death and disability in patients aged 1-46 y. Severely injured patients experience considerable blood loss and hemorrhagic shock requiring treatment with massive transfusion of red blood cells (RBCs). Preclinical and retrospective human studies in trauma patients have suggested that poorer therapeutic efficacy, increased severity of organ injury, and increased bacterial infection are associated with transfusion of large volumes of stored RBCs, although the mechanisms are not fully understood...
March 2018: PLoS Medicine
Chunling Lu, Zhihui Li, Vikram Patel
In an analysis of data from the Creditor Reporting System, Chunling Lu and colleagues investigate the level of development assistance from high-income countries towards child and adolescent mental health in low- and middle-income countries.
March 2018: PLoS Medicine
Pragna Patel, Colin Speight, Alice Maida, Fleetwood Loustalot, Denise Giles, Sam Phiri, Sundeep Gupta, Pratima Raghunathan
Pragna Patel and colleagues describe the implementation of a hypertension management model for HIV-infected people in Malawi.
March 2018: PLoS Medicine
Timothy Powell-Jackson, Camilla Fabbri, Varun Dutt, Sarah Tougher, Kultar Singh
BACKGROUND: To assess the effect of health information on immunisation uptake in rural India, we conducted an individually randomised controlled trial of health information messages targeting the mothers of unvaccinated or incompletely vaccinated children through home visits in rural Uttar Pradesh, India. METHODS AND FINDINGS: The study tested a brief intervention that provided mothers face-to-face with information on the benefits of the tetanus vaccine. Participants were 722 mothers of children aged 0-36 months who had not received 3 doses of diphtheria-pertussis-tetanus (DPT) vaccine (DPT3)...
March 2018: PLoS Medicine
Davide L Vetrano, Debora Rizzuto, Amaia Calderón-Larrañaga, Graziano Onder, Anna-Karin Welmer, Roberto Bernabei, Alessandra Marengoni, Laura Fratiglioni
BACKGROUND: Functional decline is a strong health determinant in older adults, and chronic diseases play a major role in this age-related phenomenon. In this study, we explored possible clinical pathways underlying functional heterogeneity in older adults by quantifying the impact of cardiovascular (CV) and neuropsychiatric (NP) chronic diseases and their co-occurrence on trajectories of functional decline. METHODS AND FINDINGS: We studied 2,385 people ≥60 years (range 60-101 years) participating in the Swedish National study of Aging and Care in Kungsholmen (SNAC-K)...
March 2018: PLoS Medicine
Oliver T Mytton, Christopher Jackson, Arno Steinacher, Anna Goodman, Claudia Langenberg, Simon Griffin, Nick Wareham, James Woodcock
BACKGROUND: The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation...
March 2018: PLoS Medicine
Marlous Hall, Tatendashe B Dondo, Andrew T Yan, Mamas A Mamas, Adam D Timmis, John E Deanfield, Tomas Jernberg, Harry Hemingway, Keith A A Fox, Chris P Gale
BACKGROUND: There is limited knowledge of the scale and impact of multimorbidity for patients who have had an acute myocardial infarction (AMI). Therefore, this study aimed to determine the extent to which multimorbidity is associated with long-term survival following AMI. METHODS AND FINDINGS: This national observational study included 693,388 patients (median age 70.7 years, 452,896 [65.5%] male) from the Myocardial Ischaemia National Audit Project (England and Wales) who were admitted with AMI between 1 January 2003 and 30 June 2013...
March 2018: PLoS Medicine
Jenny Tran, Robyn Norton, Nathalie Conrad, Fatemeh Rahimian, Dexter Canoy, Milad Nazarzadeh, Kazem Rahimi
BACKGROUND: Multimorbidity in people with cardiovascular disease (CVD) is common, but large-scale contemporary reports of patterns and trends in patients with incident CVD are limited. We investigated the burden of comorbidities in patients with incident CVD, how it changed between 2000 and 2014, and how it varied by age, sex, and socioeconomic status (SES). METHODS AND FINDINGS: We used the UK Clinical Practice Research Datalink with linkage to Hospital Episode Statistics, a population-based dataset from 674 UK general practices covering approximately 7% of the current UK population...
March 2018: PLoS Medicine
Amy L Slogrove, Michael Schomaker, Mary-Ann Davies, Paige Williams, Suna Balkan, Jihane Ben-Farhat, Nancy Calles, Kulkanya Chokephaibulkit, Charlotte Duff, Tanoh François Eboua, Adeodata Kekitiinwa-Rukyalekere, Nicola Maxwell, Jorge Pinto, George Seage, Chloe A Teasdale, Sebastian Wanless, Josiane Warszawski, Kara Wools-Kaloustian, Marcel Yotebieng, Venessa Timmerman, Intira J Collins, Ruth Goodall, Colette Smith, Kunjal Patel, Mary Paul, Diana Gibb, Rachel Vreeman, Elaine J Abrams, Rohan Hazra, Russell Van Dyke, Linda-Gail Bekker, Lynne Mofenson, Marissa Vicari, Shaffiq Essajee, Martina Penazzato, Gabriel Anabwani, Edith Q Mohapi, Peter N Kazembe, Makhosazana Hlatshwayo, Mwita Lumumba, Tessa Goetghebuer, Claire Thorne, Luisa Galli, Annemarie van Rossum, Carlo Giaquinto, Magdalena Marczynska, Laura Marques, Filipa Prata, Luminita Ene, Liubov Okhonskaia, Pablo Rojo, Claudia Fortuny, Lars Naver, Christoph Rudin, Sophie Le Coeur, Alla Volokha, Vanessa Rouzier, Regina Succi, Annette Sohn, Azar Kariminia, Andrew Edmonds, Patricia Lelo, Samuel Ayaya, Patricia Ongwen, Laura F Jefferys, Sam Phiri, Mwangelwa Mubiana-Mbewe, Shobna Sawry, Lorna Renner, Mariam Sylla, Mark J Abzug, Myron Levin, James Oleske, Miriam Chernoff, Shirley Traite, Murli Purswani, Ellen G Chadwick, Ali Judd, Valériane Leroy
BACKGROUND: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia...
March 2018: PLoS Medicine
Thomas J Hwang, Paolo A Tomasi, Florence T Bourgeois
BACKGROUND: Few medicines have been approved for children, leading to rates of off-label prescribing reported to be as high as 90%. In 2007, the European Union adopted the Paediatric Regulation, which mandates that pharmaceutical companies conduct paediatric studies for all new medicines, unless granted a waiver. We aimed to evaluate the availability of paediatric trial results from studies required under the Paediatric Regulation for new medicines authorised in the EU. METHODS AND FINDINGS: The European Medicines Agency (EMA) public database of paediatric investigation plans was searched for new medicines centrally authorised in the EU between 1 January 2010 and 31 December 2014 with at least 1 required paediatric study...
March 2018: PLoS Medicine
Raj S Bhopal, Laurence Gruer, Genevieve Cezard, Anne Douglas, Markus F C Steiner, Andrew Millard, Duncan Buchanan, S Vittal Katikireddi, Aziz Sheikh
BACKGROUND: Migrant and ethnic minority groups are often assumed to have poor health relative to the majority population. Few countries have the capacity to study a key indicator, mortality, by ethnicity and country of birth. We hypothesized at least 10% differences in mortality by ethnic group in Scotland that would not be wholly attenuated by adjustment for socio-economic factors or country of birth. METHODS AND FINDINGS: We linked the Scottish 2001 Census to mortality data (2001-2013) in 4...
March 2018: PLoS Medicine
Daniel Schar, Angkana Sommanustweechai, Ramanan Laxminarayan, Viroj Tangcharoensathien
In a policy forum, Daniel Schar and colleagues discuss the need for surveillance of antimicrobial consumption in animals in low- and middle-income countries and propose the establishment of antimicrobial consumption monitoring systems.
March 2018: PLoS Medicine
Vanessa Garcia-Larsen, Despo Ierodiakonou, Katharine Jarrold, Sergio Cunha, Jennifer Chivinge, Zoe Robinson, Natalie Geoghegan, Alisha Ruparelia, Pooja Devani, Marialena Trivella, Jo Leonardi-Bee, Robert J Boyle
BACKGROUND: There is uncertainty about the influence of diet during pregnancy and infancy on a child's immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease. METHODS AND FINDINGS: Two authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease...
February 2018: PLoS Medicine
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