Category: Statistics

PLoS Negl Trop Dis. 2024 Nov 25;18(11):e0012691. doi: 10.1371/journal.pntd.0012691. Online ahead of print.

ABSTRACT

BACKGROUND: Intestinal schistosomiasis caused by Schistosoma mansoni continues to be a significant public health problem in Ethiopia. This study investigated the prevalence and intensity of S.mansoni infection, and contributing factors in Alamata district of Tigray Region, Northern Ethiopia.

METHODS: A community-based cross-sectional study was conducted and 1762 participants were enrolled from five clusters in Alamata district. A questionnaire was used to collect socio-demographic data and risk factors. Stool samples were examined using Kato-katz technique to determine the prevalence and intensity of infection. The data were analyzed using SPSS version 25. Median, inter quartile range (IQR), mean, frequency, and percentage were used to descriptively summarize data. The Wilcoxon Mann-Whitney and Kruskal-Wallis tests were used to compare the differences in mean rank of egg load between different groups. Bivariate and multivariable logistic regression models were used to investigate the association between the odds of being infected with S.mansoni and the different socio-demographic and other factors. The strength of these associations was reported using odds ratio with corresponding 95% confidence intervals, and a P-value below 5% was used to report statistical significance.

RESULTS: Out of 1762 residents included in the study 941 (53.4%) were females. The age varied from 5-80 years, with a median age of 25 years (IQR = 27), the overall prevalence of S.mansoni was 21.5% with males accounting for 26% (204/821) of the infections. The proportion of infection was higher among the age groups of 15-19 and 20-29 years at 32.7% and 33.1%, respectively. The mean egg count among the infected study participants was 146.82 eggs per gram of feces (epg) ± (243.17 SD). Factors significantly associated with increased odds of infection were living in Waja cluster (AOR:8.9; 95% CI, 3.5-23.2; P< 0.001); being in the age groups 10-14 (AOR:6.0, 95% CI: 3.1-11.7, P<0.001), 15-19 (AOR:5.8, 95% CI:2.8-12.2, P<0.001), and 20-29 (AOR:3.5, 95% CI:1.8-6.8; P<0.001) years; having direct contact with water while crossing river (AOR: 2.4, 95% CI: 1.5-3.8, P<0.001); and swimming (AOR: 1.4, 95% CI: 1.01-2.0, P = 0.035).

CONCLUSION: The study indicates a notable S.mansoni burden in the area, driven by various risk factors. To effectively address this, enhancing diagnostics, implementing targeted mass drug administration, and conducting comprehensive health education campaigns on disease transmission routes are imperative.

PMID:39585912 | DOI:10.1371/journal.pntd.0012691

PLoS One. 2024 Nov 25;19(11):e0314185. doi: 10.1371/journal.pone.0314185. eCollection 2024.

ABSTRACT

BACKGROUND: Cognitive impairment (CI) in HIV is often of multifactorial causation, and remains a prominent issue in the age of effective combination antiretroviral therapy (cART), affecting approximately 14% of people living with HIV. Despite the 2018 BHIVA directive stating the importance of commencing rehabilitation strategies in people living with HIV with CI, no types of cognitive rehabilitations or other non-pharmaceutical interventions are specifically recommended. This scoping review aimed to describe the types of and evidence relating to the non-pharmaceutical interventions which have been examined in people living with HIV with CI.

METHODS: Studies were identified from five electronic databases. Criteria for study inclusion were studies describing a non-pharmaceutical intervention published after 1st January 2000 in English, in a population of adults living with HIV with CI detected at baseline, without significant psychiatric or substance-misuse co-morbidity.

RESULTS: Fourteen studies met the criteria for inclusion, with the Frascati criteria most commonly used to define CI within participant populations. The median intervention length was 12 weeks (IQR = 6.5). Nine studies investigated interventions with some component of computerised cognitive training (CCT); other interventions included diet, exercise and goal management training. Studies most commonly examined neurocognitive outcomes, but also considered other outcomes including quality of life, depressive symptomatology, intervention acceptability and cART adherence. Eight studies observed improvement in cognition with CCT, with effects often maintained for several weeks post-intervention, however, results were not always statistically significant. Self-reported cognitive improvement and intervention acceptability was high amongst participants completing CCT.

CONCLUSIONS: There was heterogeneity across studies not only in intervention type, but in diagnostic tools used, the chosen outcome measures and cognitive batteries, making comparison difficult. Findings, however, indicate that CCT interventions may produce benefits in cognition and are acceptable to patients. Further research is required in larger samples, alongside identifying specific intervention components that improve outcomes.

PMID:39585885 | DOI:10.1371/journal.pone.0314185

PLoS One. 2024 Nov 25;19(11):e0311299. doi: 10.1371/journal.pone.0311299. eCollection 2024.

ABSTRACT

BACKGROUND: About 70% of maternal fatalities (202,000) occurred in Sub-Saharan Africa alone. ANC lowers the morbidity and death rates for mothers and perinatals. The study aimed to determine the number of antenatal care and associated factors in the rural part of Ethiopia.

METHODS: We performed secondary data analysis for the 2019 intermediate EDHS, utilizing weighted data from a total of 2896.7 pregnant women. A zero-inflated Poisson regression analysis was executed using Stata version 17.0. Using the incident rate ratio and odds ratio with a 95% confidence interval, the intensity of the link and direction were shown.

RESULT: From the weighted pregnant women, 1086(37.47%) used four or more antenatal care during the current pregnancy. About 848 (29.29%) women do not attend antenatal care during pregnancy. The highest percentage (29.65%) of antenatal care visits was observed from 25 to 29 age. In comparison to women without formal education, the frequency of prenatal visits was 1.1(IRR = 1.1, 95% CI: 1.0425, 1.175) and 1.2 (IRR = 1.2, 95% CI: 1.093, 1.308) times higher among women enrolled in primary, and secondary & above education, respectively. Orthodox followers had 13% (IRR = 0.87, 95% CI: .813, 0.935) and 31% (IRR = 0.69, 95% CI: .552, 0.870) times more prenatal care visits than Protestant and other religions’ followers, respectively. Prenatal care was substantially more common among women living in wealthy households (IRR = 1.12, 95% CI: 1.051, 1.189). In the zero-inflated model, educational status, household wealth index, region, and religion show significant association with antenatal care service utilization uptake becomes zero.

CONCLUSION: In rural Ethiopia, the rate of antenatal care service utilization has been lower than the respective current national statistics. A significant proportion of mothers who received antenatal care did not receive enough visits. Living in developing regions, following the Orthodox faith, being educated, and having a better home wealth position reduces the likelihood of skipping antenatal treatment.

PMID:39585883 | DOI:10.1371/journal.pone.0311299

JMIR Form Res. 2024 Nov 25;8:e60574. doi: 10.2196/60574.

ABSTRACT

BACKGROUND: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually.

OBJECTIVE: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic.

METHODS: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics.

RESULTS: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients’ characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client’s and assessor’s sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors’ ability to perform DMCA’s virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties.

CONCLUSIONS: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach.

PMID:39585735 | DOI:10.2196/60574

Bioinformatics. 2024 Nov 25:btae707. doi: 10.1093/bioinformatics/btae707. Online ahead of print.

ABSTRACT

SUMMARY: LEfSe is a widely used Python package and Galaxy module for metagenomic biomarker discovery and visualization, utilizing the Kruskal-Wallis test, Wilcoxon Rank-Sum test, and Linear Discriminant Analysis. R/Bioconductor provides a large collection of tools for metagenomic data analysis but has lacked an implementation of this widely-used algorithm, hindering benchmarking against other tools and incorporation into R workflows. We present the lefser package to provide comparable functionality within the R/Bioconductor ecosystem of statistical analysis tools, with improvements to the original algorithm for performance, accuracy, and reproducibility. We benchmark the performance of lefser against the original algorithm using human and mouse metagenomic datasets.

AVAILABILITY AND IMPLEMENTATION: Our software, lefser, is distributed through the Bioconductor project (https://www.bioconductor.org/packages/release/bioc/html/lefser.html), and all the source code is available in the GitHub repository https://github.com/waldronlab/lefser.

CONTACT: Institute for Implementation Science in Population Health, Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, United States. E-mail: [email protected] (S.O.).

SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

PMID:39585730 | DOI:10.1093/bioinformatics/btae707

JAMA Neurol. 2024 Nov 25. doi: 10.1001/jamaneurol.2024.4058. Online ahead of print.

ABSTRACT

IMPORTANCE: Long-term exposure to total fine particulate matter (PM2.5) is a recognized dementia risk factor, but less is known about wildfire-generated PM2.5, an increasingly common PM2.5 source.

OBJECTIVE: To assess the association between long-term wildfire and nonwildfire PM2.5 exposure and risk of incident dementia.

DESIGN, SETTING, AND PARTICIPANTS: This open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024.

EXPOSURES: Three-year rolling mean wildfire and nonwildfire PM2.5 in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques.

MAIN OUTCOME AND MEASURES: The primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM2.5 exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract-level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract-level poverty.

RESULTS: Among 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m3 increase in the 3-year mean of wildfire PM2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m3 increase in nonwildfire PM2.5 exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM2.5 exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts.

CONCLUSIONS AND RELEVANCE: In this cohort study, after adjusting for measured confounders, long-term exposure to wildfire and nonwildfire PM2.5 over a 3-year period was associated with dementia diagnoses. As the climate changes, interventions focused on reducing wildfire PM2.5 exposure may reduce dementia diagnoses and related inequities.

PMID:39585704 | DOI:10.1001/jamaneurol.2024.4058

JAMA Netw Open. 2024 Nov 4;7(11):e2446851. doi: 10.1001/jamanetworkopen.2024.46851.

ABSTRACT

IMPORTANCE: The practice of deprescribing antihypertensive medications is common among long-term care residents, yet the effect on cardiovascular outcomes is unclear.

OBJECTIVE: To compare the incidence of hospitalization for myocardial infarction (MI) or stroke among long-term care residents who are deprescribed or continue antihypertensive therapy.

DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness research study used target trial emulation with observational electronic health record data from long-term care residents aged 65 years or older admitted to US Department of Veterans Affairs community living centers between October 1, 2006, and September 30, 2019, and taking at least 1 antihypertensive medication. Analyses were conducted between August 2023 and August 2024.

EXPOSURE: A reduction in the number of antihypertensive medications or dose (by ≥30%), assessed using barcode medication administration data.

MAIN OUTCOME AND MEASURES: Incidence of MI and stroke hospitalization up to 2 years was assessed using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. A pooled logistic regression model with inverse probability of treatment weighting (IPTW) and inverse probability of censoring weighting (IPCW) was used to estimate per-protocol effects.

RESULTS: Of 13 096 long-term care residents (97.4% men; median age, 77 years [IQR, 70-84 years]) taking antihypertensive medication, 17.8% were deprescribed antihypertensive medication over a period of 12 weeks. The estimated unadjusted cumulative incidence of stroke or MI hospitalization over 2 years was similar among residents who were and were not deprescribed antihypertensives in per-protocol analyses (11.2% vs 8.8%; difference, 2.4 percentage points [95% CI, -2.3 to 7.1 percentage points]). Participant characteristics were balanced after applying IPTW and IPCW; all standardized mean differences were less than 0.05. After full adjustment for confounding and informative censoring, the per-protocol analysis results showed no association of antihypertensive deprescribing with MI or stroke hospitalization (hazard ratio, 0.93; 95% CI, 0.70-1.26).

CONCLUSIONS AND RELEVANCE: In this comparative effectiveness research study, deprescribing antihypertensive medication was not associated with risk of hospitalization for MI or stroke in long-term care residents. These findings may be informative for long-term care residents and clinicians who are considering deprescribing antihypertensive medications.

PMID:39585693 | DOI:10.1001/jamanetworkopen.2024.46851

JAMA Netw Open. 2024 Nov 4;7(11):e2447605. doi: 10.1001/jamanetworkopen.2024.47605.

ABSTRACT

IMPORTANCE: The association between psychological resilience (PR) and frailty progression in older adults is not fully understood.

OBJECTIVE: To investigate the longitudinal associations between PR and its changes (ΔPR) with frailty progression among older adults.

DESIGN, SETTING, AND PARTICIPANTS: Data were collected from a community-based prospective cohort study conducted in Shanghai from 2020 to 2023. Older adults aged 60 years and above were recruited at baseline and completed follow-up assessments. Statistical analysis was performed from May to July 2024.

EXPOSURES: PR was assessed using the 25-item Connor-Davidson resilience scale (CD-RISC). ΔPR was calculated using the difference between 3-year follow-up and baseline CD-RISC scores. Multiple key covariates were included such as demographics, health behaviors, social participation, and chronic diseases.

MAIN OUTCOMES AND MEASURES: Frailty was evaluated using the Chinese Frailty Screening Scale-10. Frailty progression was categorized into 3 groups (improvement, stability, and deterioration) by the difference assessment between 3-year follow-up and baseline.

RESULTS: A total of 4033 participants were included in the study (mean [SD] age, 71.0 [6.1] years; 2257 [56.0%] women). Over a 3-year follow-up period, 1142 participants (28.3%) experienced an improvement in frailty, 1200 (29.8%) experienced stability, and 1691 (41.9%) exhibited deterioration. After controlling for confounding variables, a significant association was found between PR and future frailty, particularly when baseline frailty scores were at least 3 vs 2 or lower (β, -0.136 [95% CI, -0.214 to -0.057] vs -0.020 [-95% CI, -0.052 to 0.012]; P for interaction < .001). A similar association was observed between PR and frailty improvement (adjusted odds ratio [OR], 1.28 [95% CI, 1.05 to 1.57]). Furthermore, ΔPR displayed a significant association with frailty, exhibiting a nonlinear association that was stronger when ΔPR was less than 0 vs when ΔPR was greater than 0 (β,-0.186 [95% CI, -0.228 to -0.145] vs -0.068 [95% CI, -0.107 to -0.029]; P for nonlinear < .001). Similarly, ΔPR was significantly associated with frailty progression, indicating both improvement (adjusted OR, 1.30 [95% CI, 1.19 to 1.42]) and deterioration (adjusted OR, 0.74 [95% CI, 0.69 to 0.80]). These associations were more pronounced among older adults with higher levels of baseline frailty.

CONCLUSIONS AND RELEVANCE: In this cohort study of community-dwelling older adults, a longitudinal association between PR and frailty progression was found. The results suggest that monitoring changes in PR can help forecast future frailty trajectories, particularly highlighting the need to support individuals facing declines in resilience. Targeted interventions that prioritize enhancing PR have potential to prevent and ameliorate frailty.

PMID:39585692 | DOI:10.1001/jamanetworkopen.2024.47605

Cogn Emot. 2024 Nov 25:1-20. doi: 10.1080/02699931.2024.2430403. Online ahead of print.

ABSTRACT

Superior recognition of positive emotional facial expressions compared to negative expressions is well established. However, it is unclear whether this superiority effect differs between non-parents and parents, for whom emotion perception (EP) is an indispensable skill. Although EP has been shown to be modulated by the neuropeptide oxytocin, a central factor in the development of parental care, very little research has addressed the relationship between EP skills, the transition to parenthood, and plasma oxytocin levels. In the present study, we assessed EP abilities with a test battery and measured plasma oxytocin in 77 non-parent and 79 parent couples and applied structural equation modelling to the data. The results showed increased happiness perception abilities in both parents and individuals with elevated oxytocin levels. Furthermore, non-parents showed superior abilities to recognise anger expressions. No significant associations were found regarding the perception of other basic emotion categories or with a general EP factor. The findings are consistent with previous research indicating that elevated oxytocin levels are associated with enhanced EP abilities. They also extend the existing literature by demonstrating that mothers and fathers, regardless of their oxytocin levels, exhibit increased EP superiority.

PMID:39585690 | DOI:10.1080/02699931.2024.2430403

JAMA Pediatr. 2024 Nov 25. doi: 10.1001/jamapediatrics.2024.4552. Online ahead of print.

ABSTRACT

IMPORTANCE: Communicating clearly about who is included in a population group is a critical element to effective dissemination and knowledge transfer. This narrative review highlights the inconsistency as it relates to communicating about individuals with intellectual disability (ID) and developmental disability (DD).

OBSERVATIONS: There is enormous variability in the use of definitions and abbreviations in the field of intellectual disability and developmental disabilities. The lack of consistency has resulted in widely varying reported rates of prevalence and has contributed to confusion around the interpretation of research and clinical findings, population statistics, and policy decisions. The reported rates of prevalence for developmental disabilities published by different US federal agencies have ranged widely from 3% to 17%. This represents a 5-fold difference. Equally confusing is the inconsistent and ambiguous adoption of initialisms. These initialisms include ID/DD, IDD, and I/DD for which it is not always clear if these initialisms reference separate and independent populations (eg, ID or DD) or populations with co-occurring conditions (eg, persons with ID and DD). This Narrative Review discusses these issues and proposed a number of recommendations that would contribute to enhanced consistency and clarity of understanding for stakeholders, administrators, practitioners, researchers, and policy makers.

CONCLUSION: Authors of scholarly works, clinical publications, policies, and position papers are encouraged to provide a clear operational definition as well as the choice of initialisms used (eg, ID/DD, IDD, I/DD, etc) when it is first used.

PMID:39585684 | DOI:10.1001/jamapediatrics.2024.4552