Socio-behavioral Factors Research Articles

Association of total tooth loss with socio-behavioural health indicators in Korean elderly

This study examined the association between total tooth loss, and socio-behavioural factors and general health indicators in elderly Koreans using national databases. Cross-sectional data for this study were from the third Korean National Health and Nutrition Examination Survey (KNHANES III), which was conducted among non-institutionalised civilians by the Korean Ministry of Health and Welfare in 2005. KNHANES III used a stratified, multistage probability sampling design on a representative of total South Korean population, according to geographical areas, age and sex groups. Among them, 1091 subjects aged 65 years and above were identified as potential participants in this study. The dependent variable in this study was the self-reported total tooth loss. The independent variables consisted of the following four categories: demographic information, socio-behavioural factors, psychological factors and general health indicators. The data were weighted to adjust for the sampling complexity, and SPSS version 14 for Windows software was used for data analysis. There were significant differences in total tooth loss odds according to the socio-behavioural backgrounds (education and smoking), psychological conditions (perceived oral health) and general health status (diabetes and body mass index as underweight). This suggests that the total tooth loss is associated with the socio-economic status, health-related behaviour and general health. However, more extensive longitudinal data and research will be needed to better explain the relationship between the total tooth loss and these variables.

Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort

Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life-course stage at which they would be expected to operate, this study assessed the impacts of socio-behavioral and disease-related factors on tooth loss between ages 50 and 65. In 1992, all 50-year-olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8,888 subjects, 6,346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4,143 (65%) completed postal follow-ups at ages 55, 60 and 65. For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50-85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life-stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle-age and early-old-age life stage). Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease-related factors and socio-behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life-course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early-older age.

Abstract A75: Ten-year retrospective cross racial and ethnic prostate cancer incidence and mortality in the Florida Department of Corrections

Abstract To establish a novel environment for elucidating the relative socioenvironmental and biological etiologies of racial and ethnic disparities in prostate cancer, we are conducting a 10-year retrospective cross-racial and ethnic analysis of prostate cancer incidence and mortality within the Florida Department of Corrections (FDOC). Prostate Cancer is the most common cancer in men and exhibits the most profound racial and ethnic disparity of all cancers, with a 60% higher incidence rate and an astonishing 140% higher mortality rate in African Americans than in Caucasians. Successful efforts to thwart prostate cancer health disparities depend understanding the relative contributions of biological and socio-behavioral factors on prostate cancer disparities; however, the inherent heterogeneity of a of unlinked factors within and among racial and ethnic groups precludes the effectual determination of the relative contributions of prostate cancer health disparities. We propose that the etiologies of health disparities can be defined within the context of large, racially and ethnically diverse settings in which several variables thought to contribute to prostate cancer health disparities are normalized across racial and ethnic groups. Correctional facilities are vast congregate settings, inherently unique due to the remarkably similar socio-behavioral environments between and within racial and ethnic groups relative to non-incarcerated communities. Prisons are home to over 1.6 million people, primarily African American, Caucasian, and Hispanic men. The FDOC offices of Health Care, Food Services, and Wellness and Recreation provide services that may circuitously reduce racial and ethnic cancer disparities. Prisoners of all races and ethnicities have equal access to free and identical health care services including prostate cancer education, routine prostate cancer screening, and prostate cancer treatment. Inmates are all provided the same nutritionally balanced diets, meeting or exceeding the National Academy of Sciences’ standards, including nutritional supplements, soy-rich products, and nearly 3 million pounds of fresh produce cultivated on FDOC farms; reflecting diets thought to decrease prostate cancer risk. Physical activity in the form of exercise is a regular component of approximately 95% of prisoner's lifestyles. Cigarette smoking is common across racial and ethnic groups in the FDOC; however, alcohol consumption and drug use are prohibited. The FDOC's wellness efforts, and similar efforts by the majority of United States correctional facilities, inadvertently address several conjectural bases of health disparities, thereby providing an environment ripe for distinguishing the factors that contribute to prostate cancer and it vast racial and ethnic disparities. With support and approval by the FDOC, we have begun to elucidate the complex etiologies of racial and ethnic disparities in prostate cancer incidence and mortality by conducting a 10-year, cross-racial and ethnic retrospective analysis of prostate cancer incidence and mortality within the FDOC. The data from this study will provide the foundation for further studies to better understand the socio-environmental and biological factors that contribute to racial and ethnic disparities in prostate cancer incidence and mortality. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A75.

Impact of chronic condition status and severity on the time to first dental visit for newly Medicaid-enrolled children in Iowa.

To assess the extent to which chronic condition (CC) status and severity affected how soon children had a dental visit after enrolling in Medicaid. Data Source. Enrollment and claims data (2003-2008) for newly Medicaid-enrolled children ages 3-14 in Iowa. 3M Clinical Risk Grouping methods were used to identify CC status (no/yes) and CC severity (less severe/more severe). Survival analysis was used to identify the factors associated with earlier first dental visits after initially enrolling in Medicaid. Children with a CC were 17 percent more likely to have earlier first dental visits after enrolling in Medicaid (p < .0001). There was no significant difference by CC severity. Children who lived in a dental health professional shortage area and those who did not utilize primary medical care had significantly later first Medicaid dental visits, whereas these factors failed to reach statistical significance for children with a CC. While newly Medicaid-enrolled children with a CC were significantly more likely to have earlier first dental visits, we failed to detect a relationship between CC severity and the time to first Medicaid dental visit. The determinants of first Medicaid dental visits were heterogeneous across subgroups of newly Medicaid-enrolled children. Future studies should identify the sociobehavioral factors associated with CCs that are potential barriers to earlier first Medicaid dental visits for newly Medicaid-enrolled children.

Good intentions: risk factors for unintended pregnancies in the US cohort of a microbicide trial

Background The study was conducted to assess socio-behavioral and biological factors associated with unplanned pregnancy in the US cohort of a microbicide trial. Study Design We conducted a mixed-method, nested case-control study of risk factors for pregnancy within the US cohort of the microbicide trial HPTN 035. We developed an instrument to assess attitudes and beliefs about fertility control/contraceptive utilization among 122 women. Cases were HPTN 035 participants who became pregnant while enrolled, matched by time on study 1:4 with controls. Univariable and multivariable analysis were performed with pregnancy as the outcome of interest. Results Contraceptive method change during the trial was associated with unplanned pregnancy (OR=1.76). Participant desire/partners' desire for future children (OR=4.95) and young age (OR=0.88 annually above age 19 years) were independently associated with unintended pregnancy. Conclusion Within a trial that enrolls heterosexually active women, there may be ways to identify those at highest risk of becoming pregnant a priori.

Making RTI work: how smart schools are reforming education through schoolwide response-to-intervention

Figures and Tables. Foreword (Leonard Burrello). Acknowledgments. The Author. Preface. Part One: The Origin and Design of Schoolwide RTI. 1 Defining RTI. Features of RTI. Standard Protocol RTI. Schoolwide RTI. Evolving Definitions of RTI. Standard Protocol Definitions. Combined Standard Protocol and Problem-Solving Definitions. Schoolwide Definitions. Comprehensive Schoolwide RTI. To Sum Up. 2 Schoolwide RTI: Why Does It Matter? The Frame of Disability. RTI as a Potential Frame for Education Policy. A Focus on literacy. A Shifting Perspective. RTI as a Basis for Education Policy. Prevention. Problem Identification. Interventions. Accountability. A Focus on Sociobehavioral Factors. RTI and Academic Progress. Transdisciplinary Problem-Solving Teams. Decision Rules for Selecting Interventions. To Sum Up. 3 The Social-Behavioral Side of RTI. School Discipline. The Tactic of Exclusion. The Tactic of Inclusion. Schoolwide Positive Behavior Support. Understanding SWPBS. Evidence-Based Practice. Practical, Multicomponent Interventions. Lifestyle Outcomes. Sustainable Systems Change. To Sum Up. Part Two: How Schoolwide RTI Works. 4 Universal Screening for Prevention. Determining Success Criteria. Behavioral Screening Under RTI. School-Based Screeners for Behavioral Risk. Internalizers or Externalizers. Standardized Screeners for Behavioral Risk. Systematic Screening for Behavioral Disorders. Academic Screening Under RTI. Universal Academic Screening. Screening Accuracy and Efficiency. Normative and Criterion-Referenced Screeners. Curriculum Based Measures. Universal CBM. DIBELS, AIMSweb, and iSTEEP. Advantages of Universal CBM Screening for Teachers. Combining Results of Behavioral and Academic Screening Under RTI. RTI Team Processes and Coaches. RTI and School Teams. Coaches. To Sum Up. 5 Progress Monitoring to Measure Success. Educational Accountability. Types of Assessment for Progress Monitoring. Proximal Versus Distal Assessments. Formative Versus Summative Assessments. Categorical Versus Aggregate Assessments. Behavioral Progress Monitoring. Direct Measures of Problem Behavior. Level 3 Progress Monitoring for Behavior. Wraparound and SIMEO. Academic Progress Monitoring. Level 1 Progress Monitoring. Level 2 Progress Monitoring. Level 3 Progress Monitoring. RTI and the Organization of Service and Supports. To Sum Up. 6 Sustaining RTI Through School Reform. Challenges Confronting Schoolwide RTI. Silos Revisited. Human Capital. Professional Development. School Reform as a Context for RTI. Comprehensive School Reform Demonstration Project. A Universal Design for Learning. The Schoolwide Applications Model. Fidelity of Implementation. SAM Fidelity Assessment Tool. Scaling Up School Reform. Moving Schoolwide RTI to Scale in a District. Action Planning in Schoolwide RTI. Program Evaluation. Structural Elements of SAM. A Model for Technical Assistance. District and Site Leadership Teams. To Sum Up. Part Three: Seeing RTI in Action 7 How RTI Looks at the Schoolwide Level. Critical Features of Schoolwide RTI. RTI and the Achievement Gap. Student Motivation. School-Based Video. Leadership and Structure of the RTI School. Distributed Leadership. Leadership Teams. Madison Elementary School. Screening at Madison. Building-Level Versus State-Level Assessments. Reading Interventions. Fidelity of Intervention. Professional Development. Scheduling. Reflections on Madison Elementary School's RTI. Coaching and Collaborative Teaching. Coaching. Collaborative Teaching. To Sum Up. 8 How RTI Looks at the Districtwide Level. Scaling Up in the District. Creating Some Fanfare. Policy Analysis. Engaging the Board of Education. Managing Publicity. Getting Started in the District: Selecting Schools. Clusters and Cohorts. Leadership Qualities. Manageable Cohorts. Professional Development. Capacity Building. RTI in the Louisiana Recovery School District, New Orleans. RTI Team. Progress Monitoring. Level 1 Interventions. Level 2 Interventions. Level 3 Interventions. The Role of Special Education. Reflections on the Recovery School District. To Sum Up. 9 How RTI Looks at the Statewide Level. Federal Policy and RTI. Kansas Multi-Tiered System of Support. Colorado Multi-Tiered Model of Intervention and Instruction. New Hampshire Responds Model. State Request for Application. Components of New Hampshire Responds. To Sum Up. Conclusion: The Shape of Schools to Come. No Child Left Behind and Adequate Yearly Progress. A Privatization Agenda? Response to Intervention. Three Facets of Teaching. Science. Relationships. Inspiration. A Framework, Not a Magic Bullet. RTI for the Endangered School. Capacity Building and Sustainability. Leadership. Stability. Capacity. Potential Traps in Implementing RTI. Multilevel Sets of Interventions Screening. Progress Monitoring. Interventions. Fidelity. The Undeniable Thrill of Success. To Sum Up. Sources, References, and Additional Resources. Index.

Exploring the link between populomics and knowledge management: Patient-oriented case exemplars

The challenge of population-level health problems, such as healthcare disparities, encompasses socio-behavioural, community and biologic factors and advances in information and communication technologies (ICTs). These elements are reflected in the key ethos of contemporary knowledge management (KM), as knowledge emerges from the confluence of people, process and technology. This paper illustrates how knowledge-based health case studies can be used as effective exemplars to illuminate understanding and explore possible connections between populomics and KM.

The VicGeneration study--a birth cohort to examine the environmental, behavioural and biological predictors of early childhood caries: background, aims and methods.

BackgroundDental caries (decay) during childhood is largely preventable however it remains a significant and costly public health concern, identified as the most prevalent chronic disease of childhood. Caries in children aged less than five years (early childhood caries) is a rapid and progressive disease that can be painful and debilitating, and significantly increases the likelihood of poor child growth, development and social outcomes. Early childhood caries may also result in a substantial social burden on families and significant costs to the public health system. A disproportionate burden of disease is also experienced by disadvantaged populations.Methods/DesignThis study involves the establishment of a birth cohort in disadvantaged communities in Victoria, Australia. Children will be followed for at least 18 months and the data gathered will explore longitudinal relationships and generate new evidence on the natural history of early childhood caries, the prevalence of the disease and relative contributions of risk and protective biological, environmental and behavioural factors. Specifically, the study aims to:1. Describe the natural history of early childhood caries (at ages 1, 6, 12 and 18 months), tracking pathways from early bacterial colonisation, through non-cavitated enamel white spot lesions to cavitated lesions extending into dentine.2. Enumerate oral bacterial species in the saliva of infants and their primary care giver.3. Identify the strength of concurrent associations between early childhood caries and putative risk and protective factors, including biological (eg microbiota, saliva), environmental (fluoride exposure) and socio-behavioural factors (proximal factors such as: feeding practices and oral hygiene; and distal factors such as parental health behaviours, physical health, coping and broader socio-economic conditions).4. Quantify the longitudinal relationships between these factors and the development and progression of early childhood caries from age 1-18 months.DiscussionThere is currently a lack of research describing the natural history of early childhood caries in very young children, or exploring the interactions between risk and protective factors that extend to include contemporary measures of socio-behavioural factors. This study will generate knowledge about pathways, prevalence and preventive opportunities for early childhood caries, the most prevalent child health inequality.

Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos

BackgroundIn recent decades low-income countries experienced an increasing trend in dental caries among children, particularly recorded in 12-year olds, which is the principal WHO indicator age group for children. This increases the risks of negative affects on children's life. Some data exist on the oral health status of children in low-income countries of Southeast Asia. However, information on how oral health is associated with socio-behavioural factors is almost not available. The aims of this study were to: assess the level of oral health of Lao 12-year-olds in urban and semi-urban settings; study the impact of poor oral health on quality of life; analyse the association between oral health and socio-behavioural factors; investigate the relation between obesity and oral health.MethodsA cross sectional study of 12-year old schoolchildren chosen by multistage random sampling in Vientiane, Lao P.D.R (hereafter Laos). The final study population comprised 621 children. The study consisted of: clinical registration of caries and periodontal status, and scores for dental trauma according to WHO; structured questionnaire; measurement of anthropometric data. Frequency distributions for bi-variate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables.ResultsMean DMFT was 1.8 (SEM = 0.09) while caries prevalence was 56% (CI95 = 52-60). Prevalence of gingival bleeding was 99% (CI95 = 98-100) with 47% (CI95 = 45-49) of present teeth affected. Trauma was observed in 7% (CI95 = 5-9) of the children. High decay was seen in children with dental visits and frequent consumption of sweet drinks. Missed school classes, tooth ache and several impairments of daily life activities were associated with a high dD-component. No associations were found between Body Mass Index (BMI) and oral health or common risk factors. The multivariate analyses revealed high risk for caries for children with low or moderate attitude towards health, a history of dental visits and a preference for drinking sugary drinks during school hours. Low risk was found for children with good or average perception of own oral health. High risk for gingival bleeding was seen in semi-urban children and boys.ConclusionAlthough the caries level is low it causes considerable negative impact on daily life. School based health promotion should be implemented focussing on skills based learning and attitudes towards health.

Constructions of culture and identity in contemporary social theorising1

This article seeks to address the problematic nature of the cultural concept in social theory, and public formulations such as multiculturalism and national identity. By examining two dominant, contrasting and complementary viewpoints of culture – the ideational drawn from anthropological theory, and the structural from a more sociological perspective – it suggests that identity is the outcome of a complex interaction of Socio-behavioural factors.

Apolipoprotein E polymorphism, life stress and self-reported health among older adults

Objective:To examine the association of self-reported health (SRH) with the apolipoprotein E (APOE) gene, life stress, and sociobehavioural factors in adults aged 55 and over.Design:Secondary analysis of data from the...

Sexual Symptoms in Aging Men Indicate Poor Life Satisfaction and Increased Health Service Consumption

The deterioration of sexual, physical, and mental performance in aging men has been used to measure the clinical manifestations of androgen decrement. However, their prevalence and relation to coexisting morbidities are unknown. All men in Turku, Finland, aged 40 to 69 years (n = 28,622) in 2000 were mailed a questionnaire that included questions on general health, sociobehavioral factors, and the Aging Male Symptoms scale (17 questions, each yielded 1 to 5 points, from 1, no symptoms to 5, very severe). The participation rate was 54% (15,496 returned questionnaires). Moderate or severe sexual symptoms (decreased frequency of erections, libido, and potency) were observed in 20% of men of the youngest age group of 40 to 44 years. The proportion of men with significant symptoms increased linearly with age up to 67% in the oldest age group (65 to 69 years). Other symptoms did not show a similar age trend. On multifactor analysis, sexual symptoms were independently associated with decreased life satisfaction and increased visits to the physician after adjustment for coexisting morbidities. Visits to the physician were up to three times more frequent among men with moderate to severe sexual symptoms than among those with mild or no symptoms. Sexual symptoms in aging men are common and associated with decreased life satisfaction and an increased number of visits to the physician. These symptoms deserve more attention in the workup of aging male patients, because they offer a simple screening tool to detect impaired well-being associated with increased consumption of health services.

Nutrition, oral health and the young child.

Oral health is integral to general health and essential to well-being and quality of life. Socio-behavioural and environmental factors play a significant role in oral disease and oral health. Dental caries is a global disease with few populations exempt from its effects. In developing countries, as development increases so does dental caries and children are at the forefront of the disease disadvantage. There is a growing need to identify high caries risk groups accurately to commence prevention from a young age. The effect of early intervention in childhood on general and dental health with both population and high-risk approaches also needs examining. As an educational tool, the paediatric food-based dietary guidelines may play a significant role in nutrition and oral health interventions. This paper provides information on nutrition, including access to fluoride and use of sugar. Oral health concerns, such as early childhood caries, which are important for the young child, are also discussed.

Subordinate social status modulates the vulnerability to the immunological effects of social stress

Social stress has long been known to affect physical and psychological health in humans and a variety of animal species. In mice, disruption of the social hierarchy (social disruption, SDR) resulted in significant changes in the phenotype and function of immune cells taken from the spleen. Interestingly, there were considerable individual differences in the development of this splenic response to SDR. Studies have suggested that these individual differences were mediated by behavioral factors such as social hierarchy. To test this hypothesis, social status within cages of male mice was identified before and after SDR. Results showed that in the majority of the cages social order was stable over time. In addition, examination of the association between social status and splenic function showed that the splenic response to SDR in subordinate mice was significantly augmented compared to dominants. This relationship between subordinate social status and the splenic response to social stress was more notable in cages with stable social hierarchies. To sum up, the current study showed a role for socio-behavioral factors in determining the response to stress. This study further demonstrated the complexity of factors playing a role in mediating the physiological response to social stress resulting in considerable individual differences in the response to stress.

Redesigning electronic health record systems to support public health

Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public health’s traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.

What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe?

The purpose of this review was to study the prevalence and incidence of edentulism and tooth loss in European countries. A literature search was performed by means of Medline/PubMed using various combinations of keywords concerning prevalence and incidence of tooth loss and edentulism, complemented by a hand search. Inclusion criteria were cross-sectional and longitudinal clinical and questionnaire studies of representative or random samples of >/=100 subjects at the initial examination. Sixty articles were identified; the hand search gave 13 more references. This literature review demonstrated that there is a lack of epidemiological studies on edentulism and tooth loss in many countries in Europe. The quality of available data varied considerably. There is a documented decline of edentulism with still great differences in prevalence between countries, between geographical regions within countries and between groups with various backgrounds. The mean number of lost teeth increases with age. In several countries many dentate subjects aged 60 years and over still have reduced dentitions possibly needing prosthodontic treatment. The incidence of tooth loss is low but with geographical variation between age groups, and there is a trend for decreasing incidence over the last decades. A great number of variables are associated with tooth loss, and there is no consensus whether dental disease related or socio-behavioural factors are the most important risk factors. Institutionalised elderly people have, in general, more compromised oral health, including fewer teeth, than those at the same age living freely. Tooth loss and edentulism are declining at least in those European countries where reliable data are available. However, the WHO goal of retaining at least 20 teeth at the age of 80 years has not yet been met but is being approached in some countries.

Prevalence and Associated Factors of Hepatitis C Infection (HCV) in a Multi-site Canadian Population of Illicit Opioid and Other Drug Users (OPICAN)

Hepatitis C virus (HCV) infection is highly prevalent in illicit drug user populations, with three in four new HCV infections related to this risk behaviour and a growing HCV disease burden in Canada. Using data from a multi-site cohort study of illicit opioid users in five Canadian cities (OPICAN), this paper explores the prevalence and predictors of HCV status in this high-risk population. HCV status of cohort participants was assessed by salivary antibody test. Univariate relationships of HCV status with select variables were examined on the basis of cohort baseline data, and subsequently multivariate models using logistic regression to determine independent predictors of HCV status were generated. 54.6% of the analysis sample (n=482) was HCV positive. Significant differences in terms of HCV prevalence existed across the sites. Significant variables in the final stepwise logistic regression model included age, site (Toronto), unprotected sex, injecting drug use, drug treatment and incarceration in past year, in addition to opioid use in combination with non-opioids. Besides drug injecting, various other socio-behavioural factors were associated with HCV status in our cohort. On this basis, interventions focusing solely on injection risks are overly limited in scope to prevent HCV transmission in the high-risk population of illicit drug users and need to be broadened. Prevention efforts should also target young injectors as a priority.

National HIV incidence measures--new insights into the South African epidemic.

Currently South Africa does not have national HIV incidence data based on laboratory testing of blood specimens. The 2005 South African national HIV household survey was analysed to generate national incidence estimates stratified by age, sex, race, province and locality type, to compare the HIV incidence and HIV prevalence profiles by sex, and to examine the relationship between HIV prevalence, HIV incidence and associated risk factors. The detection of recent infections was performed on confirmed HIV-positive samples, using the BED capture enzyme immunoassay optimised for dried blood spot (DBS) specimens. BED HIV incidence calculations applied adjustment procedures that were recently revised and approved by the Centers for Disease Control and Prevention for subtype C blood specimens. HIV incidence in the study population aged 2 years and older was 1.4% per year, with 571,000 new HIV infections estimated for 2005. An HIV incidence rate of 2.4% was recorded for the age group 15-49 years. The incidence of HIV among females peaked in the 20-29-year age group at 5.6%, more than six times the incidence found in 20-29-year-old males (0.9%). Among youth aged 15-24 years, females account for 90% of the recent HIV infections. Non-condom use among youth, current pregnancy and widowhood were the socio-behavioural factors associated with the highest HIV incidence rates. The HIV incidence estimates reflect the underlying transmission dynamics that are currently at work in South Africa. The findings suggest that the current prevention campaigns are not having the desired impact, particularly among young women.

Trial participation and vaccine desirability for Vi polysaccharide typhoid fever vaccine in Hue City, Viet Nam

To identify demand for Vi typhoid fever vaccine for school-age children; obstacles and enabling factors for vaccine delivery; and socio-behavioural factors associated with trial participation and possible predictors of future vaccine acceptance, in Hue City, Viet Nam. Pre- and post-trial surveys of randomly selected households with children aged 6-17 years. Simple multinomial logistic analyses for ratios of relative risks (RRR) and significance on trial participation by demographics and variables related to typhoid fever, vaccination, and pre-trial experiences with information and consents. Multiple logistic regressions to assess differences in participation based on child's characteristics. As many as 62.6% of households let all school age children participate, 10.2% let some participate, and 26.8% let none of their children participate in the trial. Factors associated with all children participating included past use of healthcare facilities (RRR, 0.45; 95% CI, 0.24-0.83), knowledge of vaccines (RRR, 0.17; 95% CI, 0.03-0.86), and perceived causes of typhoid fever (RRR, 0.90; 95% CI, 0.81-0.99). Factors associated with some children participating included utilization of healthcare facilities (RRR, 0.08; 95% CI, 0.01-0.66) and perceived severity of typhoid fever (RRR, 0.64; 95% CI 0.46-0.88). Participation was associated with satisfaction regarding pre-vaccination information and consent procedures. Children and adolescents were active decision-makers. Only 14 of 461 (2.2%) respondents would not use the Vi vaccine in the future for their child(ren). Inter-related factors contribute to participation in a clinical vaccine trial, which may differ from desire to participate in a public health campaign. Educational campaigns need to be targeted to children and adolescents, and consideration for assent procedures for minors. Obtaining informed consent may affect trial participation within a social and political system unaccustomed to these procedures.

Referral for chronic hepatitis C treatment from a drug dependency treatment setting

To examine rates and predictors of referral for hepatitis C virus (HCV) treatment and preliminary treatment outcomes in injecting drug users (IDUs) receiving opioid replacement treatment, a prospective clinical audit was undertaken in an inner city Sydney drug dependency treatment practice between December 2002 and November 2005. The majority of IDUs (178/237; 75%) were HCV antibody positive, of whom 170 were HCV treatment naïve with no absolute treatment contraindications. Among these 170 patients, 121 (71%) had chronic HCV. Based on risk factors for HCV disease progression, 63 of 121 (52%) chronic HCV patients were targeted for referral; these patients were older, had higher alanine aminotransferase levels and longer estimated duration of HCV infection. Of these 63 patients, 43 were referred to a hepatitis treatment clinic, and 27 attended during the audit period. Patients who attended for treatment assessment were more likely to have genotype 2 or 3 ( p < 0.001), but socio-behavioural factors were similar. Liver biopsy was performed in 20 patients, with moderate or greater fibrosis in 18 patients. Of 14 patients commenced on pegylated interferon-alpha and ribavirin therapy, one ceased treatment due to non-response, 10 have completed treatment, all with an end-of-treatment ( n = 4) or sustained virological response ( n = 6), and treatment is ongoing in three. The development of HCV treatment referral criteria has allowed prioritisation of patients for referral, potentially halving those that require early assessment. Preliminary HCV treatment outcomes are encouraging and highlight the potential for reducing liver disease burden in this patient population.