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Background: Sexually transmitted infections (STIs) spread along sexual networks whose structural characteristics promote transmission that routine surveillance may not capture. Cases who have partners from multiple localities may operate as spatial network bridges, thereby facilitating geographical dissemination. We investigated how surveillance, sexual networks, and spatial bridges relate to each other for syphilis outbreaks in rural counties of North Carolina.Methods: We selected from the state health department's surveillance database cases diagnosed with primary, secondary, or early latent syphilis during October 1998 to December 2002 and who resided in central and southeastern North Carolina, along with their sex partners and their social contacts irrespective of infection status. We applied matching algorithms to eliminate duplicate names and create a unique roster of partnerships from which networks were compiled and graphed. Network members were differentiated by disease status and county of residence.Results: In the county most affected by the outbreak, densely connected networks indicative of STI outbreaks were consistent with increased incidence and a large case load. In other counties, the case loads were low with fluctuating incidence, but network structures suggested the presence of outbreaks. In a county with stable, low incidence and a high number of cases, the networks were sparse and dendritic, indicative of endemic spread. Outbreak counties exhibited densely connected networks within well-defined geographic boundaries and low connectivity between counties; spatial bridges did not seem to facilitate transmission.Conclusions: Simple visualization of sexual networks can provide key information to identify communities most in need of resources for outbreak investigation and disease control. [ABSTRACT FROM AUTHOR]

Background: Most human immunodeficiency virus (HIV) point-of-care tests detect antibodies (Ab) but not p24 antigen (Ag) or RNA. In the absence of antibodies, p24 antigen and RNA typically indicate acute HIV infection. We conducted a field evaluation of the Determine® HIV-1/2 Ag/Ab Combo rapid test (Combo RT).Methods: The antigen portion of the Combo RT (for acute HIV infection) was compared with a Roche Monitor HIV RNA polymerase chain reaction assay. The antibody portion of Combo RT (for established HIV infection) was compared with rapid test algorithms. Participants were enrolled at a sexually transmitted infection clinic and HIV testing and counseling center in Lilongwe, Malawi. Rapid testing was conducted with parallel testing in the clinic and serial testing in the center. The Combo RT was performed in clinic participants with negative or discordant antibody results and in all center participants.Results: Of the participants 838 were HIV negative, 163 had established HIV infection, and 8 had acute HIV infection. For detecting acute HIV infection, the antigen portion had a sensitivity of 0.000 and a specificity of 0.983. For detecting established HIV infection, the antibody portion had a sensitivity of 0.994 and a specificity of 0.992.Conclusions: Combo RT displayed excellent performance for detecting established HIV infection and poor performance for detecting acute HIV infection. In this setting, Combo RT is no more useful than current algorithms. [ABSTRACT FROM AUTHOR]

Purpose. To identify and evaluate the lower limb amputation rehabilitation outcome measurement instruments that quantify those outcomes classified within the International classification of functioning, disability and health (ICF) category of body function or structure. This was done to summarise the current evidence base for the most commonly used outcome measurement tools and to provide clinicians with recommendations on how specific tools might be selected for use. Method. A systematic review of the literature associated with outcome measurement in lower limb amputation rehabilitation was conducted. Only articles containing data related to metric properties (reliability, validity or responsiveness) for an instrument were included. Articles were identified by electronic and hand-searching techniques and were subsequently classified according to the ICF. Results. Sixteen instruments were identified that were classified into one of Global mental function (12), Sensory and pain (1), Cardiovascular and respiratory (1) and Neuromusculoskeletal and movement (2). Evidence about metric properties and clinical utility was summarised in tables, which formed the basis for conclusions. Conclusions. Few well-validated body function tools exist in the amputee literature, which may explain their lack of widespread use. For all scales, responsiveness to intervention has not been well established and should be the focus of future studies along with continued establishment of validity and reliability. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the social pressure overweight (OW, n=1183) and normal-weight (NW, n=550) adults perceive regarding health club exercise. METHODS: A 12-item survey, based on the theory of reasoned action and theory of planned behavior, measured subjective norm toward exercising at a health club 30 min, twice a week, for the next month. RESULTS: OW feel more social pressure to exercise at a club than do NW, but motivation to comply is the same between groups. CONCLUSIONS: Exercise interventions for OW should capitalize on individual perceived social pressures to exercise by designing strategies to increase motivation to comply with these pressures. [ABSTRACT FROM AUTHOR]

Purpose. To identify and evaluate the lower extremity amputee (LEA) rehabilitation outcome measurement instruments that quantify those outcomes that have been classified within the ICF category of activities. This was done to assist the clinicians in the selection of the most appropriate instrument based upon four determinants of successful LEA rehabilitation and outcome measurement. Method. A systematic review of the literature associated with outcome measurement in LEA rehabilitation was conducted. Only articles containing data related to metric properties (reliability, validity or responsiveness) for an instrument were included. Articles were identified by electronic and hand-searching techniques and were subsequently classified first according to the ICF and then by their clinical use. Results. Seventeen instruments were identified that were classified into one of (A) walk tests, (B) mobility grades and (C) indices (generic and amputee-specific). Evidence about metric properties and clinical utility was summarised in tables which formed the basis for conclusions and recommendations pertaining to LEA rehabilitation. Conclusions. All instruments examined have the potential for some use within the initial rehabilitation trial following amputation. There is a universal absence of quality evidence demonstrating responsiveness and most instruments would benefit from further investigation to better define their optimal use. [ABSTRACT FROM AUTHOR]

Purpose. To identify, from the perspectives of people with spinal cord injury (SCI), (a) appropriate components of a fatigue management programme; and (b) important outcomes or indicators of success. Method. Collaborative, qualitative methodology comprising four focus groups undertaken simultaneously in Kelowna, Prince George, Vancouver and Victoria, British Columbia, Canada. Participants included a purposive sample of 21 men and women with complete and incomplete SCI of high and low tetraplegia and paraplegia. Two family members, two careproviding assistants and four occupational therapists provided additional information (total n¼29). Interpretive data analysis identified common themes addressing each research question. Results. Building on those strategies they perceived to facilitate coping with fatigue, the participants identified 10 components of a helpful fatigue management programme. Dimensions of 'successful' outcomes from such a programme reflected quality of life concerns: enabling people with SCI to do the things they value, enhancing their sense of control over their lives, reducing pain and helplessness, increasing motivation and enhancing relationships strained by fatigue. Conclusions. This study identifies many of the necessary elements of a fatigue management programme to meet the specific needs of people with SCI; and ascertains important indicators of a successful programme from the perspectives of those who must live with the outcomes. [ABSTRACT FROM AUTHOR]

Purpose. This study explores the extent to which personal and environmental factors explain participation in daily activities and social roles of older adults with chronic conditions. Method. Two hundred older adults with chronic conditions completed the following assessments: Assessment of Life Habits (participation); Interpersonal Support Evaluation List (social support); Activities Specific Balance Confidence Scale (balance confidence); Timed Up and Go Test (mobility capacity); and Centre for Epidemiological Studies Depression Scale (depression symptomatology). Results. Mobility and balance confidence explained 30% of the level of participation in daily activities and 24% of participation in social roles, whereas social support and depression did not contribute to the explanation of participation. When explaining participation in daily activities, sex had a significant contribution to the model. Conclusions. Participation accomplishment is explained by personal factors related to an elder's physical and mental ability while sex differences had an important role for explaining accomplishment of daily activities. Additional aspects of participation, environmental barriers, and level of disability, are key factors identified for further inquiry. [ABSTRACT FROM AUTHOR]

College obesity is increasing, but to the authors' knowledge, no researchers to date have evaluated risk factors in this population. Objective: The authors assessed whether abnormal eating perceptions and behaviors were associated with overweight in college students. Participants and Methods: A sample of undergraduates (N = 4,201) completed an online survey containing demographic questions and the Eating Attitudes Test-26 (EAT-26) questionnaire. The authors stratified participants into normal-weight and overweight/obese groups and evaluated physical activity, EAT-26 score, purging behaviors, and answers to selected overweight screening questions on the basis of body mass index. A modified EAT-26 score of >/= 11 was associated with overweight (p = .016). Results: Compared with normal-weight peers, overweight participants displayed an increased fear of bingeing, preoccupation with food, desire to be thinner, and engagement in dieting behavior. Mean body mass index also increased with age and physical inactivity (p < .001). Conclusions: Because physical inactivity, disordered eating perceptions, and disordered behaviors are associated with increased rates of overweight and obesity, identification of these risk factors in obese youths may increase understanding of weight loss barriers and facilitate the treatment of adolescent obesity. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study was to develop and pilot-test an interactive CD-ROM aimed at the prevention of sexually transmitted infections (STIs) in female adolescents. The CD-ROM includes prevention information, models skills for negotiating abstinence and consistent condom use, teaches media literacy, and allows the user to choose a culturally appropriate host to guide them through the CD-ROM. Forty-seven female adolescents attending a health department clinic were randomized to receive the CD-ROM plus an educator-led didactic session versus the didactic session alone. The CD-ROM was highly acceptable and feasible for use among female adolescents in the clinic setting. Hispanic and African American adolescents were more likely to choose hosts of the same race/ethnicity to guide them through the CD-ROM. HIV/STI knowledge increased significantly and nearly all adolescents intended to use condoms at next intercourse after viewing the CD-ROM. However, there were no significant differences measured between CD-ROM and comparison groups. [ABSTRACT FROM AUTHOR]

This manuscript will present the results of a preliminary study that was conducted to provide support for the face validity of the Idyll Arbor Leisure Battery (IALB). The study used a qualitative, utilization-focused evaluation (UFE) format. Semi-structured interviews with individuals with spinal cord injuries and experienced Recreation Therapists who work with this population were conducted. Strengths and weaknesses of the scales were identified and some recommendations were made. Most participants believed that the majority of the IALB items were important and gathered relevant information. However, several limitations were identified and discussed, such as readability, context, burden, and readiness. Implications for therapeutic recreation are discussed. It was concluded that the IALB scales have promise as research and clinical assessment tools; and that further psychometric testing is warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Evaluate the reliability, validity, and predictive value of the L test, a performance-based walk test, among older inpatients. DESIGN: Cross-sectional study involving a consecutive sample of 50 older adults (mean age 84 +/- 5 yrs) admitted to the geriatric unit of a tertiary care hospital. Application of the L test twice and single application of the timed 'up and go' test (TUG), and the Frailty and Injuries Cooperative Studies of Intervention Techniques (FICSIT-4) balance scale, were conducted. RESULTS: Interrater and intrarater reliability (two-way ANOVA intraclass correlation coefficients [ICC]) of the L test was 1.00 (95% confidence interval, CI, 0.99-1.00) and 0.97, respectively (CI, 0.95-0.98). Hypothesized associations with the TUG and FICSIT-4 were observed (Pearson product-moment correlation, r = 0.96 and r = -0.45, respectively; P < 0.01) with regard to magnitude and direction of the relationship. L test times demonstrated a small but statistically significant independent risk factor for discharge destination after hospitalization (odds ratio = 1.05; CI, 1.01-1.09) after adjustment for age, sex, and cognitive status. CONCLUSIONS: The L test provides reliable, valid data when assessing basic walking skills among older adults in a hospital environment. The L test is potentially an important clinical and research tool to assess the mobility function of older inpatients as they transition back to the community. [ABSTRACT FROM AUTHOR]

Although outreach frequently is used to provide community-based HIV prevention services to members of underserved populations, researchers may not be familiar with the specific components of and factors influencing outreach and how systematic community outreach methods can be used to recruit participants for research purposes. This article describes key components of a theory and PRECEDE-based outreach model developed and used as part of a broader study examining the feasibility of enhancing access to STD clinical services for sexually transmitted diseases in order to reduce HIV incidence. We present a three-part outreach model and describe lessons learned from implementing it. Factors that improved access to key informants who could facilitate participant recruitment during the outreach process included sustained project visibility in the community, outreach worker affiliation with trusted community-based organizations, and development of a reliable network of key informants. This model enabled a systematic approach to reaching community members and documenting the steps taken to do so. [ABSTRACT FROM AUTHOR]

BACKGROUND: We conducted a prospective study to evaluate methods of detecting clients with sexually transmitted diseases (STDs) who were acutely coinfected with human immunodeficiency virus (HIV) in Lilongwe, Malawi. METHODS: After informed consent was obtained, all clients with acute STDs were offered voluntary HIV counseling and testing by 2 rapid antibody tests. Samples from rapid test-negative or -discordant subjects were pooled (50 : 5 : 1) and tested for HIV RNA. Western blots were performed on all rapid test-discordant specimens with detectable HIV RNA. A subset of specimens received p24 antigen testing with standard and/or ultrasensitive methods. Patients with possible acute HIV infection were followed to confirm seroconversion. RESULTS: A total of 1450 clients (34% female and 66% male) agreed to testing, of whom 588 (40.55%) had established HIV infection and 21 (1.45%) had acute infection. Discordant rapid antibody tests identified 7 of 21 (33.3% sensitivity), standard p24 antigen identified 12 of 16 (75% sensitivity), and ultrasensitive p24 antigen identified 15 of 17 (88% sensitivity) acute cases. By definition, the sensitivity of the RNA assay was 100%. CONCLUSIONS: Real-time pooled RNA testing for the detection of acute HIV infection is feasible in resource-limited settings. However, parallel rapid testing and p24 antigen testing are technologically simpler and together may detect approximately 90% of acute cases. Copyright © 2007 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

PURPOSE: To translate the Activities-specific Balance Confidence (ABC) Scale into a Chinese version and assess the reliability between Chinese versions and between Chinese and English versions of this outcome measure. METHOD: Descriptive study using a 4-week test-retest design. Data were collected from a convenience sample of community living Chinese immigrants. Of the 79 participants, data from 71 subjects were included in the analysis. Two subsamples were formed to assess the reliability between Chinese versions (n = 33) and between Chinese and English versions (n = 38) of the scale. RESULTS: Internal consistency of the ABC-C was 0.98. Test-retest reliability was intraclass correlation coefficient (ICC) = 0.87 (95% CI, 0.76 - 0.93) for the Chinese versions and ICC = 0.88 (95% CI, 0.78 - 0.94) for Chinese and English versions. The total group ICC = 0.90 (95% CI, 0.84-0.94). CONCLUSIONS: Balance confidence has been identified as an important area for clinical and research inquiry however collecting this information from Chinese speaking individuals has been limited by a lack of language specific measures. The Chinese version of the ABC has demonstrated acceptable measurement properties in this sample and should permit measurement of this unique construct in the Chinese population. [ABSTRACT FROM AUTHOR]

Although power mobility has many potential benefits for users, power mobility incidents and accidents are a serious concern. To date, little research has explored power mobility safety, and no gold standard exists to determine whether the user is a safe driver. As a possible alternative to a facility unilaterally imposing regulations on power mobility users, we conducted a research project in which power mobility users and other stakeholders used the Delphi method to develop guidelines for power mobility use within a residential facility setting. This article presents the overarching principles for power mobility use and noteworthy items from the safety guidelines that participants developed. These findings highlight the safety issues that are encountered in residential care settings and suggest some strategies to deal with them. [ABSTRACT FROM AUTHOR]

Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents' not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. - 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. - 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors. [ABSTRACT FROM AUTHOR]

BACKGROUND: To assess the effects of human immunodeficiency virus (HIV) infection on susceptibility to malaria, we compared the incidence rates of malaria by HIV type 1 (HIV-1) serostatus, baseline blood HIV-1 RNA concentration, and baseline CD4 cell count, over the course of a malaria season. METHODS: We followed a cohort of 349 adults in Malawi. For the 224 HIV-1-seropositive adults (64% of the cohort), we measured HIV-1 RNA concentration (n=187) and CD4 cell count (n=184) at baseline. Parasitemia was defined as presence of asexual parasites on a thick film of blood and was treated with sulfadoxine/pyrimethamine (SP), in accordance with national policy. Hazard ratios (HRs) of parasitemia were estimated using Cox regression. Demographics were adjusted for. RESULTS: HIV-1 seropositivity was associated with parasitemia (adjusted HR, 1.8 [95% confidence interval {CI}, 1.2-2.7] for a first parasitemia episode; adjusted HR, 2.5 [95% CI, 1.5-4.2] for a second parasitemia episode [> 14 days after the first episode]; adjusted HR, 1.9 [95% CI, 1.4-2.6] for parasitemia overall). Treatment failure (parasitemia < or = 14 days after SP treatment) did not differ by HIV-1 serostatus (risk ratio, 1.3 [95% CI, 0.5-3.2]). HIV-1 RNA concentrations and CD4 cell counts were moderately but inconsistently associated with parasitemia. A high parasite density with fever was associated with HIV-1 seropositivity and low CD4 cell count. CONCLUSION: HIV-infected adults in malaria-endemic areas are at increased risk for malaria. Where possible, additional malaria prevention efforts should be targeted at this population. Copyright © 2005 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Background and Purpose: Walk tests provide essential outcome information when assessing ambulation of individuals with lower-limb amputation and a prosthetic device. Existing tests have limitations such as ceiling effects or insufficient challenge. The objective of this study was to assess the reliability and validity of data for a clinical measure of basic mobility, the L Test of Functional Mobility (L Test). Subjects: For this methodological study, 93 people with unilateral amputations (74% transtibial, 26% transfemoral; 78% male, 22% female; mean age=55.9 years) were consecutively recruited from an outpatient clinic. Twenty-seven subjects returned for retesting. Methods: To assess concurrent validity, subjects completed the L Test, Timed 'Up & Go' Test (TUG), 10-Meter Walk Test, and 2-Minute Walk Test, followed by the Activities-specific Balance Confidence scale, Frenchay Activities Index (FAI), and mobility subscale of the Prosthetic Evaluation Questionnaire (PEQ-MS). Amputation cause and level, walking aid use, automatic stepping, and age variables were used to assess discriminant validity. Results: Intraclass correlation coefficients were .96 for interrater reliability and .97 for intrarater reliability, and minimal bias existed upon retesting. The magnitude of concurrent validity correlations (r) was very high between the L Test data and data for other walk tests and fair to moderate between the L Test data and data for self-report measures. The L Test discriminated between all groups as hypothesized. Discussion and Conclusion: The L Test is a 20-m test of basic mobility skills that includes 2 transfers and 4 turns. It demonstrated excellent measurement properties in this study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE: As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use. METHOD: In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS: A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS: Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them. [ABSTRACT FROM AUTHOR]

Purpose: To examine the reliability and validity of the Activities-specific Balance Confidence (ABC) Scale among individuals with stroke.Method: Descriptive measurement study using a 4-week test--retest design. Data were collected at a tertiary rehabilitation centre from a community-dwelling sample of ambulatory older adults who sustained one stroke at least 1 year prior to the study. During the first measurement session, the total sample (n = 77) completed the ABC as well as the Berg Balance Scale (BBS) and gait speed. The reliability sample (n = 24), a subset of the larger data set, completed the ABC again 4 weeks later. Results: Internal consistency of the ABC was 0.94 and test-retest reliability was ICC = 0.85 (95% CI, 0.68, 0.93). A moderate significant positive, linear correlation with both the BBS (p = 0.36, P < 0.001) and gait speed (p = 0.48, P < 0.001) was observed. A factor analysis using principal component analysis indicated that the ABC measures two components of balance self-efficacy (component 1 = perceived low-risk activities; component 2 = perceived high-risk activities).Conclusions: The ABC has acceptable measurement properties as demonstrated in this sample of individuals with stroke. This study provides further support for the use of the scale. [ABSTRACT FROM AUTHOR]

Objectives: Trichomonas vaginalis is the most common nonviral sexually transmitted pathogen. Wet mount microscopy performs poorly compared with culture; however, universal screening using culture would be cost-prohibitive.Goal: The goal of this study was to develop a predictive model for wet mount-negative women who may benefit from targeted use of culture for T. vaginalis detection.Study: Women presenting for sexually transmitted disease evaluation were prospectively screened for trichomoniasis using wet mount and culture. Multivariate logistic regression was used to identify predictors of culture-proven trichomoniasis among wet mount-negative women.Results: A total of 2194 women were screened for trichomoniasis; overall, the prevalence of T. vaginalis was 17.5%. Three predictors (any drug use, contact to trichomoniasis, and African-American race) provided the most specific model (100%); any 1 predictor, the most sensitive model (97.8%).Conclusions: Given the public health impact of trichomoniasis, we recommend using any 1 of 3 predictors to identify women who would benefit from targeted culture for T. vaginalis. [ABSTRACT FROM AUTHOR]

PURPOSE: To estimate the prevalence of routine physical examination among in-school adolescents of differing national Latino origins and to assess associations with gender, age, immigrant generational status, language spoken at home, parental education, poverty level, family structure, and insurance status. METHODS: Cross-sectional analysis of Wave I of the National Longitudinal Study of Adolescent Health conducted during 1995. Our sample was limited to adolescents in grades 7 through 12 of Mexican (n = 1657), Cuban (n = 490), Puerto Rican (n = 555), and Central/South American or Dominican (C/S American or DR) (n = 427) origins. We used multivariate logistic regression for survey data to conduct the data analyses. RESULTS: Mexican-origin adolescents were less likely to report a routine physical examination in the previous year, compared with other Latino populations [prevalence (95% confidence interval)]: Mexicans, 47.7% (42.0% -53.6%], Cubans 67.6% (57.4%-76.4%), Puerto Ricans 65.2% (58.4%-71.4%), and C/S American or DR (57.0% [47.3-66.2]). Among Mexican-origin adolescents, having a college-educated parent or insurance was associated with receiving care (adjusted prevalence odds ratio [95% confidence interval]), 2.12 (1.37-3.30) and 1.80 (1.31-2.47), respectively. For Cuban-origin adolescents, first-generation immigrants were less likely to receive care (0.31 [0.14-0.70]), and those living in a single-parent home were more likely to receive care (2.83 [1.52-5.25]). Having a routine physical examination among adolescents of C/S American or DR origins was associated with incomes above the poverty level (2.29 [1.10-4.77] and insurance (2.33 [1.10-4.91]). CONCLUSIONS: Reflecting the heterogeneity of Latino adolescents, the prevalence of routine physical examination and factors associated with it varied by national origin subgroup. These differences should be considered when developing strategies to better address the health needs of Latino youth. [ABSTRACT FROM AUTHOR]