Development and evaluation of a measure of patient-reported symptoms of Blepharitis.

BACKGROUND: Blepharitis is an ocular surface disease and chronic ophthalmic condition. This paper reports on the development of psychometric evaluation of a patient-reported measure of blepharitis symptoms. METHODS: Self-reports of 13 blepharitis symptoms collected in a Phase 3 multi-site, randomized, double-masked, 4-arm parallel group, clinical trial of 907 individuals with blepharitis (mean age = 62, range: 19-93; 57% female) were analyzed. Symptoms asked about were: eyes that itch; eyes that burn; eyelids feel heavy or puffy; feel like something is in your eye; dry eyes; gritty eyes; irritated eyes; eyes that tear or water; crusty eyes; flaking from your eyelids; eyelids that are stuck together; red eyes or eyelids; and debris like pieces of skin or dandruff in your eyes. RESULTS: Categorical factor analyses provided support for two multi-item symptom scales: Irritation (9 items, alpha = 0.88) and Debris (4 items, alpha = 0.85). Spearman-rank order correlations of the Irritation and Debris scales with the Ocular Surface Disease total score were 0.63 and 0.41, respectively (p's < 0.001). Rank-order correlations between ratings of clinicians and self-reports of puffy eyes (r = 0.07, p < .05), red eyes (r = 0.12, p < .001), debris (r = 0.03, p > 0.05), and irritation (r = 0.47, p < .001). CONCLUSIONS: This study provides support for the psychometric properties and construct validity of the Irritation and Debris scales for assessing symptoms of blepharitis. The associations between the self-reports and clinician ratings of 4 symptoms indicate substantial unique information in the new self-reported symptom items. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov under the registry number NCT01408082 .

Are Centers for Disease Control and Prevention Guidelines for Preexposure Prophylaxis Specific Enough? Formulation of a Personalized HIV Risk Score for Pre-Exposure Prophylaxis Initiation.

BACKGROUND: Preexposure prophylaxis (PrEP) has emerged as a human immunodeficiency virus (HIV) prevention tool for populations at highest risk for HIV infection. Current US Centers for Disease Control and Prevention (CDC) guidelines for identifying PrEP candidates may not be specific enough to identify gay, bisexual, and other men who have sex with men (MSM) at the highest risk for HIV infection. We created an HIV risk score for HIV-negative MSM based on Syndemics Theory to develop a more targeted criterion for assessing PrEP candidacy. METHODS: Behavioral risk assessment and HIV testing data were analyzed for HIV-negative MSM attending the Los Angeles LGBT Center between January 2009 and June 2014 (n = 9481). Syndemics Theory informed the selection of variables for a multivariable Cox proportional hazards model. Estimated coefficients were summed to create an HIV risk score, and model fit was compared between our model and CDC guidelines using the Akaike Information Criterion and Bayesian Information Criterion. RESULTS: Approximately 51% of MSM were above a cutpoint that we chose as an illustrative risk score to qualify for PrEP, identifying 75% of all seroconverting MSM. Our model demonstrated a better overall fit when compared with the CDC guidelines (Akaike Information Criterion Difference = 68) in addition to identifying a greater proportion of HIV infections. CONCLUSIONS: Current CDC PrEP guidelines should be expanded to incorporate substance use, partner-level, and other Syndemic variables that have been shown to contribute to HIV acquisition. Deployment of such personalized algorithms may better hone PrEP criteria and allow providers and their patients to make a more informed decision prior to PrEP use.

Sex on demand: geosocial networking phone apps and risk of sexually transmitted infections among a cross-sectional sample of men who have sex with men in Los Angeles County.

BACKGROUND: Geosocial networking applications (GSN apps) used for meeting sexual partners have become increasingly popular with men who have sex with men (MSM) since 2009. The current study aimed to determine if self-identified HIV-negative, MSM clinic attendees who used GSN apps have an increased incidence of sexually transmitted infections (STI) compared to self-identified HIV-negative, MSM attendees who met sexual partners via in-person venues, such as bars or clubs or through MSM-specific hook-up websites. METHODS: Data were collected between August 2011 and January 2013 on all self-identified HIV-negative, MSM clients visiting the L.A. Gay & Lesbian Center for STI screening. A total of 7184 individuals tested for STIs and self-reported behaviours on drug use and social networking methods to meet sexual partners. Multivariate logistic regression models were used to analyse the results. RESULTS: Individuals who used GSN apps for meeting sexual partners had greater odds of testing positive for gonorrhoea (OR: 1.25; 95% CI 1.06 to 1.48) and for chlamydia (OR: 1.37; 95% CI 1.13 to 1.65) compared to individuals who met partners through in-person methods only. There were no significant differences in syphilis and HIV incidence between those who met partners via in-person venues only, on the internet or through GSN apps. CONCLUSIONS: The present study concludes that sexual health clinic MSM attendees who are meeting on GSN apps are at greater risk for gonorrhoea and chlamydia than MSM attendees who meet in-person or on the internet. Future interventions should explore the use of these novel technologies for testing promotion, prevention and education.

Communicating actionable risk for terrorism and other hazards.

We propose a shift in emphasis when communicating to people when the objective is to motivate household disaster preparedness actions. This shift is to emphasize the communication of preparedness actions (what to do about risk) rather than risk itself. We have called this perspective "communicating actionable risk," and it is grounded in diffusion of innovations and communication theories. A representative sample of households in the nation was analyzed using a path analytic framework. Preparedness information variables (including content, density, and observation), preparedness mediating variables (knowledge, perceived effectiveness, and milling), and preparedness actions taken were modeled. Clear results emerged that provide a strong basis for communicating actionable risk, and for the conclusion both that information observed (seeing preparedness actions that other have taken) and information received (receiving recommendations about what preparedness actions to take) play key, although different, roles in motivating preparedness actions among the people in our nation.

Psychometric characteristics of Spanish and English versions of the Civilian Mississippi scale.

Following the 1994 Northridge earthquake, the psychometric properties of the Civilian Mississippi scale (CMS) were examined in three ethnic language subgroups (non-Latino-English, Latino-English, and Latino-Spanish). The psychometric patterns corroborated the existence of two subscales: 25 items with regular wording and 10 items with reversed wording. Psychometric properties were examined in relation to demographics, earthquake exposure, trauma, and psychological distress as measured by the Brief Symptom Inventory. The results suggest that items with reversed wording generated significantly higher mean posttraumatic stress disorder (PTSD) scores and lower reliability. Latinos and Spanish-speaking respondents had particular difficulty understanding items with reversed wording, which correlates with significantly lower or no correlation between the CMS-PTSD and psychological distress.

First-aid training and capabilities of the lay public: a potential alternative source of emergency medical assistance following a natural disaster.

Basic first-aid skills can be useful in treating minor injuries that commonly result from natural disasters in the United States. Yet there has been insufficient research on training and competence in first-aid skills among community residents. This study utilises panel data for 414 adults in Los Angeles, California, who were interviewed within three years of the 1994 Northridge earthquake and re-interviewed in 1999 after the El Ninõ winter of 1997-98. Descriptive, bivariate and multivariate analyses were performed. Results showed that 24 percent of the members of the sample had received first-aid training since their Northridge earthquake interview. First-aid training, particularly recent training, was associated with greater perceived first-aid skills, as well as with increased expected and actual employment of those skills. With the appropriate training and skill retention, lay members of the public can potentially contribute to a post-disaster medical response.

Suicides in LOS Angeles County in relation to the Northridge earthquake.

INTRODUCTION: Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population). HYPOTHESIS: Suicide rates increased in the three calendar years (1994-1996) following the Northridge earthquake as compared to the three calendar years (1991-1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured. METHODS: Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991-1993 vs. 1994 -1996) were analyzed using a z-statistic. RESULTS: There is a statistically significant difference in the rates for the years prior to the earthquake (1991-1993) when pooled and compared to the suicide rates for the years after the earthquake (1994-1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z = -3.85, p < 0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84, z = -3.57, p < 0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide. CONCLUSION: It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.

Pupil size and quality of vision after LASIK.

PURPOSE: To evaluate factors related to the quality of vision after LASIK. DESIGN: Survey study. PARTICIPANTS: One hundred consecutive patients. INTERVENTION: LASIK with a 6.0-mm elliptical ablation pattern without transition zone to treat mild to moderate myopia or astigmatism (preoperative manifest spherical equivalent [MSE], -4.79 +/- 1.33 diopters [D]; range, -2.88 to -9.25 D). The second eye was treated 1 month after the first. MAIN OUTCOME MEASURES: Completed questionnaires assessing night vision problems (glare, haze, and halo symptoms) before surgery and at 1, 3, and 6 months after surgery in 97, 75, 81, and 66 subjects, respectively. Mesopic pupil size and preoperative and postoperative variables were analyzed with questionnaire data using an analysis of variance (ANOVA) and multivariate regression analysis. RESULTS: Patients with large mesopic pupils had significantly more reports of glare, haze, and halo than did those with smaller pupils in the treated eye at 1 month after surgery (P=0.02, P=0.03, and P=0.02, respectively ANOVA) and of glare at 3 months (P=0.05). Significant predictors of symptoms at 6 months, identified through multivariate regression analysis, included preoperative MSE (for glare and haze), preoperative contrast acuity (glare), postoperative uncorrected visual acuity (UCVA; haze), and residual cylinder (haze). Together, these factors accounted for only 19% of the overall variability in glare and 37% of the variability in haze responses. No relationship between pupils and symptoms was noted at 6 months after surgery in either the ANOVA or regression analysis group. CONCLUSIONS: Patients with large pupils had more quality of vision symptoms in the early postoperative period, but no correlation was observed 6 months after surgery. Factors related to long-term symptoms include the level of treatment (preoperative myopia), preoperative contrast acuity, postoperative UCVA, and residual cylinder. Most of the variability in visual quality could not be explained by preoperative or clinical outcome measures, including pupil size.

Psychological distress following urban earthquakes in California.

During and following a disaster caused by a natural event, human populations are thought to be at greater risk of psychological morbidity and mortality directly attributable to increased, disaster-induced stress. Drawing both on the research of others and that conducted at the Center for Public Health and Disaster Relief of the University of California-Los Angeles (UCLA) following California earthquakes, this paper examines the extent to which research evidence supports these assumptions. Following a brief history of disaster research in the United States, the response of persons at the time of an earthquake was examined with particular attention to psychological morbidity; the number of deaths that can be attributed to cardiovascular events and suicides; and the extent to which and by whom, health services are used following an earthquake. The implications of research findings for practitioners in the field are discussed.

Victimization after a natural disaster : Social disorganization or community cohesion?

The data were collected from three independent community samples, beginning seven months after the 1994 Northridge, California earthquake and following in one year intervals for the two subsequent samples. Exposure to traumatic stress (Norris 1990)-including criminal victimization-in the 12 months prior to the interview was assessed in each sample. For all traumatic stress/victimization and for each of seven individual events, rates remain flat over time (3 data points), suggesting that neither social disorganization nor social cohesion occurred after the earthquake. In the first sample respondents only reporton pre-disaster events, for them post-earthquake rates of traumatic stress and victimization were compared with pre-earthquake rates. In contrast to the trend data, reduction in rates of robbery and, to a lesser extent, major life changes suggest that an altruistic community (social cohesion) may have risen. A third set of analyses show that the severity of exposure to the earthquake does not make a contribution to traumatic stress or victimization beyond that explained by the demographic variables repeatedly found to predict vulnerability to victimization. There is no indication that social disorganization follows a natural disaster, and there is minor support for the emergence of an altruistic community (AU)

Preparedness and hazard mitigation actions before and after two earthquakes

This study examines the current state of preparedness among Los Amgeles country and san Francisco bay area residents, determine the extent to which levels od preparedness have change since the symar earthquake in 1971, identifies the circumstances under which people was prepared, and assesses the extent to which respondents overall perceptions of preparedness match their report of preparedness activities. Since the 1971s, residents of the two areas have increased their level of survival activities substantially, but progress in home - hazard mitigation and family earthquake planning have generally remained constant and low. Pre-earthquake preparedness was predicted by home ownership, income, education, marital status, number of children at home , number of years in the neighborthood, and number of eartquakes experienced. In contrast, post -eathquake preparedness was predicted by proximity to the earthquake epicenter, earthquake-related experiences, fear,and levels of pre-earthquake preparedness (AU)