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School closure is considered as an effective measure to prevent pandemic influenza. Although Japan has implemented many class, grade, and whole school closures during the early stage of the pandemic 2009, the effectiveness of such a school closure has not been analysed appropriately. In addition, analysis based on evidence or data from a large population has yet to be performed. We evaluated the preventive effect of school closure against the pandemic (H1N1) 2009 and examined efficient strategies of reactive school closure. Data included daily reports of reactive school closures and the number of infected students in the pandemic in Oita City, Japan. We used a regression model that incorporated a time delay to analyse the daily data of school closure based on a time continuous susceptible-exposed-infected-removed model of infectious disease spread. The delay was due to the time-lag from transmission to case reporting. We simulated the number of students infected daily with and without school closure and evaluated the effectiveness. The model with a 3-day delay from transmission to reporting yielded the best fit using R2 (the coefficient of determination). This result suggests that the recommended period of school closure is more than 4 days. Moreover, the effect of school closure in the simulation of school closure showed the following: the number of infected students decreased by about 24% at its peak, and the number of cumulative infected students decreased by about 8.0%. School closure was an effective intervention for mitigating the spread of influenza and should be implemented for more than 4 days. School closure has a remarkable impact on decreasing the number of infected students at the peak, but it does not substantially decrease the total number of infected students.

School closures are a safe and important strategy for preventing infectious diseases in schools. However, the effects of school closures have not been fully demonstrated, and prolonged school closures have a negative impact on students and communities. This study evaluated class-specific school closure strategies to prevent the spread of seasonal influenza and determine the optimal timing and duration. We constructed a new model to describe the incidence of influenza in each class based on a stochastic susceptible-exposed-infected-removed model. We collected data on the number of infected absentees and class-specific school closures due to influenza from four high schools and the number of infected cases from the community in a Japanese city over three seasons (2016–2017, 2017–2018, and 2018–2019). The parameters included in the model were estimated using epidemic data. We evaluated the effects of class-specific school closures by measuring the reduced cumulative incidence of class closures per day. The greatest reduction in the cumulative absences per day was observed in the four-day class closure. When class-specific school closures lasted for four days, the reduction in the cumulative number of infections per class closure day was greater when the closure was timed earlier. The highest reduction in the number of class closures per person-day occurred when the threshold was around 5.0%. Large variations in the reduction of cumulative incidence were noted owing to stochastic factors. Reactive, class-specific school closures for seasonal influenza were most efficient when the percentage of newly infected students exceeded around 5.0%, with a closure duration of four days. The optimal strategy of class-specific school closure provides good long-term performance but may be affected by random variations.

Masticatory function is thought to be related to various eating habits, but it is difficult to evaluate overall masticatory function by assessing complex eating habits. Maximum occlusal force is an important indicator of masticatory function that is affected by age and sex. This preliminary study focused on the maximum occlusal force of young women and their eating habits, excluding food and nutritional factors, and investigated whether individual eating habits and eating habit patterns predict maximum occlusal force. We measured the maximum occlusal force for the whole dentition of 53 healthy young women before they ate lunch. The participants also completed a 12-item questionnaire about their eating habits. Scores were determined from the relationship between each item and increased maximum occlusal force. We found a significant but weak relationship between maximum occlusal force and some questions. The total questionnaire scores for the participants’ eating habits showed an almost normal distribution (mean ± standard deviation: 22.7 ± 2.6, median: 23.0, mode: 23.0, range of total scores: 17–28). The accuracy of the linear regression between the total scores for eating habits and maximum occlusal force was high but not perfect ( β : standardized regression coefficient = 0.527, P < 0.001). Although further research is needed, our findings confirm that eating habit patterns are significantly associated with maximum occlusal force and may help predict occlusal force. Our results provide important information about eating patterns in humans.

Background In Taiwan, the human immunodeficiency virus (HIV) is primarily transmitted among men who have sex with men (MSM). We believe that the primary source of heterogeneity influencing transmission is from whether the infected individuals engage in behaviors that promote transmission. Therefore, we differentiated and modeled the statuses of infected individuals, estimated parameters, and predicted future infection trends to better understand HIV transmission dynamics among MSM. Methods We devised a computational approach to accurately estimate the number of infectious individuals during early surveillance years in Taiwan using monthly data of newly diagnosed patients with HIV from January 2005 to December 2006. Subsequently, using annual incident cases from 2005 to 2019, we estimated the susceptibility rate, transmission rates, and duration of risk and conducted short-term forecasts of HIV infection among MSM through mathematical modeling based on the susceptible-infected-removed model. Parameters and their values, such as HIV and acquired immunodeficiency syndrome (AIDS) transmission rates and removal rates, were also estimated. Results A total of 850 infectious individuals with HIV were identified in 2005. From 2005 to 2019, approximately 0.68% (95% confidence interval: 0.64–0.71%) of Taiwan’s male population were estimated to be susceptible to HIV infection via MSM. The transmission rate did not significantly differ between individuals with HIV and AIDS (0.0110 and 0.107 per 10,000 individuals, respectively). The average infection duration between infection and AIDS onset was 4.5 years and between AIDS onset and death was 2.1 years. In 2019, the proportion of infectious infected individuals continuously decreased. By 2026, only 11.85% and 10.21% of individuals with HIV and AIDS, respectively, will be infectious. Conclusions Our study presents a new dynamic mathematical model for estimating infectious HIV cases among MSM in Taiwan. By accounting for the heterogeneity of infectious HIV/AIDS within the MSM population, we effectively estimated the number of infections during early surveillance years and implement concentrated measures, thereby reducing infectious HIV/AIDS cases, which contributes to the overall reduction in HIV/AIDS cases. With these estimations, identifying target populations and implementing effective intervention measures at appropriate times can be improved.

Background: The CD4 cell count of patients during diagnosis and distribution of CD4 cell counts in the patient population are important to understand infection-diagnosis interval and incidence rate of human immunodeficiency virus (HIV) infection, respectively. However, this information has not been published in Japan. This study aimed to describe the change in CD4 cell count trends and clarify the change in patients’ characteristics in association with the CD4 cell count information.Methods: A descriptive study was conducted to analyze the medical records of patients with HIV who visited one of the largest acquired immunodeficiency syndrome (AIDS) core hospitals in western Japan. The basic characteristics, CD4 cell counts, viral loads, and diagnosis-treatment intervals between the first (2003–2010) and second (2011–2017) halves of the study duration were compared.Results: The distribution of CD4 cell counts significantly changed between 2003–2010 and 2011–2017 (χ2 = 20.42, P < 0.001). The proportion of CD4 cell count <200 cells/mm3 increased (38.8% in 2003 to 45.9% in 2017), whereas CD4 cell count ≥500 cells/mm3 decreased (19.4% in 2003 to 12.2% in 2017). Moreover, the distributions of age groups, history of HIV screening test, patient outcomes, HIV viral load, and diagnosis-treatment interval also significantly changed (χ2 = 25.55, P < 0.001; χ2 = 8.37, P = 0.015; χ2 = 6.07, P = 0.014; χ2 = 13.36, P = 0.020; χ2 = 173.76, P < 0.001, respectively).Conclusion: This study demonstrated the fundamental trends of the HIV epidemic in Osaka, Japan between 2003–2010 and 2011–2017 and indicated that the incidence rate of HIV was decreasing in Japan.

Incident fatty liver increases the risk of non-alcoholic fatty liver disease (NAFLD), which may lead to end-stage liver diseases, and increase the risk of cardiovascular disease and diabetes. For its prevention, modeling the natural history of fatty liver is useful to demonstrate which lifestyle-related risk factors (e.g. body mass index and cholesterol) play the greatest role in the life-course of fatty liver. Model predictors and their predictive algorithms were determined by prospective regression analyses using 5-year data from approximately 2000 Japanese men aged 20-69 years. The participants underwent health examinations and completed questionnaires on their lifestyle behaviors annually from 2012 to 2016. The life-course of fatty liver was simulated based on this participant data using Monte Carlo simulation methods. Sensitivity analyses were performed. The validity of the model was discussed. The body mass index (BMI) and low-density/high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio significantly aided in predicting incident fatty liver. When the natural history of fatty liver was simulated using the data of participants aged 30-39 years, the prevalence increased from 20% to 32% at 40-59 years before decreasing to 24% at 70-79 years. When annual updates of BMI and LDL-C/HDL-C ratio decreased/increased by 1%, the peak prevalence of fatty liver (32%) changed by -8.0/10.7% and -1.6/1.4%, respectively. We modeled the natural history of fatty liver for adult Japanese men. The model includes BMI and LDL‒C/HDL‒C ratio, which played a significant role in predicting the presence of fatty liver. Specifically, annual changes in BMI of individuals more strongly affected the life‒course of fatty liver than those in the LDL-C/HDL-C ratio. Sustainable BMI control for individuals may be the most effective option for preventing fatty liver in a population.

Anemia is a major public health concern; however, research on anemia and its contributing variables is scarce. To address the gap, we investigated the prevalence and associated factors of anemia in school-aged adolescent girls in rural Bangladesh. We conducted a cross-sectional study in two secondary schools at Chandpur, Bangladesh, from January to April 2022. We randomly selected 422 adolescent girls based on prevalence rates from existing research to ensure reliable estimates and a robust study representation. We performed interviews with a semi-structured questionnaire after receiving ethical permission and written informed consent. In addition, physical examination and anthropometric measurements were done, followed by blood testing to identify anemia. Blood hemoglobin was measured using a spectrophotometric method, and quality control was ensured by validated results with control samples. Univariate with multiple logistic regression was employed for analysis to find the association between anemia and all other variables that were adjusted to control the potential effect of confounding variables. The overall prevalence of anemia was 37.7% (mild- 33.8% and moderate- 3.9%). In the univariate analysis having a working mother (OR 3.84; 95% CI 1.31-11.26), undernutrition (OR 2.40; 95% CI 1.27-4.52), and irregular lunch consumption (OR 2.15; 95% CI 1.00-4.60) were associated with anemia. Conversely, being a user of a slab latrine (OR 0.61; 95% CI 0.40-0.93) and not weekly consumption of pure milk (OR 0.62; 95% CI 0.41-0.92) were negatively associated with anemia. In multivariate logistic regression analysis, associated factors for prevalent anemia were working mother [adjusted odds ratio (aOR) 7.65; 95% CI 1.97-29.50], slab latrine user (aOR 0.46; 95% CI 0.26-0.79), and irregular lunch consumption (aOR 2.92; 95% CI 1.21-7.03). The prevalence of anemia among adolescent girls in rural Bangladesh remains high with undernutrition. Anemia is associated with working mothers, slab latrine users, and irregular lunch consumers within the studied population.' Thus, policymakers may promote school-based nutritional education and lunch programs with iron supplementation and improve sanitary facilities.

Masticatory function is associated with nervous function, including autonomic nervous function, and both functions are influenced by human habits. In a previous preliminary study of 53 young women, we found that eating habit patterns were associated with occlusal force as an indicator of masticatory function. Therefore, we hypothesized that relationships exist between occlusal force, the autonomic nervous system, and eating habit patterns. To test our hypothesis, we analyzed the relationship between heart rate variability measured before and after lunch in 53 young women, and measured and surveyed maximum occlusal force and eating habit patterns, respectively, in these participants. High occlusal force was associated with an increased high-frequency (HF) component (vagal tone index) of the heart rate variability index immediately before lunch (standardized regression coefficient ( ) = 0.417,  = 0.002). Each of the eating habit items surveyed in a questionnaire showed a similar tendency for the HF component immediately before lunch and maximum occlusal force; in particular, \"Habit of eating breakfast\" and \"Number of meals per day\" were significantly associated with both variables. Additionally, total eating habit scores related to higher maximum occlusal force were associated with an increase in the HF component immediately before lunch (  = 0.514,  < 0.001). The maximum occlusal force and the pre-eating HF component values were stratified by total eating habit scores (into low, medium, high categories), and the high scores were significantly higher than the medium or low scores. Occlusal force and the pre-eating cardiac vagal response of individuals were characterized by their common eating habit patterns, indicating that eating habits may be simultaneously associated with the development of masticatory function, nervous system development, and cardiovascular rhythm. Although further research is needed to investigate these relationships in detail, our findings provide insights that will inform the study of physical functions, neurodevelopment, habitual behaviors, and health in humans.

Background Anemia is a global public health concern, particularly among adolescent girls in rural Bangladesh, owing to inadequate knowledge and insufficient nutritional intake. Mobile health (mHealth) education has the potential to solve these limitations. This study aimed to evaluate the impact of mHealth education on raising hemoglobin levels and reducing anemia among adolescent girls in rural Bangladesh. Methods This open-label, parallel-group, randomized controlled trial was conducted at two schools in Chandpur district, Bangladesh from late May 2022 to January 2023. We randomly assigned one school to the intervention group and another to the control group and then performed simple random sampling to recruit 138 adolescent girls with anemia from the intervention ( n  = 69) and control ( n  = 69) groups. The intervention group received online counseling sessions and health education via mHealth technology, whereas the control group received usual care, and both groups were observed for 8 months. We performed mixed-effects model and generalized estimating equations (GEE) to evaluate the outcomes. Results The study analyzed 121 participants (intervention group, 62; control group, 59). After adjusting for covariates, mixed-effects model observed that body mass index (BMI) [coefficient: 1.10, 95% confidence interval (CI): 0.44–1.76, P  = 0.001], mid-upper arm circumference (MUAC) (coefficient: 0.77, 95% CI: 0.27–1.26, P  = 0.002), hip circumference (coefficient: 2.24, 95% CI: 0.62–3.87, P  = 0.007), and waist circumference (coefficient: 2.20, 95% CI: 0.74–3.66, P  = 0.003) were significantly improved in intervention group. Although hemoglobin levels improved in the intervention group, the change was not statistically significant. However, the intervention group experienced a higher anemia recovery than the control group (25.8% vs. 13.6%). The GEE showed improvement in knowledge (coefficient: 4.11, 95% CI: 3.63–4.58, p = < 0.001), attitude (coefficient: 1.59, 95% CI: 1.24–1.96, p = < 0.001), and practice (coefficient: 0.39, 95% CI: 0.13–0.66, p  = 0.004) in the intervention group compared to the control group after adjusting for relevant covariates. Conclusions The mHealth education led to improvements in knowledge, attitude, and practice (KAP) scores related to anemia among adolescent girls. Furthermore, the intervention resulted in improvements in BMI, MUAC, and hip and waist circumference measurements. Additionally, there were positive trends indicating a reduction in anemia prevalence, accompanied by an upward trend in hemoglobin levels. Therefore, implementing this strategy could enhance KAP and contribute to reducing adolescent girls’ anemia in low-resource settings. Trial registration NCT05185661 ( https://www.clinicaltrials.gov/ ), registered [January 11, 2022] with ClinicalTrials.gov.

Aizawa M, Inagaki S, Moriyama M, Asano K, Kakehashi M (2019) Modeling the natural history of fatty liver using lifestyle–related risk factors: The initial proportion of the clinical and biochemical predictor variables of cohort 2 were varied by −40% (dashed black curve), −20% (dashed gray curve), 20% (gray curve) and 40% (black curve). https://doi.org/10.1371/journal.pone.0226059.g002 thumbnail Download: * PPT PowerPoint slide * PNG larger image * TIFF original image Projected prevalence of fatty liver with variations by changes in the predictive algorithms of BMI and LDL–C/HDL–C ratio. Aizawa M, Inagaki S, Moriyama M, Asano K, Kakehashi M (2019) Modeling the natural history of fatty liver using lifestyle–related risk factors: