Validity of self-reports of reasons for hospitalization by young adults and risk factors for discordance with medical records: the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

This research focused on the validity of young adults' (mean age=33 years; standard deviation, 3.9) self-reports of reasons for hospitalization and factors affecting validity in a longitudinal cohort study of over 5,000 young adults in four US cities (1985-1998). Self-reported reasons were considered discordant if they differed from those in medical records. Of the 321 self-reported hospitalizations, overall concordance was 92.5%; concordance ranged from 80% for infections to 100% for injuries/fractures and procedures/surgeries. There were no significant differences among mail, telephone, or face-to-face methods of collecting self-reports. In generalized estimating equations analyses, Black race (odds ratio=4.23, 95% confidence interval: 1.72, 10.40; p=0.002) and intravenous drug use (odds ratio=6.06, 95% confidence interval: 1.17, 31.22; p=0.03) were positively associated with discordance. Nonetheless, self-reports by Blacks were 90.0% concordant. Self-reports by Whites were 95.7% concordant. These results suggest that young adults' self-reported reasons for hospitalization are overwhelmingly concordant with medical records. This has important implications, since obtaining medical records has become more costly and logistically difficult.

Behavioral risk factors for STD/HIV transmission in Bangladesh's trucking industry.

To examine behaviors that could influence STD/HIV transmission in Bangladesh's trucking industry, a survey was orally administered to 388 truck drivers/helpers at Tejgaon truck stand in Dhaka. A two-tiered sampling strategy was used: 38 trucking agencies were randomly selected and a mean of 10.2 subjects was recruited from each agency. Focus group and in-depth interviews were also conducted. The focus was on behaviors that affect (i) exposure to STD/HIV infection, (ii) efficiency of transmission of infection and (iii) duration of infectiousness. The findings illustrated that intravenous drug use was not an important risk factor; only 1 subject had used drugs intravenously. Sexual risk behaviors, however, were prevalent: the mean number of sexual partners in the past year was 4.57 (SD=8.70) and in the past 3 months was 1.82 (SD=3.27). Premarital and extramarital sex was common, often with commercial sex workers (CSW); 54% of all subjects had relations with at least 1 CSW in the past year. In a multiple logistic regression analysis, subjects who engaged in other types of socially risky behavior (drinking alcohol, ingesting or smoking recreational drugs, having sex with other men) were significantly (p<0.05) more likely to have had sex with a CSW in the past year. While 7.2% of subjects had a male sex partner in the past year, 21% had ever had one (likely youthful experimentation for most). Condom use was very infrequent: of the 343 subjects who had ever had sexual intercourse only 31% had ever used a condom and most of those subjects had used only once or occasionally. Having sex with CSWs, being married, having heard of AIDS and age were significantly associated (p<0.05) with ever use of condoms. Frequently, subjects who had genital symptoms either did not have those symptoms treated at all or treated in a timely fashion, and over 1/3 did not change their sexual behavior while infected. To reduce the potential for the spread of STD/HIV in this population, appropriate treatment practices for sexually transmitted infections need to be encouraged and condom use promoted, particularly in the context of casual sexual relations.

Diagnosing attention disorders with measures of neurocognitive functioning.

The validity of the Differential Ability Scales (DAS; Elliott, 1990) in predicting attention disorders in school-aged children was examined. The participants were 40 children diagnosed with attention deficit/hyperactivity disorder (ADHD) and 40 normal children between 7 and 12 years of age. Comorbidity was controlled by excluding children with ADHD who had a concurrent DSM-IV diagnosis such as reading disability, learning disability, mood disorder, or behavioral disorder. In addition, groups did not differ significantly by sex, age, racial/ethnic identification, or parental educational level. A stepwise discriminant analysis indicated the DAS correctly classified 72.5% of the total sample when either the Sequential and Quantitative Reasoning subtest or the Recall of Digits subtest was used to predict group membership. In general, the DAS core subtests were found to be good measures of cognitive ability in children classified with ADHD and did not appear to be influenced by attention problems.

Preventing HIV in developing countries: biomedical and behavioral approaches

The impetus for this volume was a seemingly simple query by an Asian Minister of Health. In 1995, two of the editors of this volume met with the minister who articulated his desire to take action to prevent an HIV epidemic in his country, but stated that he did not know what course of action to take. He asked for information on what had been tried and proven successful elsewhere ... We felt, therefore, that it would be helpful to have a single volume that reviewed notable interventions implemented to date in developing countries, with the aim of describing the strategies they have employed, implementation problems and opportunities encountered, and successes or failures in terms of results achieved. Such a volume would be particularly helpful if written in a style accessible to diverse audiences and if an effort were expended to make it available to those working on HIV prevention in developing countries ... Our hope is that this volume will provide a forum for insights from important and creative HIV prevention efforts undertaken in the developing world to be shared with others whose work is inspired by the common desire to prevent the transmission of a virus that is responsible for untold suffering and devastating losses to individuals, families, communities, and nations. To a greater or lesser degree, in a direct or indirect fashion, and with more or less acute awareness, we have all experienced loss as a result of this pandemic. Preventing its further spread remains a matter of urgency for us all; learning from each others success and failures may contribute to our achieving this end (Eds.)