Sexual Trauma Screening for Men and Women: Examining the Construct Validity of a Two-Item Screen.

The Veterans Health Administration (VHA), the largest integrated healthcare system in the United States, has conducted universal screening for military sexual trauma (MST) to facilitate MST-related care since 2002. VHA defines MST as sexual assault or repeated, threatening sexual harassment that occurred during military service. Evidence of construct validity, the degree to which the screen is measuring what it purports to measure (i.e., MST), was examined using the 23-item Sexual Experiences Questionnaire-Department of Defense (SEQ-DoD). Results showed individuals who endorsed no SEQ-DoD items screened MST negative. Those who had experienced more SEQ-DoD behaviors with greater frequency, and across all four SEQ-DoD domains, were more likely to screen MST positive. Findings were similar for men and women. These findings contribute to the validity evidence for the VHA MST screen.

Phase I Study Assessing the Pharmacokinetic Profile, Safety, and Tolerability of a Single Dose of Ceftazidime-Avibactam in Hospitalized Pediatric Patients.

This study aimed to investigate the pharmacokinetics (PK), safety, and tolerability of a single dose of ceftazidime-avibactam in pediatric patients. A phase I, multicenter, open-label PK study was conducted in pediatric patients hospitalized with an infection and receiving systemic antibiotic therapy. Patients were enrolled into four age cohorts (cohort 1, ≥12 to <18 years; cohort 2, ≥6 to <12 years; cohort 3, ≥2 to <6 years; cohort 4, ≥3 months to <2 years). Patients received a single 2-h intravenous infusion of ceftazidime-avibactam (cohort 1, 2,000 to 500 mg; cohort 2, 2,000 to 500 mg [≥40 kg] or 50 to 12.5 mg/kg [<40 kg]; cohorts 3 and 4, 50 to 12.5 mg/kg). Blood samples were collected to describe individual PK characteristics for ceftazidime and avibactam. Population PK modeling was used to describe characteristics of ceftazidime and avibactam PK across all age groups. Safety and tolerability were assessed. Thirty-two patients received study drug. Mean plasma concentration-time curves, geometric mean maximum concentration (Cmax), and area under the concentration-time curve from time zero to infinity (AUC0-∞) were similar across all cohorts for both drugs. Six patients (18.8%) reported an adverse event, all mild or moderate in intensity. No deaths or serious adverse events occurred. The single-dose PK of ceftazidime and avibactam were comparable between each of the 4 age cohorts investigated and were broadly similar to those previously observed in adults. No new safety concerns were identified. (This study has been registered at ClinicalTrials.gov under registration no. NCT01893346.).

Spirituality and religiosity in patients with HIV: a test and expansion of a model.

BACKGROUND: A causal model developed by Koenig suggests that higher levels of spirituality and religiosity effect intermediary variables and eventually result in better mental health, which then positively affects physical function. PURPOSE/METHODS: Using structural equation modeling, we tested the model and expanded versions that use self-report data of patients with HIV (n = 345). RESULTS: All models demonstrated good overall fit with significant parameters. The final model found that increased spirituality/religiosity predicted increased religious coping, which influenced social support. Social support, in turn, positively influenced depressed mood (as a measure of mental health); depressed mood affected fatigue; and both variables predicted self-reported physical function. These three variables predicted health rating/utility for one's health state. Additional analyses found that two covariates, religiosity and race, differentially predicted spirituality/religiosity and religious coping. CONCLUSION: In patients with HIV, an expanded version of Koenig's model found that increased spirituality/religiosity is positively associated with self-reported outcomes.

Bleeding complications in patients with squamous cell carcinoma of the head and neck.

Hemorrhage in recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) may be attributed to chemotherapy and local tumor irradiation. Evidence of the relationship between hemorrhage in R/M HNSCC and targeted therapies, including epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) inhibitors, or immune checkpoint inhibitors, is limited. We aimed to identify epidemiological and clinical data related to the occurrence of hemorrhage in R/M HNSCC and to explore its relationship with various therapies. We describe information obtained from literature searches as well as data extracted from a commercial database and a database from the author's institution (Istituto Nazionale dei Tumori of Milan). Evidence suggests that most bleeding events in R/M HNSCC are minor. Clinical trial safety data do not identify a causal association between hemorrhage and anti-EGFR agents or immune checkpoint inhibitors. In contrast, anti-VEGF agents are associated with increased, and often severe/fatal, hemorrhagic complications.

Changes in Health-Related Quality of Life among African-Americans in a lifestyle weight loss program.

PURPOSE: Changes in health-related quality of life (HRQoL) were assessed in clinically obese, African-American adults after completion of a weight loss program that resulted in modest average weight loss. METHODS: Data were analyzed for 87 men and women who provided weight measurements after an initial 10-week weight loss program (Phase 1) and a subsequent clinical trial to evaluate three weight maintenance approaches (Phase 2) over an additional 8 to 18 months. HRQoL was assessed using the Short Form SF-36 questionnaire. Intra-person changes in HRQoL were assessed and analyzed for associations with weight change within each phase. Non-parametric bivariable analyses and multivariable linear regression were used in statistical analyses. RESULTS: Changes in HRQoL were modest; clinically significant intra-subject improvements in SF-36 domains of general health and vitality and in the mental component summary score were observed after Phase 1 but were attenuated during Phase 2. Improvements in vitality were significantly associated with greater weight loss in Phase 1, but no HRQoL change scores during Phase 2 were associated with weight change. CONCLUSIONS: Short-term improvements in general health and vitality were observed. The vitality domain of the SF-36 appeared to be the domain of HRQoL most responsive to modest weight change.

Reliability and validity of two HIV/AIDS-specific quality of life instruments adapted for use in HIV-positive Zimbabweans.

We sought to assess the reliability and construct validity of the HIV/AIDS-Targeted Quality of Life instrument (HAT-QoL) and the Medical Outcomes Study HIV Health Survey (MOS-HIV) adapted for use in Shona-speaking rural Zimbabwe. HAT-QoL and MOS-HIV were translated and culturally adapted into Shona, and administered to a convenience-sample of 400 patients with HIV-related opportunistic infections. HIV disease severity and bereavement history were assessed. Factor analysis of the HAT-QoL items produced seven factors that were nearly identical to the factor structure reported for an American sample that was the basis for the current HAT-QoL scales. Factor analysis of the MOS-HIV scales resulted in a single factor, not the expected two-factor structure (physical and mental). Convergent and discriminant validity assessments confirmed, in general, that similar Shona HAT-QoL and MOS-HIV dimensions were correlated and dissimilar ones not correlated. Construct validity assessments indicated that, on the whole, most Shona HAT-QoL and MOS-HIV dimensions were capturing anticipated subgroup differences. The exceptions were the Shona MOS-HIV dimensions of general health perceptions, cognitive function, and the quality of life (QoL) item. The reliability and validity of most Shona-adapted HAT-QoL and MOS-HIV dimensions suggest that both instruments are likely useful in measuring the QoL of rural, Shona-speaking populations in Zimbabwe, Mozambique, Zambia, and Botswana.

Veterans' distress related to participation in a study about detainee abuse.

Unintended consequences of participating in research studies are not well characterized, particularly in veterans who are frequent study participants. Our objective, then, was to assess the rate of and variables associated with distress resulting from veterans' participation in a study on a sensitive subject. Veterans Administration (VA) hospital outpatients were administered questionnaires with three increasingly severe scenarios of a U.S. soldier abusing a detainee. Distress--upset requiring clinical intervention--was assessed, as were sociodemographic characteristics, post-traumatic stress disorder (PTSD), depression, and locus of control (LOC). Three hundred fifty-one veterans participated. Forty-three (12%) became distressed. Modeling indicated distress was associated with minority status (odds ratio [OR] = 5.72, 95% confidence interval [CI] = 1.59, 20.58), PTSD (OR = 2.66, 95% CI = 1.12, 6.29), and external LOC (OR = 6.27, 95% CI = 2.82, 13.90). Distress related to study participation was high in this veteran sample. Higher rates in some subgroups suggested that some individuals may not be able to accurately anticipate risk for harm in sensitive studies.

Contact isolation for infection control in hospitalized patients: is patient satisfaction affected?

The effects of contact isolation on patient satisfaction are unknown. We performed a cross-sectional survey and found that most patients lack education and knowledge regarding isolation but feel that it improves their care. In multivariable analysis, isolated patients were not less satisfied with inpatient care than were nonisolated patients.

Screening male primary care patients for intimate partner violence perpetration.

BACKGROUND: Primary prevention of intimate partner violence (IPV) at the level of the primary care provider is unexplored. OBJECTIVE: We sought to identify whether men disclose current IPV perpetration when asked by a primary care provider. DESIGN: Cross-sectional study. PARTICIPANTS: Consecutive male patients of 6 providers in public health, university, and VA hospital clinics. MEASUREMENTS: Men were screened for IPV perpetration during routine visits, then given a Conflict Tactics Scale questionnaire (CTS2) to complete and mail back anonymously. RESULTS: One hundred twenty-eight men were screened; 46 (36%) returned CTS2 questionnaires. Twenty-three and 2 men disclosed past and current perpetration to providers, respectively. Providers assessed lethality/safety issues in 58% of those reporting a perpetration history (including both with current perpetration), responded with direct counseling to 63% (including both with current perpetration), and referred 17% for services related to the screening (including 1 with current perpetration). Nine and 26 men reported current, CTS2-assessed physical and psychological aggression of a partner, respectively. CONCLUSIONS: Men appear to underreport current IPV perpetration in face-to-face primary care encounters when compared to other methods of reporting. Men may more readily report past IPV perpetration in face-to-face encounters.

Test-retest evaluation of HAT-QoL and SF-36 in an HIV-seropositive sample.

We sought to correct previously reported psychometric and content problems of the HIV/AIDS-Targeted Quality of Life Instrument (HAT-QoL) and to assess test-retest reliability of this revised HAT-QoL as well as the MOS 36-Item Short-Form Health Survey (SF-36) when used in an HIV-seropositive outpatient sample. A total of 153 participants randomly sampled from an HIV specialty and general medical clinics completed a test booklet that contained HAT-QoL and the SF-36; a random subsample of 60 participants were asked to return in approximately two weeks to complete the instruments again. Using the baseline sample, internal consistency coefficients of all final HAT-QoL dimensions were > or =0.80. The retest subsample, for which there were no significantly different characteristics than the baseline sample, completed the instruments again an average of 14.7 days after baseline completion. For HAT-QoL, only one (Provider Trust) of the nine dimensions revealed a significant test-retest difference (+5.9, p=0.05). All HAT-QoL intraclass correlation coefficients (ICCs) were > or =0.64 (seven values were > or =0.73). All effect sizes were small. For SF-36, two dimensions (Physical Functioning and Social Functioning) revealed significant test-retest differences, and one dimension (Mental Health) revealed a difference approaching significance (p=0.06). The SF-36 ICCs were similar to those for HAT-QoL, with the exception of three dimensions--Vitality, Role-Emotional and Mental Health (all were<0.56). Though most effect sizes were small, Social Functioning and Mental Health estimates were approaching more moderate effect sizes. HAT-QoL reveals considerable short-term stability and has psychometric features in the seropositive population comparable to instruments such as SF-36, while obtaining unique information.

Volumetric bladder ultrasound performed by trained nurses increases catheterization success in pediatric patients.

OBJECTIVE: The objective of the study was to determine whether the use of volumetric ultrasound by trained pediatric emergency department (ED) nurses improves first-attempt urine collection success rates. METHODS: This randomized controlled trial was conducted in children aged < or = 36 months requiring diagnostic urine samples. Children were randomized to either the conventional (nonimaged) or the ultrasound arm. Demographics, number of catheterizations required for success, postponements, and collection times were recorded. RESULTS: Forty-five children were assigned to the conventional and 48 to the ultrasound arm (n = 93). First-attempt success rates were higher in the ultrasound arm: 67% (conventional) vs 92% (ultrasound) (P = .003). Both urinalysis and culture were less likely to be completed on conventional group specimens (91% vs 100%; P = .04). However, mean conventional group urine collection time was less than the ultrasound group's collection time (12 vs 28 minutes; P < .001). CONCLUSIONS: Although there is a time delay, urine collection in the ultrasound arm generated a significant improvement over conventional catheterization in obtaining an adequate urine sample.

Men's self-definitions of abusive childhood sexual experiences, and potentially related risky behavioral and psychiatric outcomes.

OBJECTIVES: To estimate how many heterosexual and gay/bisexual men self-define abusive childhood sexual experiences (CSEs) to be childhood sexual abuse (CSA) and to assess whether CSA self-definition is associated with risky behavioral and psychiatric outcomes in adulthood. METHODS: In Philadelphia County, 197 (66%) of 298 recruited men participated in a telephone survey. They were screened for CSEs and then asked if they self-defined abusive CSEs to be CSA; they also were asked about risk behavior histories and post-traumatic stress disorder (PTSD) and depression symptoms. RESULTS: Of 43 (22%) participants with abusive CSEs, 35% did not and 65% did self-define abusive CSEs to be CSA ("Non-Definers" and "Definers," respectively). Heterosexual and gay/bisexual subgroups' CSA self-definition rates did not significantly differ. When self-definition subgroups were compared to those without CSEs ("No-CSEs"), Non-Definers had lower perceived parental care (p=.007) and fewer siblings (p=.03), Definers had more Hispanics and fewer African Americans (p=.04), and No-CSEs had fewer gay/bisexual men (p=.002) and fewer reports of physical abuse histories (p=.02) than comparison groups. Non-Definers reported more sex under the influence (p=.001) and a higher mean number of all lifetime sex partners (p=.004) as well as (only) female sex partners (p=.05). More Non-Definers than Definers reported having experienced penetrative sex as part of their CSA (83% vs. 35%, p=.006). Different explanations about self-definition were provided by subgroups. CONCLUSIONS: Many men with abusive CSEs do not self-define these CSEs to be CSA, though not in a way that differs by sexual identity. The process by which men self-define their abusive CSEs to be CSA or not appears to be associated not only with self-explanations that differ by self-definition subgroup, but also with behavioral outcomes that impart risk to Non-Definers.

Stigma and the acceptability of depression treatments among african americans and whites.

BACKGROUND: Stigma is associated with depression treatment, however, whether stigma differs between depression treatment modalities is not known, nor have racial differences in depression treatment stigma been fully explored. OBJECTIVE: To measure stigma for four depression treatments and estimate its association with treatment acceptability for African Americans and whites. DESIGN: Cross-sectional, anonymous mailed survey. PARTICIPANTS: Four hundred and ninety African-American and white primary care patients. MEASUREMENTS: The acceptability of four depression treatments (prescription medication, mental health counseling, herbal remedy, and spiritual counseling) was assessed using a vignette. Treatment-specific stigma was evaluated by asking whether participants would: (1) feel ashamed; (2) feel comfortable telling friends and family; (3) feel okay if people in their community knew; and (4) not want people at work to know about each depression treatment. Sociodemographics, depression history, and current depressive symptoms were measured. RESULTS: Treatment-specific stigma was lower for herbal remedy than prescription medication or mental health counseling (p < .01). Whites had higher stigma than African Americans for all treatment modalities. In adjusted analyses, stigma relating to self [AOR 0.43 (0.20-0.95)] and friends and family [AOR 0.42 (0.21-0.88)] was associated with lower acceptability of mental health counseling. Stigma did not account for the lower acceptability of prescription medication among African Americans. CONCLUSIONS: Treatment associated stigma significantly affects the acceptability of mental health counseling but not prescription medication. Efforts to improve depression treatment utilization might benefit from addressing concerns about stigma of mental health counseling.

Men's childhood sexual abuse histories by one-parent versus two-parent status of childhood home.

OBJECTIVES: To estimate the association between number of parents in the childhood home and childhood sexual abuse (CSA) with adjustment for childhood socioeconomic status (CSES). METHODS: Probability sample of 298, 18-49-year-old men from Philadelphia County, number of parents living in childhood home, socioeconomic data and CSA histories were obtained. RESULTS: 197 (66%) men participated. 186 (94%) of these lived with at least one parent; 76 (39%) and 110 (56%) lived with one parent versus two parents, respectively. 22 (29%) of 76 and 18 (16%) of 110 reported CSA histories, respectively (OR 2.08, p = 0.04). Two approaches to adjustment for CSES indicated continued association between parent number and CSA (OR 2.38-2.39, p = 0.05-0.07). Parent number was associated with numerous differences in CSA perpetrator characteristics and abuse experiences. Men from one-parent versus two-parent families reported significantly more non-family and female perpetrators (p = 0.03 and 0.01, respectively) and fondling experiences (p = 0.04). CONCLUSIONS: Findings provide additional support for the association between parent number and CSA in boys, suggesting that parent number is not just a proxy for CSES. CSA experiences also differed between one-parent and two-parent homes. Findings generate numerous hypotheses for future study.

Abuse of war zone detainees: veterans' perceptions of acceptability.

We assessed detainee abuse acceptance and variables associated with it. Outpatients from a veterans' hospital were administered questionnaires with three increasingly severe scenarios of a U.S. soldier abusing a detainee. Three questionnaire versions differed in the final line of each version's scenarios, describing abuse either as: soldier initiated, superior ordered, or wrong by a "whistleblower" soldier. Three hundred fifty-one veterans participated, 80% with service during the Vietnam War. Zero tolerance for abuse--"completely unacceptable" regardless of who the detainee was--increased with abuse severity (16% for exposure, 31% for humiliation, and 48% for rape of detainee) and with soldier initiation. The strongest, most consistently significant odds were of depressed veterans, veterans with comorbid depression/post-traumatic stress disorder, and men being approximately 2, 3, and 4 to 20 times more tolerant of abuse than those without depression/post-traumatic stress disorder and women, respectively. There may be potential value to using similar scenario-based questionnaires to study active duty military perceptions of detainee abuse. Results may inform prevention policies.

Changes in religiousness and spirituality attributed to HIV/AIDS: are there sex and race differences?

BACKGROUND/OBJECTIVE: Having a serious illness such as HIV/AIDS raises existential issues, which are potentially manifested as changes in religiousness and spirituality. The objective of this study was (1) to describe changes in religiousness and spirituality of people with HIV/AIDS, and (2) to determine if these changes differed by sex and race. METHODS: Three-hundred and forty-seven adults with HIV/AIDS from 4 sites were asked demographic, clinical, and religious/spiritual questions. Six religious/spiritual questions assessed personal and social domains of religiousness and spirituality. RESULTS: Eighty-eight participants (25%) reported being "more religious" and 142 (41%) reported being "more spiritual" since being diagnosed with HIV/AIDS. Approximately 1 in 4 participants also reported that they felt more alienated by a religious group since their HIV/AIDS diagnosis and approximately 1 in 10 reported changing their place of religious worship because of HIV/AIDS. A total of 174 participants (50%) believed that their religiousness/spirituality helped them live longer. Fewer Caucasians than African Americans reported becoming more spiritual since their HIV/AIDS diagnosis (37% vs 52%, respectively; P<.015), more Caucasians than African Americans felt alienated from religious communities (44% vs 21%, respectively; P<.001), and fewer Caucasians than African Americans believed that their religiousness/spirituality helped them live longer (41% vs 68% respectively; P<.001). There were no significantly different reported changes in religious and spiritual experiences by sex. CONCLUSIONS: Many participants report having become more spiritual or religious since contracting HIV/AIDS, though many have felt alienated by a religious group-some to the point of changing their place of worship. Clinicians conducting spiritual assessments should be aware that changes in religious and spiritual experiences attributed to HIV/AIDS might differ between Caucasian and African Americans.

Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women.

CONTEXT: Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC. METHODS: Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software. RESULTS: We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health. CONCLUSIONS: Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.

Brief communication: physical abuse of boys and possible associations with poor adult outcomes.

BACKGROUND: Men's childhood physical abuse experiences are understudied. OBJECTIVE: To obtain descriptions about men's personal childhood physical abuse histories and estimate their association with adult outcomes. DESIGN: Population-based telephone survey. SETTING: Urban areas with high frequency of domestic violence against girls and women. PARTICIPANTS: 298 men recruited through random-digit dialing. MEASUREMENTS: 6 Conflict Tactics Scale items and psychiatric, sexual, and legal history questions. RESULTS: One hundred of 197 (51%) participants had a history of childhood physical abuse. Most (73%) participants were abused by a parent. Childhood physical abuse history was associated with depression symptoms (P = 0.003), post-traumatic stress disorder symptoms (P < 0.001), number of lifetime sexual partners (P = 0.035), legal troubles (P = 0.002), and incarceration (P = 0.007) in unadjusted analyses and with depression symptoms (P = 0.015) and post-traumatic stress disorder symptoms (P = 0.003) in adjusted analyses. LIMITATIONS: There may have been inaccurate recall of past events. Lack of exposure time data disallowed direct comparison of abuse perpetration by mothers versus fathers. Other unmeasured variables related to childhood physical abuse might better explain poor adult outcomes. CONCLUSIONS: The high frequency of childhood physical abuse histories in this population-based male sample, coupled with the high proportion of parent perpetrators and the association between childhood physical abuse and adult outcomes that are often associated with perpetration of violence, argues for more study of and clinical attentiveness to potential adult outcomes of men's own childhood physical abuse histories.

Assessment of a Stool Symptom Screener and Understanding the Opioid-Induced Constipation Symptom Experience.

BACKGROUND: Many patients with chronic opioid-induced constipation (OIC) seek treatment to relieve their symptoms. A symptom screener may be useful in identifying symptomatic OIC patients. AIM: The aims of this study were to assess patient understanding of Stool Symptom Screener content and to evaluate how patients described their constipation experience, to better understand the relationship between constipation symptoms and patterns of laxative use. METHODS: Adult OIC patients were recruited through five clinical sites across the USA. Patients were classified as either frequent or non-frequent laxative users. Patients participated in a semi-structured interview to assess their understanding of a Stool Symptom Screener and to discuss their constipation symptoms and laxative use experience. Interview transcripts were reviewed using content analysis. Descriptive statistics were used to characterize the sample. RESULTS: Sixty-six OIC patients participated: 39 frequent laxative users (mean age 53.3 years) and 27 non-frequent laxative users (mean age 55.5 years). Both patient groups described high levels of symptom burden on the Stool Symptom Screener as well as anecdotally. Both patient groups generally understood the Stool Symptom Screener items and felt the questions were relevant to their symptom experience. Most (95.5%) reported that they could remember their constipation symptoms "easily" over the previous 2 weeks. No qualitative differences were found between frequent and non-frequent laxative users in how they described their OIC symptom experience. CONCLUSION: OIC patients understood this Stool Symptom Screener, and its content was relevant to this highly symptomatic patient sample. Pain and bloating may be considered as additional symptoms for future versions of the screener. An emerging conceptual model of the OIC experience, laxative use, and symptoms is presented.