Recent publications on cleaning, hygiene, health and mindful living, selected from open journal feeds. Follow the evidence back to the people who produced it.
Publisher abstract excerptAn Artificial Neural Network (ANN) model was created to predict how injection-molded parts made from flexible mechanisms would hold up under twisting fatigue. These parts were made from three common plastics—ABS (Acrylonitrile Butadiene Styrene), PP (polypropylene), and PA6 (Polyamide 6)—strengthene…
Abstract & author credits for ANN-based prediction of torsional fatigue behavior in an injection-molded compliant mechanism component
Authors: Vu Quang Huy, Tran Minh The Uyen, Pham Son Minh, Van-Thuc Nguyen, Hai Nguyen Le Dang
An Artificial Neural Network (ANN) model was created to predict how injection-molded parts made from flexible mechanisms would hold up under twisting fatigue. These parts were made from three common plastics—ABS (Acrylonitrile Butadiene Styrene), PP (polypropylene), and PA6 (Polyamide 6)—strengthened with up to 30 wt.% short glass fibers. The team also looked at how many times the parts were cycled during manufacturing.To test them, the samples were twisted back and forth ±40° for 100 cycles. The study examined how the type of plastic, the amount of glass fiber, and key injection molding settings affected the results. It turned out that PA6’s ability to withstand fatigue really improved when it had more glass fiber, especially 20 wt.% or more. PA6 turned out to be the strongest material in this test, followed by ABS. PP was the most consistent but also the weakest in terms of twisting strength. The ANN model was quite successful at predicting the twisting force, with a match range (R ≈ 0.94 to 0.98) and cross validation 0.93 and 0.97. The research also pointed out specific injection molding conditions—like melt temperature, filling pressure, and packing pressure—as being particularly important for the final performance. Overall, this proposed approach offers a tool to help engineers design and make plastic flexible mechanisms more effectively.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0361201. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptWild edible plants grow in natural environments with little direct human management; consequently, their productivity and quality frequently exhibit pronounced spatiotemporal variability, making stable supply difficult. This variability represents a major constraint on the exploitation of wild edibl…
Abstract & author credits for Environmental drivers of taste characteristics in wild edible plants: Effects of topographic gradients and human harvesting evaluated using dwarf bamboo culms
Wild edible plants grow in natural environments with little direct human management; consequently, their productivity and quality frequently exhibit pronounced spatiotemporal variability, making stable supply difficult. This variability represents a major constraint on the exploitation of wild edible plants as local food resources, and overcoming it requires an ecological understanding of the factors affecting variation in both productivity and quality. Here, we examined the effects of human harvesting and environmental factors on the taste characteristics of young culms of Sasa kurilensis. No statistically significant differences were detected between harvested and control plots in any major taste index, including umami, bitter aftertaste, astringency, umami richness, and sweetness (measured as Brix values). In contrast, taste characteristics showed substantial variation among study plots, suggesting a strong association with local environmental conditions. Elevation and slope angle were significantly correlated with bitter aftertaste, umami, and sweetness; plots at higher elevations and on steeper slopes tended to produce plants with a less bitter aftertaste, and higher sweetness and umami. Principal component analysis integrating multiple taste indices revealed that the major axis of taste variation was significantly associated with elevation, and that harvesting treatment had no detectable effect. These results suggest that the taste characteristics of young culms in the study area are governed primarily by topographic gradients rather than by human harvesting. Although wild edible plants are important food resources in boreal and temperate forests worldwide, many are poorly managed. By quantitatively establishing relationships between taste characteristics and environmental factors in young culms, this study provides a scientific basis for determining the optimal timing, location, and selection criteria for wild edible plant harvesting, thereby contributing to the development of sustainable use strategies.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0360962. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptExisting studies on resource and environmental carrying capacity (RECC) have primarily focused on comprehensive evaluation and linear identification. But the quantification of driving effect on RECC have not been fully explored, especially the interaction and nonlinear effects. Therefore, this paper…
Abstract & author credits for Revealing nonlinear and interaction mechanisms of resource and environmental carrying capacity through explainable machine learning
Authors: Qianrong Zhang, Yongfeng Zhang, Hongzhen Yu, Feilong Qing, Yao Wang
Existing studies on resource and environmental carrying capacity (RECC) have primarily focused on comprehensive evaluation and linear identification. But the quantification of driving effect on RECC have not been fully explored, especially the interaction and nonlinear effects. Therefore, this paper constructs an explainable machine learning framework, to comprehensively assess the RECC index of 31 provincial regions in China and to reveal nonlinear and interaction mechanisms of influence factors. Firstly, the XGBoost model is utilized to surrogate the evaluation results, which demonstrates outstanding predictive performance (R2 = 0.95, RMSE = 0.08) and stability. The results shows that the average RECC index in China dropping from 1.18 to 0.39, marking a transition from a high-risk state to a safe and sustainable state. Then, the SHAP model quantifies the nonlinear and threshold effects of key influence factors. The results indicate that the total emissions of pollutants in wastewater (X2) and industrial sulfur dioxide emissions (X3) are the two most critical factors, with a cumulative contribution rate of 49%. 50000 tons is a threshold for X2, beyond which the RECC index significantly increases with the increase of X2. 10 billion cubic meters is the marginal contribution of X3, with the greatest impact on RECC index. The interaction effect indicates a significant positive synergistic effect between X2 and X3, with the maximum increase in SHAP value reaching 0.1. There is a significant antagonistic effect between resource availability and environmental pressure. This study offering new directions for understanding the underlying mechanisms of complex environmental systems.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0360548. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptBackground Nutrition plays a crucial role in oral health, influencing the risk of caries, periodontal disease, erosion, and oral cancers. Dentists are key providers of dietary guidance, but require adequate knowledge to do this effectively. This study compared the impact of multimedia versus audio-b…
Abstract & author credits for Multimedia versus audio-based education for improving dentists’ nutrition-related knowledge and behavior: A randomized comparative study
Authors: Mehdi Farhadi, Afsaneh Pakdaman, Mahdia Gholami
Background Nutrition plays a crucial role in oral health, influencing the risk of caries, periodontal disease, erosion, and oral cancers. Dentists are key providers of dietary guidance, but require adequate knowledge to do this effectively. This study compared the impact of multimedia versus audio-based educational interventions on the knowledge and self-reported behavior of general dentists in Tehran regarding nutrition and oral health. Methods In this randomized controlled trial, 166 general dentists in Tehran were recruited in 2023 through professional online platforms and randomly allocated to either a multimedia-based or an audio-based educational intervention. Knowledge (11 items) and behavior (9 items) regarding the impact of nutrition on periodontal health, dental caries, oral cancer, and erosion were assessed using a validated questionnaire. The educational intervention was delivered over a one-month period. Within-group changes were assessed using paired t-tests, between-group differences using repeated-measures ANOVA, and the effect of demographic variables on post-intervention scores using ANCOVA, with baseline values as covariates (α = 0.05). Results Of the participants, 53.6% were women, and 37.9% worked in private practice. Both groups demonstrated significant improvements in knowledge and behavior scores following the intervention (p < 0.001), with greater gains observed in the multimedia group. Analysis of covariance indicated that baseline knowledge and behavior were not significantly associated with age, gender, dental school, years of professional experience, or practice setting. Conclusion Both multimedia- and audio-based educational interventions effectively improved dentists’ knowledge and self-reported behaviors related to nutrition and oral health. Therefore, given dentists’ busy work schedules, the use of these educational approaches may enhance their capacity to provide evidence-based counseling in the field of nutrition and oral health.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0360426. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptObjective To evaluate the associations of peripheral perfusion index (PI) and end-tidal carbon dioxide (PETCO2), individually and in combination, with sustained return of spontaneous circulation (ROSC) in adults with in-hospital cardiac arrest, and to assess their predictive performance. Methods Thi…
Abstract & author credits for Peripheral perfusion index combined with end-tidal carbon dioxide in predicting sustained return of spontaneous circulation in adults with in-hospital cardiac arrest: A prospective observational study
Authors: Hong Zhong, Xianjuan Gou, Nana Xu, Linfei Li, Xiaoling Du, Ya Gong, Zhi Kou, Manhong Zhou
Objective To evaluate the associations of peripheral perfusion index (PI) and end-tidal carbon dioxide (PETCO2), individually and in combination, with sustained return of spontaneous circulation (ROSC) in adults with in-hospital cardiac arrest, and to assess their predictive performance. Methods This prospective observational study included 125 adults with in-hospital cardiac arrest, of whom 62 achieved sustained ROSC and 63 did not. Measurements obtained after ROSC or termination of resuscitation were excluded. Changes in PI and PETCO2 during resuscitation were analyzed using linear mixed-effects models. Event-average PI and PETCO2 were evaluated for their ability to predict sustained ROSC using receiver operating characteristic (ROC) analysis. The combined model was internally validated using 2,000 bootstrap resamples. Results The median time to ROSC was 11 min (IQR, 5–20). Significant group-by-time interactions were observed for both PI and PETCO2 (both P < 0.001). Event-average PI was higher in the ROSC group than in the non-ROSC group [0.62% (IQR, 0.42–0.90) vs. 0.37% (0.31–0.52)], as was event-average PETCO2 [15.5 mmHg (12.2–17.8) vs. 12.0 mmHg (10.4–13.7)] (both P < 0.001). The areas under the ROC curve (AUCs) were 0.756 (95% CI, 0.670–0.842) for PI, 0.753 (95% CI, 0.666–0.839) for PETCO2, and 0.808 (95% CI, 0.731–0.886) for their combination. The optimism-corrected AUC for the combined model was 0.800. Pairwise comparisons showed no significant differences among the AUCs. In the exploratory fully adjusted model, PETCO2 remained independently associated with sustained ROSC (adjusted OR, 1.626; 95% CI, 1.148–2.302; P = 0.006), whereas PI was not statistically significant (adjusted OR, 1.359 per 0.1% increase; 95% CI, 0.962–1.920; P = 0.082). Conclusion Higher PI and PETCO2 during resuscitation were associated with sustained ROSC. Combining PI with PETCO2 yielded numerically better discrimination than either measure alone, although the differences in AUC were not statistically significant. External validation is needed before the combined model can be applied in clinical practice.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0359869. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptNursing students experience high levels of stress that can negatively affect mental health and well-being. This study explored practical nursing students’ perceptions of the acceptability and perceived value of a brief mental fitness workshop integrated into nursing education. Two sessions from a co…
Abstract & author credits for Implementing a mental fitness workshop in a Canadian Practical Nursing Program: A qualitative descriptive study
Authors: Linda Frost, Jana Borras, Ariel Dysangco, Vimbayi Carine Makwaira
Nursing students experience high levels of stress that can negatively affect mental health and well-being. This study explored practical nursing students’ perceptions of the acceptability and perceived value of a brief mental fitness workshop integrated into nursing education. Two sessions from a condensed version of the Mastering My Mental Fitness for Nurses program were embedded within a fourth‑semester laboratory course. A qualitative descriptive design was used, drawing on reflexive thematic analysis of semi‑structured interviews (n = 5) and free‑text post‑session feedback forms (n = 49). Participants reported enhanced awareness of stress and burnout, reframed self‑care as a professional responsibility, and valued opportunities for peer connection through small‑group discussions. Students recommended earlier and more frequent integration within the curriculum and greater flexibility in delivery. While the findings reflect short‑term perceptions rather than clinical outcomes, the workshops were perceived as feasible and acceptable, with implications for mental health promotion and burnout prevention among nursing students. Future research should examine impact using validated mental health and well-being measures.
Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000760. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptBullying victimization is an important public health concern that has been linked to adverse psychological outcomes among adolescents. The study used mental health well-being data collected in the most recent Bangladesh Adolescent Health and Wellbeing Survey (2019–2020) (BAHWS). A total of 9,116 ado…
Abstract & author credits for Exploring the association between bullying and depression symptoms among adolescents in Bangladesh: Findings from nationally representative survey
Authors: Ruhul Amin, A S M Rafad Asgar
Bullying victimization is an important public health concern that has been linked to adverse psychological outcomes among adolescents. The study used mental health well-being data collected in the most recent Bangladesh Adolescent Health and Wellbeing Survey (2019–2020) (BAHWS). A total of 9,116 adolescents aged 15–19 years with complete depression data were included in the analysis. A three-level linear mixed-effects model was employed to account for the hierarchical structure of the survey, with adolescents nested within primary sampling units and districts. Additional analyses examined gender and marital status interactions, subgroup differences, and the cumulative association between multiple forms of bullying and depressive symptoms using a composite bullying measure. The findings revealed that verbal bullying (β = 1.39, p < 0.001) and cyberbullying (β = 1.15, p = 0.012) were independently associated with higher depressive symptom scores. The association between physical bullying and depressive symptoms differed significantly by gender, whereas interactions of gender with verbal and cyberbullying were not statistically significant. Exploratory subgroup analyses showed variation in the magnitude of estimated associations across ever-married females, unmarried females, and unmarried males. A graded association was observed for cumulative bullying exposure: compared with adolescents reporting no bullying exposure, those exposed to on (β = 1.25), two (β = 2.61), and three (β = 4.99) bullying types had progressively higher depressive symptom scores (all p < 0.001). Adolescent Age, Current school or college attendance and higher household wealth were associated with lower depressive symptom scores. Bullying victimization, particularly verbal bullying, cyberbullying, and exposure to multiple forms of bullying, was associated with higher depressive symptoms among Bangladeshi adolescents. These findings highlight the need for comprehensive bullying prevention strategies and accessible psychosocial support services, with particular attention to adolescents experiencing multiple forms of bullying and other vulnerable groups.
Source: PLOS Mental Health. DOI: 10.1371/journal.pmen.0000722. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptUniversal health coverage (UHC) and human development are closely linked, but whether this relationship differs across UHC domains remains unclear. We conducted a retrospective country-level longitudinal panel study using publicly available data from 2000 to 2021 to examine associations of the UHC s…
Abstract & author credits for Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study
Authors: Akira Hayasaka, Yasuhiro Nakanishi, Marika Nomura, Eri Osawa
Universal health coverage (UHC) and human development are closely linked, but whether this relationship differs across UHC domains remains unclear. We conducted a retrospective country-level longitudinal panel study using publicly available data from 2000 to 2021 to examine associations of the UHC service coverage index (SCI) and its four sub-indices with the Human Development Index (HDI) and its component indices for gross national income (GNI), education, and life expectancy. We also quantified differences in the UHC SCI, its sub-indices, and the HDI across World Bank income groups and World Health Organization regions using population-averaged generalized estimating equation models. UHC service coverage improved over time across income groups and regions, but progress was uneven. Persistent income-group disparities were observed for the overall UHC SCI, infectious diseases (IDs), service capacity and access (SCA), and the HDI, whereas disparities were smaller for reproductive, maternal, newborn, and child health (RMNCH) and less pronounced for noncommunicable diseases (NCDs). After covariate adjustment, regional differences were generally smaller than income-group disparities; RMNCH showed little regional variation, whereas SCA remained significantly lower in the African Region. Higher HDI was associated with better UHC performance, with adjusted increases of 6.8 points (95% CI 5.6–8.1) for the UHC SCI, 11.7 (95% CI 9.2–14.1) for SCA, 6.2 (95% CI 4.2–8.1) for ID, and 4.9 (95% CI 3.2–6.7) for RMNCH per 0.1-unit increase, whereas the increase for NCD was smaller (2.2 points, 95% CI 0.4–4.0). Among HDI components, the education index was not associated with NCD after adjustment, whereas the GNI and life expectancy indices were positively associated with NCD, although the estimated increases were smaller than those for most other sub-indices. These findings may help policymakers interpret the UHC SCI and its sub-indices in the context of their countries’ broader development trajectories.
Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0007328. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptThe 17th century was a period of significant climatic and social challenges in Europe, marked by the transition to the Maunder Minimum, as part of the Little Ice Age; marked by low solar activity, many negative thermal anomalies, long and harsh winters, rainy years, numerous extreme weather phenomen…
Abstract & author credits for Climatic extremes and their social implications in 17th century Transylvania: An historical climate reconstruction
Authors: Ovidiu Razvan Gaceu, Tudor Caciora, Mihai Dudaș, Ștefan Baias, Marius Stupariu, Maria Maxim, Cătălina Mărculeț
The 17th century was a period of significant climatic and social challenges in Europe, marked by the transition to the Maunder Minimum, as part of the Little Ice Age; marked by low solar activity, many negative thermal anomalies, long and harsh winters, rainy years, numerous extreme weather phenomena, famines, epidemics, etc. Taking these aspects into account, the present study aims to reconstruct, based on written historical sources, the climatic variability in the Principality of Transylvania during the 17th century. The emphasis is placed on reconstructing anomalies in temperature and precipitation regimes, as well as on analysing climate-related calamities and their impacts on society. The analysis identified a high prevalence of events associated with abnormally cold weather, with 55 winters mentioned as particularly harsh in this century; 36 of these occurred during the Maunder Minimum (between 1645 and 1700, which falls within our study period). This interval was also characterised by numerous episodes of excessive precipitation, especially during winter, and a clear imbalance between events associated with excessive humidity and those associated with drought. Variable climatic conditions caused poor harvests, famine, high prices and favoured the emergence of severe epidemics (especially plague) and social crises. The correlation of historical sources with other proxy data from natural archives confirms the exceptional character of this century and validates the reconstruction based on historical sources. They also indicate that natural factors, such as solar activity and general atmospheric circulation, could have generated the colder and wetter climatic conditions in 17th century Transylvania, particularly during the winters of the Maunder Minimum.
Source: PLOS Climate. DOI: 10.1371/journal.pclm.0000961. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptAn increasing number of households in the United States keep backyard poultry, including small hobby flocks, or purchase eggs from backyard poultry farmers. Concerns about rising grocery prices and a growing interest in homesteading have driven a surge in poultry-related sales. Some research has bee…
Abstract & author credits for A One Health approach to antibiotic resistance profiles in backyard (hobby) poultry settings in Central North Carolina
Authors: Sarah Tong, Grace Faulkner, Sarah Rhea, Annette Greer, Emily S. Bailey
An increasing number of households in the United States keep backyard poultry, including small hobby flocks, or purchase eggs from backyard poultry farmers. Concerns about rising grocery prices and a growing interest in homesteading have driven a surge in poultry-related sales. Some research has been conducted to understand the prevalence of zoonotic bacteria and antimicrobial resistance of the backyard environment; however, with the expansion of backyard hobby flocks and increasing availability in chicken breeds, more information is needed about these interactions at the human-animal interface. This study aimed to identify the presence of three common bacterial species (Salmonella spp., E. coli, and Campylobacter spp.), and describe their antimicrobial resistance (AMR) profiles, among samples taken from backyard hobby poultry owners and their flocks. During January−June 2024, a total of 99 samples were collected, including 17 human nasopharyngeal swabs, 15 poultry fecal matter swabs, 12 poultry water bowl swabs, 14 soil samples, 10 poultry bedding samples, and 31 other environmental swabs, from across 15 participating farms. Analysis of resistance by Kirby-Bauer disc diffusion showed that 40% (40/99) tested positive for E. coli and 46% (46/99) tested positive for Campylobacter, with 32.5% (13/40) of E.coli having TEM and 91.3% (42/46) of Campylobacter strains exhibiting resistance to erythromycin. Antimicrobial resistance in backyard hobby poultry settings could contribute to the spread of resistant strains – and harder-to-treat infections - in poultry and humans. Future studies, including additional participants and serial environmental sampling, could help inform backyard hobby poultry-related public health interventions like enhanced husbandry practices and biosecurity.
Source: PLOS Water. DOI: 10.1371/journal.pwat.0000565. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptPeople with pre-existing mental health disorders (PMHD) often have lower cancer screening uptake and later-stage diagnoses. It remains unclear whether these disparities persist within highly accessible universal healthcare systems without strict gatekeeping. We simultaneously investigated the associ…
Abstract & author credits for Disparities in screening participation and stage at diagnosis for breast and bowel cancers among individuals with pre-existing mental health disorders: A population-based study
Authors: Yueh-Hsin Wang, Ajay Aggarwal, Elizabeth A. Davies
People with pre-existing mental health disorders (PMHD) often have lower cancer screening uptake and later-stage diagnoses. It remains unclear whether these disparities persist within highly accessible universal healthcare systems without strict gatekeeping. We simultaneously investigated the associations between PMHD and both screening participation and stage at diagnosis of breast and bowel cancers within the Taiwan health service. Using nationwide National Health Insurance and Cancer Registry data covering over 99% of the population, we compared outcomes between individuals with and without PMHD. Propensity score matching was applied for the screening cohort. Adjusted odds ratios were estimated using logistic regression, with subgroup analyses for severe PMHD. Overall, PMHD was associated with higher screening participation (adjusted odds ratios [aOR]: breast = 1.04, bowel = 1.12) and reduced odds of metastatic disease at diagnosis (breast = 0.72, bowel = 0.93), although the magnitude of these associations was modest, particularly for bowel cancer. Conversely, individuals with severe PMHD had significantly lower odds of screening (breast = 0.81, bowel = 0.88) despite high outpatient use. Furthermore, while the severe group retained reduced odds of metastatic breast cancer at diagnosis (aOR = 0.79), they showed no staging advantage for bowel cancer. While Taiwan’s highly accessible universal healthcare system may contribute to a surveillance effect benefiting the general PMHD population, significant disparities persist for individuals with severe illnesses. Targeted interventions, procedural simplifications for self-administered tests, and multidisciplinary person-centred care models, may be needed to ensure health equity.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0361617. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
Publisher abstract excerptObjective Problematic micro-drama use (PMDU) has received increasing attention as micro-dramas have become widely consumed among young adults in China. This study examined the associations between academic stress and PMDU among Chinese university students, explored which dimensions of academic stres…
Abstract & author credits for Linking academic stress to loneliness, anxiety, and depression: The association of problematic micro-drama use among Chinese university students
Authors: Haoyuan Yu, Zhibiao Yang
Objective Problematic micro-drama use (PMDU) has received increasing attention as micro-dramas have become widely consumed among young adults in China. This study examined the associations between academic stress and PMDU among Chinese university students, explored which dimensions of academic stress were uniquely associated with PMDU, and examined the associations between PMDU and loneliness, anxiety symptoms, and depressive symptoms. Methods A cross-sectional online survey was conducted among 510 Chinese university students. Participants completed measures of academic stress, PMDU, loneliness, anxiety symptoms, and depressive symptoms. Multiple linear regression analyses were conducted while controlling for gender and age. The Benjamini–Hochberg false discovery rate (FDR) procedure was applied to relevant families of multiple tests. Results Higher academic stress was associated with greater PMDU (β = .447, p < .001). Among the five dimensions of academic stress, learning effectiveness pressure remained significantly associated with PMDU after correction for multiple comparisons (β = .292, FDR-adjusted p < .001), whereas the other dimensions did not show statistically significant unique associations after correction. PMDU was positively associated with loneliness (β = .331), depressive symptoms (β = .323), and anxiety symptoms (β = .305), and all three associations remained significant after FDR correction (all FDR-adjusted p < .001). Conclusions Academic stress, particularly stress related to perceived learning effectiveness, was associated with greater problematic micro-drama use among Chinese university students. Higher PMDU was also associated with greater loneliness, depressive symptoms, and anxiety symptoms. These findings identify PMDU as a media-use behavior relevant to both academic stress and psychological well-being, although the cross-sectional design does not establish the direction of these associations.
Source: PLOS ONE. DOI: 10.1371/journal.pone.0361597. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.
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