The Impact of Family Economic Empowerment Intervention on Psychological Difficulties and Prosocial Behavior Among AIDS-Orphaned Children in Southern Uganda.

PURPOSE: Children orphaned by AIDS are more likely to have psychological and emotional problems compared to their counterparts. Poverty resulting from orphanhood is linked to the negative psychological outcomes experienced by AIDS-orphaned adolescents. No studies have investigated the impact of an economic empowerment intervention on child psychological and emotional problems and prosocial behavior. Therefore, we aimed to examine the impact of a family economic empowerment intervention on psychological difficulties and prosocial behavior among AIDS-orphaned adolescents. METHODS: We analyzed data from a two-arm cluster randomized controlled trial conducted in 10 primary schools in southern Uganda. Schools were randomized to either bolstered usual care (n = 5 schools; 167 participants) or a family-economic empowerment intervention (Suubi-Maka; n = 5 schools; 179 individuals). We used t-test and multi-level mixed effects models to examine the impact of Suubi-Maka on psychological and behavioral outcomes. RESULTS: No differences were observed between intervention and control groups in almost all the outcomes at baseline, 12 months, and 24 months. Simple main effects comparisons of 12 months versus baseline within each condition indicate modest to significant declines in emotional symptoms, hyperactivity, peer relationships (Δs = -1.00 to -2.11, all p < .001), and total difficulties (Δs = -4.85 to -4.89, both p < .001) across both groups. DISCUSSION: Our analysis found no meaningful difference between intervention and control groups in child psychological difficulties and prosocial behavior postintervention. However, improvements were observed across both control and treatment groups following the intervention. Future studies should investigate the impact of different components of the intervention.

The Effects of Race and Ethnicity on the Risk of Large-for-Gestational-Age Newborns in Women Without Gestational Diabetes by Prepregnancy Body Mass Index Categories.

Objectives Children born large for gestational age (LGA) are at risk of numerous adverse outcomes. While the racial/ethnic disparity in LGA risk has been studied among women with Gestational Diabetes Mellitus (GDM), the independent effect of race on LGA risk by maternal prepregnancy BMI is still unclear among women without GDM. Therefore, the objective of this study was to assess the association between maternal race/ethnicity and LGA among women without GDM. Methods This was a population-based cohort study of 2,842,278 singleton births using 2012 U.S. Natality data. We conducted bivariate and multivariate logistic regression analyses to assess the association between race and LGA. Due to effect modification by maternal prepregnancy BMI, we stratified our analysis by four BMI subgroups. Results The prevalence of LGA was similar across the different racial/ethnic groups at about 9%, but non-Hispanic Asian Americans had slightly higher prevalence of 11%. After controlling for potential confounders, minority women had higher odds of birthing LGA babies compared to non-Hispanic white women. Non-Hispanic Asian Americans had the highest odds of LGA babies across all BMI categories: underweight (aOR = 2.67; 95% CI: 2.24, 3.05); normal weight (aOR = 2.53; 2.43, 2.62); overweight (aOR = 2.45; 2.32, 2.60) and obese (aOR = 2.05; 1.91, 2.20). Conclusions for practice Racial/ethnic disparities exist in LGA odds, particularly among women with underweight or normal prepregnancy BMI. Most minorities had higher LGA odds than non-Hispanic white women regardless of prepregnancy BMI category. These racial/ethnic disparities should inform public health policies and interventions to address this problem.

Validity of self-reported history of Chlamydia trachomatis infection.

BACKGROUND: Chlamydia trachomatis infection is common and largely asymptomatic in women. If untreated, it can lead to sequelae such as pelvic inflammatory disease and infertility. It is unknown whether a patient's self-reported history of Chlamydia trachomatis infection is a valid marker of past infection. OBJECTIVE: Our objective was to evaluate the validity of women's self-reported history of Chlamydia trachomatis infection compared with Chlamydia trachomatis serology, a marker for previous infection. STUDY DESIGN: We analyzed data from the Fertility After Contraception Termination study. We compared participants' survey responses with the question, "Have you ever been told by a health care provider that you had Chlamydia?" to serological test results indicating the presence or absence of antibodies to Chlamydia trachomatis as assessed by a microimmunofluorescence assay. Prevalence of past infection, sensitivity, specificity, predictive values, and likelihood ratios were calculated. The Cohen's kappa statistic was computed to assess agreement between self-report and serology. RESULTS: Among 409 participants, 108 (26%) reported having a history of Chlamydia trachomatis infection, whereas 146 (36%) had positive serological test results. Relative to positive microimmunofluorescence assay, the sensitivity and specificity of self-reported history of Chlamydia trachomatis infection were 52.1% (95% confidence interval, 43.6-60.4%) and 87.8% (95% confidence interval, 83.3-91.5%), respectively. The positive predictive value of the self-report was 70.4% (95% confidence interval, 60.8-78.8%), and the negative predictive value was 76.7% (95% confidence interval, 71.6-81.4%). The likelihood ratio was found to be 4.28. Agreement between self-report and serology was found to be moderate (kappa = 0.42, P < .001). CONCLUSION: Self-reported history of Chlamydia trachomatis infection commonly yields false-negative and false-positive results. When definitive status of past Chlamydia trachomatis infection is needed, serology should be obtained.

Surgical Management of Benign Adnexal Masses in the Pediatric/Adolescent Population: An 11-Year Review.

STUDY OBJECTIVE: The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution. DESIGN: A retrospective cohort review. SETTING: Children's and adult tertiary care university-based hospital. PARTICIPANTS: Patients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013. INTERVENTIONS: Patient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy. MAIN OUTCOME MEASURES: The primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty. RESULTS: Of 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005). CONCLUSION: Results of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible.

Sexual Desire and Hormonal Contraception.

OBJECTIVE: To examine the effect of hormonal contraception on sexual desire. MATERIALS AND METHODS: We performed a cross-sectional analysis of 1,938 of the 9,256 participants enrolled in the Contraceptive CHOICE Project. This subset included participants enrolled between April and September 2011 who completed a baseline and 6-month telephone survey. Multivariable logistic regression was used to assess the association between contraceptive method and report of lacking interest in sex controlling for potential confounding variables. RESULTS: More than 1 in 5 participants (23.9%) reported lacking interest in sex at 6 months after initiating a new contraceptive method. Of 262 copper intrauterine device (IUD) users (referent group), 18.3% reported lacking interest in sex. Our primary outcome was more prevalent in women who were young (younger than 18 years: adjusted odds ratio [OR] 2.04), black (adjusted OR 1.78), and married or living with a partner (adjusted OR 1.82). Compared with copper IUD users, participants using depot medroxyprogesterone (adjusted OR 2.61, 95% confidence interval [CI] 1.47-4.61), the vaginal ring (adjusted OR 2.53, 95% CI 1.37-4.69), and the implant (adjusted OR 1.60, 95% CI 1.03-2.49) more commonly reported lack of interest in sex. We found no association between use of the hormonal IUD, oral contraceptive pill, and patch and lack of interest in sex. CONCLUSION: CHOICE participants using depot medroxyprogesterone acetate, the contraceptive ring, and implant were more likely to report a lack of interest in sex compared with copper IUD users. Future research should confirm these findings and their possible physiologic basis. Clinicians should be reassured that most women do not experience a reduced sex drive with the use of most contraceptive methods.

Knowledge and risk perception of oral cavity and oropharyngeal cancer among non-medical university students.

BACKGROUND: To assess non-medical university students' knowledge and perceived risk of developing oral cavity and oropharyngeal cancer. METHODS: A cross-sectional survey was conducted among non-medical students of a private Midwestern university in the United States in May 2012. Questionnaire assessed demographic information and contained 21 previously validated questions regarding knowledge and perceived risk of developing oral cavity and oropharyngeal cancer. Knowledge scale was categorized into low and high. Risk level was estimated based on smoking, drinking, and sexual habits. Bivariate associations between continuous and categorical variables were assessed using Pearson correlation and Chi-square tests, respectively. RESULTS: The response rate was 87% (100 out of 115 students approached). Eighty-one percent (81%) had low oral cavity and oropharyngeal cancer knowledge; and only 2% perceived that their oral cavity and oropharyngeal cancer risk was high. Risk perception was negatively correlated with age at sexual debut, r (64) = -0.26, p = 0.037; one-way ANOVA showed a marginally significant association between risk perception and number of sexual partners, F(4, 60) = 2.48, p = 0.05. There was no significant association between knowledge and perception of risk; however, oral cavity and oropharyngeal cancer knowledge was significantly associated with frequency of prevention of STDs (p < 0.05). Although 86% had heard about oral cavity and oropharyngeal cancer, only 18% had heard of oral mouth examination, and 7% of these reported ever having an oral cavity and oropharyngeal cancer exam. CONCLUSIONS: Oral cavity and oropharyngeal cancer knowledge and risk perception is low among this student population. Since oral cavity and oropharyngeal cancer incidence is increasingly shifting towards younger adults, interventions must be tailored to this group in order to improve prevention and control.

Spinal cord tract diffusion tensor imaging reveals disability substrate in demyelinating disease.

OBJECTIVE: This study assessed the tissue integrity of major cervical cord tracts by using diffusion tensor imaging (DTI) to determine the relationship with specific clinical functions carried by those tracts. METHODS: This was a cross-sectional study of 37 patients with multiple sclerosis or neuromyelitis optica with remote cervical cord disease. Finger vibratory thresholds, 25-foot timed walk (25FTW), 9-hole peg test (9HPT), and Expanded Disability Status Scale were determined. DTI covered cervical regions C1 through C6 with 17 5-mm slices (0.9 × 0.9 mm in-plane resolution). Regions of interest included posterior columns (PCs) and lateral corticospinal tracts (CSTs). Hierarchical linear mixed-effect modeling included covariates of disease subtype (multiple sclerosis vs neuromyelitis optica), disease duration, and sex. RESULTS: Vibration thresholds were associated with radial diffusivity (RD) and fractional anisotropy (FA) in the PCs (both p < 0.01), but not CSTs (RD, p = 0.29; FA, p = 0.14). RD and FA in PCs, and RD in CSTs were related to 9HPT (each p < 0.0001). 25FTW was associated with RD and FA in PCs (p < 0.0001) and RD in CSTs (p = 0.008). Expanded Disability Status Scale was related to RD and FA in PCs and CSTs (p < 0.0001). Moderate/severe impairments in 9HPT (p = 0.006) and 25FTW (p = 0.017) were more likely to show combined moderate/severe tissue injury within both PCs and CSTs by DTI. CONCLUSIONS: DTI can serve as an imaging biomarker of spinal cord tissue injury at the tract level. RD and FA demonstrate strong and consistent relationships with clinical outcomes, specific to the clinical modality.

Diffusion tensor imaging in acute optic neuropathies: predictor of clinical outcomes.

OBJECTIVE: To evaluate directional diffusivities within the optic nerve in a first event of acute optic neuritis to determine whether decreased axial diffusivity (AD) would predict 6-month visual outcome and optic nerve integrity measures. DESIGN: Cohort study. SETTING: Academic multiple sclerosis center. Patients  Referred sample of 25 individuals who presented within 31 days after acute visual symptoms consistent with optic neuritis. Visits were scheduled at baseline, 2 weeks, and 1, 3, 6, and 12 months. MAIN OUTCOME MEASURES: Visual acuity, contrast sensitivity, visual evoked potentials (VEPs), and thickness of the retinal nerve fiber layer (RNFL). RESULTS: An incomplete 6-month visual recovery was associated with a lower baseline AD (1.50 µm(2)/ms [95% confidence interval {CI}, 1.36-1.64 µm(2)/ms for incomplete recovery vs 1.75 µm(2)/ms [95% CI, 1.67-1.83 µm(2)/ms] for complete recovery). Odds of complete recovery decreased by 53% (95% CI, 27%-70%) for every 0.1-unit decrease in baseline AD. A lower baseline AD correlated with worse 6-month visual outcomes in visual acuity (r = 0.40, P = .03), contrast sensitivity (r = 0.41, P = .02), VEP amplitude (r = 0.55, P < .01), VEP latency (r = -0.38, P = .04), and RNFL thickness (r = 0.53, P = .02). Radial diffusivity increased between months 1 and 3 to become higher in those with incomplete recovery at 12 months than in those with complete recovery (1.45 µm(2)/ms [95% CI, 1.31-1.59 µm(2)/ms] vs 1.19 µm(2)/ms [95% CI, 1.10-1.28 µm(2)/ms]). CONCLUSIONS: Decreased AD in acute optic neuritis was associated with a worse 6-month visual outcome and correlated with VEP and RNFL measures of axon and myelin injury. Axial diffusivity may serve as a marker of axon injury in acute white matter injury.

Acute and bilateral blindness due to optic neuropathy associated with copper deficiency.

BACKGROUND: Acquired copper deficiency in adults is associated with a subacute to chronic progressive myeloneuropathy and optic neuropathy. OBJECTIVE: To describe an individual after gastric bypass surgery who developed a chronic progressive myeloneuropathy, an acute optic neuropathy, along with anemia and leukopenia. DESIGN: Case report. SETTING: Academic center. Patient A 55-year-old woman, following gastric bypass surgery 22 years earlier, developed progressive numbness, weakness, and sphincter disturbance over 6 years. She awoke one morning with bilateral blindness. Examination findings showed evidence of severe myelopathy and peripheral neuropathy. MAIN OUTCOME MEASURES: Magnetic resonance imaging, optical coherence tomography, electrophysiologic studies, nerve and muscle biopsy specimens, and vision testing. RESULTS: Over 1 year of follow-up, copper infusion therapy seemed to stabilize the progressive myeloneuropathy and improved leukopenia and anemia. It had no effect on the optic neuropathy. Optic nerve tissue injury was observed on magnetic resonance diffusion tensor imaging and on optical coherence tomography. CONCLUSIONS: Copper deficiency should be considered in cases of atypical optic neuropathy. Serum copper levels should be monitored in patients with a compatible neurologic syndrome who have undergone gastric bypass surgery. Although visual acuity did not improve after copper infusion in our patient, prompt recognition of copper deficiency may prevent further deterioration.

Automated surveillance for central line-associated bloodstream infection in intensive care units.

OBJECTIVE: To develop and evaluate computer algorithms with high negative predictive values that augment traditional surveillance for central line-associated bloodstream infection (CLABSI). SETTING: Barnes-Jewish Hospital, a 1,250-bed tertiary care academic hospital in Saint Louis, Missouri. METHODS: We evaluated all adult patients in intensive care units who had blood samples collected during the period from July 1, 2005, to June 30, 2006, that were positive for a recognized pathogen on culture. Each isolate recovered from culture was evaluated using the definitions for nosocomial CLABSI provided by the National Healthcare Safety Network of the Centers for Disease Control and Prevention. Using manual surveillance by infection prevention specialists as the gold standard, we assessed the ability of various combinations of dichotomous rules to determine whether an isolate was associated with a CLABSI. Sensitivity, specificity, and predictive values were calculated. RESULTS: Infection prevention specialists identified 67 cases of CLABSI associated with 771 isolates recovered from blood samples. The algorithms excluded approximately 40%-62% of the isolates from consideration as possible causes of CLABSI. The simplest algorithm, with 2 dichotomous rules (ie, the collection of blood samples more than 48 hours after admission and the presence of a central venous catheter within 48 hours before collection of blood samples), had the highest negative predictive value (99.4%) and the lowest specificity (44.2%) for CLABSI. Augmentation of this algorithm with rules for common skin contaminants confirmed by another positive blood culture result yielded in a negative predictive value of 99.2% and a specificity of 68.0%. CONCLUSIONS: An automated approach to surveillance for CLABSI that is characterized by a high negative predictive value can accurately identify and exclude positive culture results not representing CLABSI from further manual surveillance.