Nevin Manimala

PLOS Digit Health. 2025 Jan 13;4(1):e0000670. doi: 10.1371/journal.pdig.0000670. eCollection 2025 Jan.

ABSTRACT

Epidemiology and Public Health have increasingly relied on structured and unstructured data, collected inside and outside of typical health systems, to study, identify, and mitigate diseases at the population level. Focusing on infectious diseases, we review the state of Digital Epidemiology at the beginning of 2020 and how it changed after the COVID-19 pandemic, in both nature and breadth. We argue that Epidemiology’s progressive use of data generated outside of clinical and public health systems creates several technical challenges, particularly in carrying specific biases that are almost impossible to correct for a priori. Using a statistical perspective, we discuss how a definition of Digital Epidemiology that emphasizes “data-type” instead of “data-source,” may be more operationally useful, by clarifying key methodological differences and gaps. Therefore, we briefly describe some of the possible biases arising from varied collection methods and sources, and offer some recommendations to better explore the potential of Digital Epidemiology, particularly on how to help reduce inequity.

PMID:39804936 | DOI:10.1371/journal.pdig.0000670

PLoS Negl Trop Dis. 2025 Jan 13;19(1):e0012783. doi: 10.1371/journal.pntd.0012783. Online ahead of print.

ABSTRACT

INTRODUCTION: Visceral leishmaniasis (VL) also known as Kala-azar is one of the neglected tropical diseases (NTD) of public health importance. Despite being a disease of a long history, the condition remains poorly studied especially in East Africa. For instance, whereas, the geographical location of the disease is known, there is a stark paucity of data on the burden, risk factors and clinical outcomes of this contribution in Northeastern Uganda. Therefore, the disease picture in these settings is incomplete. The overarching aim for this study was to describe pre-elimination prevalence, associated factors and treatment outcomes of VL in Moroto District.

METHODS: We conducted a cross-sectional study in which community cases were identified at baseline. They were followed up at Amudat Hospital Kala-azar Treatment Centre for the treatment outcomes. We used a customized data collection tool to elicit data on demographic characteristics, socio-economic and anthropometry. Data were entered on excel database and exported to Stata software for analyses. Proportions and measures of central tendency were computed. Binary associations were determined using Chi-square statistical test. In addition, variables independently associated with VL were determined via logistic regression analyses. At follow up stage, the outcomes were determined.

RESULTS: The overall prevalence of VL infection in Moroto district was 5.21% (95%CI: 3.15% – 8.48%) with varying county level prevalence at Matheniko, Tepeth and Mororo at 6.90%, 4.49% and 3.61%; respectively. The common risk factors for VL infection included lack of knowledge of habitat for Sand flies, AOR 5.33 (95%CI: 1.69-16.82). Patients with VL presented with fever, headache, abdominal pain and swelling, coughing, night sweats, diarrhea, fatigue, breathlessness, and nose bleeding. The average hospitalization for VL was 17 days. All the patients who were treated at the hospital cured.

CONCLUSION: The prevalence of VL in Moroto district was 5.21% and within elimination threshold. The high-risk factors for VL infection included lack of knowledge about the habitat for Sand flies. The average hospitalization for VL was 17 days.

PMID:39804935 | DOI:10.1371/journal.pntd.0012783

PLoS One. 2025 Jan 13;20(1):e0316445. doi: 10.1371/journal.pone.0316445. eCollection 2025.

ABSTRACT

BACKGROUND: The July effect in US teaching hospitals has been studied with conflicting results. We aimed to evaluate the effect of physician turnover in July on the clinical outcomes of patients hospitalized with cirrhosis.

METHODS: We utilized the Nationwide Inpatient Sample database (2016-2019) to identify patients hospitalized with cirrhosis and liver-related complications (variceal bleeding, hepatorenal syndrome, acute-on-chronic liver failure). We used difference-in-differences analysis to compare teaching and non-teaching hospital differences in mortality and length of stay (LOS) in May and July, and trends in outcomes in other months before and after July.

RESULTS: We included 78,371 hospitalizations in teaching and 23,518 in non-teaching hospitals in May and July. Teaching hospital admissions had overall higher complication rates and mortality compared to non-teaching hospitals. We did not find a difference in mortality between teaching and non-teaching hospitals in all cirrhotic patients (adjusted odds ratio 1.01, 95%CI [0.88-1.16]) or in those with severe complications (0.87, [0.72-1.06]). There was greater LOS in July vs. May in teaching hospitals relative to non-teaching hospitals for all patients with cirrhosis (adjusted rate ratio 1.03, 95%CI [1.02-1.05]) and for those with severe complications (1.19, [1.17-1.21]). The months after July were associated with longer LOS in teaching hospitals, with the effect gradually diminishing over the subsequent months.

CONCLUSIONS: Our study suggests trainee turnover in July did not affect mortality, but lengthened hospital stays for patients with cirrhosis, highlighting the need for effective supervision of new trainees and strategies to mitigate operational disruptions for improved clinical management.

PMID:39804918 | DOI:10.1371/journal.pone.0316445

PLoS One. 2025 Jan 13;20(1):e0317016. doi: 10.1371/journal.pone.0317016. eCollection 2025.

ABSTRACT

INTRODUCTION: The population is heterogeneous with varying levels of healthcare needs. Clustering individuals into health segments with more homogeneous healthcare needs allows for better understanding and monitoring of health profiles in the population, which can support data-driven resource allocation.

METHODS: Using the developed criteria, data from several of Singapore’s national administrative datasets were used to classify individuals into the various health segments. Cross-sectional analysis of healthcare utilization charges was conducted. Validation was done for the framework’s prognostic ability of clinically relevant outcomes measured in the following year.

RESULTS: The framework is comprised of twelve segments classed within four broad groups. The segments comprising individuals with cancer, with transitional care needs, and in the last year of their lives had the highest mean per resident healthcare charges. The segments comprising adults and seniors with complex chronic conditions and with transitional care needs had the highest percentage of individuals historically diagnosed with obesity. The framework was able to distinguish varying tiers of healthcare utilization charges and relative risk of death in the following year.

DISCUSSION: The framework was developed using a hybrid approach, with expert input and comprehensive national data that extended beyond the usual hospital patient population. The framework can be directly applied for use in program or policy design, evaluation, and cost-effectiveness analyses.

CONCLUSION: The HealthSCOPES framework was developed to segment the entire population in Singapore with similar healthcare needs.

PMID:39804885 | DOI:10.1371/journal.pone.0317016

PLoS One. 2025 Jan 13;20(1):e0311730. doi: 10.1371/journal.pone.0311730. eCollection 2025.

ABSTRACT

BACKGROUND: Maternal mortality ratio (MMR) has decreased worldwide but Pakistan is still striving towards achieving the SDG targets for maternal health. This study highlights the trends in maternal mortality levels and risk factors in Pakistan between 2007 and 2019.

METHODS: This study compares the results of secondary data analysis of the Pakistan Maternal Mortality Survey 2019 with the Pakistan Demographic and Health Survey 2007. A nested case-control study was carved to compare maternal deaths with the women who survived a pregnancy, in the same sampling clusters during the same period. Logistic regression was used to estimate odds ratios (OR) for major risk factors of maternal mortality after adjusting for the women’s age, parity, education, and wealth quintile.

RESULTS: In 2019, Pakistan’s MMR was 186 per 100,000 live births, registering a 33% decline from 2007 (rural 42% vs. urban 11%). The leading causes of maternal mortality were postpartum hemorrhage, hypertensive disease of pregnancy, postpartum infection, and post-abortion complications. Women > 35 years and those expecting their first child were more likely to die from childbirth, while those who had ever used family planning had a lower risk according to the data for both years. In 2007, a distance of > 40 kilometers to a hospital significantly increased the risk of mortality but this association was not significant in 2019. In 2019, women who died were more likely to receive antenatal care than those who survived (adjusted OR 9.3); this association was not significant in 2007.

CONCLUSION: The modest reduction in MMR can be attributed to improved access to maternal health services in rural areas with increased antenatal care and institutional deliveries. However, most maternal deaths were caused by poor accessibility to quality emergency obstetric care. Lack of family planning remains a major risk factor for high maternal mortality in Pakistan.

PMID:39804883 | DOI:10.1371/journal.pone.0311730

PLoS One. 2025 Jan 13;20(1):e0304293. doi: 10.1371/journal.pone.0304293. eCollection 2025.

ABSTRACT

BACKGROUND: It is unclear what impact iron deficiency has on fatigue in people with inflammatory bowel disease (IBD). This systematic review examined the evidence of whether iron deficiency, with or without anaemia, was associated with fatigue in IBD. Fatigue is a common symptom in patients with IBD that can be difficult to manage and treat. A greater understanding of the role and contribution of iron deficiency to fatigue may help improve the management of this condition.

METHODS: The databases searched were MEDLINE, OVID, CINAHL and Web of Science. Inclusion criteria were studies measuring iron status for iron deficiency (ID) and patient-reported outcome measures (PROMs) for fatigue in patients with IBD of any level of disease activity. Assessment of bias was conducted using the Newcastle Ottawa Scale. Studies were grouped for syntheses according to whether exposure was iron deficiency without anaemia (IDWA) or ID regardless of haemoglobin level.

RESULTS: Two hundred and eighty-five individual database results were identified and screened; 32 complete records were reviewed, from which seven studies with 1425 individuals were deemed eligible for inclusion in the results synthesis. Considerable variation in the methods and statistical analysis used to investigate the relationship between ID and fatigue prevented any quantitative synthesis. Studies varied by population disease activity levels, approaches used to define ID and PROMs used to measure fatigue. Three studies directly compared fatigue scores in IDWA to those not iron deficient, two of which showed patients with IDWA had significantly lower fatigue scores. Four studies used ID irrespective of anaemia as the exposure and reported mixed results on fatigue, with only one study reporting a higher prevalence of fatigue in the ID group.

CONCLUSIONS: There was marked heterogeneity between studies in this review. Two studies found evidence of a slight increase in fatigue levels in patients with IDWA. Though this does not explain all fatigue in patients with IBD, iron replacement should be considered to improve fatigue in iron-deficient patients.

PMID:39804874 | DOI:10.1371/journal.pone.0304293

PLoS One. 2025 Jan 13;20(1):e0317406. doi: 10.1371/journal.pone.0317406. eCollection 2025.

ABSTRACT

INTRODUCTION: Sedation ensures a child remains motionless during a procedure and decreases anxiety. Several pharmacologic regimes exist for paediatric sedation. However, often, intravenous cannulation is required, causing distress for the child. Creating a low-stress environment for children during medical procedures is crucial. Intranasal dexmedetomidine offers a promising alternative by either removing the need for intravenous cannulation or significantly reducing stress and anxiety when cannulation is necessary. We aim to investigate the safety and efficiency of sedating children with intranasal dexmedetomidine.

METHODS AND ANALYSIS: We will systematically search MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), CENTRAL, Clinicaltrials.gov, and the WHO ICTRP portal. We will include all randomized controlled trials (RCT) that investigate the use of intranasal dexmedetomidine compared to alternative sedatives for premedication or sedation of children. Two researchers will independently screen title/abstract and full-text articles for eligibility using Covidence. Our primary outcome is sedation success rate. RCTs that meet the inclusion criteria will form the unit of analysis. Data extracted from each study will be presented in table format (S2 Table). Information on parameters that describe safety and efficiency outcomes will be extracted and analysed. Outcome data will be reported as risk ratios and 95% confidence intervals (CI) for dichotomous outcomes or mean and standardized mean differences with 95% CI for continuous outcomes. The assessment of statistical heterogeneity will be examined using Chi2- and I2-statistics. PROSPERO registration number CRD42024532993.

DISCUSSION: Sedation with intranasal dexmedetomidine is not common practice in all countries, though the medicament has the potential to provide a child-friendly approach to sedation and premedication. Reviews on the area are conflicting, and new RCT studies have been published. Our systematic review aims to comprehensively assess intranasal paediatric sedation, focusing on dexmedetomidine and guiding clinicians in daily decision-making for optimal paediatric sedation.

PMID:39804873 | DOI:10.1371/journal.pone.0317406

PLoS One. 2025 Jan 13;20(1):e0316800. doi: 10.1371/journal.pone.0316800. eCollection 2025.

ABSTRACT

OBJECTIVES: Clinical breast examination (CBE) open the pathway to early detection and diagnosis of breast cancer. This study examined barriers to CBE uptake in seven sub-Saharan African (SSA) countries.

METHODS: Data from the most current Demographic and Health Surveys of Burkina Faso, Cote d’Ivoire, Ghana, and Kenya Mozambique, Senegal and Tanzania was used. A weighted sample size of 65,486 women aged 25-49 years was used to estimate the pooled prevalence of CBE. We employed a multilevel logistic regression modelling technique, with results presented in adjusted odds ratios (aOR) along with a 95% confidence interval (CI).

RESULTS: The pooled prevalence of CBE uptake in the studied SSA countries is low at 19.2% [95%CI: 18.5-19.8]. Screening uptake was significantly low among women reporting difficulty in getting permission (aOR = 0.88, 95% CI: 0.82-0.95), and distance (aOR = 0.95, 95% CI: 0.89-0.99), as well as those who reported financial constraints (aOR = 0.92, 95% CI: 0.88-0.97), as barriers to access healthcare facilities. However, surprisingly, women who faced travel-alone barriers were 1.19 times (95%CI: 1.10-1.28) more likely to utilise CBE than those who did not face this barrier.

CONCLUSIONS: We conclude that barriers such as difficulties in obtaining permission, long distances to healthcare facilities, and financial constraints significantly reduce the likelihood of women undergoing CBE. The study underscores a need to improve access to healthcare facilities. Practically, this can be achieved by expanding mobile health services and integrating CBE into primary healthcare will help overcome distance-related challenges. Additionally, targeted outreach and transportation initiatives are necessary to support women facing travel barriers.

PMID:39804868 | DOI:10.1371/journal.pone.0316800

PLoS One. 2025 Jan 13;20(1):e0317417. doi: 10.1371/journal.pone.0317417. eCollection 2025.

ABSTRACT

INTRODUCTION: Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF.

METHODS: A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman’s rank correlation, Pearson’s correlation, and multiple regression analyses.

RESULTS: Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011).

CONCLUSIONS: Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients’ communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management.

PMID:39804863 | DOI:10.1371/journal.pone.0317417

PLoS One. 2025 Jan 13;20(1):e0316833. doi: 10.1371/journal.pone.0316833. eCollection 2025.

ABSTRACT

BACKGROUND: Youth soccer players in the UK transition into the professional game at 16 years of age. Understanding the differences between youth and professional standards can help coaches and clubs to support player development during this transition.

OBJECTIVES: To (i) assess the differences in technical and possession statistics between different age groups (U16, U18, U23) and outfield positions (central defender [CD], wide defender [WD], central midfielder [CM], attacking midfielder [AM], wide midfielder [WM], striker [ST]), within an English academy soccer programme, during match-play.

METHODS: All matches were monitored using foot-mounted inertial measurements units (F-IMU; Playermaker™) to quantify the technical (touches and releases from the feet) and individual possession statistics (Time on the ball, Time on the ball per possession) from each match. Teams were instructed to play a 1-4-3-3 formation as part of their clubs playing philosophy, with positions defined per this formation. Data were analysed using a multi-variate ANOVA Two-tailed statistical significance was accepted as p ≤ 0.05 and measures of effect size were calculated using partial eta-squared (η2). Magnitude of the effect sizes were small (0.2<ES<0.6), moderate (0.6<ES<1.2), large (1.2<ES<2) and very large (≥2).

RESULTS: Trivial to small effect sizes were observed across age groups for both technical and possession-based statistics during match-play. Across all age groups and positions, CD`s had the highest number of technical actions (touches and releases), whereas ST`s & AM`s, had the highest amount of time in possession of the ball. Further, positional analysis showed ST`s and AM`s had moderate to large decreases in time on the ball per possession at the U23’s age group in comparison to the U16 and U18’s, with no technical differences observed within the same positional analysis.

CONCLUSION: Attacking players (AM & ST) are required to move the ball quicker as they progress from U16 to U23’s within the current English football academy. Further exploration is required to assess if these changes are context specific given requirements of those age groups.

PMID:39804859 | DOI:10.1371/journal.pone.0316833