Predictive validity of a brief antiretroviral adherence index: Retrospective cohort analysis under conditions of repetitive administration

<p>Abstract</p> <p>Background</p> <p>Newer antiretroviral (ARV) agents have improved pharmacokinetics, potency, and tolerability and have enabled the design of regimens with improved virologic outcomes. Successful antiretroviral therapy is dependent on patient adherence. In previous research, we validated a subset of items from the ACTG adherence battery as prognostic of virologic suppression at 6 months and correlated with adherence estimates from the Medication Event Monitoring System (MEMS). The objective of the current study was to validate the longitudinal use of the Owen Clinic adherence index in analyses of time to initial virologic suppression and maintenance of suppression.</p> <p>Results</p> <p>278 patients (naïve n = 168, experienced n = 110) met inclusion criteria. Median [range] time on the first regimen during the study period was 286 (30 – 1221) days. 217 patients (78%) achieved an undetectable plasma viral load (pVL) at median 63 days. 8.3% (18/217) of patients experienced viral rebound (pVL > 400) after initial suppression. Adherence scores varied from 0 – 25 (mean 1.06, median 0). The lowest detectable adherence score cut point using this instrument was ≥ 5 for both initial suppression and maintenance of suppression. In the final Cox model of time to first undetectable pVL, controlling for prior treatment experience and baseline viral load, the adjusted hazard ratio for time updated adherence score was 0.36_{score ≥ 5}(95% CI: 0.19–0.69) [reference: <5]. In the final generalized estimating equations (GEE) logistic regression model the adjusted odds ratio for time-updated adherence score was 0.17_{score ≥ 5}(0.05–0.66) [reference: <5].</p> <p>Conclusion</p> <p>A brief, longitudinally administered self report adherence instrument predicted both initial virologic suppression and maintenance of suppression in patients using contemporary ARV regimens. The survey can be used for identification of sub-optimal adherence with subsequent appropriate intervention.</p

The prevalence of corporal punishment in Australia:Findings from a nationally representative survey

Corporal punishment is associated with adverse outcomes; however, little empirical data exists about the state of corporal punishment in Australia. This paper presents the first national prevalence estimates of experiences of corporal punishment during childhood among Australians and its use as adults by Australian parents and caregivers. We also report community beliefs about the necessity of corporal punishment. Results show corporal punishment remains common in Australia. A high proportion of Australians (62.5%) experienced corporal punishment in childhood, including almost 6 in 10 (58.4%) young people aged 16–24. Approximately half of all parents surveyed (53.7%) had used corporal punishment. A quarter of Australians (26.4%) believe corporal punishment is necessary to raise children, 73.6% do not view it as necessaryThe use of corporal punishment and belief in its necessity are lower among younger people. Findings indicate the experience of corporal punishment remains unacceptably high in Australia but that the use of corporal punishment and beliefs about its necessity may be changing. These findings have significant implications for policy and practice in Australia. Changes in legislation could reduce this form of violence toward children. Relatively low rates of endorsement of the necessity of corporal punishment suggest the Australian community may be receptive to attempts for law reform in this area

IoT-based BIM integrated model for energy and water management in smart homes

Increasing urbanization and growth in infrastructure create a demand to utilize modern tools to manage human needs. Effective integration of the Internet of Things (IoT) into the design of smart homes is an actively growing area in the construction industry. The ever-increasing demand and cost of energy require a smart solution in the design stage by the construction industry. It is possible to reduce household energy consumption by utilizing energy-efficient sustainable materials in infrastructure construction. Building Information Modeling (BIM) can provide a solution to effectively manage energy. The integration of the IoT further improves the design of comfortable smart homes by utilizing natural lighting. BIM aids in determining energy efficiency and making decisions by presenting the user with several design options via the 6D method. The present study considered a sample home design following the National Building Code (NBC) and American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) standards for implementation. Natural lighting analysis is carried out with the tool Insight 360 to analyze the energy consumption of the building. Some of the outputs obtained from the analysis are wall-to-window ratio (WWR), window shades, design options for window glass, energy use intensity (EUI), and annual energy cost (AEC). The results of the outputs are compared to find the energy-efficient optimum natural lighting of the proposed building. The lesser EUI (16%–21%) and AEC (23%–28%) are identified with the utilization of low emissivity glass in window panels compared with other types of glass. The proposed IoT-based BIM integration model proves that the effective utilization of natural lighting reduces overall household energy consumption

Child sexual abuse by different classes and types of perpetrator: prevalence and trends from an Australian national survey

Background Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents). Objective To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group. Participants and setting The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over. Methods We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group. Results Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends. Conclusions CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised

Expanding the genotypic and phenotypic spectrum of severe serine biosynthesis disorders.

Serine biosynthesis disorders comprise a spectrum of very rare autosomal recessive inborn errors of metabolism with wide phenotypic variability. Neu-Laxova syndrome represents the most severe expression and is characterized by multiple congenital anomalies and pre- or perinatal lethality. Here, we present the mutation spectrum and a detailed phenotypic analysis in 15 unrelated families with severe types of serine biosynthesis disorders. We identified likely disease-causing variants in the PHGDH and PSAT1 genes, several of which have not been reported previously. Phenotype analysis and a comprehensive review of the literature corroborates the evidence that serine biosynthesis disorders represent a continuum with varying degrees of phenotypic expression and suggest that even gradual differences at the severe end of the spectrum may be correlated with particular genotypes. We postulate that the individual residual enzyme activity of mutant proteins is the major determinant of the phenotypic variability, but further functional studies are needed to explore effects at the enzyme protein level.We are indebted to all families for participating in this study. We would like to acknowledge Dr. Natasha Laidlew, who initially suggested the diagnosis in one of the cases and provided important phenotypic information, and Dr. María-Luisa Martínez-Fernández for the critical management of biosamples in ECEMC Program of Spain. Financial assistance was received in support of the study by grants from the German Federal Ministry of Education and Research (BMBF) (GeNeRARe, FKZ: 01GM1519D) to M. Z. and from the Institute of Health Carlos III: Convenio ISCIII-ASEREMAC, and Fundación 1000 sobre Defectos Congénitos, of Spain to E. B.-S. and I. R. G.S

The prevalence and nature of multi‐type child maltreatment in Australia

Objectives To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences. Design Retrospective cross-sectional survey using a validated questionnaire. Setting and participants Mobile phone random digit-dial sample of the Australian population aged 16 years and older. Main outcome measures National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study). Results Of 8503 participants, 62.2% (95% CI, 60.9–63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7–24.0%), whereas 39.4% (95% CI, 38.1–40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0–4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7–78.7%]) and women (43.2% [95% CI, 41.3–45.1%]) than for men (34.9% [95% CI, 33.0–36.7%]). Multi-type maltreatment prevalence was highest for those aged 25–44 years. Family-related adverse childhood experiences — especially mental illness and alcohol or substance misuse — increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns. Conclusions Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment

The prevalence of child maltreatment in Australia: findings from a national survey

Objectives To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. Design, setting Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. Results Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7–33.3%), sexual abuse by 28.5% (95% CI, 27.3–29.8%), emotional abuse by 30.9% (95% CI, 29.7–32.2%), neglect by 8.9% (95% CI, 8.1–9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3–40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16–24 years was lower than for those aged 25–34 years, and that of sexual abuse was lower than for those aged 35–44 years, suggesting recent declines in the prevalence of these maltreatment types. Conclusions Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities

The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study

Objectives To examine the associations between experiences of child maltreatment and mental disorders in the Australian population. Design Population-representative survey conducted by computer-assisted telephone interviewing. Setting, participants Australian residents aged 16 years and older. Main outcome measures Mental disorder diagnoses of lifetime major depressive disorder, current alcohol use disorder (mild, moderate and severe), current generalised anxiety disorder and current post-traumatic stress disorder. Results More than one in three Australians (3606/8503 surveyed participants; 38.0%; 95% CI, 36.7–39.3%) met the diagnostic criteria for a mental disorder. The prevalence of mental disorders in non-maltreated participants was 21.6% (95% CI, 19.9–23.3%; n = 851). This increased to 36.2% (95% CI, 33.5–38.9%; n = 764) for those who experienced a single type of maltreatment and 54.8% (95% CI, 52.6–56.9%; n = 1991) for participants who experienced multi-type maltreatment. Compared with non-maltreated Australians, maltreated participants had about three times the odds of any mental disorder (odds ratio [OR], 2.82; 95% CI, 2.47–3.22), generalised anxiety disorder (OR, 3.14; 95% CI, 2.48–3.97), major depressive disorder (OR, 3.19; 95% CI, 2.68–3.80) and severe alcohol use disorder (OR, 2.62; 95% CI, 1.83–3.76), and almost five times the odds of post-traumatic stress disorder (OR, 4.60; 95% CI, 3.00–7.07). Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations. Conclusions Mental disorders are significantly more likely to occur in individuals who experience child maltreatment, particularly multi-type maltreatment. Prevention of child maltreatment provides an opportunity to substantially reduce the prevalence of mental illness and improve the health of the Australian population

The prevalence of peer sexual harassment during childhood in Australia

Sexual harassment inflicted by adolescents on their peers is a major public health issue, but its prevalence across childhood is not known. We provide the first nationally representative data on the prevalence of peer sexual harassment across childhood, using cross-sectional data from the Australian Child Maltreatment Study (ACMS). The ACMS surveyed 8,503 people aged 16 and over about their experiences of child maltreatment and associated health outcomes. The prevalence of peer sexual harassment was assessed using the Juvenile Victimization Questionnaire (JVQ)-R2 Adapted Version (ACMS), with survey data weighted to reflect characteristics of the Australian population. Overall, 1 in 10 (10.4% (95% Confidence Intervals (CI) [9.7, 11.3])) Australians experienced peer sexual harassment during childhood. Peer sexual harassment is an issue disproportionately affecting gender-diverse individuals (24.0%, 95% CI [15.5, 35.2]) and women (15.3%, 95% CI [14.0, 16.7%]), compared to men (5.0%, 95% CI [4.3, 5.9]). Rates of peer sexual harassment were also very high among sexuality diverse participants (prevalence estimates ranging between 14.2% and 29.8%). Peer sexual harassment was predominately inflicted by male peers (9.6%, 95% CI [8.9, 10.4]), compared to 1.8% (95% CI [1.5, 2.2]) reporting harassment from female peers. These findings have implications for understanding and reducing attitudes supporting peer sexual harassment in childhood, particularly against girls and gender and sexuality diverse youth, and associations with other gendered violence both in childhood and later life