PLoS Medicine

by The PLOS Medicine Staff

by Roxanne Hastie, Farhatulain Ahmed, Parinaz Mehdipour, Bernard Yan, Susan P. Walker, Jacqui Visser, Anam Bashir, Lyle Gurrin, Anthea Lindquist, Jessica A. Atkinson, Catherine Cluver, Lina Bergman, Stephen Tong 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.

by Hui G. Cheng, Livingstone Aduse-Poku, Chelsey McGill, Oxana Palesh, Susan Hong 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.

by Sebastian Walsh, Susanne Röhr, Joaquin Mígeot, Yuliya Bodryzlova, Etuini Ma’u, Simone Salemme, Charles R. Marshall, Timothy Daly, Gary Cheung, Blossom C. M. Stephan, Raj Kalaria, Kenneth M. Langa, Naaheed Mukadam, Leslie Grasset, Sarah Cullum, Ishtar Govia, Nikki-Anne Wilson, Daniele Urso, Ruth Peters, Jingxuan Wang, Edo Richard, Giancarlo Logroscino, Stefano Giannoni-Luza, Nicola T. Lautenschlager, Josephine E. Prynn, Cleusa P. Ferri, Susan Yates, Frank J. Wolters, Lindsay Wallace, Carol Brayne, Kaarin J. Anstey Author summary: 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. This Policy Forum by Sebastian Walsh and colleagues outlines the principles and aims of the Population-Level Approaches to Dementia Risk Reduction (PLADRR) research group, an international network of researchers committed to investigating how structural, social, and environmental conditions can promote brain health and reduce dementia risk across the population.

by Annelies Wilder-Smith 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. Dengue is a rapidly expanding global health threat driven by urbanization, climate change, and complex transmission dynamics. In this Perspective, Annelies Wilder-Smith details why modeling and tailored vaccination programs will be critical to developing effective, context-specific strategies to reducing disease burden.