Estimating the Prevalence of over- and Under-Reporting in HIV Testing, Status and Treatment in Rural Northeast South Africa: A Comparison of a Survey and Clinic Records

We assess the accuracy of self-reported testing, HIV status, and treatment responses compared to clinical records in Ehlanzeni District, South Africa. We linked a 2018 population-based survey of adults 18-49 years old with clinical data at local primary healthcare facilities from 2014 to 2018. We calculated self-reported testing, HIV status, and treatment, and triangulated findings with clinic record data. We adjusted testing estimates for known gaps in HIV test documentation. Of 2089 survey participants, 1657 used a study facility and were eligible for analysis. Half of men and 84% of women reported an HIV test in the past year. One third of reported tests could be confirmed in clinic data within 1 year and an additional 13% within 2 years; these fractions increased to 57% and 22% respectively limiting to participants with a verified clinic file. After accounting for gaps in clinic documentation, we found that prevalence of recent HIV testing was closer to 15% among men and 51% in women. Estimated prevalence of known HIV was 16.2% based on self-report vs. 27.6% with clinic documentation. Relative to clinical records among confirmed clinic users, self report of HIV testing and of current treatment were highly sensitive but non-specific (sensitivity 95.5% and 98.8%, specificity 24.2% and 16.1% respectively), while self report of HIV status was highly specific but not sensitive (sensitivity 53.0%, specificity 99.3%). While clinical records are imperfect, survey-based measures should be interpreted with caution in this rural South African setting.

Comparative Assessment of Modified Self-Reported Periodontal Risk Assessment Model and Periodontal Risk Assessment Model among the Adult Population

Introduction

A high burden of periodontal diseases is seen in the adult population. Hence, it is important to monitor the risk and progression of periodontal diseases. Instead of using complex clinical periodontal risk assessment models, self-reported measures would be favorable for obtaining data in order to conduct research and surveillance of population over time on the progression of periodontitis. Our aim was to compare two tools for periodontal risk assessment, the originally described periodontal risk assessment (PRA) model given by Lang and Tonetti and the modified self-reported periodontal risk assessment model, in patients, depending upon can be changed to after.

Materials and Methods

All the participants completed a questionnaire used for modified self-reported periodontal risk assessment model. Periodontal status of the participants was recorded using the periodontal risk assessment (PRA) model given by Lang and Tonetti.

Results

Among 50 patients examined 28, 14, and eight were in low-, moderate-, high-risk groups, respectively, identified by self-reported periodontal risk assessment, whereas 34, 10, and six were in low-, moderate-, high-risk groups, respectively, when identified by the PRA model given by Lang and Tonetti. Receiver operating characteristic curve (ROC curve) showed an area under the curve (AUC) of 0.835, and it represents good predictability of self-reported periodontal risk assessment model.

Conclusion

This is feasible method with self-reported measures; it is easier, of low cost, and requires less equipment for obtaining data for research and surveillance of the periodontal status of a population.

Guardians' Self-Reported Fair/Poor Oral Health Is Associated with Their Young Children's Fair/Poor Oral Health and Clinically Determined Dental Caries Experience

In this cross-sectional, community-based study among a multi-ethnic sample of preschool-age children in North Carolina, United States, we sought to quantify the association between guardians' self-reported oral health and their children's oral health and determine whether race/ethnicity and education level modify these associations. We used questionnaire (n = 7852) responses about caregivers' and their children's oral health and clinical examination-derived (n = 6243) early childhood caries (ECC) status defined at the ICDAS ≥ 3 caries lesion detection threshold. We used multi-level mixed-effects generalized linear models to examine the associations between the guardians' reported oral health and their children's reported and clinically determined oral health among the entire sample and within strata of race/ethnicity, guardians' education, and children's dental home. The guardians' and their children's reported fair/poor oral health (FPOH) were 32% and 15%, respectively, whereas 54% of the children had ECC and 36% had unrestored disease. The guardians' FPOH was strongly associated with their children's FPOH (average marginal effect (AME) = +19 percentage points (p.p.); 95% CI = 17-21), and this association was most pronounced among Hispanics, lower-educated guardians, and children without a dental home. Similar patterns, but smaller-in-magnitude associations, were found for the guardians' FPOH and their children's clinically determined ECC (AME = +9 p.p.; 95% CI = 6-12) and unrestored disease (AME = +7 p.p.; 95% CI = 4-9). The study's findings support a strong association between guardians' and their children's reported and clinically determined oral health and implicate ethnicity, education, and having a dental home as factors possibly modifying the magnitude of these associations.

Cross-cultural adaptation and validation of the Ukrainian version of the ABILHAND-Kids questionnaire

PURPOSE

To develop and cross-culturally validate the Ukrainian version of the ABILHAND-Kids questionnaire by testing its psychometric properties in a sample of Ukrainian children with cerebral palsy.

METHODS

The ABILHAND-Kids questionnaire was translated into Ukrainian, cross-culturally adapted, and administered to 113 parents of children with cerebral palsy. The psychometric properties of the Ukrainian version and its cross-cultural validation were investigated through the Rasch rating scale model.

RESULTS

One major misfit has been found for the item "Rolling up a sleeve of a sweater" that further was removed. The item "Putting on a backpack/schoolbag" was split into gender-specific items, separately for girls and for boys, as it was systematically easier for Ukrainian girls. All remaining items contributed to the definition of a unidimensional measure of manual ability. The internal consistency reliability of the scale was high (R = 0.95). No significant floor (4%) and ceiling effects (5%) were observed. Three major differential item functioning items were found across Belgium and Ukraine, highlighting the need to use the Ukrainian calibration of ABILHAND-Kids in Ukraine.

CONCLUSION

The Ukrainian ABILHAND-Kids questionnaire has good psychometric properties for assessing manual ability in Ukrainian children with cerebral palsy, holding potential to be implemented in clinical practice nationwide.Implications for rehabilitationCerebral palsy impairs manual ability leading to decreased quality of life and participation.Professionals need valid and reliable tools to detect small changes of manual ability during rehabilitation.Metric properties and availability of the Ukrainian version of the ABILHAND-Kids questionnaire make it a useful tool in the assessment of children with cerebral palsy.

Methods for Measuring Multiple Medication Adherence: A Systematic Review-Report of the ISPOR Medication Adherence and Persistence Special Interest Group

BACKGROUND

A broad literature base exists for measuring medication adherence to monotherapeutic regimens, but publications are less extensive for measuring adherence to multiple medications.

OBJECTIVES

To identify and characterize the multiple medication adherence (MMA) methods used in the literature.

METHODS

A literature search was conducted using PubMed, PsycINFO, the International Pharmaceutical Abstracts, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library databases on methods used to measure MMA published between January 1973 and May 2015. A two-step screening process was used; all abstracts were screened by pairs of researchers independently, followed by a full-text review identifying the method for calculating MMA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct this systematic review. For studies that met the eligibility criteria, general study and adherence-specific characteristics and the number and type of MMA measurement methods were summarized.

RESULTS

The 147 studies that were included originated from 32 countries, in 13 disease states. Of these studies, 26 used proportion of days covered, 23 used medication possession ratio, and 72 used self-reported questionnaires (e.g., the Morisky Scale) to assess MMA. About 50% of the studies included more than one method for measuring MMA, and different variations of medication possession ratio and proportion of days covered were used for measuring MMA.

CONCLUSIONS

There appears to be no standardized method to measure MMA. With an increasing prevalence of polypharmacy, more efforts should be directed toward constructing robust measures suitable to evaluate adherence to complex regimens. Future research to understand the validity and reliability of MMA measures and their effects on objective clinical outcomes is also needed.

Delinquency and sexual experiences across adolescence: does depression play a role?

PURPOSE

To elucidate a possible connection between delinquency and adolescent sexual behaviours in different age groups from 14 to 20 and the role of depression therein.

MATERIALS AND METHODS

Data were gathered from the cross-sectional Finnish School Health Promotion Study 2010 and 2011 with 186,632 respondents. We first examined the bivariate relationship between delinquency and sexual behaviour, and then proceeded to multivariate models accounting for self-reported depression. Analyses were conducted separately for girls and boys, in seven age groups. The main outcomes were analysed by χ² test and logistic regression.

RESULTS

Delinquency was connected to having experienced sexual intercourse across all age groups, and was related to reporting multiple sexual partners among sexually active adolescents, in both boys and girls, before and after controlling for depression. Delinquency and depression were independently associated with the sexual behaviours studied.

CONCLUSIONS

Being sexually active and engaging in risky sexual behaviours are related to delinquency in the adolescent population throughout the developmental phase, even in late adolescence when being sexually active is developmentally normative. Being sexually active is further connected to depression until middle adolescence, and risky sexual behaviours across adolescence. Clinicians working with adolescents presenting with delinquent behaviour with or without depression need to address their sexual health needs.

Increased Risk Taking in Relation to Chronic Stress in Adults

Chronic stress is a public health problem that affects a significant part of the population. While the physiological damage it causes is under ongoing scrutiny, its behavioral effects have been overlooked. This is one of the first studies to examine the relation between chronic stress and decision-making, using a standard lottery paradigm. We measured risk taking in the gain domain through binary choices between financially incentivized lotteries. We then measured self-reported chronic stress with the Trier Inventory for the Assessment of Chronic Stress (TICS). We additionally collected hair samples in a subsample of volunteers, in order to quantify accumulation of the stress hormone cortisol. We discovered a significant positive, though modest, correlation between self-reported chronic stress and risk taking that is stronger for women than for men. This confirms part of the findings in acute stress research that show a connection between higher stress and increased risk taking. However, unlike the biologically-based results from acute stress research, we did not identify a significant relation between hair cortisol and behavior. In line with previous literature, we found a clear gender difference in risk taking and self-reports: women generally take less risk and report slightly higher stress levels than men. We conclude that perceived chronic stress can impact behavior in risky situations.

Gastroesophageal reflux disease and odds of head and neck squamous cell carcinoma in North Carolina

OBJECTIVES/HYPOTHESIS

Exposure to excess gastric acid resulting from gastroesophageal reflux disease, also known as acid reflux or heartburn, might contribute to initiation of head and neck squamous cell carcinoma, particularly laryngeal cancer. Prior epidemiologic studies have reported inconsistent results. We sought to clarify this relationship using an observational study with a larger available sample size and better-characterized exposure information than most prior studies.

STUDY DESIGN

A population-based case-control study of head and neck cancer in North Carolina with 1,340 newly diagnosed cases and 1,378 controls matched on age, race, and sex.

METHODS

We used unconditional logistic regression to examine associations between self-reported heartburn and development of overall head and neck cancer as well as development of cancer at specific tumor sites. Subgroup analysis by smoking and alcoholic drinking status was used to make comparisons with a previous study that used a similar study design.

RESULTS

Overall, an increased odds of head and neck cancer was not associated with either self-reported history of heartburn symptoms (odds ratio = 0.85; 95% confidence interval 0.68, 1.06) or self-reported medical diagnosis of GERD (OR = 0.89; 95% CI 0.71, 1.11). These patterns held for specific tumor sites. For laryngopharyngeal cancer, we did not detect any associations regardless of joint smoking and alcoholic drinking status.

CONCLUSION

Gastroesophageal reflux does not appear to play a role in development of head and neck cancer.

LEVEL OF EVIDENCE

3b. Laryngoscope, 126:1091-1096, 2016.

Knee Confidence as It Relates to Self-reported and Objective Correlates of Knee Osteoarthritis: A Cross-sectional Study of 220 Patients

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

The objective was to validate, if possible, previously reported associations and to investigate other potential associations between knee confidence and various self-reported and objective measures in an independent cohort of patients with knee osteoarthritis (OA).

BACKGROUND

Lack of knee confidence is a frequent symptom in patients with knee OA, but little is known of associations between knee confidence and other common correlates of knee OA.

METHODS

Baseline data from 220 patients with knee OA were applied in ordinal regression analyses, with knee confidence, assessed using item Q3 of the Knee injury and Osteoarthritis Outcome Score, as the dependent variable and self-reported (pain on walking, general health, fear of movement, self-efficacy, function, and previous serious injury) and objective measures (muscle strength, 20-m walk time, and radiographic severity of tibiofemoral OA) as predictor variables.

RESULTS

Most (95%) of the participants reported lack of knee confidence, and 54% experienced severe or extreme lack of knee confidence. Fear of movement (odds ratio [OR] = 2.06; 95% confidence interval [CI]: 1.15, 3.68), pain on walking (OR = 1.21; 95% CI: 1.09, 1.34), and general health (OR = 0.024; 95% CI: 0.002, 0.259) explained 19% of the variance in knee confidence (P<.001).

CONCLUSION

Severe lack of knee confidence is a common finding in individuals with knee OA. Pain on walking was confirmed as a correlate of knee confidence, whereas muscle strength was not. Fear of movement and poor general health were new variables associated with lack of knee confidence. The noncorrelations or poor correlations with other tested variables suggest that a lack of knee confidence may represent an independent treatment target in knee OA of importance to improve mobility. Trials registered at ClinicalTrials.gov (NCT01410409 and NCT01535001).