Resilience and associated factors in orphaned and separated adolescents in Kenya: Understanding the relationship with care environment and HIV risks.

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one's material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10-26 living in Charitable Children's Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7-36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors.

The relationships between resilience, care environment, and social-psychological factors in orphaned and separated adolescents in western Kenya.

The relationships between care environment, resilience, and social factors in orphaned and separated adolescents and youths (OSAY) in western Kenya are complex and under-studied. This study examines these relationships through the analysis of survey responses from OSAY living in Charitable Children's Institutes (CCI) and family-based care settings (FBS) in Uasin Gishu County, Kenya. The associations between 1) care environment and resilience (measured using the 14-item Resilience Scale); 2) care environment and factors thought to promote resilience (e.g. social, family, and peer support); and 3) resilience and these same resilience-promoting factors, were examined using multivariable linear and logistic regressions. This cross-sectional study included 1202 OSAY (50.4% female) aged 10-26 (mean=16; SD=3.5). The mean resilience score in CCIs was 71 (95%CI=69-73) vs. 64 (95%CI=62-66) in FBS. OSAY in CCIs had higher resilience (ß=7.67; 95%CI=5.26-10.09), social support (ß=0.26; 95%CI=0.14-0.37), and peer support (ß=0.90; 95%CI=0.64-1.17) than those in FBS. OSAY in CCIs were more likely to volunteer than those in FBS (OR=3.72; 95%CI=1.80-7.68), except in the male subgroup. Family (ß=0.42; 95%CI=0.24-0.60), social (ß=4.19; 95%CI=2.53-5.85), and peer (ß=2.13; 95%CI=1.44-2.83) relationships were positively associated with resilience in all analyses. Volunteering was positively associated with resilience (ß=5.85; 95%CI=1.51-10.19). The factor most strongly related to resilience in both fully adjusted models was peer support. This study found a strong relationship between care environment and resilience. Care environment and resilience each independently demonstrated strong relationships with peer support, social support, and participating in volunteer activities. Resilience also had a strong relationship with familial support. These data suggest that resilience can be developed through strategic supports to this vulnerable population.

Reliability and validity of the RS14 in orphaned and separated adolescents and youths in western Kenya.

PURPOSE: The 14-item Resilience Scale (RS14) is a tool designed to measure psychological resilience. It has been used effectively in diverse populations. However, its applicability is largely unknown for Sub-Saharan adolescent populations and completely unknown for orphaned and separated adolescents and youths (OSAY), a highly vulnerable population for whom resilience may be critical. This study assesses the RS14's psychometric properties for OSAY in Uasin Gishu County, Kenya. METHODS: Survey responses from a representative sample of 1016 OSAY (51.3% female) aged 10-25 (mean = 16; SD = 3.5) living in institutional and home-based environments in Uasin Gishu County were analyzed. The RS14's psychometric properties were assessed by examining internal consistency reliability, confirmatory factor analyses, and convergent validity using correlations between resilience and each of social support and depression. Sub-analyses were conducted by age and sex. RESULTS: Resilience scores ranged from 14-98 (mean = 66; SD = 19) with no sex-based significant difference. Resilience was higher for those aged ≥18 (mean = 69; range = 14-98) versus age <18 (mean = 65; range = 14-98). Internal consistency was good (Cronbach's α = .90). Confirmatory factor analysis indicated a 1-factor solution, though the model fit was only moderate. Resilience was positively correlated with social support in all ages (.22; p < .001) and negatively correlated with depression in individuals age <18 (-.22; p < .001). The relationship between resilience and depression in individuals age ≥18 was statistically significant only in females (-.17; p = .026). CONCLUSION: This study demonstrates reasonable evidence that the RS14 is both valid and reliable for measuring psychological resilience in the population of OSAY in western Kenya.

Psychometric properties of an Arabic-language health literacy assessment scale for adolescents (HAS-A-AR) in Palestine.

OBJECTIVES: Health literacy research in Palestine is limited, and a locally validated tool for use among adolescents has been unavailable until now. Therefore, this study aimed to adapt health literacy assessment scale for adolescents (HAS-A) into Arabic language (HAS-A-AR) and Palestinian context and to investigate its psychometric properties. DESIGN: We conducted a cross-sectional household survey using a stratified random sample and household face-to-face interviews. SETTING AND PARTICIPANTS: We conducted 1200 interviews with sixth to ninth graders in the Ramallah and al-Bireh district of the West Bank, Palestine in 2017. METHODS: We translated and adapted HAS-A to be sensitive to the Palestinian context and tested its psychometric properties. We evaluated face and content validity during the back-translation process and checked for construct validity through exploratory factor analysis (EFA). We tested for internal consistency using Cronbach's alpha, MacDonald's omega test and the greatest lower bound (GLB). Furthermore, we calculated the scale's average inter-item correlation. RESULTS: EFA revealed that HAS-A-AR has a similar structure to the original HAS-A. It extracted three factors (communication, confusion and functional health literacy) whose eigenvalues were >1. Together they explained 57% of the total variance. The proportions of adolescents with high levels of communication, confusion and functional health literacy were 45%, 68% and 80%, respectively. Cronbach's alpha, MacDonald's omega and the GLB values for communication subscale were 0.87, 0.88 and 0.90, and they were 0.78, 0.77 and 0.79 for confusion subscale, while they were 0.77, 0.77 and 0.80, respectively, for functional healthy literacy subscale. The average inter-item correlation for the subscales ranged between 0.36 and 0.59. CONCLUSION: HAS-A-AR is a valid and reliable health literacy measuring instrument with appropriate psychometric properties. HAS-A-AR is currently available for use among adolescents in Palestine and the surrounding Arab countries with similar characteristics as Palestine, including language, culture and political instability.

Interpreting angina: symptoms along a gender continuum.

BACKGROUND: 'Typical' angina is often used to describe symptoms common among men, while 'atypical' angina is used to describe symptoms common among women, despite a higher prevalence of angina among women. This discrepancy is a source of controversy in cardiac care among women. OBJECTIVES: To redefine angina by (1) qualitatively comparing angina symptoms and experiences in women and men and (2) to propose a more meaningful construct of angina that integrates a more gender-centred approach. METHODS: Patients were recruited between July and December 2010 from a tertiary cardiac care centre and interviewed immediately prior to their first angiogram. Symptoms were explored through in-depth semi-structured interviews, transcribed verbatim and analysed concurrently using a modified grounded theory approach. Angiographically significant disease was assessed at ≥70% stenosis of a major epicardial vessel. RESULTS: Among 31 total patients, 13 men and 14 women had angiograpically significant CAD. Patients describe angina symptoms according to 6 symptomatic subthemes that array along a 'gender continuum'. Gender-specific symptoms are anchored at each end of the continuum. At the centre of the continuum, are a remarkably large number of symptoms commonly expressed by both men and women. CONCLUSIONS: The 'gender continuum' offers new insights into angina experiences of angiography candidates. Notably, there is more overlap of shared experiences between men and women than conventionally thought. The gender continuum can help researchers and clinicians contextualise patient symptom reports, avoiding the conventional 'typical' versus 'atypical' distinction that can misrepresent gendered angina experiences.

Association of urban slum residency with infant mortality and child stunting in low and middle income countries.

This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15-49 years) and their children (0-59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15-1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63-0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16-1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies.

Validating chronic disease ascertainment algorithms for use in the Canadian longitudinal study on aging.

We validated seven chronic disease ascertainment algorithms for use in the Canadian Longitudinal Study on Aging. The algorithms pertained to diabetes mellitus type 2, parkinsonism, chronic airflow obstruction (CAO), hand osteoarthritis (OA), hip OA, knee OA, and ischemic heart disease. Our target recruitment was 20 cases and controls per disease; some cases were controls for unrelated diseases. Participants completed interviewer-administered disease symptom and medication use questionnaires. Diabetes cases and controls underwent fasting glucose testing; CAO cases and controls underwent spirometry testing. For each disease, the appropriate algorithm was used to classify participants' disease status (positive or negative for disease). We also calculated sensitivity and specificity using physician diagnosis as the reference standard. The final sample involved 176 participants recruited in three Canadian cities between 2009 and 2011. Most estimated sensitivities and specificities were 80 per cent or more, indicating that the seven algorithms correctly identified individuals with the target disease.

Caesarean delivery and neonatal mortality rates in 46 low- and middle-income countries: a propensity-score matching and meta-analysis of Demographic and Health Survey data.

BACKGROUND: Previous research on the association between caesarean delivery (CD) and neonatal mortality has had methodological limitations and given conflicting results. We conducted a study to: (i) estimate the association between CD at the individual level and neonatal mortality rates (NMR) in 46 countries; and (ii) examine whether this association varies among countries according to country-level rates of CD or gross domestic product (GDP). METHODS: We obtained data from nationally representative Demographic and Health Surveys of women aged 15-49 years and their children aged 0-59 months (N = 392 883). Propensity-score matching, meta-analysis, and meta-regression were used to address the study objectives. RESULTS: The pooled odds ratio (OR) for the association between individual level CD and NMR in 46 countries was 1.67 (95% confidence interval (CI) 1.48-1.89), with moderate heterogeneity (I(2) = 39%). A meta-analysis of subgroups indicated that CD at the individual level was positively associated with NMR in countries with low (OR = 1.99, 95% CI 1.71-2.33, I(2) = 8.5%) and medium (OR = 1.53, 95% CI 1.29-1.82, I(2) = 24%) rates of CD. There was substantial heterogeneity of the effects of CD among countries with high rates of CD (I(2) = 63%). Results of meta-regression showed that the association of individual-level CD with NMR depended upon country-level rates of CD. Compared with countries with high rates of CD, the OR of the NMR associated with individual-level CD in countries with low rates of CD was estimated to increased by a factor of 1.48 (95% CI 1.09-1.97). CONCLUSIONS: Studies are needed to better understand the risks posed by CD in countries with low and medium rates of CD and to identify possible reasons for the heterogeneity in effects of CD among countries with high rates of CD.

Evaluation of the association between long-lasting insecticidal nets mass distribution campaigns and child malaria in Nigeria.

BACKGROUND: Nigeria carries the greatest malaria burden among countries in the world. As part of the National Malaria Control Strategic Plan, free long-lasting insecticidal nets (LLINs) were distributed in 14 states of Nigeria through mass campaigns led by different organizations (the World Bank, UNICEF, or the Global Fund) between May 2009 and August 2010. The objective of this study was to evaluate the association between LLIN distribution campaigns and child malaria in Nigeria. METHODS: Data were from the Nigeria Malaria Indicator Survey which was carried out from October to December 2010 on a nationally representative sample of households. Participants were women aged 15-49 years and their children aged less than five years (N = 4082). The main outcome measure was the presence or absence of malaria parasites in blood samples of children (6-59 months). RESULTS: Compared with children living in communities with no campaigns, those in the campaign areas were less likely to test positive for malaria after adjusting for geographic locations, community- and individual-level characteristics including child-level use of insecticide-treated nets (ITNs). The protective effects were statistically significant for the World Bank Booster Project areas (OR = 0.18, 95% CI = 0.04-0.73) but did not reach statistical significance for other campaign areas. Results also showed that community-level wealth (OR = 0.51, 95% CI = 0.34-0.76), community-level maternal knowledge regarding malaria prevention (OR = 0.70, 95% CI = 0.50-0.97), and child-level use of ITNs (OR = 0.79, 95% CI = 0.63-0.99) were negatively associated with child malaria. CONCLUSIONS: The observed protective effects on child malaria of these campaigns (statistically significant in the World Bank Booster Project areas and non-significant in the other areas) need to be corroborated by future effectiveness studies. Results also show that improving community-level maternal knowledge through appropriate channels might be helpful in preventing child malaria in Nigeria.

Screening for depression: a systematic review and meta-analysis.

BACKGROUND: The Canadian Task Force on Preventive Health Care has a guideline on screening for depression among adults 18 years of age or older at average or high risk for depression. To provide evidence for an update of this guideline, we evaluated the literature on the effectiveness of screening for depression in adults. METHODS: For the period 1994 to May 23, 2012, we searched the following electronic databases: MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Randomized controlled trials, observational studies and systematic reviews with evidence for the benefits or harms of screening for depression were eligible for inclusion. We performed screening for relevance, extraction of data, analysis of risk of bias and quality assessments in duplicate. We used the generic inverse variance method to conduct a meta-analysis. To determine confidence in the effect, we analyzed the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Five quasi-experimental studies (before-after design with a nonrandomized control group) met the inclusion criteria for this review. These studies reported on the effect of community-based screening for depression, with follow-up on the risk of suicide completion, for older residents in regions of rural Japan with high suicide rates. Meta-analysis showed that the screening program had a protective effect on the overall incidence of suicide completion (ratio of rate ratios [RRR] 0.50, 95% confidence interval [CI], 0.32-0.78). When sex was considered, the RRR indicated a significantly lower rate of suicide among women (RRR 0.37, 95% CI 0.21-0.66) but not among men (RRR 0.67, 95% CI 0.35-1.27). The overall GRADE rating applied to this evidence indicated very low quality. No studies addressing the harms of screening for depression met the inclusion criteria for the review. INTERPRETATION: There is very limited research evidence allowing conclusions about the effectiveness of screening for depression in either average-risk or high-risk populations.

Choosing a survey sample when data on the population are limited: a method using Global Positioning Systems and aerial and satellite photographs.

BACKGROUND: Various methods have been proposed for sampling when data on the population are limited. However, these methods are often biased. We propose a new method to draw a population sample using Global Positioning Systems and aerial or satellite photographs. RESULTS: We randomly sampled Global Positioning System locations in designated areas. A circle was drawn around each location with radius representing 20 m. Buildings in the circle were identified from satellite photographs; one was randomly chosen. Interviewers selected one household from the building, and interviews were conducted with eligible household members. CONCLUSIONS: Participants had known selection probabilities, allowing proper estimation of parameters of interest and their variances. The approach was made possible by recent technological developments and access to satellite photographs.

Health-related quality of life of Gaza Palestinians in the aftermath of the winter 2008-09 Israeli attack on the Strip.

BACKGROUND: We document the health-related quality of life (HRQoL) of people living in the Gaza Strip 6 months after 27 December 2008 to 18 January 2009, Israeli attack. METHODS: Cross-sectional survey 6 months after the Israeli attack. Households were selected by cluster sampling in two stages: a random sample of enumeration areas (EAs) and a random sample of households within each chosen EA. One randomly chosen adult from each of 3017 households included in the survey completed the World Health Organization Quality of Life instrument, in addition to reported information on distress, insecurities and threats. RESULTS: Mean HRQoL score (range 0-100) for the physical domain was 69.7, followed by the psychological (59.8) and the environmental domain score (48.4). Predictors of lower (worse) scores for all three domains were: lower educational levels, residence in rural areas, destruction to one's private property or high levels of distress and suffering. Worse physical and psychological domain scores were reported by people who were older and those living in North Gaza governorate. Worse physical and environmental domain scores were reported by people with no one working at home, and those with worse standard of living levels. Respondents who reported suffering stated that the main causes were the ongoing siege, the latest war on the Strip and internal Palestinian factional violence. CONCLUSION: Results reveal poor HRQoL of adult Gazans compared with the results of WHO multi-country field trials and significant associations between low HRQoL and war-related factors, especially reports of distress, insecurity and suffering.

Individual participant data meta-analysis of mechanical workplace risk factors and low back pain.

OBJECTIVES: We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain. METHODS: We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data. RESULTS: The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics. CONCLUSIONS: We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data.

Growth and inactivation of Salmonella at low refrigerated storage temperatures and thermal inactivation on raw chicken meat and laboratory media: mixed effect meta-analysis.

Growth and inactivation regression equations were developed to describe the effects of temperature on Salmonella concentration on chicken meat for refrigerated temperatures (⩽10°C) and for thermal treatment temperatures (55-70°C). The main objectives were: (i) to compare Salmonella growth/inactivation in chicken meat versus laboratory media; (ii) to create regression equations to estimate Salmonella growth in chicken meat that can be used in quantitative risk assessment (QRA) modeling; and (iii) to create regression equations to estimate D-values needed to inactivate Salmonella in chicken meat. A systematic approach was used to identify the articles, critically appraise them, and pool outcomes across studies. Growth represented in density (Log10CFU/g) and D-values (min) as a function of temperature were modeled using hierarchical mixed effects regression models. The current meta-analysis analysis found a significant difference (P⩽0.05) between the two matrices - chicken meat and laboratory media - for both growth at refrigerated temperatures and inactivation by thermal treatment. Growth and inactivation were significantly influenced by temperature after controlling for other variables; however, no consistent pattern in growth was found. Validation of growth and inactivation equations against data not used in their development is needed.

Validity and responsiveness of presenteeism scales in chronic work-related upper-extremity disorders.

BACKGROUND: The Work Limitations Questionnaire-25 (WLQ-25) and the Work Instability Scale for Rheumatoid Arthritis (RA-WIS) have been used to measure at-work disability related to musculoskeletal disorders. However, a recent systematic review has shown that important psychometric properties still needed to be evaluated. OBJECTIVE: The purpose of this study was to establish the validity and responsiveness of the WLQ-25 and RA-WIS in people with chronic work-related upper-extremity disorders. DESIGN: Two-hundred six participants with chronic upper-extremity disorders who attended a specialty clinic operated by the Workplace Safety & Insurance Board of Ontario were evaluated at their initial visit and 6 months later. METHODS: Questionnaires completed at each evaluation were: the WLQ-25, the RA-WIS, the QuickDASH, the pain subscale of the Shoulder Pain and Disability Questionnaire, and the Chronic Pain Grade Questionnaire. At the 6-month evaluation, participants completed a global rating of change question. Known-group and construct convergent validity were assessed using analysis of variance and Pearson correlations, and standardized response means (SRMs) were used to assess responsiveness. Clinically important differences (CIDs) also were determined. RESULTS: The WLQ-25 and RA-WIS had low to moderate correlations with pain and disability scales (.28

Translation of mechanical exposure in the workplace into common metrics for meta-analysis: a reliability and validity study.

OBJECTIVES: We previously assessed inter-rater reliability of expert raters using six scales to estimate the intensity of literature-based mechanical exposures. The objectives of this study were to estimate the impact on the inter-rater reliability of using non-expert (NE) raters and to assess the validity of our scales. METHODS: We used 7-point scales to represent three dimensions of mechanical exposures at work: 1) trunk posture, 2) weight lifted or force exerted and 3) spinal loading. We estimated both peak and cumulative loads and called this an "interpretive translation" of exposure. A second method, "algorithmic translation", used the original units in which the exposure data was collected. These data were used to assess the inter-rater reliability and validity of the NE interpretive translation of exposure. RESULTS: The NE inter-rater reliability for the scales ranged from 0.24 to 0.46. The correlation between the means of the NE and expert ratings were >0.7. Although there was a strong relationship between the NE interpretive and the algorithmic translation, there was some evidence that the interpretive translation plateaus at higher level of exposure. CONCLUSIONS: This study supports using NE raters to estimate the intensity of literature-based mechanical exposure metrics using a common set of scales which can be applied across epidemiologic studies. We would need to average the ratings of at least five NE raters to have an acceptable level of reliability (>0.7). These metrics may be useful to quantify the relationship between workplace mechanical exposure and low back pain in a systematic review and meta-analysis.