Evaluation of renal lesions using contrast-enhanced ultrasound (CEUS); a 10-year retrospective European single-centre analysis.

OBJECTIVE: To investigate the usefulness of contrast-enhanced ultrasound (CEUS) in the evaluation of renal masses. METHODS: This study included 255 patients with renal masses. Ages ranged from 18-86 years. CEUS was used for determining malignancy or benignancy and findings were correlated with the histopathological outcome. Out of 255 lesions, 212 lesions were malignant (83.1%) and 43 were benign (16.9%). Diagnostic accuracy was tested using the histopathological diagnosis as the gold standard. RESULTS: CEUS showed a sensitivity of 99.1% [95% confidence interval (CI): 96.7%, 99.9%], a specificity of 80.5% (CI: 65.1%, 91.2%), a positive predictive value of 96.4% (CI: 93.0%, 98.4%) and a negative predictive value of 94.3% (CI: 80.8%, 99.3%). Kappa for diagnostic accuracy was κ = 0.85 (CI: 0.75, 0.94). Of 212 malignant lesions, 200 renal cell carcinomas and 12 other malignant lesions were diagnosed. Out of 43 benign lesions, 10 angiomyolipomas, 3 oncocytomas, 8 renal cysts and 22 other benign lesions were diagnosed. CONCLUSION: CEUS is an useful method to differentiate between malignant and benignant renal lesions. To date, to our knowledge, this is the largest study in Europe for the evaluation of renal lesions using CEUS with a histopathological validation. KEY POINTS: • CEUS helps clinicians detect and characterise unclear solid and cystic renal lesions • CEUS shows a high diagnostic accuracy in the characterization of these lesions • Proper surgical treatment or follow-up can be given with better diagnostic confidence.

A Bayesian Analysis of Prenatal Maternal Factors Predicting Nonadherence to Infant HIV Medication in South Africa.

While efforts to prevent mother-to-child transmission of HIV been successful in some districts in South Africa, rates remain unacceptably high in others. This study utilized Bayesian logistic regression to examine maternal-level predictors of adherence to infant nevirapine prophylaxis, including intimate partner violence, maternal adherence, HIV serostatus disclosure reaction, recency of HIV diagnosis, and depression. Women (N = 303) were assessed during pregnancy and 6 weeks postpartum. Maternal adherence to antiretroviral therapy during pregnancy predicted an 80% reduction in the odds of infant nonadherence [OR 0.20, 95% posterior credible interval (.11, .38)], and maternal prenatal depression predicted an increase [OR 1.04, 95% PCI (1.01, 1.08)]. Results suggest that in rural South Africa, failure to provide medication to infants may arise from shared risk factors with maternal nonadherence. Intervening to increase maternal adherence and reduce depression may improve adherence to infant prophylaxis and ultimately reduce vertical transmission rates.

[CEUS-diagnosis of benign liver lesions]. / CEUS ­ Diagnostik benigner Leberläsionen.

CLINICAL/METHODICAL ISSUE: Focal liver lesions are commonly seen during routine ultrasound examinations. STANDARD RADIOLOGICAL METHODS: With native ultrasound there are lesions that cannot be sufficiently characterized. In these cases additional imaging might be necessary. METHODICAL INNOVATIONS: With contrast-enhanced ultrasound (CEUS), focal liver lesions can be characterized with high diagnostic accuracy. After the ultrasound contrast agent has been injected into a peripheral vein, the examiner saves video loops of the arterial, portal venous and late contrast phases. Combing the findings of native and contrast-enhanced ultrasound allows not only assessment of the etiology as benign or malignant but also detailed characterization of the focal liver lesion in most cases. PERFORMANCE: Using CEUS, focal liver lesions can be characterized with a sensitivity of over 95% and a specificity of about 83%. ACHIEVEMENTS: The advantages of CEUS include that there is no radiation exposure and that the ultrasound contrast agent has no effects on the function of the liver, kidneys or the thyroid gland. The main limiting factors for CEUS are bowel gas and obesity of the patient. PRACTICAL RECOMMENDATIONS: CEUS can visualize micro- and macrovascularization of benign focal liver lesions in real time. It is a useful imaging modality in unclear cases.

[CEUS-Diagnostic of malignant liver lesions]. / CEUS ­ Diagnostik maligner Leberläsionen.

CLINICAL/METHODICAL ISSUE: Cross-sectional modalities or conventional ultrasound are not always able to sufficiently identify and characterize malignant liver lesions. STANDARD RADIOLOGICAL METHODS: The evaluation of malignant liver lesions in conventional ultrasound relies on echostructure, shape and borders, but often warrants additional contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) studies. METHODICAL INNOVATIONS: Contrast-enhanced ultrasound (CEUS) is a relatively safe imaging technique used for the detection and characterization of malignant liver lesions. The use of a second-generation contrast agent in dynamic real-time imaging allows the visualization of vascularization in any kind of liver lesion as well as liver perfusion during the arterial, portal venous and late phase. PERFORMANCE: Due to the different enhancement patterns, it is possible to differentiate a liver lesion with high diagnostic accuracy (over 90%). ACHIEVEMENTS: CEUS is a helpful complementary technique to cross-sectional imaging for the evaluation of unclear liver lesions and may frequently obviate additional contrast-enhanced MRI or CT studies. PRACTICAL RECOMMENDATIONS: CEUS enables the detection and characterization of liver lesions in real time.

[Reliable diagnosis of cystic renal lesions]. / Sichere Diagnostik zystischer Nierenläsionen.

CLINICAL/METHODICAL ISSUE: Cystic renal lesions are commonly seen during routine ultrasound examinations of the abdomen. STANDARD RADIOLOGICAL METHODS: Some cystic renal lesions cannot be sufficiently characterized using native ultrasound. In these cases additional imaging might be necessary. METHODICAL INNOVATIONS: Contrast-enhanced ultrasound (CEUS) is a reliable imaging modality to characterize cystic renal lesions. Contrast enhancement of septations and the cystic wall are visualized in high resolution. This information helps to categorize the cystic renal lesions applying the CEUS Bosniak classification. This classification helps to estimate the probability of a malignant etiology of cystic renal lesions. PERFORMANCE: Using CEUS, cystic renal lesions can be characterized with a high sensitivity and specificity. ACHIEVEMENTS: The advantages of CEUS include that there is no effect on the function of the kidneys or the thyroid gland and no radiation exposure. In some cases, additional cross-sectional imaging is necessary to optimize diagnostic accuracy. PRACTICAL RECOMMENDATIONS: CEUS is a helpful imaging modality to characterize cystic renal lesions, to avoid unnecessary follow-ups and to detect malignant cystic renal lesions.

[CEUS-diagnostic workup of cystic renal lesions]. / CEUS ­ Diagnostik zystischer Nierenläsionen.

CLINICAL/METHODICAL ISSUE: Cystic renal lesions are common incidental findings in radiological imaging and they should be adequately examined to be able to characterize them as benign or malignant. STANDARD RADIOLOGICAL METHODS: It is not always possible to sufficiently characterize cystic renal lesion solely using native B­mode sonography and color-Doppler sonography. METHODICAL INNOVATIONS: Using contrast-enhanced ultrasound (CEUS), it is possible to dynamically evaluate the perfusion of cystic renal lesions and to characterize the potential malignancy of these lesions using the Bosniak classification in order to give recommendations regarding further work-up. CEUS can also be used in patients with contraindications for other radiological imaging modalities as it uses a contrast agent with almost no side effects. PERFORMANCE: Using CEUS, cystic renal lesions can be reliably characterized with a diagnostic accuracy greater than 90%. ACHIEVEMENTS: CEUS is a useful method in diagnosing and characterizing unclear cystic renal lesions and should always be considered as a viable diagnostic tool. PRACTICAL RECOMMENDATIONS: CEUS should always be performed in initially unclear cases and is a useful additional tool for the diagnosis and characterization of unclear cystic renal lesions.

[Contrast-enhanced ultrasound (CEUS) of the liver : Critical evaluation of use in clinical routine diagnostics]. / Kontrastverstärkter Ultraschall (CEUS) der Leber : Kritische Bewertung des Einsatzes in der Routinediagnostik.

CLINICAL/METHODICAL ISSUE: Focal liver lesions are common incidental findings in abdominal ultrasound diagnostics. STANDARD RADIOLOGICAL METHODS: Characterization of focal liver lesions solely based on b­mode and color duplex is not feasible in all cases. METHODICAL INNOVATIONS: Using contrast-enhanced ultrasound (CEUS) it is possible to dynamically visualize the vascularization of focal liver lesions, which enables the characterization of benign and malignant liver tumors. The advantages of CEUS are that ultrasound contrast media do not show renal, hepatic or cardiac toxicity and do not influence the thyroid gland. The approach by fusion of CEUS and contrast-enhanced cross-sectional imaging combines the advantages of both imaging modalities. PERFORMANCE: Using CEUS focal liver lesions can be characterized with a diagnostic accuracy greater than 90%. ACHIEVEMENTS: The use of CEUS has become an important imaging modality to evaluate unclear liver lesions. PRACTICAL RECOMMENDATIONS: The use of CEUS provides vital information as a supplement to cross-sectional imaging and it has become an important tool in therapy planning, control and monitoring of malignant liver lesions.

[Sonoelastography in daily clinical routine]. / Ultraschallelastographie in der klinischen Routinediagnostik.

CLINICAL ISSUE: In the daily clinical routine characterization of focal lesions using native B­mode classical ultrasound and color Doppler can be difficult or insufficient; therefore, additional diagnostic information must be taken into consideration. STANDARD RADIOLOGICAL METHODS: Standard radiological methods in the daily clinical routine include native B­mode ultrasound and color Doppler ultrasound. METHODICAL INNOVATIONS: Using sonoelastography it is possible to evaluate and characterize tissue properties and focal lesions regarding their stiffness to acquire additional information on a noninvasive basis. PERFORMANCE: Sonoelastography enables the differentiation between benign and malignant lesions especially in organs that can be easily evaluated using ultrasound. This particularly includes the liver, the thyroid gland, the breasts and the testicles. Regarding the liver, sonoelastography techniques can also be used for evaluation of the tissue flexibility in the diagnostics of fibrosis and cirrhosis. ACHIEVEMENTS: Nowadays, elastography is implemented into every modern ultrasound system and has been established as a supplementary examination technique to the conventional ultrasound techniques. PRACTICAL RECOMMENDATIONS: Sonoelastography should be used in cases with unclear findings as an additional noninvasive tool for the differentiation between benign and malignant lesions.

"Safe Foods" or "Fear Foods": the implications of food avoidance in college students from low- and middle-income countries.

PURPOSE: The primary objective of this study was to explore if self-reported food avoidance (fats, carbohydrates and protein) exists among college students in low- and middle-income countries (LMICs) and its relationship with body mass index (BMI), dieting, mood/anxiety symptoms, physical activities and general health knowledge. METHODS: This study is a subset (N = 6096) of a larger 26 LMICs cross-sectional survey, which consisted of 21,007 college students. We ascertained socio-demographic information, food avoidance, physical activities, dieting behaviours, depressive and PTSD symptoms, and recorded anthropometric measurements. Chi-square analyses assessed the relationship between predictor variables and food categories eliminated from participants' diet. Multiple logistic regression assessed if food avoidance predicts outcome variables such as binge drinking, high physical activity, being underweight, exhibiting significant depressive and PTSD symptoms. RESULTS: Food avoidance exists in as many as one-third of college students in low- and middle-income countries, with this being more likely in persons who are trying to lose weight whether by dieting or otherwise. Food avoidance was associated with higher BMI, depressive symptoms, and high intensity exercises, as well as the level of health knowledge influencing the types of food avoided. A significant difference was noted between lower middle-income and upper middle-income countries with respect to the foods they avoided. CONCLUSION: Despite being knowledgeable about health-related behaviours, we found that college students in our sample were not that different from those in developed countries and may be influenced by a similar advice given by non-experts about macronutrients. These results hold implications for intervention programmes and policy makers. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional survey.

Associations between intimate partner violence, depression, and suicidal behavior among women attending antenatal and general outpatients hospital services in Thailand.

BACKGROUND: Battered women are exposed to multiple types and different severity of intimate partner abuse, however, little is known about the relationship between severity and different types of intimate partner violence (IPV) (physical, sexual, psychological, and danger) and symptoms of depression and suicidal behavior in a sample of women attending antenatal care or general outpatient hospital services in Thailand. MATERIALS AND METHODS: A cross-sectional study was conducted among adult women who were consecutively sampled and screened for IPV in antenatal care and general outpatient clinics in nine randomly selected hospitals in two provinces in the central region. The measures included the "Severity of Violence Against Women Scale," "Edinburgh Postnatal Depression Scale 10," "Danger Assessment Scale," and one item for suicidal behavior. Hierarchical regressions were used to assess the effects of the different types of IPV on depression and suicidal behavior. RESULTS: Of the final sample (N = 207) that screened positive for IPV, 49.3% scored positive for depression, and 17.6% reported suicidal threats or attempts in the past 12 months. One type of IPV (sexual) was significantly associated with depression, whereas psychological abuse and femicide risk or danger was correlated with suicidal behavior. CONCLUSION: A high proportion of women with IPV suffered from depression and suicidal behavior. The study provides evidence of an association between the severity of IPV and mental health problems (depression and suicidal behavior). In assessing IPV, the different identified dimensions contributing to poor mental health should be incorporated.

Early Sexual Debut and Associated Factors among In-school Adolescents in Six Caribbean Countries.

OBJECTIVE: This report examines early sexual debut (< age 15 years) among 15-year old in-school adolescents in six Caribbean countries. SUBJECTS AND METHODS: The total sample included 9948 school children aged primarily 13-16 years from nationally representative samples from six Caribbean countries. Univariate and multivariate analyses were conducted to assess the relationship between early sexual debut and substance use, unintentional injuries and violence, mental distress, physical activity, protective factors and socio-economic status variables. RESULTS: Approximately one-fourth of the sample (26.9%) had experienced sexual debut before age 15 years, 37.2% among boys and 16.9% among girls. In multivariate logistic regression analysis, it was found that male gender, substance use (smoking and alcohol use), having been in a physical fight in the past 12 months, sedentary behaviour, truancy and lack of parental or guardian attachment were associated with early sexual debut. CONCLUSION: This study found a high prevalence of early sexual debut. The risk factors identified were consistent with the Problem Behaviour Theory, which can be incorporated into broader sexual health promotion programmes.

[Pregnant women with COVID-19 ARDS on the intensive care unit]. / Die Schwangere mit COVID-19-ARDS auf der Intensivstation.

BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. OBJECTIVE: Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). MATERIAL AND METHODS: We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021. RESULTS: The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV­2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a PaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV­2 at birth. CONCLUSION: High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.

Reducing the risk of HIV infection during pregnancy among South African women: a randomized controlled trial.

Mpumalanga Province, South Africa has one of the highest HIV/AIDS diagnosis rates among pregnant women (~29.4%). This study sought to enhance male involvement in pregnancy to increase HIV disclosure, sexual communication, HIV knowledge and reduce unprotected sex. Participants attending Antenatal Clinics (ANC) completed HIV counseling and testing and were enrolled with male partners (n=239 couples, 478 individuals). Twelve ANCs were randomly assigned to provide a prevention of mother-to-child transmission (PMTCT) intervention or the standard of care, health education sessions plus PMTCT. Participants were assessed at baseline and post-intervention (approximately 6-8 weeks post-baseline) on demographics, sexual behavior, HIV-related knowledge, and conflict resolution strategies. Experimental participants increased HIV knowledge, use of negotiation, and decreased intimate partner violence. Additionally, they were more likely to have increased condom use from baseline to post-intervention (OR=5.1, 95% CI=[2.0, 13.3]). Seroconversions in the control condition exceeded experimental (6 vs. 0). HIV serostatus disclosure to partner did not increase over time for men or women within the experimental or control condition. Male involvement in pregnancy may be an important strategy to reduce sexual risk behavior and HIV transmission. Results support the utility of group interventions to enhance communication and HIV knowledge among pregnant couples.

[Explaining radiation dose exposure : The role of the banana equivalent dose compared to the effective dose in patient communication]. / Strahlenexposition erklären : Die Rolle der Bananenäquivalentdosis im Vergleich zur effektiven Dosis im Rahmen der Patientenkommunikation.

BACKGROUND AND OBJECTIVES: Communicating the amount and effects of ionizing radiation to patients prior to an examination using x­rays is associated with challenges: first, calculating the expected dose prior to the examination and, second, quantifying and illustrating cancer risks. Analogies, such as comparing radiation exposure to accident risks, have limitations and may evoke unease. This study explores and compares two new approaches to discuss radiation exposure from common clinical examinations with patients: effective dose and exposure based on radioactive potassium-40 intake from the ingestion of bananas, the banana equivalent dose (BED). MATERIALS AND METHODS: The effective doses of the diagnostic reference levels (DRL) for computed tomography (CT) and X-ray examinations in adults were calculated using mean conversion factors for specific anatomic body regions. For the BED calculation of the diagnostic reference levels, the radiation dose from a conventional banana ingested over 50 years per becquerel was calculated. The outcomes were juxtaposed against an equivalent number of bananas and its respective radiation doses. RESULTS: The calculated doses, namely effective dose and BED, of the German DRL can serve as a reliable metric to discuss radiation exposure from medical imaging with patients prior to an examination. CONCLUSION: This is the first study to calculate the effective doses of the current DRL and to compare these with the pseudoscientific unit BED. While the BED serves as an interesting illustration to metaphorize radiation exposure, it is recommended to use the calculated effective dose of the DRL as the basis for educational consultations with patients.

Alcohol use and associated factors among adolescent students in Thailand.

OBJECTIVE: Alcohol misuse is a relevant public health issue in Thailand. The assessment of the prevalence of alcohol use among adolescents may guide policies and programmes aimed at reducing alcohol use among this age group. METHOD: Using data from the Thailand Global School-based Student Health Survey (GSHS) 2008, we assessed the prevalence of alcohol use and the associated factors among adolescents (n = 2758). RESULTS: Overall, the prevalence of current alcohol use was 14.8% (21.2% males and 9.3% females). Variables positively associated with the outcome in multivariable analysis among boys were older age, other substance use (smoking and illicit drug use), sex in the past 12 months, physical fighting, injury in the past 12 months; and among girls, poverty, smoking, physical fighting and lack of parental or guardian connectedness. CONCLUSION: Efforts to prevent and control alcohol misuse may need to address a cluster of risk behaviours including cigarette smoking.

Is there a role for chemotherapy and radiation in the treatment of patients with low-grade myofibroblastic sarcoma?

PURPOSE: Low-grade myofibroblastic sarcoma (LGMS) is a rare entity with a predilection for the head and neck. There are still no optimal treatment strategies for patients with LGMS. We retrospectively investigated the efficacies of chemotherapy and radiation treatment for patients with LGMS. METHODS/PATIENTS: We obtained data from the Surveillance, Epidemiology, and End Result (SEER) database for 96 patients diagnosed with LGMS between 2001 and 2015. We used Kaplan-Meier curves and log-rank tests to estimate overall survival (OS) and Cox proportional hazard regression to identify prognostic factors. RESULTS: The median age of the patients was 55.0 years. Twenty-two of the patients had LGMS in the head and neck region. Of the 96 patients, 86 (89.6%) received surgical treatment, 28 (29.2%) received radiation treatment, and 20 (10.4%) received chemotherapy. The mean OS was 125.2 [95% confidence interval (CI) 106.3-144.2] months. The 1, 3, 5, and 10-year OS rates were 88%, 77%, 70%, and 59%, respectively. Age greater than 60 years, positive nodal status, and no surgical treatment were independent prognostic factors for patients with LGMS, whereas chemotherapy and radiation treatment were not. CONCLUSIONS: Surgical resection is the most effective therapy for LGMS. Chemotherapy and radiation had limited effects on survival improvement for patients with LGMS. Therefore, chemotherapy and/or radiation therapy should not be routinely performed in LGMS, especially for those with negative margins after surgery.

Factors determining HIV viral testing of infants in the context of mother-to-child transmission.

AIM: The aim of this study was to investigate factors determining HIV viral testing of infants in the context of Prevention of Mother-to-Child Transmission of HIV (PMTCT). METHODS: Post-delivery HIV infected mothers 18 years and above with babies aged 3-6 months were interviewed on HIV viral testing of infants and factors associated with it. RESULTS: Among 311 HIV infected women 61.7% had their infant tested for HIV between 4 and 8 weeks. Bivariate analyses found that older age of the mothers, lower depression scores, higher PMTCT knowledge, low PMTCT risk behaviour (maternal and infant nevirapine adherence, health facility delivery and exclusive formula feeding), HIV status disclosure and attending a support group were associated with PCR test participation. In multivariate analyses higher PMTCT knowledge, infant nevirapine adherence, and not exclusive breast feeding were associated with polymerase chain reaction test participation. CONCLUSION: Various determinants of acceptance of participation in HIV viral testing of infants in the context of PMTCT were identified that can guide infant testing and diagnosis counselling and support services of PMTCT programmes.

Drug prescription habits in public and private health facilities in 2 provinces in South Africa.

The aim of this study was to explore drug prescription habits using WHO standard indicators in public hospitals and 36 private surgeries in 2 provinces in South Africa. A high mean number of drugs were prescribed per patient (3.2 versus 2.8) in public hospitals and by general practitioners (GPs) respectively andc generic prescribing rates were low (45.2% versus 24.5%). The rates of prescribing in public hospitals and by GPsa were 8.3% versus 23.3% for injections, 68.1% versus 31.9% for antibiotics and 92.6% versus 68.5% for drugs from the essential drugs list. Drug prescribing in both sectors needs to be regulated, especially the use of antibiotics, essential drugs and generic prescribing.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia.

OBJECTIVE: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. METHODS: This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. RESULTS: In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. CONCLUSION: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

Stigma interdependence among pregnant HIV-infected couples in a cluster randomized controlled trial from rural South Africa.

BACKGROUND: Stigma can exacerbate negative health outcomes in people living with HIV (PLWH). This longitudinal, cluster randomized controlled trial in rural Mpumalanga, South Africa, examined the interdependence of HIV-related stigma among pregnant couples living with HIV, and the potential impact of a lay health worker delivered intervention, Protect Your Family, on changes in stigma over time across couples, controlling for physical intimate partner violence (IPV), verbal IPV, gender, HIV knowledge, and months since HIV diagnosis. Using a form of the Actor-Partner Interdependence model, changes in stigma over time were also examined within each dyad of seroconcordant participants with HIV. METHOD: Antenatal clinics were randomized to experimental or control conditions, and participants completed baseline antenatal and 12-month postpartum assessments. Both women and male partners participated in intervention sessions in gender concordant groups and couple or individual sessions. RESULTS: Multilevel models (N = 1475) revealed stigma was related to condition and verbal intimate partner violence, but not time. Using an Actor-Partner Interdependence cross-lagged path model to examine within dyad changes in stigma for seroconcordant couples (n = 201), intervention condition participants' stigma levels were not interdependent over time. Women's 12-month stigma was related to their partners' stigma at baseline in the control condition, but not in the intervention condition. DISCUSSION: Compared to women in the control condition, postpartum stigma among women in the intervention condition was not related to their male partners' stigma, suggesting that women's perception of stigma became uncoupled from that of their partners. The intervention may have promoted female empowerment to shape their own beliefs and attitudes towards what it means to be infected with HIV, and express their own agency in responding to how others treat them and they treat themselves.