Category: Statistics

Indian J Public Health. 2021 Apr-Jun;65(2):172-177. doi: 10.4103/ijph.IJPH_1395_20.

ABSTRACT

BACKGROUND: Disclosure of human immunodeficiency virus (HIV) status has potential benefits for both the individual and society.

OBJECTIVES: This study aimed to determine the disclosure rate and its associated factors in people living with HIV receiving care in Enugu, Nigeria.

METHODS: A cross-sectional study using mixed methods was carried out in 5 comprehensive treatment facilities in Enugu, Nigeria during March to August 2019. 300 participants for the quantitative aspect were selected using a simple random sampling method and 30 participants for the qualitative aspect were selected purposively. Interviewer administered questionnaire and focus group discussion were applied for data collection. The quantitative data was analyzed using Epi info version 7; Chi-square test and multivariable logistic regression were applied and a level of statistical significance was set at P < 0.05. The qualitative data were analyzed using thematic analysis.

RESULTS: Among 300 participants, 241 (80.3%) had voluntarily disclosed their status to someone within their social network. 228 respondents had sexual partners and 122 (52.4%) had disclosed to their sexual partners. Twenty-five (11.0%) disclosed to their partners on the day of diagnosis. Predictors of disclosure were being female, having a formal education and being 35 years or more.

CONCLUSION: This study revealed high voluntary disclosure rate to someone within the social network, but lower and delayed disclosure rate to sexual partners.

PMID:34135187 | DOI:10.4103/ijph.IJPH_1395_20

Indian J Public Health. 2021 Apr-Jun;65(2):185-189. doi: 10.4103/ijph.IJPH_1407_20.

ABSTRACT

BACKGROUND: Under programmatic settings, routine monitoring and evaluation of household consumption of iodized salt are recommended to track the reach of universal salt iodization strategy. The program needs evaluation in different settings and locations.

OBJECTIVE: The objective of this study was to assess urine-based estimation for recent iodine intake among pregnant women living in hilly terrains of two districts of northern state of India.

METHODS: A community-based cross-sectional observational study was conducted during September- December 2019 among 202 randomly selected pregnant women in two districts of Himachal Pradesh. With a predesigned schedule, data regarding sociodemographic and behavioral factors and salt consumption were collected by interview. Iodine level of salt was assessed by spot iodine testing kit and urinary iodine concentration (UIC) was measured using ammonium persulfate digestion using spectrophotometer.

RESULTS: Women had a mean age of about 26 years, and the period of gestation was of mean 163.7 days. The consumption of iodized salt (>15 ppm) at family level was found to be 83.7%, and the median UIC was 169.0 μg/L. Among assessed, 26.7% had an acceptable level of UIC, whereas 41.1% and 32.2% of women had less (<150 μg/L) and excessive (>250 μg/L) level of UIC, respectively.

CONCLUSION: Recent iodine intake among pregnant women was observed to be adequate, but efforts are to be done to assess the reasons for less and excessive UIC among women.

PMID:34135189 | DOI:10.4103/ijph.IJPH_1407_20

Indian J Public Health. 2021 Apr-Jun;65(2):103-109. doi: 10.4103/ijph.IJPH_1351_20.

ABSTRACT

BACKGROUND: Smoking is a significant risk factor for morbidity and mortality. Health education by health promotion is such a gauge to control tobacco epidemic at both national and multinational levels.

OBJECTIVES: The objectives of the study were to systematically review the literature to identify models for health behavior change and evaluate evidence for their effectiveness in smoking cessation.

METHODS: A systematic review of the literature identified four peer-reviewed studies describing two smoking cessation behavioral interventional models (transtheoretical model [TTM] and health belief model [HBM]) between 2008 and 2018. Electronic databases MEDLINE (PubMed) and Google Scholar and Trip database were carried out. There were two randomized controlled trials and two nonrandomized controlled interventional studies. There was a high degree of homogeneity of design, definition of smoking and smoking abstinence, and implementation, followed by comparison of studies. All included studies have evaluated outcome by stage of changes (component of TTM model) and therefore show the reduction of smoking rate. All studies did not have blinding of study participants, leading to a higher risk of bias in the outcome.

RESULTS: There was a statistically significant difference between TTM-based interventional group and control group in smoking cessation rate. While comparing HBM- and TTM-based behavioral counseling, there was no statistically significant difference in smoking cessation rate.

CONCLUSION: Both HBM- and TTM-based trainings were found to have positive effects on both smoking cessation and progression between the stages.

PMID:34135176 | DOI:10.4103/ijph.IJPH_1351_20

Indian J Public Health. 2021 Apr-Jun;65(2):147-151. doi: 10.4103/ijph.IJPH_1272_20.

ABSTRACT

BACKGROUND: Appropriate infant and young child feeding (IYCF) practices in the early years of life will ensure optimal growth and development of the child. However, many children are not fed in the recommended way.

OBJECTIVES: To assess the risk of malnutrition as a result of various feeding practice patterns among the children with the application of the decision tree algorithm.

METHODS: It was a community-based cross-sectional study conducted in the urban slums of Berhampur Municipal Corporation in Ganjam District, Odisha, India, from January to December 2019. Among a sample of 360 children of 6-23 months, nutritional status and feeding practices were determined. Data were analyzed using R version 3.6.1 developed by R Foundation for Statistical Computing, Vienna, Austria. The effect of IYCF practices on nutritional status was explained with the decision tree method with the use of a Chi-squared automatic interaction detection algorithm.

RESULTS: The prevalence of children with early initiation of breastfeeding (EIBF), exclusive breastfeeding (EBF), minimum meal frequency (MMF), and minimum dietary diversity (MDD) was 62.2%, 59.7%, 41.9%, and 19.4%, respectively. The prevalence of wasting, stunting, and underweight among the participants was 36.4%, 31.1%, and 35.3%, respectively. The significant factors which classified and predicted wasting were EBF, EIBF, and MDD, for stunting factors were EBF, MMF, and MDD and for underweight, significant factors were EBF, EIBF, and MDD.

CONCLUSION: With the decision tree approach, the probability of malnutrition in relation to various feeding practices patterns can be easily explained to the mothers and health workers as compared to interpreting odds ratio and strict adherence to IYCF guidelines can also be ensured.

PMID:34135183 | DOI:10.4103/ijph.IJPH_1272_20

Indian J Public Health. 2021 Apr-Jun;65(2):166-171. doi: 10.4103/ijph.IJPH_760_20.

ABSTRACT

BACKGROUND: Vitamin D deficiency is highly prevalent among the Indian population and it is found to be associated with many diseases among perimenopausal women in various hospital-based studies.

OBJECTIVES: This study aimed to find out the Vitamin D status among perimenopausal women and to assess the association of selected factors with Vitamin D status among them.

METHODS: A cross-sectional study was conducted among 184 perimenopausal women in two districts of Kerala from July 2018 to February 2019. The data were collected and blood sample was taken for determining the 25(OH) D levels after obtaining informed written consent. Descriptive and inferential statistics were done using SPSS version 22.

RESULTS: Among the 184 women, 2 (1.1%) had sufficient, 18 (9.8%) had insufficient, and 164 (89.1%) had deficient 25(OH) D levels. The mean 25(OH) D levels among the population were 15.01 ± 4.32 ng/ml (95% confidence interval 14.38-15.63), much lower than the required level of 30 ng/ml. Vitamin D level was significantly higher among women who had exposure to sunlight, were on Vitamin D supplementation, and those who had skin diseases. 25(OH) D levels were higher among residents of Ernakulam district, older age group, low socioeconomic status, mixed-diet consumers, those who attained menopause, and those had calcium supplementation. The level was low among those who regularly use sunscreen topical applications and had other comorbidities such as hypothyroidism. However, none of these factors were significantly associated with 25(OH) D levels.

CONCLUSION: The study showed that Vitamin D deficiency is highly prevalent among the study population.

PMID:34135186 | DOI:10.4103/ijph.IJPH_760_20

BMJ Open. 2021 Jun 16;11(6):e043960. doi: 10.1136/bmjopen-2020-043960.

ABSTRACT

OBJECTIVES: The main study objective was to identify challenges and barriers experienced by dermatologists and rheumatologists when engaging women of reproductive age in shared decision-making (SDM) related to treatment and management of chronic inflammatory disease (CID) before, during and after pregnancy.

DESIGN: A mixed-methods study was conducted, employing (1) semistructured interviews, (2) an online survey and (3) triangulation of findings.

PARTICIPANTS: 524 dermatologists and rheumatologists entered the study; 495 completed it; 388 met inclusion criteria for analysis. Participants were included if actively practising in Germany (GER), the UK or the USA; had a minimum 5% caseload of female patients of reproductive age with either axial spondyloarthritis, psoriasis, psoriatic arthritis or rheumatoid arthritis; and had experience prescribing biologics.

RESULTS: 48 interviews and 340 surveys were analysed. Interviews underscored dermatologists and rheumatologists’ suboptimal integration of SDM in clinical practice. In the survey, 90% (n=305) did not know about SDM models. A perceived lack of competency counselling patients on pregnancy and family planning was also identified during interviews. Among the survey sample, 44% (n=150) of specialists agreed they preferred leaving pregnancy-related discussions to obstetricians and/or gynaecologists and 57% (n=189) reported having suboptimal skills discussing contraceptive methods with patients. Another finding that emerged from interviews was the perception that all biologics are strictly contraindicated during pregnancy. Suboptimal knowledge was noted among 57% (n=95) of dermatologists and 48% (n=83) of rheumatologists surveyed in that regard, with a statistically significant difference by country among dermatologists (GER: 42% vs UK: 71% vs USA: 57%, p=0.015).

CONCLUSIONS: This study identified low levels of knowledge, skill and confidence, as well as attitudinal issues, that explain why SDM is not fully integrated in dermatology and rheumatology clinical practice. Blended-learning interventions are recommended to assist CID specialists in developing effective communication and patient engagement competencies.

PMID:34135086 | DOI:10.1136/bmjopen-2020-043960

Sci Transl Med. 2021 Jun 16;13(598):eabd8034. doi: 10.1126/scitranslmed.abd8034.

ABSTRACT

Intermittent fasting may impart metabolic benefits independent of energy balance by initiating fasting-mediated mechanisms. This randomized controlled trial examined 24-hour fasting with 150% energy intake on alternate days for 3 weeks in lean, healthy individuals (0:150; n = 12). Control groups involved a matched degree of energy restriction applied continuously without fasting (75% energy intake daily; 75:75; n = 12) or a matched pattern of fasting without net energy restriction (200% energy intake on alternate days; 0:200; n = 12). Primary outcomes were body composition, components of energy balance, and postprandial metabolism. Daily energy restriction (75:75) reduced body mass (-1.91 ± 0.99 kilograms) almost entirely due to fat loss (-1.75 ± 0.79 kilograms). Restricting energy intake via fasting (0:150) also decreased body mass (-1.60 ± 1.06 kilograms; P = 0.46 versus 75:75) but with attenuated reductions in body fat (-0.74 ± 1.32 kilograms; P = 0.01 versus 75:75), whereas fasting without energy restriction (0:200) did not significantly reduce either body mass (-0.52 ± 1.09 kilograms; P ≤ 0.04 versus 75:75 and 0:150) or fat mass (-0.12 ± 0.68 kilograms; P ≤ 0.05 versus 75:75 and 0:150). Postprandial indices of cardiometabolic health and gut hormones, along with the expression of key genes in subcutaneous adipose tissue, were not statistically different between groups (P > 0.05). Alternate-day fasting less effectively reduces body fat mass than a matched degree of daily energy restriction and without evidence of fasting-specific effects on metabolic regulation or cardiovascular health.

PMID:34135111 | DOI:10.1126/scitranslmed.abd8034

Indian J Pathol Microbiol. 2021 Jun;64(Supplement):S160-S165. doi: 10.4103/IJPM.IJPM_537_19.

ABSTRACT

BACKGROUND: Aggressive pancreatobiliary tumors often require oxaliplatin-based therapies, instead of standard gemcitabine-based therapy and biomarker studies at diagnosis to decide the appropriate therapeutic regimen. The ribonucleotide Reductase catalytic subunit M1 (RRM1) and excision repair cross-complementing gene-1 (ERCC1) are related to DNA synthesis and repair and essential in this regard. However, apart from the therapeutic benefit, their prognostic implication is controversial.

METHODS: In this retrospective study, paraffin-embedded tissue from 51 cases of pancreatic cancer and 29 cases of cholangiocarcinoma were evaluated for RRM1 and ERCC1 expression by immunohistochemical technique along with 18 control pancreatic and biliary tissues. The semiquantitatively H score was calculated based on stain distribution and stain intensities.

RESULTS: Both RRM1 and ERCC1 expression were high in tumor epithelium than in controls (RRM1: the difference was statistically significant in cholangiocarcinoma (P = 0.008); ERCC1: the difference was statistically significant both in pancreatic and cholangiocarcinoma (P < 0.05)]. However, no correlation was noted between RRM1 and ERCC1-low and high tumors with histological markers of prognosis and overall survival in these patients.

CONCLUSIONS: The present study adds further evidence against the controversy that if RRM1 and ERCC1 expression in pancreatic and biliary carcinomas have any prognostic significance apart from their proven therapeutic benefits in these tumors.

PMID:34135160 | DOI:10.4103/IJPM.IJPM_537_19

BMJ Open. 2021 Jun 16;11(6):e050541. doi: 10.1136/bmjopen-2021-050541.

ABSTRACT

INTRODUCTION: Approximately 7.2% of children in the world suffer from attention-deficit/hyperactivity disorder (ADHD). Due to the availability of the osmotic-release oral-system methylphenidate, ADHD currently has a remission rate of up to 30.72%. Nevertheless, it has been reported that patients with ADHD tend to exhibit vitamin A and vitamin D deficiency, which may aggravate the symptoms of ADHD. This study aims to determine the effect of vitamin A and vitamin D supplementation as adjunctive therapy to methylphenidate on the symptoms of ADHD.

METHODS AND ANALYSIS: This is a parallel, prospective, interventional multicentric study. Patients will be enrolled from the southern, central and northern parts of China. A target of 504 patients will be followed for 8 weeks. They will be allocated into three groups (vitamin AD, vitamin D and placebo) and administered the interventions accordingly. Data on changes in the symptoms of ADHD as well as changes in the serum concentrations of vitamin A and vitamin D will be recorded. Both responders and nonresponders based on the sociodemographic and clinical data will also be described to mitigate selection bias.

ETHICS AND DISSEMINATION: This study is performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Children’s Hospital of Chongqing Medical University, China (approval number: (2019) IRB (STUDY) number 262). The results of the trial will be reported in peer-reviewed scientific journals and academic conferences regardless of the outcomes.

TRIAL REGISTRATION NUMBER: NCT04284059.

PMID:34135055 | DOI:10.1136/bmjopen-2021-050541

BMJ Glob Health. 2021 Jun;6(6):e004451. doi: 10.1136/bmjgh-2020-004451.

ABSTRACT

BACKGROUND: Reducing adult mortality by 2030 is a key component of the United Nations Sustainable Development Goals (UNSDGs). Monitoring progress towards these goals requires timely and reliable information on deaths by age, sex and cause. To estimate baseline measures for UNSDGs, this study aimed to use several different data sources to estimate subnational measures of premature adult mortality (between 30 and 70 years) for India in 2017.

METHODS: Age-specific population and mortality data were accessed for India and its 21 larger states from the Civil Registration System and Sample Registration System for 2017, and the most recent National Family and Health Survey. Similar data on population and deaths were also procured from the Global Burden of Disease Study 2016 and the National Burden of Disease Estimates Study for 2017. Life table methods were used to estimate life expectancy and age-specific mortality at national and state level from each source. An additional set of life tables were estimated using an international two-parameter model life table system. Three indicators of premature adult mortality were derived by sex for each location and from each data source, for comparative analysis RESULTS: Marked variations in mortality estimates from different sources were noted for each state. Assuming the highest mortality level from all sources as the potentially true value, premature adult mortality was estimated to cause a national total of 2.6 million male and 1.8 million female deaths in 2017, with Bihar, Maharashtra, Tamil Nadu, Uttar Pradesh and West Bengal accounting for half of these deaths. There was marked heterogeneity in risk of premature adult mortality, ranging from 351 per 1000 in Kerala to 558 per 1000 in Chhattisgarh among men, and from 198 per 1000 in Himachal Pradesh to 409 per 1000 in Assam among women.

CONCLUSIONS: Available data and estimates for mortality measurement in India are riddled with uncertainty. While the findings from this analysis may be useful for initial subnational health policy to address UNSDGs, more reliable empirical data is required for monitoring and evaluation. For this, strengthening death registration, improving methods for cause of death ascertainment and establishment of robust mortality statistics programs are a priority.

PMID:34135070 | DOI:10.1136/bmjgh-2020-004451