Post-exposure prophylaxis for rape survivors

CITATION: Pluddemann, A., Reuter, H. & Johnson, C. 2007. Post-exposure prophylaxis for rape survivors. South African Medical Journal, 97(1):12-13The original publication is available at http://www.samj.org.za[No abstract available]Publisher’s versio

Verification bias

This article is part of the Catalogue of Bias series. We present a description of verification bias, and outline its potential impact on research studies and the preventive steps to minimise its risk. We also present teaching slides in the online supplementary file. Verification bias (sometimes referred to as 'work-up bias') concerns the test(s) used to confirm a diagnosis within a diagnostic accuracy study. Verification bias occurs when only a proportion of the study participants receive confirmation of the diagnosis by the reference standard test, or if some participants receive a different reference standard test

What are the environmental factors that affect respiratory viral pathogen transmission and outcomes? A scoping review of the published literature

Introduction: Respiratory viral pathogens are a major cause of morbidity and mortality, and there is a need to understand how to prevent their transmission. Methods: We performed a scoping review to assess the amount and scope of published research literature on environmental factors, including meteorological factors and pollution, that affect the transmission of respiratory viral pathogens. We used Joanna Briggs Institute methodology for conducting a scoping review. We searched the electronic databases: MEDLINE, Register of Controlled Trials (Cochrane CENTRAL), TRIP database, WHO Covid-19 Database, Global Index Medicus, LitCovid, medRxiv, and Google Scholar. We included studies on environmental exposures and transmission of respiratory viruses (including but not restricted to: influenza, respiratory syncytial virus (RSV), human coronaviruses, viral pneumonia). Results: The searches identified 880 studies for screening; after screening we included 481 studies, including 395 primary studies and 86 reviews. Data were extracted by one reviewer (ES) and independently checked by a second reviewer for accuracy (AP). All primary studies were observational, mostly using an ecological design; 2/395 primary studies were prospective cohorts. Among the primary studies, 241/395 were on SARS-CoV-2/COVID-19; 95 focussed on influenza; the remaining 59 reported on RSV, other coronaviruses, and other respiratory viruses. Exposures were most commonly temperature (306 primary studies) and humidity (201 primary studies); other commonly reported exposures were air pollution, wind speed, precipitation, season, and UV radiation. It was frequently reported, but not consistently, that temperature, humidity and air pollution were positively correlated with COVID-19 cases/deaths; for influenza, season/seasonality was commonly reported to be associated with cases/deaths. Discussion: The majority of studies reported on SARS-CoV-2/COVID-19 and were of ecological design. Few prospective cohort studies have been done for any respiratory virus and environmental exposures. Understanding the role of environmental factors on transmission is limited by the lack of prospective cohort studies to inform decision making. Systematic Review Registration: https://osf.io/ntdjx/, identifier: 10.17605/OSF.IO/NTDJX

Endometrial scratching before in vitro fertilisation does not increase live birth rate

Endometrial scratching can be offered to women undergoing in vitro fertilisation to increase the probability of pregnancy. Previous research has indicated that it may increase live birth rates in some women; however, the evidence is conflicting and of moderate quality. This large randomised trial addresses this lack of clear evidence

Accuracy of self-diagnosis in conditions commonly managed in primary care: diagnostic accuracy systematic review and meta-analysis

Objectives To assess the diagnostic accuracy of self-diagnosis compared with a clinical diagnosis for common conditions in primary care. Design Systematic review. Meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews and CINAHL from inception to 25 January 2021. Study selection Eligible studies were prospective or retrospective studies comparing the results of self-diagnosis of common conditions in primary care to a relevant clinical diagnosis or laboratory reference standard test performed by a healthcare service provider. Studies that considered self-testing only were excluded. Data extraction Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2. Methods and results 5047 records identified 18 studies for inclusion covering the self-diagnosis of three common conditions: vaginal infection (five studies), common skin conditions (four studies) and HIV (nine studies). No studies were found for any other condition. For self-diagnosis of vaginal infection and common skin conditions, meta-analysis was not appropriate and data were reported narratively. Nine studies, using point-of-care oral fluid tests, reported on the accuracy of self-diagnosis of HIV and data were pooled using bivariate meta-analysis methods. For these nine studies, the pooled sensitivity was 92.8% (95% CI, 86% to 96.5%) and specificity was 99.8% (95% CI, 99.1% to 99.9%). Post hoc, the robustness of the pooled findings was tested in a sensitivity analysis only including four studies using laboratory testing as the reference standard. The pooled sensitivity reduced to 87.7% (95% CI, 81.4% to 92.2%) and the specificity remained the same. The quality of all 18 included studies was assessed as mixed and overall study methodology was not always well described. Conclusions and implications of key findings Overall, there was a paucity of evidence. The current evidence does not support routine self-diagnosis for vaginal infections, common skin conditions and HIV in primary care

The impact of the UK‘two-week rule’on stage-on-diagnosis of oral cancer and the relationship to socio-economic inequalities

Background:The‘two-week rule’(TWR) fast-track cancer referral system for head and neck cancers was introduced by the UK government in 2000, to facilitate earlier diagnosis. However, little work has compared stage on diagnosis of cancer before and after the implementation of the system.Objectives:•Describe the presentation of oral cancer in Merseyside from 1992 to 2012.•To evaluate whether stage on presentation has improved after the introduction of the TWR using data from a clinical database in Merseyside 1992–2012.•To assess the relationship between stage on presentation and social deprivation 1992–2012.•To assess the change in presentation for different sites within the oral cavity.Method and setting:Patients were identified using the Aintree (Liverpool) head and neck oncology database,containing all diagnoses of oral squamous cell carcinoma (SCC) between 1992–2012. Cancers were clinically staged using the American Joint Committee on Cancer (AJCC) stage groupings and divided into‘early’(stage 1 and 2) and‘late’(stage 3 and 4). Index of Multiple Deprivation (IMD) 2004 data were derived from patient postcodes. Appropriate regression analyses were undertaken.Results:1485 consecutive patients diagnosed were studied. Median (IQR) age was 63 (55–73) years and 61% were male. 36% of cancers were located on anterior 2/3rds tongue, 30% floor of mouth, and 34% elsewhere.‘Late’ tumour presentation was 52% (95%CI 46.8–56.4%) for 1992–2000, and 44% (95%CI 41.4–47.5%) for 2001–2012 (P = 0.01).Join point regression analysis of‘late’presentation indicated a steady fall 1992–2012, at an annual percentage decrease of 1.27% (95% CI−2.3 to−0.2). No statistically significant change in trend was identified either overall or within deprivation groups following the TWR. For patients in‘more deprived' neighbourhoods, ‘late’ tumour presentation was: 56% and 47%; in‘less deprived’areas: 48% and 42%, before and after the introduction of the TWR, respectively.Year of diagnosis, tumour site and IMD2004 were significantly associated with‘late’presentation, and lo-cation of tumour was also associated with time period and IMD2004. Main conclusions:Stage on presentation improved between 1992–2012. Join point analysis showed no significant change in trend following the introduction of the TWR. The rate of improvement was highest for most deprived; nevertheless, deprivation inequality persists and this should be a focus of further initiatives and research

The Pandemic EVIDENCE Collaboration Pillar 1: diagnostics and transmission

The COVID-19 pandemic starkly revealed a lack of high-quality evidence for non-pharmacological interventions (NPIs). The evidence produced to support the optimal deployment of NPIs to reduce transmission of SARS-CoV-2 was often of poor quality, and decisions were made without considering the wealth of previous research on respiratory virus transmission from human challenge studies. Respiratory virus infections cause illnesses varying from the “common cold” to invasive pneumonitis with multisystem involvement with severity dependent on the host-virus-immune response interaction. Despite the learnings from the recent pandemic, significant gaps remain in our understanding of the diagnosis of acute respiratory viral infections and their sequelae, the modes of transmission, and how to effectively synthesise the existing evidence from the past 70 years of research on respiratory viruses. It is crucial to examine further the evidence on how common respiratory viral agents are transmitted. The transmission dynamics to allow for a replication-competent virus to move from a reservoir to a susceptible host and establish an invasive infection is complex and it is likely multiple modes of transmission exist from direct reservoir-to-host (contact, droplet deposition, transplacental) and indirect reservoir-to-intermediary-to- host (vehicle-borne, foodborne, waterborne, and airborne) routes. To enhance our understanding of both diagnostics and transmission, we need to characterise viral entry and attachment, viral load dynamics, duration of virus infectivity both inside and outside the host, duration of viral nucleic acid shedding using molecular testing, the role of whole genome sequencing, and factors that may affect the duration of infectivity and transmission. There are still uncertainties surrounding current testing strategies and their connection to NPIs, as well as fundamental issues such as the accuracy of symptom reporting during acute respiratory infections. The importance of animal-to-animal, human-to-animal and human-to-human challenge studies in expanding our knowledge of the transmission of respiratory viruses cannot be overstated

The impact of the UK‘two-week rule’on stage-on-diagnosis of oral cancer and the relationship to socio-economic inequalities

Background:The‘two-week rule’(TWR) fast-track cancer referral system for head and neck cancers was introduced by the UK government in 2000, to facilitate earlier diagnosis. However, little work has compared stage on diagnosis of cancer before and after the implementation of the system.Objectives:•Describe the presentation of oral cancer in Merseyside from 1992 to 2012.•To evaluate whether stage on presentation has improved after the introduction of the TWR using data from a clinical database in Merseyside 1992–2012.•To assess the relationship between stage on presentation and social deprivation 1992–2012.•To assess the change in presentation for different sites within the oral cavity.Method and setting:Patients were identified using the Aintree (Liverpool) head and neck oncology database,containing all diagnoses of oral squamous cell carcinoma (SCC) between 1992–2012. Cancers were clinically staged using the American Joint Committee on Cancer (AJCC) stage groupings and divided into‘early’(stage 1 and 2) and‘late’(stage 3 and 4). Index of Multiple Deprivation (IMD) 2004 data were derived from patient postcodes. Appropriate regression analyses were undertaken.Results:1485 consecutive patients diagnosed were studied. Median (IQR) age was 63 (55–73) years and 61% were male. 36% of cancers were located on anterior 2/3rds tongue, 30% floor of mouth, and 34% elsewhere.‘Late’ tumour presentation was 52% (95%CI 46.8–56.4%) for 1992–2000, and 44% (95%CI 41.4–47.5%) for 2001–2012 (P = 0.01).Join point regression analysis of‘late’presentation indicated a steady fall 1992–2012, at an annual percentage decrease of 1.27% (95% CI−2.3 to−0.2). No statistically significant change in trend was identified either overall or within deprivation groups following the TWR. For patients in‘more deprived' neighbourhoods, ‘late’ tumour presentation was: 56% and 47%; in‘less deprived’areas: 48% and 42%, before and after the introduction of the TWR, respectively.Year of diagnosis, tumour site and IMD2004 were significantly associated with‘late’presentation, and lo-cation of tumour was also associated with time period and IMD2004. Main conclusions:Stage on presentation improved between 1992–2012. Join point analysis showed no significant change in trend following the introduction of the TWR. The rate of improvement was highest for most deprived; nevertheless, deprivation inequality persists and this should be a focus of further initiatives and research

Long-term effects of functional appliances in treated versus untreated patients with Class II malocclusion: A systematic review and meta-analysis

Objective To assess the cephalometric skeletal and soft-tissue of functional appliances in treated versus untreated Class II subjects in the long-term (primarily at the end of growth, secondarily at least 3 years after retention). Search methods Unrestricted electronic search of 24 databases and additional manual searches up to March 2018. Selection criteria Randomised and non-randomised controlled trials reporting on cephalometric skeletal and soft-tissue measurements of Class II patients (aged 16 years or under) treated with functional appliances, worn alone or in combination with multi-bracket therapy, compared to untreated Class II subjects. Data collection and analysis Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated with the random-effects model. Data were analysed at 2 primary time points (above 18 years of age, at the end of growth according to the Cervical Vertebral Maturation method) and a secondary time point (at least 3 years after retention). The risk of bias and quality of evidence were assessed according to the ROBINS tool and GRADE system, respectively. Results Eight non-randomised studies published in 12 papers were included. Functional appliances produced a significant improvement of the maxillo-mandibular relationship, at almost all time points (Wits appraisal at the end of growth, MD -3.52 mm, 95% CI -5.11 to -1.93, P < 0.0001). The greatest increase in mandibular length was recorded in patients aged 18 years and above (Co-Gn, MD 3.20 mm, 95% CI 1.32 to 5.08, P = 0.0009), although the improvement of the mandibular projection was negligible or not significant. The quality of evidence was ‘very low’ for most of the outcomes at both primary time points. Conclusions Functional appliances may be effective in correcting skeletal Class II malocclusion in the long-term, however the quality of the evidence was very low and the clinical significance was limited

How common and frequent is heterosexual anal intercourse among South Africans? A systematic review and meta-analysis.

BACKGROUND: HIV is transmitted more effectively during anal intercourse (AI) than vaginal intercourse (VI). However, patterns of heterosexual AI practice and its contribution to South Africa's generalized epidemic remain unclear. We aimed to determine how common and frequent heterosexual AI is in South Africa. METHODS: We searched for studies reporting the proportion practising heterosexual AI (prevalence) and/or the number of AI and unprotected AI (UAI) acts (frequency) in South Africa from 1990 to 2015. Stratified random-effects meta-analysis by sub-groups was used to produce pooled estimates and assess the influence of participant and study characteristics on AI prevalence. We also estimated the fraction of all sex acts which were AI or UAI and compared condom use during VI and AI. RESULTS: Of 41 included studies, 31 reported on AI prevalence and 14 on frequency, over various recall periods. AI prevalence was high across different recall periods for sexually active general-risk populations (e.g. lifetime = 18.4% [95%CI:9.4-27.5%], three-month = 20.3% [6.1-34.7%]), but tended to be even higher in higher-risk populations such as STI patients and female sex workers (e.g. lifetime = 23.2% [0.0-47.4%], recall period not stated = 40.1% [36.2-44.0%]). Prevalence was higher in studies using more confidential interview methods. Among general and higher-risk populations, 1.2-40.0% and 0.7-21.0% of all unprotected sex acts were UAI, respectively. AI acts were as likely to be condom protected as vaginal acts. CONCLUSION: Reported heterosexual AI is common but variable among South Africans. Nationally and regionally representative sexual behaviour studies that use standardized recall periods and confidential interview methods, to aid comparison across studies and minimize reporting bias, are needed. Such data could be used to estimate the extent to which AI contributes to South Africa's HIV epidemic