Nevin Manimala

BMJ Glob Health. 2023 Sep;8(9):e013703. doi: 10.1136/bmjgh-2023-013703.

ABSTRACT

OBJECTIVES: Assess the relationship between income inequality and HIV incidence, AIDS mortality and COVID-19 mortality.

DESIGN: Multicountry observational study.

SETTING: 217 countries for HIV/AIDS analysis, 151 countries for COVID-19 analysis.

PARTICIPANTS: Used three samples of national-level data: a sample of all countries with available data (global sample), a subsample of African countries (African sample) and a subsample excluding African countries (excluding African sample).

MAIN OUTCOME MEASURES: HIV incidence rate per 1000 people, AIDS mortality rate per 100 000 people and COVID-19 excess mortality rate per 100 000 people. The Gini index of income inequality was the primary explanatory variable.

RESULTS: A positive and significant relationship exists between the Gini index of income inequality and HIV incidence across all three samples (p<0.01), with the effect of income inequality on HIV incidence being higher in the African sample than in the rest of the world. Also, a statistically positive association exists for all samples between income inequality and the AIDS mortality rate, as higher income inequality increases AIDS mortality (p<0.01). For COVID-19 excess mortality rate, a positive and statistically significant relationship exists with the Gini index for the entire sample and the excluding African sample (p<0.05), but the African sample alone did not deliver significant results (p<0.1).

CONCLUSION: COVID-19 excess deaths, HIV incidence and AIDS mortality are significantly associated with income inequality globally-more unequal countries have a higher HIV incidence, AIDS mortality and COVID-19 excess deaths than their more equal counterparts. Income inequality undercuts effective pandemic response. There is an urgent need for concerted efforts to tackle income inequality and to build pandemic preparedness and responses that are adapted and responsive to highly unequal societies, prioritising income inequality among other social determinants of health.

PMID:37717952 | DOI:10.1136/bmjgh-2023-013703

Clin Exp Ophthalmol. 2023 Sep 17. doi: 10.1111/ceo.14296. Online ahead of print.

ABSTRACT

BACKGROUND: Evaluation of ocular inflammation via common imaging modalities like optical coherence tomography (OCT) has emphasised cell visualisation, but automated detection of uveitic keratic precipitates (KPs) remains unexplored.

METHODS: Anterior segment (AS)-OCT dense volumes of the corneas of patients with uveitic KPs were collected at three timepoints: with active (T0), clinically improving (T1), and resolved (T2) inflammation. At each visit, visual acuity and clinical grading of the anterior chamber cells were assessed. A bespoke algorithm was used to create an en face rendering of the KPs and to calculate their volume and a ratio of the volume of precipitates over the analysed area. The variation of AS-OCT-derived measurements over time was assessed, and compared with clinical grading.

RESULTS: Twenty eyes from 20 patients (13 females, mean age 39 years) were studied. At T0, the mean volume of the corneal KPs was 0.1727 mm³ , and it significantly reduced to 0.1111 mm³ (p = 0.03) only at T2. The ratio between the volume of the KPs and the corneal area decreased from T0 (0.007) to T1 (0.006; p = 0.2) and T2 (0.004; p = 0.009). There was a statistically significant correlation between the AC cell count and the AS-OCT volume measurements of the KPs at the three time points.

CONCLUSIONS: AS-OCT can image uveitic KPs and through a bespoke algorithm we were able to create an en face rendering allowing us to extrapolate their volume. We found that objective quantification of KPs correlated with inflammatory cell counts in the anterior chamber.

PMID:37717946 | DOI:10.1111/ceo.14296

Pharm Stat. 2023 Sep 17. doi: 10.1002/pst.2338. Online ahead of print.

ABSTRACT

The sum of the longest diameter (SLD) of the target lesions is a longitudinal biomarker used to assess tumor response in cancer clinical trials, which can inform about early treatment effect. This biomarker is semicontinuous, often characterized by an excess of zeros and right skewness. Conditional two-part joint models were introduced to account for the excess of zeros in the longitudinal biomarker distribution and link it to a time-to-event outcome. A limitation of the conditional two-part model is that it only provides an effect of covariates, such as treatment, on the conditional mean of positive biomarker values, and not an overall effect on the biomarker, which is often of clinical relevance. As an alternative, we propose in this article, a marginalized two-part joint model (M-TPJM) for the repeated measurements of the SLD and a terminal event, where the covariates affect the overall mean of the biomarker. Our simulation studies assessed the good performance of the marginalized model in terms of estimation and coverage rates. Our application of the M-TPJM to a randomized clinical trial of advanced head and neck cancer shows that the combination of panitumumab in addition with chemotherapy increases the odds of observing a disappearance of all target lesions compared to chemotherapy alone, leading to a possible indirect effect of the combined treatment on time to death.

PMID:37717945 | DOI:10.1002/pst.2338

Behav Processes. 2023 Sep 15:104944. doi: 10.1016/j.beproc.2023.104944. Online ahead of print.

ABSTRACT

This study employs supervised machine learning algorithms to test whether locomotive features during exploratory activity in open field arenas can serve as predictors for the genotype of fruit flies. Because of the nonlinearity in locomotive trajectories, traditional statistical methods that are used to compare exploratory activity between genotypes of fruit flies may not reveal all insights. 10-minute-long trajectories of four different genotypes of fruit flies in an open-field arena environment were captured. Turn angles and step size features extracted from the trajectories were used for training supervised learning models to predict the genotype of the fruit flies. Using the first five minute locomotive trajectories, an accuracy of 83% was achieved in differentiating wild-type flies from three other mutant genotypes. Using the final 5minutes and the entire ten minute duration decreased the performance indicating that the most variations between the genotypes in their exploratory activity are exhibited in the first few minutes. Feature importance analysis revealed that turn angle is a better predictor than step size in predicting fruit fly genotype. Overall, this study demonstrates that features of trajectories can be used to predict the genotype of fruit flies through supervised machine learning methods.

PMID:37717930 | DOI:10.1016/j.beproc.2023.104944

Nanomedicine. 2023 Sep 15:102709. doi: 10.1016/j.nano.2023.102709. Online ahead of print.

ABSTRACT

According to the latest World Health Organization statistics, around 50 to 80 million people worldwide suffer from infertility, amongst which male factors are responsible for around 20 to 30 % of all infertility cases while 50 % were attributed to the female ones. As it is becoming a recurrent health problem worldwide, clinicians require more accurate methods for the improvement of both diagnosis and treatment schemes. By emphasizing the potential use of innovative methods for the rapid identification of the infertility causes, this review presents the news from this dynamic domain and highlights the benefits brought by emerging research fields. A systematic description of the standard techniques used in clinical protocols for diagnosing infertility in both genders is firstly provided, followed by the presentation of more accurate and comprehensive nanotechnology-related analysis methods such as nanoscopic-resolution imaging, biosensing approaches and assays that employ nanomaterials in their design. Consequently, the implementation of nanotechnology related tools in clinical practice, as recently demonstrated in the selection of spermatozoa, the detection of key proteins in the fertilization process or the testing of DNA integrity or the evaluation of oocyte quality, might confer excellent advantages both for improving the assessment of infertility, and for the success of the fertilization process.

PMID:37717928 | DOI:10.1016/j.nano.2023.102709

J Acad Nutr Diet. 2023 Sep 15:S2212-2672(23)01554-X. doi: 10.1016/j.jand.2023.09.006. Online ahead of print.

ABSTRACT

BACKGROUND: Women living in WIC-eligible households may be pregnant or breastfeeding. Stress during pregnancy and breastfeeding may affect women’s mental health making them more vulnerable to higher rates of food insecurity.

OBJECTIVE: Determine whether food insecurity (FI) is associated with moderate-to-severe mental distress among women living in WIC-eligible households, and whether the strength of the association differs among WIC participants compared to eligible non-participants with low-income.

DESIGN: Cross-sectional data from the 2011-2018 National Health Interview Survey (NHIS) were utilized.

PARTICIPANTS/SETTING: A total of 7,700 women living in WIC-eligible households with at least one child were analyzed.

MAIN OUTCOME MEASURE(S): Moderate-to-severe mental distress was measured using the validated K6 non-specific psychological distress scale. FI was measured using the 10-item, United States Adult Food Security Survey Module.

STATISTICAL ANALYSES PERFORMED: Multivariate logistic regression was used to examine the association between FI and mental distress. The conditional effects of WIC participation were examined by including interaction terms for FI and WIC participation as well as by stratifying the sample by WIC participation.

RESULTS: Among women in WIC-eligible households, FI was associated with moderate-to-severe mental distress in a dose-response fashion: compared to those who were food secure, the adjusted odds of moderate-to-severe mental distress were 1.8 times higher among those with marginal food security (adjusted odds ratio [AOR] 1.83, 95% CI 1.50-2.23), 2.1 times higher among those with low food security (AOR 2.14, 95% CI 1.76-2.60), and 3.7 times higher among those with very low food security (AOR 3.73, 95% CI 2.95-4.71). The interaction between FI and WIC participation was not significant, with similar associations between FI and mental distress among WIC participants and non-participants.

CONCLUSIONS: Among this nationally representative sample of women in WIC-eligible households, increasing severity of food insecurity was associated with poor mental health among WIC participants and non-participants. WIC participation was not observed to moderate the association between FI and mental distress. More research should consider including mental health screening at WIC clinic visits to enable early identification and referral for care.

PMID:37717918 | DOI:10.1016/j.jand.2023.09.006

Osteoarthritis Cartilage. 2023 Sep 15:S1063-4584(23)00919-6. doi: 10.1016/j.joca.2023.09.006. Online ahead of print.

ABSTRACT

OBJECTIVES: The design, analysis and interpretation of cluster randomized clinical trials (RCTs) requires accounting for potential correlation of observations on individuals within the same cluster. Reporting of observed intracluster correlation coefficients (ICCs) in cluster RCTs, as recommended by CONSORT, facilitates sample size calculation of future cluster RCTs and understanding of the trial statistical power. Our objective was to summarize observed ICCs in osteoarthritis (OA) cluster RCTs.

DESIGN: Systematic review of knee/hip OA cluster RCTs. We searched CENTRAL for trials published from 2012, when CONSORT cluster RCTs extension was published, to September 2022. We calculated the proportion of cluster RCTs that reported observed ICCs. Of those that did, we extracted observed ICCs.

PROSPERO: CRD42022365660.

RESULTS: We screened 1121 references, and included 20 cluster RCTs. Only 5 trials (25%) reported the observed ICC for at least one outcome variable. ICC values for pain outcomes were: 0, 0.01, 0.18; for physical function outcomes were: 0, 0.06, 0.13 (knee)/0.27 (hip); WOMAC total: 0.02, 0.02; symptoms of anxiety/depression: 0.22; disability: 0; and global change: 0. One out of four (25%) trials reported an ICC that was larger than the ICC used for sample size calculation and thus was underpowered.

CONCLUSIONS: Despite CONSORT statement recommendations for reporting of cluster RCTs, few OA trials reported the observed ICC. Given the importance of the ICC to interpretation of trial results and future trial design, this reporting gap warrants attention.

PMID:37717903 | DOI:10.1016/j.joca.2023.09.006

Environ Pollut. 2023 Sep 15:122568. doi: 10.1016/j.envpol.2023.122568. Online ahead of print.

ABSTRACT

Biomass fuel burning is a significant contributor of household fine particulate matter (PM_2.5) in the low to middle income countries (LMIC) and assessing PM_2.5 levels is essential to investigate exposure-related health effects such as pregnancy outcomes and acute lower respiratory infection in infants. However, measuring household PM_2.5 requires significant investments of labor, resources, and time, which limits the ability to conduct health effects studies. It is therefore imperative to leverage lower-cost measurement techniques to develop exposure models coupled with survey information about housing characteristics. Between April 2017 and March 2018, we continuously sampled PM_2.5 in three seasonal waves for approximately 48-h (range 46 to 52-h) in 74 rural and semi-urban households among the participants of the Bangladesh Cook Stove Pregnancy Cohort Study (CSPCS). Measurements were taken simultaneously in the kitchen, bedroom, and open space within the household. Structured questionnaires captured household-level information related to the sources of air pollution. With data from two waves, we fit multivariate mixed effect models to estimate 24-h average, cooking time average, daytime and nighttime average PM_2.5 in each of the household locations. Households using biomass cookstoves had significantly higher PM_2.5 concentrations than those using electricity/liquefied petroleum gas (626 μg/m³ vs. 213 μg/m³). Exposure model performances showed 10-fold cross validated R² ranging from 0.52 to 0.76 with excellent agreement in independent tests against measured PM_2.5 from the third wave of monitoring and ambient PM_2.5 from a separate satellite-based model (correlation coefficient, r = 0.82). Significant predictors of household PM_2.5 included ambient PM_2.5, season, and types of fuel used for cooking. This study demonstrates that we can predict household PM_2.5 with moderate to high confidence using ambient PM_2.5 and household characteristics. Our results present a framework for estimating household PM_2.5 exposures in LMICs, which are often understudied and underrepresented due to resource limitations.

PMID:37717899 | DOI:10.1016/j.envpol.2023.122568

Eur J Cancer. 2023 Aug 18;193:113292. doi: 10.1016/j.ejca.2023.113292. Online ahead of print.

ABSTRACT

BACKGROUND: Despite metastatic renal cell carcinoma (mRCC) expanded treatment options, disease progression ultimately occurs for most patients. Rechallenge may be a compelling strategy in a refractory setting. Cabozantinib is the standard of care in first and later lines of therapy, but its activity in rechallenge is unknown.

METHODS: This retrospective study assessed the efficacy and safety of cabozantinib rechallenge, as defined by a second exposure after an interval of ≥3 months without treatment or ≥1 other treatment line, in patients with mRCC. The primary endpoint was median progression-free survival (PFS) at rechallenge. Secondary endpoints included overall survival, objective response rate, and safety at rechallenge.

RESULTS: We included 51 mRCC patients who received cabozantinib in a rechallenge setting between 2017 and 2022. Median age at diagnosis was 54 years, 78% were male, 90% had clear cell mRCC, and 92% had prior nephrectomy. 15 patients (29%) were rechallenged after a pause in treatment, whereas 36 (70.6%) had ≥1 other treatment lines between first cabozantinib exposure (CABO-1) and rechallenge (CABO-2). Median PFS was 15.1 months (mo, 95% Confidence interval 11.2-22.1) at CABO-1 and 14.4mo (95%CI 9.8-NR) at CABO-2. Median overall survival was 67.6mo for CABO-1 (95% CI 52.2-NR) and 27.4mo for CABO-2 (95%CI 17.2-NR); objective response rate was 70.6% for CABO-1 and 60% for CABO-2. CABO-2 PFS was higher for patients with CABO-1 PFS > 12 months, and for those who discontinued CABO-1 because of toxicity, without statistical significance. There were no unexpected adverse events.

CONCLUSIONS: Cabozantinib rechallenge is a feasible treatment option with potential clinical benefit for mRCC patients.

PMID:37717282 | DOI:10.1016/j.ejca.2023.113292

J Clin Neurosci. 2023 Sep 15;117:1-10. doi: 10.1016/j.jocn.2023.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have reported a higher prevalence of sexual dysfunction (SD) in patients with Parkinson’s disease (PD). In the current study, we aimed to conduct a systematic review and meta-analysis to investigate the role of PD as a potential risk factor for SD in both genders.

METHODS: We performed a comprehensive search on PubMed, Embase, Scopus, and Web of Science. All observational studies comparing the prevalence of SD in PD with the general population were included.

RESULTS: After screening 22 studies were included in our qualitative and statistical analysis. We included 13 studies that reported odds ratio (OR) and found a significant association between PD and SD (pooled OR = 3.5, 95% CI = 2.19-5.58). Five studies included only male patients and reported an OR of 3.34 (95% CI = 1.34-8.35; heterogeneity I2 = 81%, Tau2 = 0.79, p < 0.00), while seven studies included both sexes and reported an OR of 3.55 (95% CI = 1.89-6.66; heterogeneity I2 = 78%, Tau2 = 0.53, p < 0.00).

CONCLUSION: In conclusion, our study suggests a strong association between PD and SD in both men and women. Our analysis of 22 observational studies reveals that the prevalence of sexual dysfunction is significantly higher in patients with PD compared to the general population. These findings highlight the importance of addressing SD as part of the comprehensive management of patients with PD.

PMID:37717275 | DOI:10.1016/j.jocn.2023.09.008