Category: Nevin Manimala

PLoS Med. 2023 Feb 6;20(2):e1004186. doi: 10.1371/journal.pmed.1004186. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal nutrition is crucial during the critical period of the first 1,000 days from conception to 2 years after birth. Prenatal and postnatal supplementation of mothers with multimicronutrient-fortified balanced energy-protein (BEP) supplements is a potential nutritional intervention. However, evidence on the long-term effects of BEP supplementation on child growth is inconsistent. We evaluated the efficacy of daily fortified BEP supplementation during pregnancy and lactation on infant growth in rural Burkina Faso.

METHODS AND FINDINGS: A 2 × 2 factorial individually randomized controlled trial (MISAME-III) was implemented in 6 health center catchment areas in Houndé district under the Hauts-Bassins region. From October 2019 to December 2020, 1,897 pregnant women aged 15 to 40 years with gestational age <21 completed weeks were enrolled. Women were randomly assigned to the prenatal intervention arms receiving either fortified BEP supplements and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control), which is the standard of care during pregnancy. The same women were concurrently randomized to receive either of the postnatal intervention, which comprised fortified BEP supplementation during the first 6 months postpartum in combination with IFA for the first 6 weeks (i.e., intervention), or the postnatal control, which comprised IFA alone for 6 weeks postpartum (i.e., control). Supplements were provided by trained village-based project workers under direct observation during daily home visits. We previously reported the effect of prenatal BEP supplementation on birth outcomes. The primary postnatal study outcome was length-for-age z-score (LAZ) at 6 months of age. Secondary outcomes were anthropometric indices of growth (weight-for length and weight-for-age z-scores, and arm and head circumferences) and nutritional status (prevalence rates of stunting, wasting, underweight, anemia, and hemoglobin concentration) at 6 months. Additionally, the longitudinal prevalence of common childhood morbidities, incidence of wasting, number of months of exclusive breastfeeding, and trajectories of anthropometric indices from birth to 12 months were evaluated. Prenatal BEP supplementation resulted in a significantly higher LAZ (0.11 standard deviation (SD), 95% confidence interval (CI) [0.01 to 0.21], p = 0.032) and lower stunting prevalence (-3.18 percentage points (pp), 95% CI [-5.86 to -0.51], p = 0.020) at 6 months of age, whereas the postnatal BEP supplementation did not have statistically significant effects on LAZ or stunting at 6 months. On the other hand, postnatal BEP supplementation did modestly improve the rate of monthly LAZ increment during the first 12 months postpartum (0.01 z-score/month, 95% CI [0.00 to 0.02], p = 0.030), whereas no differences in growth trajectories were detected between the prenatal study arms. Furthermore, except for the trend towards a lower prevalence of underweight found for the prenatal BEP intervention at 6 months (-2.74 pp, 95% CI [-5.65 to 1.17], p = 0.065), no other secondary outcome was significantly affected by the pre- or postnatal BEP supplementation.

CONCLUSIONS: This study provides evidence that the benefits obtained from prenatal BEP supplementation on size at birth are sustained during infancy in terms of linear growth. Maternal BEP supplementation during lactation may lead to a slightly better linear growth towards the second half of infancy. These findings suggest that BEP supplementation during pregnancy can contribute to the efforts to reduce the high burden of child growth faltering in low- and middle-income countries.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT03533712.

PMID:36745684 | DOI:10.1371/journal.pmed.1004186

PLoS One. 2023 Feb 6;18(2):e0281280. doi: 10.1371/journal.pone.0281280. eCollection 2023.

ABSTRACT

INTRODUCTION: Access to innovative pharmaceuticals is thought to be associated with several exogenous factors related to the local legal or financial framework of pharmaceutical reimbursement. Our aim was to describe the association between the outcome of the reimbursement procedure on innovative pharmaceutical submissions in Hungary and several potential explanatory variables related to the legal or financial framework of reimbursement procedures, such as the submission implying a need for a legal act to conclude on a positive decision; having a risk-sharing agreement (RSA) in place at the time of submission; the aim of the submission and expenditure on individual funding requests.

METHODS: Publicly available administrative announcements of the Hungarian National Health Insurance Fund Manager were used to construct the analysis dataset including all concluded procedures between 1 January 2018 and 7 June 2021, complemented with information on the overall aim of the submission (new compound or new indication). Logistic regression models were used to estimate odds ratios while adjusting for potential confounding.

RESULTS: Needing a legislative change as a proxy of involving high-level decision makers to reimburse had a lower (OR = 0.05, CI95%:0.02-0.11), whereas having an RSA had a statistically significant higher chance of a positive decision (OR = 3.49, CI95%:1.56-7.82). In contrast, neither the overall purpose of the submission (OR = 1.32, CI95%:0.65-2.69), nor the average biennial expenditure on individual funding requests exceeding 200 million HUFs (OR = 1.04, CI95%:0.92-1.19) had a statistically significant association with the decision.

CONCLUSIONS: This study quantitatively demonstrated that the need for legal acts to conclude on a positive decision decreases, whereas having an RSA for the particular product increases the likelihood of a positive reimbursement decision in Hungary. The role of other factors remain unclear. Our findings suggest that the legal requirements and RSAs play key roles in the reimbursement of innovative pharmaceuticals and can be viewed as potential areas of policy interventions in expanding access to these products, although the feasibility of such interventions need strong commitment from decision-makers, as well as implying increased autonomy to the entities involved in reimbursement procedures. Further research is needed to assess the impact of endogenous and exogenous factors in a coherent framework.

PMID:36745671 | DOI:10.1371/journal.pone.0281280

PLoS One. 2023 Feb 6;18(2):e0280454. doi: 10.1371/journal.pone.0280454. eCollection 2023.

ABSTRACT

BACKGROUND: Frontline providers mostly outside specific emergency areas deliver emergency care around the world, yet often they do not receive dedicated training in managing emergency conditions. When designed for low-resource settings, emergency care training has been shown to improve provider skills, facilitate efficient use of available resources, and reduce death and disability by ensuring timely access to life-saving care.

METHODS: The WHO/ICRC Basic Emergency Care (BEC) Course with follow up longitudinal mentorship for 6 months was implemented in rural Neno District Malawi from September 2019-April 2020. We completed a mixed-methods analysis of the course and mentorship included mentor and participant surveys and feedback, mentorship quantification, and participant examination results. Simple descriptive statistics and boxplot visuals were used to describe participant demographics and mentorship quantification with a Wilcoxon signed-rank test to evaluate pre- and post-test scores. Qualitative feedback from participants and mentors were inductively analyzed using Dedoose.

RESULTS: The median difference of BEC course examination percentage score between participants before the BEC course and immediately following the course was 18.0 (95% CI 14.0-22.0; p<0.001). Examination scores from the one-year post-test was lower but sustained above the pre-course test score with a median difference of 11.9 (95% CI 4.0-16.0; p<0.009). There were 174 mentorship activities with results suggesting that a higher number of mentorship touches and hours of mentor-mentee interactions may assist in sustained knowledge test scores. Reported strengths included course delivery approach leading to improved knowledge with mentorship enhancing skills, learning and improved confidence. Suggestions for improvement included more contextualized training and increased mentorship.

CONCLUSION: The BEC course and subsequent longitudinal mentorship were feasible and acceptable to participants and mentors in the Malawian low resource context. Follow-up longitudinal mentorship was feasible and acceptable and is likely important to cementing the course concepts for long-term retention of knowledge and skills.

PMID:36745667 | DOI:10.1371/journal.pone.0280454

PLoS One. 2023 Feb 6;18(2):e0277213. doi: 10.1371/journal.pone.0277213. eCollection 2023.

ABSTRACT

OBJECTIVE: We hypothesize that synbiotic supplementation could modulate the intestinal microbiota and subsequently, improve the condition of hypothyroid patients.

METHODS: Fifty-six adult hypothyroid patients were recruited to this double-blind, placebo-controlled, randomized clinical trial. The intervention was 10 weeks of synbiotic (500 mg of 109 CFU/g probiotics plus fructo-oligosaccharide, n = 28) compared to placebo (lactose, magnesium stearate, talc, and silicon dioxide, n = 28). Randomization and allocation to trial groups were carried out using random number sequences drawn from https://sealedenvelope.com/. Primary outcomes were serum thyroid stimulating hormone (TSH) and free thyroxine (FT4), and secondary outcomes were depression, quality of life, and blood pressure (BP). P-values< 0.05 were considered statistically significant.

RESULTS: Analysis on 51 patients who completed the trial showed that TSH and depression (p> 0.05) did not change significantly, while serum FT4 significantly increased in both groups (p = 0.03 and p = 0.02 in symbiotic and placebo respectively). A significant decrease in systolic BP occurred only in the synbiotic group (p = 0.05). Significant improvements occurred regarding different domains and areas of quality of life in the crude and adjusted analysis, including perceived mental health (p = 0.02), bodily pain (p = 0.02), general health perception (p = 0.002), and wellbeing (p = 0.002), which were significantly higher in the synbiotic group.

CONCLUSIONS: Ten-week supplementation with synbiotic had no favorable effect on depression and TSH, but it improved blood pressure and quality of life in patients with hypothyroidism. More trials are needed to support or reject these findings.

TRIAL REGISTRATION: IRCT20210926052583N1, Iranian Registry of Clinical Trials (IRCT), registered October 1st, 2021.

PMID:36745650 | DOI:10.1371/journal.pone.0277213

PLoS One. 2023 Feb 6;18(2):e0281419. doi: 10.1371/journal.pone.0281419. eCollection 2023.

ABSTRACT

A new three-parameter cubic transmuted power distribution is proposed using the cubic rank transformation. The density and hazard functions of the new distribution provide great flexibility. Some mathematical properties of the new model such as quantile function, moments, dispersion index, mean residual life, and order statistics are derived. The model parameters are estimated using five different estimation methods. A comprehensive simulation study is carried out to understand the behavior of derived estimators and choose the best estimation method. The usefulness of the proposed distribution is illustrated using a real dataset. It is concluded that the proposed distribution is better than some well-known existing distributions.

PMID:36745649 | DOI:10.1371/journal.pone.0281419

PLoS Negl Trop Dis. 2023 Feb 6;17(2):e0011117. doi: 10.1371/journal.pntd.0011117. Online ahead of print.

ABSTRACT

BACKGROUND: Snakebite envenoming is a neglected tropical disease affecting deprived populations, and its burden is underestimated in some regions where patients prefer using traditional medicine, case reporting systems are deficient, or health systems are inaccessible to at-risk populations. Thus, the development of strategies to optimize disease management is a major challenge. We propose a framework that can be used to estimate total snakebite incidence at a fine political scale.

METHODOLOGY/PRINCIPAL FINDINGS: First, we generated fine-scale snakebite risk maps based on the distribution of venomous snakes in Colombia. We then used a generalized mixed-effect model that estimates total snakebite incidence based on risk maps, poverty, and travel time to the nearest medical center. Finally, we calibrated our model with snakebite data in Colombia from 2010 to 2019 using the Markov-chain-Monte-Carlo algorithm. Our results suggest that 10.19% of total snakebite cases (532.26 yearly envenomings) are not reported and these snakebite victims and do not seek medical attention, and that populations in the Orinoco and Amazonian regions are the most at-risk and show the highest percentage of underreporting. We also found that variables such as precipitation of the driest month and mean temperature of the warmest quarter influences the suitability of environments for venomous snakes rather than absolute temperature or rainfall.

CONCLUSIONS/SIGNIFICANCE: Our framework permits snakebite underreporting to be estimated using data on snakebite incidence and surveillance, presence locations for the most medically significant venomous snake species, and openly available information on population size, poverty, climate, land cover, roads, and the locations of medical centers. Thus, our algorithm could be used in other countries to estimate total snakebite incidence and improve disease management strategies; however, this framework does not serve as a replacement for a surveillance system, which should be made a priority in countries facing similar public health challenges.

PMID:36745647 | DOI:10.1371/journal.pntd.0011117

PLoS One. 2023 Feb 6;18(2):e0275457. doi: 10.1371/journal.pone.0275457. eCollection 2023.

ABSTRACT

Vegetation land fragmentation has had numerous negative repercussions on sustainable development around the world. Urban planners are currently avidly investigating vegetation land fragmentation due to its effects on sustainable development. The literature has identified a research gap in the development of Artificial Intelligence [AI]-based models to simulate vegetation land fragmentation in urban contexts with multiple affecting elements. As a result, the primary aim of this research is to create an AI-based simulation framework to simulate vegetation land fragmentation in metropolitan settings. The main objective is to use non-linear analysis to identify the factors that contribute to vegetation land fragmentation. The proposed methodology is applied for Western Province, Sri Lanka. Accessibility growth, initial vegetation large patch size, initial vegetation land fragmentation, initial built-up land fragmentation, initial vegetation shape irregularity, initial vegetation circularity, initial building density, and initial vegetation patch association are the main variables used to frame the model among the 20 variables related to patches, corridors, matrix and other. This study created a feed-forward Artificial Neural Network [ANN] using R statistical software to analyze non-linear interactions and their magnitudes. The study likewise utilized WEKA software to create a Decision Tree [DT] modeling framework to explain the effect of variables. According to the ANN olden algorithm, accessibility growth has the maximum importance level [44] between -50 and 50, while DT reveals accessibility growth as the root of the Level of Vegetation Land Fragmentation [LVLF]. Small, irregular, and dispersed vegetation patches are especially vulnerable to fragmentation. As a result, study contributes detech and managing vegetation land fragmentation patterns in urban environments, while opening up vegetation land fragmentation research topics to AI applications.

PMID:36745645 | DOI:10.1371/journal.pone.0275457

PLoS One. 2023 Feb 6;18(2):e0281346. doi: 10.1371/journal.pone.0281346. eCollection 2023.

ABSTRACT

BACKGROUND: The gut-brain axis has been potentially proposed as a link between the intake of fermented dairy foods and depression. We carried out this meta-analysis on published cohort studies to estimate the overall depression risk of fermented dairy foods intake.

METHODS: We searched the CNKI (China National Knowledge Infrastructure) and PubMed databases for all articles within a range of published years from 2010 to 2022 on the association between fermented dairy foods intake and depression.

RESULTS: Finally, 8 studies met the inclusion criteria for this study, with 83,533 participants. Overall, there was statistical evidence of significantly decreased depression risk was found to be associated with fermented dairy foods intake (OR = 0.89, 95% CI = 0.81-0.98). In subgroup analysis, cheese and yogurt consumptions were significantly associated with decreased depression risk (OR = 0.91, 95% CI = 0.84-0.98 for cheese and OR = 0. 84, 95% CI = 0.72-0.99 for yogurt). However, we failed to find superabundant intake of fermented dairy foods intake decreased the risk of depression.

CONCLUSION: Our meta-analysis indicated that fermented dairy foods intake may have potential beneficial effect on depression via the gut-brain axis.

PMID:36745637 | DOI:10.1371/journal.pone.0281346

PLoS One. 2023 Feb 6;18(2):e0280306. doi: 10.1371/journal.pone.0280306. eCollection 2023.

ABSTRACT

Addiction is an extreme craving for and commitment to something, physically or psychologically. Currently, addiction to social media is the main emerging technology addiction, especially among the young generation. The main aim of the current study was to evaluate the status of Facebook addiction and its relation to academic performance and other correlates among university students. A cross-sectional study was conducted among 422 students from December 1-30, 2021, and Facebook addiction was examined with the Bergen Facebook Addiction Scale (BFAS). The Rosenberg Self-Esteem Scale (RSES), Hospital Anxiety and Depression Scale (HADS), and Study Habit Questionnaire (SHQ) were employed to assess self-esteem, anxiety and depression symptoms, and study habits, respectively. Systematic random sampling was used to recruit the subjects, and the data were analyzed by SPSS version 23.0. Statistics such as percentages, frequencies, mean ± SD, and mean differences were calculated. Multiple regression analysis was performed, and all the required assumptions were checked. The statistical significance was declared at a p-value < 0.05 and a 95% CI. Results revealed that, the mean age of the students was 23.62 (SD = ±1.79) and 51.6% of the participants were male. The majority of the participants were addicted to Facebook, and Facebook addiction was positively linked with factors like lower academic achievements and the symptoms of anxiety and depression. In conclusion, Facebook addiction was found to be higher among study participants, and it is negatively affecting their academic performances. Similarly, it was associated with affected mental well-being and reduced self-esteem. It is better for the legislative body of the university to put firm policies in place for promoting safe use and reducing the detrimental effects of this problem among students.

PMID:36745630 | DOI:10.1371/journal.pone.0280306

Oper Dent. 2023 Feb 6. doi: 10.2341/21-173-L. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the influence of blood and saliva contamination on the microshear bond strength (μSBS) between resin-modified glass ionomer cement (RMGIC) and resin composite (RC).

METHODS AND MATERIALS: Eighty RMGIC discs were allocated into four groups (n=20). Group 1 received universal dental adhesive application in a self-etch mode followed by a build-up with RC. Group 2 received saliva as a contaminant, Group 3 received blood as a contaminant, Group 4 received a 1:1 blood-saliva mixture as a contaminant. Specimens from Groups 2, 3, and 4 were submerged into their respective contaminants for 15 seconds and dried prior to the adhesive application, followed by the protocol for Group 1. All specimens were stored in distilled water for 24 hours. Subsequently, the bonded specimens were subjected to μSBS testing using a universal testing machine. Failure mode of the debonded RMGIC surfaces was examined using scanning electron microscopy.

RESULTS: The μSBS from groups 1-4 were 10.76 ± 3.03 MPa, 9.36 ± 2.54 MPa, 6.55 ± 1.67 MPa and 8.42 ± 2.79 MPa, respectively. Contamination by blood and blood-saliva significantly decreased the μSBS (p<0.001, p=0.029). Saliva contamination alone had no statistically significant effect on the μSBS (p=0.524). A statistically significant difference in the mode of failure was detected between the experimental groups (p=0.012).

CONCLUSION: Saliva contamination has no influence on μSBS between RMGIC and RC when it is dried thoroughly, while blood and blood-saliva contamination reduced μSBS between RMGIC and RC even when dried thoroughly.

PMID:36745507 | DOI:10.2341/21-173-L