Category: Statistics

PLoS One. 2022 Jan 24;17(1):e0263032. doi: 10.1371/journal.pone.0263032. eCollection 2022.

ABSTRACT

BACKGROUND: Undernutrition is one of the serious health problems among adolescents in India where 253 million adolescents are in the age group of 10-19 years. Since adolescents represent the next generation of adults, it is important to understand the nutritional status of adolescents. Even though several studies have been carried out in different states in India on adolescent undernutrition (stunting, wasting /underweight), there is no study or review that estimated the national pooled prevalence of adolescent undernutrition and its determinants. Therefore, this review aims to determine the pooled prevalence and determinants of undernutrition (stunting, underweight/wasting) among Indian adolescents.

METHODS: A systematic review of eligible articles will be conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A comprehensive searching of the literature will be made in Pub Med, EMBASE, SCOPUS, Google, Google Scholar, and Cochrane databases. The quality of the articles included in the review will be evaluated using the Newcastle-Ottawa Scale (NOS) for observational studies in meta-analyses. The pooled prevalence and odds ratio of the associated risk factors or determinants with their 95% confidence interval will be computed using STATA version 16 software. The existence of heterogeneity among studies will be assessed by computing p-values of Higgins’s I2 test statistics and Cochran’s Q-statistics based on chi-square with a 5% level of significance among reported prevalence. Sensitivity analysis and subgroup analysis will be conducted based on study quality to investigate the possible sources of heterogeneity. Publication bias will be assessed through visual examination of funnel plots and objectively by Egger’s regression test. This review protocol has been registered at PROSPERO (CRD42021286814).

DISCUSSION: By collecting and summarizing information on adolescent undernutrition can be a step towards a better understanding of the prevalence of nutritional status of Indian adolescents and how the associated factors influence the prevalence of undernutrition. This review will provide directions for further research and healthcare practitioners. This summarized finding at the national level will provide impetus to build nutritional strategies and proper healthcare services to fight against undernutrition among the most ignored population.

PMID:35073386 | DOI:10.1371/journal.pone.0263032

PLoS One. 2022 Jan 24;17(1):e0262997. doi: 10.1371/journal.pone.0262997. eCollection 2022.

ABSTRACT

Acute coronary syndromes (ACS) are a leading cause of deaths worldwide, yet the diagnosis and treatment of this group of diseases represent a significant challenge for clinicians. The epidemiology of ACS is extremely complex and the relationship between ACS and patient risk factors is typically non-linear and highly variable across patient lifespan. Here, we aim to uncover deeper insights into the factors that shape ACS outcomes in hospitals across four Arabian Gulf countries. Further, because anemia is one of the most observed comorbidities, we explored its role in the prognosis of most prevalent ACS in-hospital outcomes (mortality, heart failure, and bleeding) in the region. We used a robust multi-algorithm interpretable machine learning (ML) pipeline, and 20 relevant risk factors to fit predictive models to 4,044 patients presenting with ACS between 2012 and 2013. We found that in-hospital heart failure followed by anemia was the most important predictor of mortality. However, anemia was the first most important predictor for both in-hospital heart failure, and bleeding. For all in-hospital outcome, anemia had remarkably non-linear relationships with both ACS outcomes and patients’ baseline characteristics. With minimal statistical assumptions, our ML models had reasonable predictive performance (AUCs > 0.75) and substantially outperformed commonly used statistical and risk stratification methods. Moreover, our pipeline was able to elucidate ACS risk of individual patients based on their unique risk factors. Fully interpretable ML approaches are rarely used in clinical settings, particularly in the Middle East, but have the potential to improve clinicians’ prognostic efforts and guide policymakers in reducing the health and economic burdens of ACS worldwide.

PMID:35073375 | DOI:10.1371/journal.pone.0262997

PLoS One. 2022 Jan 24;17(1):e0262910. doi: 10.1371/journal.pone.0262910. eCollection 2022.

ABSTRACT

The loaded mechanical function of transtibial prostheses that result from the clinical assembly, tuning, and alignment of modular prosthetic components can directly influence an end user’s biomechanics and overall mobility. Footwear is known to affect prosthesis mechanical properties, and while the options of footwear are limited for most commercial feet due to their fixed geometry, there exists a selection of commercial prosthetic feet that can accommodate a moderate rise in heel height. These feet are particularly relevant to women prosthesis users who often desire to don footwear spanning a range of heel heights. The aim of this study was to assess the effects of adding women’s footwear (flat, trainer, 5.08 cm heel) on the mechanical properties (deformation and energy efficiency) of four models of heel-height accommodating prosthetic feet. Properties were measured through loading-unloading at simulated initial contact, midstance and terminal stance orientations with a universal materials test system, and statistically compared to a barefoot condition. Results suggest that the addition of footwear can alter the level of foot deformation under load, which may be a function of the shoe and alignment. Moreover, while each foot displayed different amounts of energy storage and return, the addition of footwear yielded similar levels of energy efficiency across foot models. Overall, prosthesis users who don shoes of varying heel heights onto adjustable prosthetic feet and their treating clinicians should be aware of the potential changes in mechanical function that could affect the user experience.

PMID:35073370 | DOI:10.1371/journal.pone.0262910

PLoS One. 2022 Jan 24;17(1):e0262900. doi: 10.1371/journal.pone.0262900. eCollection 2022.

ABSTRACT

OBJECTIVES: Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures.

SUBJECT AND METHODS: This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed.

RESULTS: We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure.

CONCLUSIONS: Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.

PMID:35073368 | DOI:10.1371/journal.pone.0262900

PLoS One. 2022 Jan 24;17(1):e0262907. doi: 10.1371/journal.pone.0262907. eCollection 2022.

ABSTRACT

INTRODUCTION: As of February 2021 COVID-19 report in 57 African countries, there were 3,761,512 confirmed cases and 98,088 deaths. Ethiopia reported the highest number of cases in East Africa with a total of 147,092 cases and 2,194 deaths. Over 1.5 billion students from 195 countries across the world separated from school as a consequence of the closure of schools related to the pandemic. This study aimed to determine the level of knowledge, attitude, prevention practices, and determinant factors regarding COVID-19 among preparatory school students in southwest Ethiopia.

METHODS: An institution-based cross-sectional study design was used for 422 samples. Each respondent was selected using simple random sampling. Data were collected using a self-administered questionnaire. The collected data were entered and analyzed using Statistical Package for social science software version 25.0. Multivariable binary logistic regression was used to identify factors that were significantly associated with the practice of COVID-19 prevention.

RESULTS: The response rate in this study was 96.2%. A higher proportion of the respondents were female (53.9%), Bench (43.6%), and protestant (47.3%). The level of good knowledge, positive attitude, and good practice were 81.8%, 70.9%, and 47.0% respectively. Using social media [AOR: 1.801, 95% CI: 1.005, 3.226], watching television [AOR: 1.884 95% CI: 1.093, 3.247], being knowledgeable [AOR: 5.173 95% CI: 2.276, 11.755], and having a positive attitude [AOR: 4.300 95% CI: 2.351, 7.868] were positively associated with COVID-19 prevention practice.

CONCLUSION: Despite the high level of knowledge and a moderate level of positive attitude, the practice of COVID-19 prevention measures was low. Using social media, watching television, being knowledgeable, and having positive attitudes towards COVID-19 increases the tendency to practice COVID-19 prevention measures. School directors and teachers should strictly monitor students for their adherence to COVID-19 prevention measures as directed by the local and national health care departments.

PMID:35073358 | DOI:10.1371/journal.pone.0262907

PLoS One. 2022 Jan 24;17(1):e0262620. doi: 10.1371/journal.pone.0262620. eCollection 2022.

ABSTRACT

Research in intertemporal decisions shows that people value future gains less than equivalent but immediate gains by a factor known as the discount rate (i.e., people want a premium for waiting to receive a reward). A robust phenomenon in intertemporal decisions is the finding that the discount rate is larger for small gains than for large gains, termed the magnitude effect. However, the psychological underpinnings of this effect are not yet fully understood. One explanation proposes that intertemporal choices are driven by comparisons of features of the present and future choice options (e.g., information on rewards). According to this explanation, the hypothesis is that the magnitude effect is stronger when the absolute difference between present and future rewards is emphasized, compared to when their relative difference is emphasized. However, this hypothesis has only been tested using one task (the two-choice paradigm) and only for gains (i.e., not losses). It’s therefore unclear whether the findings that support the hypothesis can be generalized to different methodological paradigms (e.g., preference matching) and to the domain of losses. To address this question, we conducted experiments using the preference-matching method whereby the premium amounts that people could ask for were framed in terms of either currencies (emphasizing absolute differences) or percentages (emphasizing relative differences). We thus tested the robustness of the evidence in support of the hypothesis that percent framing, relative to currency framing, attenuates the magnitude effect in the domain of gains (Studies 1, 2, and 3) and in the domain of losses (Study 1, 3, and 4). The data were heavily skewed and the assumption of equal variances was violated. Therefore, in place of parametric statistical tests, we calculated and interpreted parametric and nonparametric standardized and unstandardized effect size estimates and their confidence intervals. Overall, the results support the hypothesis.

PMID:35073359 | DOI:10.1371/journal.pone.0262620

PLoS One. 2022 Jan 24;17(1):e0262640. doi: 10.1371/journal.pone.0262640. eCollection 2022.

ABSTRACT

BACKGROUND: The SafeBoosC II, randomised clinical trial, showed that the burden of cerebral hypoxia was reduced with the combination of near infrared spectroscopy and a treatment guideline in extremely preterm infants during the first 72 hours after birth. We have previously reported that a high burden of cerebral hypoxia was associated with cerebral haemorrhage and EEG suppression towards the end of the 72-hour intervention period, regardless of allocation. In this study we describe the associations between the burden of cerebral hypoxia and the 2-year outcome.

METHODS: Cerebral oxygenation was continuously monitored from 3 to 72 hours after birth in 166 extremely preterm infants. At 2 years of age 114 of 133 surviving children participated in the follow-up program: medical examination, Bayley II or III test and the parental Ages and Stages Questionnaire. The infants were classified according to the burden of hypoxia: within the first three quartiles (n = 86, low burden) or within in the 4th quartile (n = 28, high burden). All analyses were conducted post hoc.

RESULTS: There were no statistically significant differences between the quantitative assessments of neurodevelopment in the groups of infants with the low burden of cerebral hypoxia versus the group of infants with the high burden of cerebral hypoxia. The infants in the high hypoxia burden group had a higher-though again not statistically significant-rate of cerebral palsy (OR 2.14 (0.33-13.78)) and severe developmental impairment (OR 4.74 (0.74-30.49).

CONCLUSIONS: The burden of cerebral hypoxia was not significantly associated with impaired 2-year neurodevelopmental outcome in this post-hoc analysis of a feasibility trial.

PMID:35073354 | DOI:10.1371/journal.pone.0262640

PLoS One. 2022 Jan 24;17(1):e0262143. doi: 10.1371/journal.pone.0262143. eCollection 2022.

ABSTRACT

Paint technology, namely paint preparation and application procedures, is an important aspect of painting traditions. With the expansion of archaeometric studies and in situ non-destructive analytical methods, a renewal of technological studies is being observed in rock art. In situ analyses have several limitations that are widely discussed in the literature, however. It is not yet clear whether they provide accurate information on paint technology, except under certain conditions. Here, we evaluated digital microscopic and pXRF in situ analyses for the characterisation of a large set of red and yellow paintings from the El Castillo cave, Cantabria, Spain. We have set experiments and used statistical methods to identify differences between paint components and determine factors impacting pXRF measurements. We found that the compositional heterogeneity of the paintings’ environment, especially variations in secondary deposits, was responsible for most of the differences observed between the pXRF signals recorded on the paintings. We concluded that the El Castillo cave environment is not suitable for non-destructive technological studies, but that more favourable contexts might exist. Following previous works and our own results, we advocate a combination of both in situ and laboratory invasive analyses for the study of paint composition and paint technology. Our research protocol, based on the comparison of rock paintings, their substrate, experimental paintings and Fe-normalisation of the signals can improve the reliability of pXRF results. We also propose to include more systematic characterisation of rock wall heterogeneity and the use of microscopic analyses in non-destructive approaches.

PMID:35073338 | DOI:10.1371/journal.pone.0262143

PLoS One. 2022 Jan 24;17(1):e0262545. doi: 10.1371/journal.pone.0262545. eCollection 2022.

ABSTRACT

Insight into the metabolic biosignature of tuberculosis (TB) may inform clinical care, reduce adverse effects, and facilitate metabolism-informed therapeutic development. However, studies often yield inconsistent findings regarding the metabolic profiles of TB. Herein, we conducted an untargeted metabolomics study using plasma from 63 Korean TB patients and 50 controls. Metabolic features were integrated with the data of another cohort from China (35 TB patients and 35 controls) for a global functional meta-analysis. Specifically, all features were matched to a known biological network to identify potential endogenous metabolites. Next, a pathway-level gene set enrichment analysis-based analysis was conducted for each study and the resulting p-values from the pathways of two studies were combined. The meta-analysis revealed both known metabolic alterations and novel processes. For instance, retinol metabolism and cholecalciferol metabolism, which are associated with TB risk and outcome, were altered in plasma from TB patients; proinflammatory lipid mediators were significantly enriched. Furthermore, metabolic processes linked to the innate immune responses and possible interactions between the host and the bacillus showed altered signals. In conclusion, our proof-of-concept study indicated that a pathway-level meta-analysis directly from metabolic features enables accurate interpretation of TB molecular profiles.

PMID:35073339 | DOI:10.1371/journal.pone.0262545

PLoS Negl Trop Dis. 2022 Jan 24;16(1):e0010071. doi: 10.1371/journal.pntd.0010071. Online ahead of print.

ABSTRACT

The dengue virus affects millions of people every year worldwide, causing large epidemic outbreaks that disrupt people’s lives and severely strain healthcare systems. In the absence of a reliable vaccine against dengue or an effective treatment to manage the illness in humans, most efforts to combat dengue infections have focused on preventing its vectors, mainly the Aedes aegypti mosquito, from flourishing across the world. These mosquito-control strategies need reliable disease activity surveillance systems to be deployed. Despite significant efforts to estimate dengue incidence using a variety of data sources and methods, little work has been done to understand the relative contribution of the different data sources to improved prediction. Additionally, scholarship on the topic had initially focused on prediction systems at the national- and state-levels, and much remains to be done at the finer spatial resolutions at which health policy interventions often occur. We develop a methodological framework to assess and compare dengue incidence estimates at the city level, and evaluate the performance of a collection of models on 20 different cities in Brazil. The data sources we use towards this end are weekly incidence counts from prior years (seasonal autoregressive terms), weekly-aggregated weather variables, and real-time internet search data. We find that both random forest-based models and LASSO regression-based models effectively leverage these multiple data sources to produce accurate predictions, and that while the performance between them is comparable on average, the former method produces fewer extreme outliers, and can thus be considered more robust. For real-time predictions that assume long delays (6-8 weeks) in the availability of epidemiological data, we find that real-time internet search data are the strongest predictors of dengue incidence, whereas for predictions that assume short delays (1-3 weeks), in which the error rate is halved (as measured by relative RMSE), short-term and seasonal autocorrelation are the dominant predictors. Despite the difficulties inherent to city-level prediction, our framework achieves meaningful and actionable estimates across cities with different demographic, geographic and epidemic characteristics.

PMID:35073316 | DOI:10.1371/journal.pntd.0010071