Alcohol Use among Orphans in Sub-saharan Africa: a Literature Review

The current global orphan population is estimated to be 130 million children with a large proportion residing in sub-Saharan Africa. Children without parental influence are at increased risk for a range of health-risk behaviors including alcohol use. Despite the magnitude of the problems facing orphans, few studies have examined the prevalence of health-risk behaviors, including alcohol use, in this vulnerable population. There is also limited guidance in published work related to recommendations for future research and programs that can better meet the needs of orphans, particularly those who live in urban slums. A literature search of databases (EBSCO, PubMed, Google Scholar and Wiley Online Library) was performed using several key search terms to summarize published research. The findings show that research related to alcohol use among orphans in sub-Saharan Africa is scarce and primarily comprise youth in Uganda. The literature review on orphans and alcohol within sub-Saharan Africa suggest the need for further research. Some studies suggest the need for program implementation, alcohol prevention marketing strategies, alcohol regulation and overall education on alcohol awareness for the OVC population within sub-Saharan Africa. More research is needed to address the association between orphan status and alcohol consumption within this region

Autonomous and controlled motivational regulations for multiple health related behaviors: between- and within-participants analyses

Self-determination theory has been applied to the prediction of a number of health-related behaviors with self-determined or autonomous forms of motivation generally more effective in predicting health behavior than non-self-determined or controlled forms. Research has been confined to examining the motivational predictors in single health behaviors rather than comparing effects across multiple behaviors. The present study addressed this gap in the literature by testing the relative contribution of autonomous and controlling motivation to the prediction of a large number of health-related behaviors, and examining individual differences in self-determined motivation as a moderator of the effects of autonomous and controlling motivation on health behavior. Participants were undergraduate students (N = 140) who completed measures of autonomous and controlled motivational regulations and behavioral intention for 20 health-related behaviors at an initial occasion with follow-up behavioral measures taken four weeks later. Path analysis was used to test a process model for each behavior in which motivational regulations predicted behavior mediated by intentions. Some minor idiosyncratic findings aside, between-participants analyses revealed significant effects for autonomous motivational regulations on intentions and behavior across the 20 behaviors. Effects for controlled motivation on intentions and behavior were relatively modest by comparison. Intentions mediated the effect of autonomous motivation on behavior. Within-participants analyses were used to segregate the sample into individuals who based their intentions on autonomous motivation (autonomy-oriented) and controlled motivation (control-oriented). Replicating the between-participants path analyses for the process model in the autonomy- and control-oriented samples did not alter the relative effects of the motivational orientations on intention and behavior. Results provide evidence for consistent effects of autonomous motivation on intentions and behavior across multiple health-related behaviors with little evidence of moderation by individual differences. Findings have implications for the generalizability of proposed effects in self-determination theory and intentions as a mediator of distal motivational factors on health-related behavior

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

BACKGROUND: Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point-of-care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)-recommended main diagnostic test for enteric fever.OBJECTIVES: To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas.SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies.SELECTION CRITERIA: We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone).DATA COLLECTION AND ANALYSIS: Two review authors independently extracted the test result data. We used a modified QUADAS-2 extraction form to assess methodological quality. We performed a meta-analysis when there were sufficient studies for the test and heterogeneity was reasonable.MAIN RESULTS: Thirty-seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence rates in the study populations ranged from 1% to 75% (median prevalence 24%, interquartile range (IQR) 11% to 46%). The included studies evaluated 16 different RDTs, and 16 studies compared two or more different RDTs. Only three studies used the Grade 1 reference standard, and only 11 studies recruited unselected febrile patients. Most included studies were from Asia, with five studies from sub-Saharan Africa. All of the RDTs were designed to detect S.Typhi infection only.Most studies evaluated three RDTs and their variants: TUBEX in 14 studies; Typhidot (Typhidot, Typhidot-M, and TyphiRapid-Tr02) in 22 studies; and the Test-It Typhoid immunochromatographic lateral flow assay, and its earlier prototypes (dipstick, latex agglutination) developed by the Royal Tropical Institute, Amsterdam (KIT) in nine studies. Meta-analyses showed an average sensitivity of 78% (95% confidence interval (CI) 71% to 85%) and specificity of 87% (95% CI 82% to 91%) for TUBEX; and an average sensitivity of 69% (95% CI 59% to 78%) and specificity of 90% (95% CI 78% to 93%) for all Test-It Typhoid and prototype tests (KIT). Across all forms of the Typhidot test, the average sensitivity was 84% (95% CI 73% to 91%) and specificity was 79% (95% CI 70% to 87%). When we based the analysis on the 13 studies of the Typhidot test that either reported indeterminate test results or where the test format means there are no indeterminate results, the average sensitivity was 78% (95% CI 65% to 87%) and specificity was 77% (95% CI 66% to 86%). We did not identify any difference in either sensitivity or specificity between TUBEX, Typhidot, and Test-it Typhoid tests when based on comparison to the 13 Typhidot studies where indeterminate results are either reported or not applicable. If TUBEX and Test-it Typhoid are compared to all Typhidot studies, the sensitivity of Typhidot was higher than Test-it Typhoid (15% (95% CI 2% to 28%), but other comparisons did not show a difference at the 95% level of CIs.In a hypothetical cohort of 1000 patients presenting with fever where 30% (300 patients) have enteric fever, on average Typhidot tests reporting indeterminate results or where tests do not produce indeterminate results will miss the diagnosis in 66 patients with enteric fever, TUBEX will miss 66, and Test-It Typhoid and prototype (KIT) tests will miss 93. In the 700 people without enteric fever, the number of people incorrectly diagnosed with enteric fever would be 161 with Typhidot tests, 91 with TUBEX, and 70 with Test-It Typhoid and prototype (KIT) tests. The CIs around these estimates were wide, with no difference in false positive results shown between tests.The quality of the data for each study was evaluated using a standardized checklist called QUADAS-2. Overall, the certainty of the evidence in the studies that evaluated enteric fever RDTs was low.AUTHORS' CONCLUSIONS: In 37 studies that evaluated the diagnostic accuracy of RDTs for enteric fever, few studies were at a low risk of bias. The three main RDT tests and variants had moderate diagnostic accuracy. There was no evidence of a difference between the average sensitivity and specificity of the three main RDT tests. More robust evaluations of alternative RDTs for enteric fever are needed.</p

Diagnostic accuracy studies: how to report and analyse inconclusive test results.

Failure to report inconclusive test results can lead to misleading conclusions regarding the accuracy and clinical usefulness of a diagnostic tool. We show that these results are often overlooked in research on test accuracy and provide guidance on suitable approaches to reporting and analysing these problematic results

The structural drivers of homelessness in Australia 2001-11

This second and final report, from a project addressing this broad question, builds on our earlier analysis of the spatial dynamics of homelessness from 2001 to 2011. It examines the role of housing and labour markets, household income, income inequality, climate and demographic profiles in shaping the spatial distribution of homelessness across Australia. Interest in the role of structural versus individual level drivers of homelessness has been longstanding in the homelessness research and policy fields. Some have argued that homelessness is caused by structural factors such as weak labour markets and tight housing markets (Neale 1997), while others have emphasised individual factors such as mental illness, a history of contact with institutions, or poor decision-making as the key causes (Neale 1997). More recently a loose consensus has emerged where homelessness is understood to be caused by the interaction of individual risk factors and adverse structural conditions (Fitzpatrick & Christian 2006; Lee et al. 2010; Pleace 2000; O'Flaherty 2004)

Race/ethnicity, citizenship status, and crime examined through trauma experiences among young adults in the United States

Race/ethnicity, citizenship status, and trauma, have significant impact on delinquency and crime outcomes; though the rea- sons for some expected and unexpected crime pathways are still unanswered. Using data from the National Longitudinal Survey of Youth 1997 (n = 7,103), this study found the follow- ing results: no difference in the likelihood of engagement in delinquency and crime between blacks and whites; cumulative trauma increased delinquency and crime rates for all racial and ethnic groups; racial and ethnic minority groups compared to whites reported a significantly higher level of child- hood trauma experiences; and native-born female immigrant groups (but not male) were more likely to engage in delin- quency and crime than first-generation female immigrant groups. Implications and recommendations are set forth

Explicating Correlates of Juvenile Offender Detention Length: The Impact of Race, Mental Health Difficulties, Maltreatment, Offense Type, and Court Dispositions

Detention and confinement are widely acknowledged juvenile justice system problems which require further research to understand the explanations for these outcomes. Existing juvenile court, mental health, and child welfare histories were used to explicate factors which predict detention length in this random sample of 342 youth from one large, urban Midwestern county in the United States. Data from this sample revealed eight variables which predict detention length. Legitimate predictors of longer detention length such as committing a personal crime or violating a court order were nearly as likely in this sample to predict detention length as other extra-legal predictors such as race, court disposition for mental health problems, child welfare involvement, and child physical abuse victimization. Many of the factors that increase duration of detention are actually disadvantages that these youth endure; therefore preventative and intervention measures are in order