Testing and testing positive: childhood adversities and later life HIV status among Kenyan women and their partners.

Background: Adverse childhood experiences are a critical feature of lifelong health. No research assesses whether childhood adversities predict HIV-testing behaviors, and little research analyzes childhood adversities and later life HIV status in sub-Saharan Africa. Methods: We use regression models with cross-sectional data from a representative sample (n = 1974) to analyze whether adverse childhood experiences, separately or as cumulative exposures, predict reports of later life HIV testing and testing HIV+ among semi-rural Kenyan women and their partners. Results: No significant correlation was observed between thirteen cumulative childhood adversities and reporting prior HIV testing for respondent or partner. Separately, childhood sexual abuse and emotional neglect predicted lower odds of reporting having previously been tested for HIV. Witnessing household violence during one's childhood predicted significantly higher odds of reporting HIV+. Sexual abuse predicted higher odds of reporting a partner tested HIV+. Conclusions: Preventing sexual abuse and household violence may improve HIV testing and test outcomes among Kenyan women. More research is required to understand pathways between adverse childhood experiences and partner selection within Kenya and sub-Saharan Africa, and data presented here suggest understanding pathways may help improve HIV outcomes.

Adverse Childhood Experiences Predict Alcohol Consumption Patterns Among Kenyan Mothers.

OBJECTIVE: We analyze whether adverse childhood experiences predict weekly alcohol consumption patterns of Kenyan mothers and their partners. METHOD: Randomly selected respondents (n = 1,976) were asked about adverse childhood experiences and alcohol consumption patterns for themselves and their partners. Fixed effect models were used to determine odds of reporting weekly alcohol consumption and the number of beverages typically consumed, controlling for wealth, age, education, and partner alcohol consumption. RESULTS: Cumulative adverse childhood experiences predicted higher odds of weekly alcohol consumption of the respondent and her partner. Childhood exposure to physical abuse, emotional neglect, and mental illness in the household significantly increased odds of weekly alcohol consumption by the respondent. More drinks consumed per typical session were higher among respondents with more cumulative adversities. Physical and emotional abuse significantly predicted number of drinks typically consumed by the respondent. CONCLUSIONS: To our knowledge, this is the first study to explore and find associations between adverse childhood experiences and alcohol consumption in Kenya. Consistent with high-income settings, exposure to childhood adversities predicted greater alcohol consumption among Kenyan women.

Type 2 diabetes management in Hong Kong ethnic minorities: what primary care physicians need to know.

OBJECTIVES: To identify the demographics and compare diabetes control in ethnic minority group diabetes patients with Chinese diabetes patients who are managed in primary care settings and to explore strategies to improve their care. DESIGN: Retrospective case series. SETTING: General Outpatient Clinic of a Hong Kong Hospital Authority hospital. PATIENTS: Chinese type 2 diabetes patients and ethnic minority groups who had been regularly followed up with annual assessments carried out between 1 March 2012 to 28 February 2013 were recruited. Their serum levels of fasting glucose, creatinine, estimated glomerular filtration rate, haemoglobin A1c levels, lipid profile, blood pressure, and co-morbidities were retrieved from the Clinical Management System. Student's t test and analysis of variance were used to evaluate continuous variables and the Chi squared test for categorical data. All statistical tests were two-sided, and a P value of <0.05 was considered significant. RESULTS: Among 4346 type 2 diabetes patients fulfilling the inclusion criteria, 3966 (91.3%) patients were Chinese and 380 (8.7%) were from the ethnic minority groups. Compared with Chinese diabetes patients, the latter were much younger and more obese (both P<0.001). Their glycaemic control was poorer than age- and sex-matched Chinese diabetes patients (P=0.006). Control of systolic blood pressure was similar in the two groups, but the mean diastolic blood pressure was higher in the ethnic minority groups than in the controls (78 ± 11 mm Hg vs 73 ± 11 mm Hg; P<0.001). With regard to lipid control, their total cholesterol, low-density lipoprotein, and triglyceride levels were similar, but high-density lipoprotein levels were much lower in the ethnic minority groups than their Chinese counterparts (1.19 ± 0.33 mmol/L vs 1.28 ± 0.36 mmol/L; P=0.001). Among the five major ethnic minority groups with diabetes, Pakistani patients had particularly poor glycaemic control and the Nepalese had the poorest diastolic blood pressure control. CONCLUSIONS: Ethnic minority groups are an integral part of the Hong Kong population. Compared with Chinese diabetes patients, those from the ethnic minorities were much younger and more obese. Deficiencies exist in the comprehensive management of diabetes in these ethnic minorities, particularly with respect to glycaemic control. Culturally tailored health care interventions are therefore warranted to promote patient education and clinical effectiveness and to improve their long-term health status.

Defining Pediatric Trauma Center Resource Utilization: Multidisciplinary Consensus-Based Criteria from the Pediatric Trauma Society.

BACKGROUND: Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. METHODS: Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. RESULTS: The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. CONCLUSIONS: This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a gold standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. LEVEL OF EVIDENCE/STUDY TYPE: Level II, diagnostic test/criteria.

Secondary prevention of stroke: an evidence-based clinical audit in the primary care.

OBJECTIVE: To audit secondary preventive care in non-acute stroke patients in a local General Outpatient Clinic of the Hospital Authority. DESIGN: Comparison of two samples from a case series at different time-points. SETTING: General Outpatient Clinic, Hong Kong. PATIENTS: Non-acute stroke patients fulfilling the inclusion criteria and regularly followed up in a local General Outpatient Clinic during the audit cycle were recruited. Evidence-based audit criteria and performance standards were established after thorough literature review. A sample from this case series was compared retrospectively at two time-points. First-phase evaluation was performed in October 2009 and deficiencies were identified. After 9 months of active intervention, second-phase evaluation was performed in July 2010. Chi squared test and student's t test were used to compare the significance of relevant changes noted. RESULTS: First-phase data showed marked deficiencies in proper assessment of cardiovascular risk factors. Satisfactory blood pressure, glucose and lipid control was evident only in 47% of the hypertensive, 45% of the diabetic, and 37% of the dyslipidaemic stroke patients, respectively. After 9 months of implementing changes, significant improvements were noted with respect to standard targets being achieved. In the second phase, more comprehensive tackling of cardiovascular risk factors was noted, with satisfactory blood pressure control in 73% of hypertensive patients, and adequate metabolic control in 62% diabetic patients (P<0.01 for both). Only 59% of the dyslipidaemic stroke patients had optimal lipid control, though their mean low-density lipoprotein concentration was significantly reduced (P<0.05). CONCLUSION: This study provided a valuable lesson in identifying deficiencies in secondary prevention for stroke patients managed in a local primary care facility. Using a team approach intervention, quality assurance was promoted and a definite impact on patient care was demonstrated.