Category: Nevin Manimala

Epidemiology. 2023 Jan 1;34(1):38-44. doi: 10.1097/EDE.0000000000001545. Epub 2022 Sep 27.

ABSTRACT

BACKGROUND: In many research settings, the intervention implied by the average causal effect of a time-varying exposure is impractical or unrealistic, and we might instead prefer a more realistic target estimand. Instead of requiring all individuals to be always exposed versus unexposed, incremental effects quantify the impact of merely shifting each individual’s probability of being exposed.

METHODS: We demonstrate the estimation of incremental effects in the time-varying setting, using data from the Effects of Aspirin in Gestation and Reproduction trial, which assessed the effect of preconception low-dose aspirin on pregnancy outcomes. Compliance to aspirin or placebo was summarized weekly and was affected by time-varying confounders such as bleeding or nausea. We sought to estimate what the incidence of pregnancy by 26 weeks postrandomization would have been if we shifted each participant’s probability of taking aspirin or placebo each week by odds ratios (OR) between 0.30 and 3.00.

RESULTS: Under no intervention (OR = 1), the incidence of pregnancy was 77% (95% CI: 74%, 80%). Decreasing women’s probability of complying with aspirin had little estimated effect on pregnancy incidence. When we increased women’s probability of taking aspirin, estimated incidence of pregnancy increased, from 83% (95% confidence interval [CI] = 79%, 87%) for OR = 2 to 89% (95% CI = 84%, 93%) for OR=3. We observed similar results when we shifted women’s probability of complying with a placebo.

CONCLUSIONS: These results estimated that realistic interventions to increase women’s probability of taking aspirin would have yielded little to no impact on the incidence of pregnancy, relative to similar interventions on placebo.

PMID:36455245 | DOI:10.1097/EDE.0000000000001545

Epidemiology. 2023 Jan 1;34(1):8-19. doi: 10.1097/EDE.0000000000001555. Epub 2022 Sep 27.

ABSTRACT

In longitudinal studies with time-varying exposures and mediators, the mediational g-formula is an important method for the assessment of direct and indirect effects. However, current methodologies based on the mediational g-formula can deal with only one mediator. This limitation makes these methodologies inapplicable to many scenarios. Hence, we develop a novel methodology by extending the mediational g-formula to cover cases with multiple time-varying mediators. We formulate two variants of our approach that are each suited to a distinct set of assumptions and effect definitions and present nonparametric identification results of each variant. We further show how complex causal mechanisms (whose complexity derives from the presence of multiple time-varying mediators) can be untangled. We implemented a parametric method, along with a user-friendly algorithm, in R software. We illustrate our method by investigating the complex causal mechanism underlying the progression of chronic obstructive pulmonary disease. We found that the effects of lung function impairment mediated by dyspnea symptoms accounted for 14.6% of the total effect and that mediated by physical activity accounted for 11.9%. Our analyses thus illustrate the power of this approach, providing evidence for the mediating role of dyspnea and physical activity on the causal pathway from lung function impairment to health status. See video abstract at, http://links.lww.com/EDE/B988.

PMID:36455244 | DOI:10.1097/EDE.0000000000001555

PLoS One. 2022 Dec 1;17(12):e0278224. doi: 10.1371/journal.pone.0278224. eCollection 2022.

ABSTRACT

INTRODUCTION: Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance.

METHODS: We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar’s funnel plot and Egger’s test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282).

RESULTS: Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%-97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%-99.0%) and among mothers, it was 94.4% (95% CI:90.8%-97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine’s requirement for multiple injections, and poor level of awareness.

CONCLUSION: Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

PMID:36455209 | DOI:10.1371/journal.pone.0278224

JCO Clin Cancer Inform. 2022 Nov;6:e2200093. doi: 10.1200/CCI.22.00093.

ABSTRACT

PURPOSE: The aim of the present work was to investigate the role of apoptosis inhibitor BIRC6 (baculoviral IAP repeat-containing protein 6) in breast cancer (BC), focusing particularly on its involvement in the metastatic cascade.

METHODS: We analyzed BIRC6 mRNA expression levels and copy number variations in three BC databases from The Cancer Genome Atlas comparing clinical and molecular attributes. Genomic analysis was performed using the cBioPortal platform, whereas transcriptomic studies (mRNA expression levels, correlation heatmaps, survival plots, and gene ontology) were performed using USC Xena and R. Statistical significance was set at P < .05.

RESULTS: Our bioinformatic analyses showed that there was a differential expression of BIRC6 in cancer samples when compared with normal samples. Copy number variations that involve amplification and gain of BIRC6 gene were correlated with negative hormone receptor tumors, higher prognostic indexes, younger age at diagnosis, and both chemotherapy and radiotherapy administration. Transcriptomic and gene ontology analyses showed that, under conditions of high BIRC6 mRNA levels, there are differential expression patterns in apoptotic, proliferation, and metastatic pathways.

CONCLUSION: In summary, our in silico data suggest that BIRC6 plays an antiapoptotic, pro-proliferative, and apparent prometastatic role and could be a relevant molecular target for treatment of BC tumors.

PMID:36455174 | DOI:10.1200/CCI.22.00093

Altern Ther Health Med. 2022 Dec 2:AT7274. Online ahead of print.

ABSTRACT

CONTEXT: Cardiovascular diseases (CVDs caused by atherosclerosis, such as coronary heart disease and stroke, have become major causes of death and disability worldwide. Atherosclerosis is the primary pathological factor causing CVDs. Managing weight, blood pressure, and lipids is one of the tenets of chronic-disease management, including atherosclerosis.

OBJECTIVE: The study intended to investigate the effects of managing weight, blood pressure, and lipids on disease severity in patients with carotid atherosclerosis.

DESIGN: The research team designed a randomized, controlled trial.

SETTING: The study took place in the pediatric department at the First Hospital of Hebei Medical University in Shijiazhuang, Hebei Province, China.

PARTICIPANTS: Participants were 380 patients with carotid atherosclerosis who entered the hospital between March 2018 and June 2020.

INTERVENTION: Participants were randomly assigned, using the random-number-table method, to an intervention or a control group, with 190 participants in each group. Both groups received anti-atherosclerotic treatments, and the intervention group also took part in a program for combined management of weight, blood pressure, and blood lipids.

OUTCOME MEASURES: All measurements occurred at baseline and postintervention. Using a questionnaire, the study measured the changes in the two groups related to alcohol consumption, smoking, high-fat diet, high-salt diet, and lack of exercise. A physical examination provided participants’ weights, blood pressures, and lipid levels, and the Self-Care Ability Assessment Scale (ESCA) provided the changes in their self-management ability. A carotid-artery examination measured parameters related to carotid atherosclerosis, including intima-media thickness (IMT), Crouse scores, plaque-class scores, and plaque-grade scores.

RESULTS: At baseline, no statistically significant differences existed between the groups. Postintervention, the intervention group had significantly greater decreases than the control group for alcohol consumption, smoking, high-fat diet, high-salt diet, lack of exercise, weight, blood pressure, lipid levels, intima-media thickness (IMT) scores, Crouse scores, and plaque-grade scores. Postintervention, the intervention group had significantly greater increases than the control group for self-responsibility, health knowledge, self-concept, and self-care-skills scores.

CONCLUSIONS: A program for management of body weight, blood pressure, and blood lipids can effectively control the severity of carotid atherosclerosis, can prevent the disease’s progression, and can be promoted as a clinical application.

PMID:36455146

Altern Ther Health Med. 2022 Dec 2:AT7645. Online ahead of print.

ABSTRACT

CONTEXT: Patients receiving in vitro fertilization and embryo transfer (IVF-ET) treatments can be anxious and depressed and have other negative emotions. Psychological interventions might improve the clinical pregnancy rate of infertile patients. Heart rate variability (HRV) biofeedback can be an effective technique to treat anxiety and stress symptoms.

OBJECTIVE: The study intended to investigate the effects and clinical outcomes of HRV biofeedback for women undergoing in vitro fertilization-embryo transfer (IVF-ET) for the first time.

DESIGN: The research team performed a prospective randomized controlled study.

SETTING: The study took place at the Reproduction Center of the First Affiliated Hospital of Hebei Medical University in Shijiazhuang, Hebei, China.

PARTICIPANTS: Participants were 60 women who received IVF-ET for the first time at the hospital between January 2015 and December 2017.

INTERVENTION: Participants were randomly divided into the intervention group (n = 30), who received HRV biofeedback, and the control group, who received routine education (n = 30).

OUTCOME MEASURES: At baseline and postintervention, the research team analyzed outcomes using: (1) the scores from a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS); (2) HRV indexes, including the standard deviation of normal to normal (SDNN), root mean square of successive differences (RMSSD), percentage of successive R-R intervals that differ by more than 50 milliseconds (PNN50), total power (TP), low frequency (LF), high frequency (HF), and rate of LF and HF (LF/HF); and (3) pregnancy rates.

RESULTS: The control group’s SAS scores were significantly higher postintervention, at 48.63 ± 4.75, than those of the intervention group, at 39.23 ± 7.60 (P = .000). The control group’s SDS scores, at 53.07 ± 3.89, were also significantly higher postintervention than those of the intervention group, at 41.40 ± 9.60 (P = .000). For the intervention group, between baseline and postintervention four of the HRV indexes significantly increased: (1) SDNN-from 53.67 ± 9.03 to 79.57 ± 20.48 (p=0.000), (2) RMSSD-from 54.97 ± 13.94 to. 83.74 ± 34.40 (P = .000), (5) PNN50-15.04 ± 6.06 to 22.92 ± 9.90 (P = .001) and (4) TP-from 851.32 ± 486.47 to 1579.59 ± 746.86 (P = .000). The clinical pregnancy rate in the intervention group was higher than that in the control group but the difference wasn’t statistically significant, at 60.00% and 46.67%, respectively (P = .438).

CONCLUSIONS: HRV biofeedback treatment significantly increased four HRV indexes and decreased the anxiety and depression of women undergoing IVF-ET for the first time, showing a potential clinical application.

PMID:36455143

Am J Audiol. 2022 Dec 1:1-9. doi: 10.1044/2022_AJA-22-00055. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the stress, quality of life, and access to hearing health services experienced by adults and children who use hearing aid and/or cochlear implant and their families during the COVID-19 pandemic.

METHOD: Perceived Stress Scale, Personal Wellbeing Index, and World Health Organization Quality of Life questionnaires were applied online to 30 adults with hearing loss and parents of 61 children with hearing loss. Also, a survey was conducted to acquire more about the demographics of people who use cochlear implants and conventional hearing aids, as well as the difficulties they encountered during the COVID-19 period.

RESULTS: Although child user families experienced more problems than adults during the COVID-19 period, the stress levels of child user families were higher than that of adult user families (p = .05). Even though there was no statistically significant difference, the families of pediatric users had lower quality of life than adult users.

CONCLUSIONS: The stress/anxiety problems that arise as a result of this are coming to the forefront of both patients and their relatives. The findings indicate that creative strategies should be developed to give individuals with hearing loss efficient access to hearing health services.

PMID:36455137 | DOI:10.1044/2022_AJA-22-00055

ACS Appl Mater Interfaces. 2022 Dec 1. doi: 10.1021/acsami.2c17962. Online ahead of print.

ABSTRACT

Since its discovery, atomic force microscopy (AFM) has become widely used for surface characterization, evolving from a tool for probing surface topography to a versatile method for characterizing mechanical, electrical, chemical, magnetic, and electro-optical properties of surfaces at the nanoscale. Developments of several AFM-based techniques have enabled even subsurface imaging, which is routinely being carried out at the qualitative level of feature detection for localized subsurface inhomogeneities. We surmise, however, that a quantitative three-dimensional (3D) subsurface characterization can emerge from the AFM mechanical response of flat buried interfaces, and present here a methodology for determining the depth of a film and its mechanical properties. Using load-dependent contact resonance atomic force microscopy (CR-AFM) and accurate modeling of the contact between the AFM tip and a layered sample, we determine the relationship between the measured resonance frequency of the AFM probe and the contact stiffness. Our subsequent statistical analysis reveals an intrinsic and sample-specific interdependence between the depth and modulus sensitivities of CR-AFM. This interdependence prevents the simultaneous accurate determination of both depth and modulus from measurements on a single-layered sample. If the elastic moduli of the sample components are predetermined from separate investigations of bulk samples (or otherwise known), then this methodology accurately yields the location of the interface between the layers of the sample; as such, it can serve as a nondestructive and robust technique for probing layer thickness, subsurface features, and elastic properties of materials used in semiconductor electronics, additive manufacturing, or biomaterials.

PMID:36455132 | DOI:10.1021/acsami.2c17962

Diabetes Care. 2022 Dec 1;45(12):3091-3100. doi: 10.2337/dc22-0835.

ABSTRACT

BACKGROUND: Optimal length of biliopancreatic (BP) and Roux limb in Roux-en-Y gastric bypass (RYGB) for improved glycemic control are not known.

PURPOSE: To investigate how the lengths of the BP and Roux limbs in RYGB differentially affect postoperative glycemic outcomes in patients with type 2 diabetes.

DATA SOURCES: We conducted a systematic literature search using the PubMed, Embase, and the Cochrane Library databases.

STUDY SELECTION: We included studies that reported glycemic outcomes after RYGB and lengths of the BP and Roux limbs.

DATA EXTRACTION: A total of 28 articles were included for data extraction. Glycemic outcomes after RYGB were assessed on the basis of two definitions: remission and improvement.

DATA SYNTHESIS: We categorized the included studies into four groups according to the BP and Roux limb lengths. The type 2 diabetes remission/improvement rates were as follows: long BP-long Roux group 0.80 (95% CI 0.70-0.90)/0.81 (0.73-0.89), long BP-short Roux group 0.76 (0.66-0.87)/0.82 (0.75-0.89), short BP-long Roux group 0.57 (0.36-0.78)/0.64 (0.53-0.75), and short BP-short Roux group 0.62 (0.43-0.80)/0.53 (0.45-0.61). Meta-regression analysis also showed that a longer BP limb resulted in higher postoperative type 2 diabetes remission and improvement rates, whereas a longer Roux limb did not. There was no significant difference or heterogeneity in baseline characteristics, including diabetes-related variables, among the four groups.

LIMITATIONS: Not all included studies were randomized controlled trials.

CONCLUSIONS: Longer BP limb length led to higher rates of type 2 diabetes remission and improvement by 1 year after RYGB in comparisons with the longer Roux limb length.

PMID:36455123 | DOI:10.2337/dc22-0835

Diabetes Care. 2022 Dec 1;45(12):e188-e189. doi: 10.2337/dci22-0038.

NO ABSTRACT

PMID:36455121 | DOI:10.2337/dci22-0038