Category: Statistics

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

Oper Dent. 2023 Feb 6. doi: 10.2341/21-082-L. Online ahead of print.

ABSTRACT

This study aimed to investigate the effects of 16% carbamide peroxide (CP) on the relative translucency parameter (RTP) and color stability of thermally aged CAD-CAM glass-ceramics with glazing or polishing. Three different CAD-CAM blocks-feldspathic (VM), lithium disilicate (IPS), and zirconia-reinforced lithium silicate ceramic (VS)-were used in this study. The specimens were divided into two groups (n=10) according to surface treatments (glazing or polishing). Bleaching treatment with 16% CP was applied to the thermally aged specimens. A spectrophotometer (VITA Easyshade Advance) was used to measure the CIE L*a*b*coordinates of the specimens on white and black backgrounds, and RTP and color difference (ΔE00) values were calculated. The surface topography of the specimens and the atomic weight of the elements were analyzed with scanning electron microscopy and energy-dispersive x-ray. The data were analyzed by using the two-way ANOVA test for ΔE00 values and twoway repeated measures ANOVA test for RTP and color parameters values (α=0.05) and the Tukey post-hoc test was used for multiple comparisons of the groups. RTP values were statistically influenced by material type, bleaching, and finishing technique, and the interaction among these factors was found to be significant (p<0.05). ΔE00 values were statistically influenced by material type, finishing technique, and the interaction among these factors was also found to be significant (p<0.05). IPS presented significantly lower RTP and ΔE00 values for both glazed and polished surfaces (p<0.05). 16% CP bleaching agent caused changes in translucency of aged VM and IPS at different levels. Glazed surfaces presented higher color stability in comparison to mechanically polished surfaces for VS (p<0.05).

PMID:36745505 | DOI:10.2341/21-082-L

JMIR Ment Health. 2023 Feb 6;10:e42566. doi: 10.2196/42566.

ABSTRACT

BACKGROUND: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority.

OBJECTIVE: This study aimed to evaluate the effectiveness of a stand-alone app-delivered Acceptance and Commitment Training intervention for improving medical students’ self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version.

METHODS: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students’ identified psychological flexibility training needs.

RESULTS: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: -0.52, 95% CI -3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI -1.84 to 5.03, P=.37), cynicism (individualized: -1.26, 95% CI -4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI -2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI -0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI -0.92 to -0.04; P=.04), and reduced stress (-6.89, 95% CI -12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (-6.36, 95% CI -11.90 to -0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed.

CONCLUSIONS: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/32992.

PMID:36745486 | DOI:10.2196/42566

JAMA Netw Open. 2023 Feb 1;6(2):e2254075. doi: 10.1001/jamanetworkopen.2022.54075.

ABSTRACT

IMPORTANCE: Large-scale data on type-specific human papillomavirus (HPV) prevalence and disease burden worldwide are needed to guide cervical cancer prevention efforts. Promoting the research and application of health care big data has become a key factor in modern medical research.

OBJECTIVE: To examine the prevaccination prevalence of high-risk HPV (hrHPV) and type distribution by cervical cytology grade in Estonia.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used text mining and the linking of data from electronic health records and health care claims to examine type-specific hrHPV positivity in Estonia from 2012 to 2019. Participants were women aged at least 18 years. Statistical analysis was performed from September 2021 to August 2022.

MAIN OUTCOMES AND MEASURES: Type-specific hrHPV positivity rate by cervical cytological grade.

RESULTS: A total of 11 017 cases of cervical cytology complemented with data on hrHPV testing results between 2012 and 2019 from 66 451 women aged at least 18 years (mean [SD] age, 48.1 [21.0] years) were included. The most common hrHPV types were HPV16, 18, 31, 33, 51 and 52, which accounted for 73.8% of all hrHPV types detected. There was a marked decline in the positivity rate of hrHPV infection with increasing age, but the proportion did not vary significantly based on HPV type. Implementation of nonavalent prophylactic vaccination was estimated to reduce the number of women with high-grade cytology by 50.5% (95% CI, 47.4%-53.6%) and the number with low-grade cytology by 27.8% (95% CI, 26.3%-29.3%), giving an overall estimated reduction of 33.1% (95% CI, 31.7%-34.5%) in the number of women with precancerous cervical cytology findings.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, text mining and natural language processing techniques allowed the detection of precursors to cervical cancer based on data stored by the nationwide health system. These findings contribute to the literature on type-specific HPV distribution by cervical cytology grade and document that α-9 phylogenetic group HPV types 16, 31, 33, 52 and α-7 phylogenetic group HPV 18 are the most frequently detected in normal-to-high-grade precancerous lesions in Estonia.

PMID:36745455 | DOI:10.1001/jamanetworkopen.2022.54075

JAMA Netw Open. 2023 Feb 1;6(2):e2254765. doi: 10.1001/jamanetworkopen.2022.54765.

ABSTRACT

IMPORTANCE: Gestational diabetes (GD) affects up to 10% of pregnancies and increases lifetime risk of type 2 diabetes 10-fold; postpartum diabetes evaluation and primary care follow-up are critical in preventing and detecting type 2 diabetes. Despite clinical guidelines recommending universal follow-up, little remains known about how often individuals with GD access primary care and type 2 diabetes screening.

OBJECTIVE: To describe patterns of primary care follow-up and diabetes-related care among individuals with and without GD in the first year post partum.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a private insurance claims database to compare follow-up in the first year post partum between individuals with GD, type 2 diabetes, and no diabetes diagnosis. Participants included postpartum individuals aged 15 to 51 years who delivered between 2015 and 2018 and had continuous enrollment from 180 days before to 366 days after the delivery date. Data were analyzed September through October 2021 and reanalyzed November 2022.

MAIN OUTCOMES AND MEASURES: Primary care follow-up visits and diabetes-related care (blood glucose testing and diabetes-associated visit diagnoses) were determined by evaluation and management, Current Procedural Terminology, and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, respectively.

RESULTS: A total of 280 131 individuals were identified between 2015 and 2018 (mean age: 31 years; 95% CI, 27-34 years); 12 242 (4.4%) had preexisting type 2 diabetes and 18 432 (6.6%) had GD. A total of 50.9% (95% CI, 49.9%-52.0%) of individuals with GD had primary care follow-up, compared with 67.2% (95% CI, 66.2%-68.2%) of individuals with preexisting type 2 diabetes. A total of 36.2% (95% CI, 35.1%-37.4%) of individuals with GD had diabetes-related care compared with 56.9% (95% CI, 55.7%-58.0%) of individuals with preexisting diabetes. Only 36.0% (95% CI, 34.4%-37.6%) of individuals with GD connected with primary care received clinical guideline concordant care with blood glucose testing 12 weeks post partum.

CONCLUSIONS AND RELEVANCE: In this cohort study of postpartum individuals, individuals with GD had lower rates of primary care and diabetes-related care compared with those with preexisting type 2 diabetes, and only 36% of those with GD received guideline-recommended blood glucose testing in the first 12 weeks post partum. This illustrates a missed opportunity for early intervention in diabetes surveillance and prevention and demonstrates the need to develop a multidisciplinary approach for postpartum follow-up.

PMID:36745454 | DOI:10.1001/jamanetworkopen.2022.54765

JAMA Netw Open. 2023 Feb 1;6(2):e2254771. doi: 10.1001/jamanetworkopen.2022.54771.

ABSTRACT

IMPORTANCE: The impact of serial changes in alcohol consumption on dementia risk has rarely been investigated to date.

OBJECTIVE: To investigate the association of comprehensive patterns of changes in alcohol consumption with the incidence of all-cause dementia, Alzheimer disease (AD), and vascular dementia (VaD).

DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study. Data were obtained from the Korean National Health Insurance Service database. Adults aged 40 years and older underwent 2 health examinations in 2009 and 2011. The cohort was assessed until December 31, 2018, and statistical analysis was performed in December 2021.

EXPOSURES: Alcohol consumption level was categorized into none (0 g per day), mild (<15 g per day), moderate (15-29.9 g per day), and heavy (≥30 g per day) drinking. On the basis of changes in alcohol consumption level from 2009 to 2011, participants were categorized into the following groups: nondrinker, quitter, reducer, sustainer, and increaser.

MAIN OUTCOMES AND MEASURES: The primary outcome was newly diagnosed AD, VaD, or other dementia.

RESULTS: Among 3 933 382 participants (mean [SD] age, 55.0 [9.6] years; 2 037 948 men [51.8%]), during a mean (SD) follow-up of 6.3 (0.7) years, there were 100 282 cases of all-cause dementia, 79 982 cases of AD, and 11 085 cases of VaD. Compared with sustained nondrinking, sustained mild (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.77-0.81) and moderate (aHR, 0.83; 95% CI, 0.79-0.88) drinking were associated with a decreased risk of all-cause dementia, whereas sustained heavy drinking was associated with an increased risk of all-cause dementia (aHR, 1.08; 95% CI, 1.03-1.12). Compared with sustained levels of drinking, reducing alcohol consumption from a heavy to a moderate level (aHR, 0.92; 95% CI, 0.86-0.99) and the initiation of mild alcohol consumption (aHR, 0.93; 95% CI, 0.90-0.96) were associated with a decreased risk of all-cause dementia. Increasers and quitters exhibited an increased risk of all-cause dementia compared with sustainers. The trends in AD and VaD remained consistent.

CONCLUSIONS AND RELEVANCE: In this cohort study of a Korean population, decreased risk of dementia was associated with maintaining mild to moderate alcohol consumption, reducing alcohol consumption from a heavy to a moderate level, and the initiation of mild alcohol consumption, suggesting that the threshold of alcohol consumption for dementia risk reduction is low.

PMID:36745453 | DOI:10.1001/jamanetworkopen.2022.54771