Category: Nevin Manimala

PLoS One. 2023 Feb 13;18(2):e0281506. doi: 10.1371/journal.pone.0281506. eCollection 2023.

ABSTRACT

BACKGROUND: Research confirms the negative relationship between early marriage and mothers’ and children’s health outcomes. This is why studies of the changes in age at marriage are an important task from the point of view of the health status and well-being of a mother and her offspring, especially in groups represented by extremely disadvantaged social strata in India. The results of such studies may influence the future family planning policy in the country.

OBJECTIVES: This study aims to investigate the trend of age at marriage among the Scheduled Castes (SCs) women from two Indian states: Madhya Pradesh and Uttar Pradesh relative to the level of education and also to socioeconomic changes in the states. These states manifest the highest proportion of girls getting married below the age of 18 years-far above the proportion observed in entire India.

METHODS: Women from Scheduled Caste, N = 1,612, aged 25-65, born in 1950-1990 were investigated. A modern semiparametric regression approach was used. To capture the relationship between age at marriage and year of birth, categories of women’s level of education (illiterate; primary: 1st-5th standards; middle school: 6th-8th standards; high school: 9th-10th standards; higher secondary: 11th-12th standards), and categories of the profession (women working in the agricultural sector or the non-agricultural sector), flexible framework of the Generalized Additive Model (GAM) was applied.

RESULTS: A significant impact of the cohort defined by the year of birth (<0.001), and women’s education (<0.001) on age at marriage was noted, while the influence of women’s occupation was not significant (p = 0.642). Mean age at marriage differed significantly with different education level. Women who graduated from primary school married 0.631 years later on average than illiterate ones, while those who graduated from middle schools, high schools (9th-10th standards) and higher secondary schools married significantly later than illiterate ones by 1.454 years and 2.463 years, respectively. Age at marriage increased over time: from slightly above 15 years in the cohort of illiterate women born in 1950 to almost 19 years in quite well-educated women born in 1990. The average age at marriage estimated for four education levels in 1990 ranged between 16.39 years (95%CI: 15.29-17.50) in the group of illiterate women and 18.86 years (95%CI: 17.76-19.95) in women graduated from high and higher secondary schools.

CONCLUSION: The rise of age at marriage can be partly explained by the increase of females enrolled in schools, the alleviation of poverty, and the implementation of social programs for women.

PMID:36780494 | DOI:10.1371/journal.pone.0281506

PLoS One. 2023 Feb 13;18(2):e0281580. doi: 10.1371/journal.pone.0281580. eCollection 2023.

ABSTRACT

BACKGROUND: The WHO recommended 1200mg/day of fluconazole (FCZ) in the induction phase of cryptococcal meningitis (CM) in HIV prior to 2018 in regions where amphotericin-B (AMB) was unavailable. A 2-stage AMB-controlled, dose-escalation study to determine the maximum tolerated dose and the safety/efficacy of an induction-consolidation strategy of higher doses FCZ (1200mg-2000mg/day), adjusted for weight and renal function (eGFR)in adults with CM was undertaken.

METHODS: In Stage-1, three induction doses of FCZ (1200mg/day, 1600mg/day and 2000mg/day) were tested in sequential cohortsand compared with AMB in a 3:1 ratio. A particular dose was not tested in Stage 2 if there were significant predetermined safety or efficacy concerns. In Stage-2, the 1200mg dose was excluded per protocol because of increased mortality, and participants were randomised to 1600mg, 2000mg FCZ or AMB in a 1:1:1 ratio.

FINDINGS: One hundred and sixty eight participants were enrolled with 48, 50, and 48 in the AMB, 1600mg and 2000mg cohorts. The Kaplan Meier proportion for mortality (90% CI) at 10 and 24 weeks for AMB was 17% (10, 29) and 24% (15, 37), compared to 20% (12, 32) and 30% (20, 43) for 1600mg, and 33% (23, 46) and 38% (27, 51) for 2000mg/day FCZ. With the exception of a higher incidence of gastrointestinal side effects in the 2000mg cohort, both induction doses of FCZ were safe and well tolerated. There were no life-threatening changes in electrocardiogram QTc which were similar across all doses of FCZ and AMB. The median (IQR) change in log10 cryptoccal colony forming units (CFU) from week 0 to week 2 was -8(-4.1,-1.9) for AMB; -2.5(-4.0, -1.4) for 1600mg FCZ and -8 (-3.2, -1.0) for 2000mg FCZ. The proportion (90% CI) CSF CM negative at 10 weeks was 81%(71,90) for AMB; 56%(45,69) for 1600mg FCZ and 60%(49,73) for 2000mg FCZ.

INTERPRETATION: Induction phase weight and renal-adjusted doses of 1600mg and 2000mg/day FCZ for CM were safe and well tolerated except for increased GI side effects in the 2000mg/day dose, and had similar times to achieve CSF sterilization, but took significantly longer than AMB. The WHO recommended 1200mg FCZ was associated with a high mortality. While not statistically significant, mortality was numerically lower in the AMB compared to 1600mg and 2000mg FCZ These data make a case for a phase 3 study of higher doses of FZC.

PMID:36780493 | DOI:10.1371/journal.pone.0281580

PLoS One. 2023 Feb 13;18(2):e0262899. doi: 10.1371/journal.pone.0262899. eCollection 2023.

ABSTRACT

Autonomous vehicles (AVs) are entering the market, which will have a great impact on future decision making on mode choice in transportation systems. The aim of this study is to explore the determinants which influence travelers’ intentions to use AVs based on structural equation modelling (SEM). 310 valid sets of data from an online survey were collected to analyze factors which influence travelers’ intentions. Data analyses were conducted using IBM SPSS Statistics 23 and AMOS 23. The results showed that personality and preferences in relation to AVs are the main potential factors that cause travelers’ AVs use. Attitudes to modal services also affect intentions to use AVs. Personality has a significant positive effect on both attitude and preferences. The results provide exploratory empirical support for all hypotheses. The research results will help understand travelers’ choice motivation from psychological and service perspectives, and provide support for governments and enterprises to improve the management and services of autonomous vehicles.

PMID:36780491 | DOI:10.1371/journal.pone.0262899

PLoS One. 2023 Feb 13;18(2):e0281776. doi: 10.1371/journal.pone.0281776. eCollection 2023.

ABSTRACT

BACKGROUND: The prevalence and burden of obesity continues to grow worldwide. Psychological comorbidities may not only influence quality of life, but may also hinder successful weight loss. The causality between excess weight and mental health issues is still not fully understood. The aim of the study was to investigate whetherweight history parameters, (ie.age of onset) are related to psychological comorbidities.

METHOD: The data were derived from a representative telephone survey in Germany, collecting information on weight loss patterns and mental health outcomes among individuals with BMI>30kg/m2. Overall, 787 participants were examined in terms of depressive symptoms (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Questionnaire, GAD7). In addition, participants were asked about different aspects of their weight history (ie. weight loss patterns and trajectories) over the lifespan. The relationship between weight history and mental health was analyzed using multivariate statistics.

RESULTS: According to regression analyses, having had more weight loss attempts, a greater weight loss being desired and being a “weight maintainer” was associated with more symptoms of depression (p < 0.001), whereas a greater desired weight loss and being categorized as a “weight maintainer” was associated with more anxiety (p < 0.001). Moroever, the prevalence of depressive symptoms was significantly higher in male individuals who desire to lose more weight or had more weight loss attempts in the past.

CONCLUSION: Gender-specific differences were observed in terms of weight history parameters, as well as mental health outcomes. Especially for men, weight loss patterns seem to be related to depressive symptoms. Concerning the overall results, it becomes clear that screening for weight history at the beginning of a multidisciplinary weight loss program in the context of gender-specific psychological comorbidities is important. The question remains why some aspects of weight history seem to be more important than others.

PMID:36780486 | DOI:10.1371/journal.pone.0281776

PLoS One. 2023 Feb 13;18(2):e0280571. doi: 10.1371/journal.pone.0280571. eCollection 2023.

ABSTRACT

BACKGROUND: Human immunodeficiency virus is primarily transmitted through sexual contact with an infected partner and babies born to mothers infected with the virus. Partners of people living with HIV and children whose parents have HIV are at higher risk of contracting HIV unless they take preventive measures. This study aimed at identifying prevalence and determinants of HIV infection among family members of index cases on antiretroviral treatment (ART).

METHODS: A community-based cross-sectional study was conducted among 623 randomly selected family members of HIV index cases in Sodo Town from February to June 2021. A pre-tested structural questionnaire was used to collect data. Binary logistic regression was used to identify variables independently associated with the outcome variable. The adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to show the strength of association, and a P-value 0.05 was used as a cut-off point to determine the level of statistical significance of point estimate.

RESULTS: This study revealed that 31.5% (95%CI: 27.6-35.2%) of family members of index cases were HIV seropositive. In subgroup analysis, this study also revealed that 11.1% (95%CI 8.4-14.5%) of biological children and 69.6% (95%CI 63.1-75.6%) of spousal partners of index cases were HIV seropositive. Immediate ART initiation of index cases (AOR = 0.148, 95%CI: 0.067-0.325), being bedridden or ambulatory functional status at enrollment (AOR = 7.71, 95%CI: 3.5-17), and baseline CD4 level of 350 cells/ml (AOR = 8.06, 95%CI: 1.8-36) were statistically significant with the outcome variable among biological children. Among spousal partners, STI history or symptoms (AOR = 5.7, 95%CI: 1.86-17.5), early disclosure (AOR = 0.062, 95%CI: 0.024-0.159), immediate ART initiation (AOR = 0.172, 95%CI: 0.044-0.675), and duration of infection (AOR = 5.09, 95%CI: 1.8-14.4) were statistically associated with the outcome variable.

CONCLUSION: As evidenced by our data, the risk of HIV among family members of index cases is high. Interventions like immediate ART initiation, early disclosure, screening, and early treatment of STIs for minimizing HIV transmission might be given.

PMID:36780456 | DOI:10.1371/journal.pone.0280571

JMIR Res Protoc. 2023 Feb 13;12:e44308. doi: 10.2196/44308.

ABSTRACT

BACKGROUND: Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and public health care systems. The private system is well resourced, whereas the public sector, which treats more than 80% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector.

OBJECTIVE: The primary objective was to quantify the cost of health care resource utilization over a 12-month period in patients with controlled and uncontrolled T1DM in the public health care sector. In addition, we will project costs for 5, 10, and 25 years and determine if there are cost differences in managing subsets of patients who achieve glycemic control (hemoglobin A_1c [HbA_1c] <7%) and those who do not.

METHODS: The study was performed in accordance with Good Epidemiological Practice. Ethical clearance and institutional permissions were acquired. Clinical data were collected from 2 tertiary hospitals in South Africa. Patients with T1DM, who provided written informed consent, and who satisfied the inclusion criteria were enrolled in the study. Data collection included demographic and clinical characteristics, acute and chronic complications, hospital admissions, and so on. We plan to perform a cost-effectiveness analysis to quantify the costs of health care utilization in the preceding 12 months. In addition, we will estimate projected costs over the next 10 years, assuming that study participants maintain their current HbA_1c level. The cost-effectiveness analysis will be modeled using the IQVIA CORE Diabetes Model. The primary outcome measures are incremental quality-adjusted life years, incremental costs, incremental cost-effectiveness ratios, and incremental life years.

RESULTS: Ethical clearance and institutional approval were obtained (reference number 200407). Enrollment began on February 9, 2021, and was completed on August 24, 2021, with 224 participants. A database lock was performed on October 29, 2021. The statistical analysis and clinical study report were completed in January 2022.

CONCLUSIONS: At present, there are no data assessing the short- and long-term costs of managing patients with T1DM in the South African public sector. It is hoped that the findings of this study will help policy makers optimally use limited resources to reduce morbidity and mortality in people living with T1DM.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/44308.

PMID:36780227 | DOI:10.2196/44308

Elife. 2023 Feb 13;12:e79928. doi: 10.7554/eLife.79928.

ABSTRACT

Single spikes can trigger repeatable firing sequences in cortical networks. The mechanisms that support reliable propagation of activity from such small events and their functional consequences remain unclear. By constraining a recurrent network model with experimental statistics from turtle cortex, we generate reliable and temporally precise sequences from single spike triggers. We find that rare strong connections support sequence propagation, while dense weak connections modulate propagation reliability. We identify sections of sequences corresponding to divergent branches of strongly connected neurons which can be selectively gated. Applying external inputs to specific neurons in the sparse backbone of strong connections can effectively control propagation and route activity within the network. Finally, we demonstrate that concurrent sequences interact reliably, generating a highly combinatorial space of sequence activations. Our results reveal the impact of individual spikes in cortical circuits, detailing how repeatable sequences of activity can be triggered, sustained, and controlled during cortical computations.

PMID:36780217 | DOI:10.7554/eLife.79928

JMIR Res Protoc. 2023 Feb 13;12:e37801. doi: 10.2196/37801.

ABSTRACT

BACKGROUND: Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD.

OBJECTIVE: This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC.

METHODS: Individuals aged over 18 years who identify as Native American females with IDD and their caregivers (N=30 women-caregiver dyads) are eligible for the study. Participants, who are affiliated with 2 partnering sites in Arizona (1 rural and 1 urban), complete pre- and postsurveys assessing knowledge, self-efficacy, and screening expectations before and immediately after completing the program. In addition, all participants complete brief satisfaction surveys after each of the 6 educational sessions. A subsample of Native American women with an IDD (n=12), caregivers (n=12), and community health educators (n=2) who participate in the MHMC program will provide semistructured qualitative input regarding the content, delivery, and cultural relevance of the program.

RESULTS: The adaptation of the culturally responsive MHMC program was completed in August 2021. In November 2021, the project team began recruitment for feasibility and acceptability studies. Feasibility will be examined using participation metrics, and acceptability will be measured using satisfaction measures. Pre- and postmeasures in cancer screening knowledge, self-efficacy, and screening expectations will examine improvements among participants.

CONCLUSIONS: The results of feasibility and acceptability testing of MHMC will guide future implementation studies of the program.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37801.

PMID:36780214 | DOI:10.2196/37801

JMIR Res Protoc. 2023 Feb 13;12:e39058. doi: 10.2196/39058.

ABSTRACT

BACKGROUND: Excessive dietary sodium intake is an independent risk factor for hypertension and cardiovascular disease (CVD). Despite the large body of evidence concerning the effects of dietary interventions on blood pressure (BP) and CVD outcomes, trials have often reported low adherence to decreased sodium intake, likely due in part to heterogeneous BP responses. To address the challenges, recent clinical findings suggested a precise and personalized dietary approach that seeks to deliver more preventive and practical dietary advice than the “one-size-fits-all” guidelines and weighs the personal risk of developing specific diseases.

OBJECTIVE: The purpose of this pilot randomized controlled trial was to test the feasibility and preliminary efficacy of integrating the use of mobile technology and metabolomics with a low-sodium diet intervention in patients with hypertension to develop personalized low-sodium diet programs. Additionally, the study will examine the associations of urine metabolites with urinary sodium levels and BP control based on the hypothesis that targeted urine metabolites. In this report, we describe the design and protocol of the pilot trial.

METHODS: A total of 40 patients with hypertension will be randomly assigned to either a 8-week low-sodium diet group (n=20) or a standard care group (n=20). Each week, intervention participants went through individual sessions with an interventionist via videoconferencing to discuss low-sodium diet regimens, patients’ food choices, and BP tracks on mobile apps. The control group followed their usual care for hypertension management. All participants in both groups monitored diet and BP using mobile apps for 8 weeks. A 24-hour urinary sodium excretion for the estimation of dietary sodium intake, systolic, and diastolic BPs were measured at the baseline and at 8 weeks. The primary outcomes of this study include the feasibility of conducting a randomized controlled trial (RCT) by reporting recruitment, retention, and completion statistics. The preliminary effects of intervention will be tested by a generalized estimating equation model.

RESULTS: This pilot RCT study was approved by the institutional review board at the University of Texas Health San Antonio in January 2021. The first participant was enrolled in April 2021, and currently, 26 participants were enrolled. All data collection is expected to conclude by March 2023, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study.

CONCLUSIONS: The findings of this proposed study will establish a comprehensive knowledge base for future research and development of personalized dietary interventions to promote adherence to dietary strategies and self-management of chronic disease using the Precision Health approach for millions of Americans who are struggling with uncontrolled hypertension.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04764253; https://clinicaltrials.gov/ct2/show/NCT04764253.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39058.

PMID:36780210 | DOI:10.2196/39058

Clin Exp Dent Res. 2023 Feb 13. doi: 10.1002/cre2.721. Online ahead of print.

ABSTRACT

OBJECTIVE: In dental restorations, color determination is very important for achieving esthetic results. The aim of this study was to compare visual shade selection using digital methods and to assess the repeatability of the utilized intraoral scanners.

MATERIALS AND METHODS: In 31 probands, tooth color was determined on teeth 11, 13, and 16. Shade selection was performed visually by a dentist and digitally using Trios 3 and Cerec Omnicam. Three measurements were performed to determine the repeatability of intraoral scanners. Fleiss’ κ was used for statistical evaluation of the repeatability and Cohen’s κ was used for comparison of methods.

RESULTS: The visual method showed only slight agreement with Trios 3 (Cohen’s κ: 0.198) and Cerec Omnicam (Cohen’s κ: 0.115). Moderate agreement was found between Trios 3 and Cerec Omnicam (Cohen’s κ: 0.452). In terms of repeatability, Trios 3 scored higher overall than Cerec Omnicam (Fleiss’ κ: 0.612 vs. 0.474).

CONCLUSION: Intraoral scanners can facilitate the workflow in clinical practice. They are a good supplement for color determination, but should additionally be confirmed by the visual method. Clinical significance: The use of digital instruments is increasingly being preferred over conventional treatments. Therefore, it is essential to continuously improve the accuracy of intraoral scanners for color selection in order to offer an alternative to visual methods.

PMID:36780185 | DOI:10.1002/cre2.721