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1.
Dipika Sur Mohammad Ali Lorenz von Seidlein Byomkesh Manna Jacqueline L Deen Camilo J Acosta John D Clemens Sujit K Bhattacharya 《BMC public health》2007,7(1):289
Background:
Exposure of the individual to contaminated food or water correlates closely with the risk for enteric fever. Since public health interventions such as water improvement or vaccination campaigns are implemented for groups of individuals we were interested whether risk factors not only for the individual but for households, neighbourhoods and larger areas can be recognised?Methods:
We conducted a large enteric fever surveillance study and analyzed factors which correlate with enteric fever on an individual level and factors associated with high and low risk areas with enteric fever incidence. Individual level data were linked to a population based geographic information systems. Individual and household level variables were fitted in Generalized Estimating Equations (GEE) with the logit link function to take into account the likelihood that household factors correlated within household members.Results:
Over a 12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were detected among 56,946 residents in two bustees (slums) of Kolkata, India. The incidence of paratyphoid fever was lower (0.8/1000/year), and the mean age of paratyphoid patients was older (17.1 years) than for typhoid fever (incidence 1.4/1000/year, mean age 14.7 years). Residents in areas with a high risk for typhoid fever had lower literacy rates and economic status, bigger household size, and resided closer to waterbodies and study treatment centers than residents in low risk areas.Conclusion:
There was a close correlation between the characteristics detected based on individual cases and characteristics associated with high incidence areas. Because the comparison of risk factors of populations living in high versus low risk areas is statistically very powerful this methodology holds promise to detect risk factors associated with diseases using geographic information systems.2.
Objective
To examine relationships between work-based cultural activities and mental employee health in working Swedes.Hypothesis
A positive relationship between frequent cultural activity at work and good employee health was expected.Research design
Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.Methods
A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of “non-listening manager” and work environment (“psychological demands” and “decision latitude”) as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006–2008 and 2008–2010 were performed.Main outcome and results
Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant “protective” effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.Conclusions
Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.Implications for future research
There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.3.
B. Fougère S. Mazzuco P. Spagnolo S. Guyonnet B. Vellas M. Cesari M. Gallucci 《The journal of nutrition, health & aging》2016,20(4):415-419
Objectives
To determine the association between Mediterranean-Style Dietary Pattern Score and physical performance.Design
Data analysis of a longitudinal study of a representative, age stratified, population sample.Setting
The TREVISO LONGEVA (TRELONG) Study, in Treviso, Italy.Participants
In 2010, 123 men and 181 women, age 77 years and over (mean age 86.3 ± 6.8 years).Measurements
Performing a logistic regression in a multivariate analysis, hand grip strength and Short Physical Performance Battery (SPPB) were tested in relation to Mediterranean-Style Dietary Pattern Score (MSDPS).Results
The hand grip mean value was 10.9 kg (± 9.5) and the SPPB score was 6.3 (± 3.8). The MSDPS mean value in this study sample was 38.1/100 (± 8.1). A significant association (p=0.036) between a high adherence to the Mediterranean diet (fourth quartile) and higher performance lower limbs (SPPB>7) was found. No correlation was reported for the hand grip strength.Conclusion
We found an association statistically significant between a high adherence to the Mediterranean diet and higher physical performance.4.
Erika Berggren Y. Orrevall A. Ödlund Olin P. Strang R. Szulkin L. Törnkvist 《The journal of nutrition, health & aging》2016,20(4):428-438
Objective
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.Design
Observational cohort study.Setting
10 primary health care centers in Stockholm County, Sweden.Participants
140 district nurses/registered nurses and general practitioners/physicians working with home care.Intervention
87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.Measurements
The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.Results
In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.Conclusion
The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.5.
Background
Meningitis caused by Neisseria meningitidis is a serious infection which is most common in young children and adolescents. This study investigated the relationships between the incidence and age distribution of meningococcal disease, and socioeconomic environment.Methods
An ecological design was used, including mapping using a Geographical Information System (GIS) at census ward level.Results
Incidence of meningococcal disease was highest in the most deprived wards, with a relative risk of 1.97 (1.55 – 2.51). Mapping revealed geographical coincidence of deprivation and meningococcal disease, particularly in urban areas. Two-thirds of the increased incidence was due to cases in the under fives.Conclusions
The results suggest that area deprivation is a risk factor for meningococcal disease, and that its effects are seen most in young children.6.
Background
Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.Aim
The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.Methods
A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.Results
Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.Conclusion
Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.7.
Silvia Giovannini G. Onder F. Lattanzio S. Bustacchini G. di Stefano R. Moresi A. Russo R. Bernabei F. Landi 《The journal of nutrition, health & aging》2018,22(5):608-612
Background
Selenium has a wide range of pleiotropic effects, influencing redox homeostasis, thyroid hormone metabolism, and protecting from oxidative stress and inflammation. Serum selenium levels are reduced in the older population.Objectives
to investigate the association of serum selenium levels with all-cause mortality in a sample of community-dwelling older adults.Design and Setting
Data are from the ‘Invecchiamento e Longevità nel Sirente’ (Aging and Longevity in the Sirente geographic area, ilSIRENTE) study, a prospective cohort study that collected information on individuals aged 80 years and older living in an Italian mountain community (n=347). The main outcome was risk of death after ten years of follow-up.Participants and measurements
Participants were classified according to the median value of selenium (105.3 μg/L) in two groups: high selenium and low selenium.Results
A total of 248 deaths occurred during a 10-year follow-up. In the unadjusted model, low levels of selenium was associated with increased mortality (HR, 0.66; 95% CI 0.51-0.85). After adjusting for potential confounders the relationship remained significant (HR, 0.71; 95% CI 0.54-0.92).Conclusions
Low serum levels of selenium are associated with reduced survival in elderly, independently of age and other clinical and functional variables.8.
Piet Ter Wee M. Kuhn H. van der Woude D. van de Looverbosch H. Heyman L. Mikušová D. Fouque 《The journal of nutrition, health & aging》2016,20(9):944-951
Background/Objective
High protein oral nutritional supplements (ONS) are regularly prescribed to undernourished patients; however usage of these in older adults is being discussed, as their renal function might have declined with age. Therefore, the aim of the current study was to evaluate the effects of 8 week long consumption of high protein ONS on the renal function of nursing home residents in need of supplementation. Furthermore, within the same setup, differences in gastro-intestinal tolerance between a standard and a more concentrated version of an ONS were investigated.Design
Randomized, controlled, single-blind, parallel-group, multi-country trial (NTR2565).Setting
Nursing home.Participants
67 nursing home residents in need of ONS (energy-dense, small volume group n=32; standard volume group n=35).Intervention
Protein supplementation was provided by either a standard (200ml, 300kcal, 20g protein) or an energy-dense, small volume (125ml, 300kcal, 18g protein) ONS during the 8 week long study.Measurements
Primary outcome was gastro-intestinal tolerance, assessed by daily stool frequency and consistency, and occurrence and intensity of self-reported gastrointestinal symptoms. Safety was measured via the occurrence of (serious) adverse events, vital signs, as well as liver-and kidney function monitoring.Results
No clinically relevant and, except for flatulence, no statistically significant differences in gastro-intestinal tolerance were observed between groups. No significant difference between groups was found for estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio at baseline and week 8, nor for the changes from baseline. Adverse events and the changes in monitored renal parameters over the study period did not point to a deterioration of renal function.Conclusion
High protein ONS seems to be well-tolerated and safe; there is no indication that it affects renal function in nursing home residents, including patients with stage 3 chronic kidney disease, under the conditions tested. Results did not suggest a difference in the effect on renal function between standard and energy-dense small volume ONS format.9.
Objectives
Studies have produced conflicting results assessing hyperhomocysteinemia (HYH) treatment with B vitamins in patients with normal cognition, Alzheimer’s disease and related disorders (ADRD). This study examined the effect of HYH management with L-methylfolate (LMF), methylcobalamin (MeCbl; B12), and N-acetyl-cysteine (CFLN: Cerefolin®/Cerefolin-NAC®) on cognitive decline.Design
Prospective, case-control study of subjects followed longitudinally.Setting
Outpatient clinic for cognitive disorders.Participants
116 ADRD patients (34 with HYH, 82 with No-HYH) met inclusion and exclusion criteria to participate. No study participant took B vitamins.Intervention
HYH patients received CFLN, and No-HYH patients did not.Measurements
Cognitive outcome measures included MCI Screen (memory), CERAD Drawings (constructional praxis), Ishihara Number Naming (object recognition), Trails A and B (executive function), and F-A-S test (verbal fluency). Dependent or predictor measures included demographics, functional severity, CFLN and no CFLN treatment duration, ADRD diagnosis, memantine and cholinesterase inhibitor treatment. Linear mixed effects models with covariate adjustment were used to evaluate rate of change on cognitive outcomes.Results
The duration of CFLN treatment, compared to an equivalent duration without CFLN treatment, significantly slowed decline in learning and memory, constructional praxis, and visual-spatial executive function (Trails B). CFLN treatment slowed cognitive decline significantly more for patients with milder baseline severity. CFLN treatment effect increased as baseline functional severity decreased. The analytical model showed that treatment duration must exceed some minimum period of at least one year to slow the rate of cognitive decline.Conclusion
After covariate adjustment, HYH+CFLN significantly slowed cognitive decline compared to No-HYH+No-CFLN. Longer CFLN treatment duration, milder baseline severity, and magnitude of homocysteine reduction from baseline were all significant predictors. There are a number of factors that could account for disagreement with other clinical trials of B vitamin treatment of HYH. Moreover, CFLN is chemically distinct from commonly used B vitamins as both LMF and MeCbl are the fully reduced and bioactive functional forms; CLFN also contains the glutathione precursor, N-acetyl-cysteine. The findings of other B vitamin trials of HYH can, therefore, only partly account for treatment effects of CFLN. These findings warrant further evaluation with a randomized, placebo-controlled trial.10.
Background
Urban youth are often exposed to compounded risk factors which make them more vulnerable to negative outcomes. Research examining promotive factors which may reduce vulnerabilities to poor psychosocial adjustment among this population is limited.Objective
The current study addresses this limitation by examining the impact of self-efficacy and positive expectations about the future, as promotive factors, on levels of depressive and anxious symptomatology, sense of belonging, and friendship among a sample of urban youth.Methods
Data are from 1202 4th and 5th grade students enrolled at 27 elementary schools in a high poverty, high minority school district in the Southeastern United States.Results
Using ordinary least squares regression, analyses reveal that promotive factors are significant predictors of psychosocial adjustment and thus have implications for improving negative outcomes among urban minority youth.Conclusions
The findings suggests that interventions aimed at increasing self-efficacy and positive expectations about the future may reduce child and adolescent vulnerability to negative outcomes associated with poor psychosocial adjustment.11.
Crane Paul K. Gibbons Laura E. Ocepek-Welikson Katja Cook Karon Cella David Narasimhalu Kaavya Hays Ron D. Teresi Jeanne A. 《Quality of life research》2007,16(1):69-84
Background
Several techniques have been developed to detect differential item functioning (DIF), including ordinal logistic regression (OLR). This study compared different criteria for determining whether items have DIF using OLR.Objectives
To compare and contrast findings from three different sets of criteria for detecting DIF using OLR. General distress and physical functioning items were evaluated for DIF related to five covariates: age, marital status, gender, race, and Hispanic origin.Research design
Cross-sectional study.Subjects
1,714 patients with cancer or HIV/AIDS.Measures
A total of 23 items addressing physical functioning and 15 items addressing general distress were selected from a pool of 154 items from four different health-related quality of life questionnaires.Results
The three sets of criteria produced qualitatively and quantitatively different results. Criteria based on statistical significance alone detected DIF in almost all the items, while alternative criteria based on magnitude detected DIF in far fewer items. Accounting for DIF by using demographic-group specific item parameters had negligible effects on individual scores, except for race.Conclusions
Specific criteria chosen to determine whether items have DIF have an impact on the findings. Criteria based entirely on statistical significance may detect small differences that are clinically negligible.12.
Midori Ishikawa T. Yokoyama Y. Takemi Y. Fukuda T. Nakaya K. Kusama N. Yoshiike M. Nozue K. Yoshiba N. Murayama 《The journal of nutrition, health & aging》2017,21(5):514-520
Objective
This study aimed to examine perceptions of shopping difficulty, and the relationships with satisfaction with state of health and meals, physical condition, food diversity and health behavior in older people living alone in Japan.Design
A cross-sectional, multilevel survey was designed. The questionnaire was distributed by mail and self-completed by participants.Setting
The sample was drawn from seven towns and cities across Japan.Participants
A geographic information system was used to select the sample of older people living alone, by proximity to a supermarket. In total, 2,346 older people (827 men and 1,519 women) completed the questionnaire.Measurements
The dependent variable was whether shopping was easy or difficult. A logistic regression analysis was performed, adjusting for age, socioeconomic status and proximity of residence to a supermarket using stepwise variable analyses.Results
The response rate was 67.8%. Overall, 14.5% of men and 21.7% of women considered shopping difficult. The stepwise logistic analysis showed that the factors most strongly related to shopping difficulty were a subjective feeling of poor health (men: OR = 3.01, women: OR = 2.16) and lack of satisfaction with meals (men: OR = 2.82, women: OR = 3.69). Other related physical condition and dietary factors were requiring nursing care (men: OR = 3.69, women: OR = 1.54), a high level of frailty, measured using the frailty index score (women: OR = 0.36) and low food diversity score (men: OR = 1.84, women: OR = 1.36).Conclusion
The study found that older people’s assessment of their shopping difficulty was related to satisfaction aspects, including a subjective feeling of poor health, and lack of satisfaction with meals, as well as physical condition. These have a greater influence on shopping difficulty than income in both sexes, and proximity to a supermarket in women.13.
Giuditta Pagliai F. Sofi F. Vannetti S. Caiani G. Pasquini R. Molino Lova F. Cecchi S. Sorbi C. Macchi Mugello Study Working Group 《The journal of nutrition, health & aging》2018,22(5):569-574
Objective
To investigate eating habits and adherence to Mediterranean Diet (MD) in relation to the risk of depression in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status.Design
Cross-sectional study.Setting
Homes and nursing homes in the Mugello area, Florence, Italy.Participants
Subjects aged 90-99 years [N=388 (271F; 117M) mean age: 92.7±3.1].Measurements
All subjects were evaluated through questionnaires and instrumental examinations. Adherence to MD was assessed through the Mediterranean Diet Score. A shorter version of the Geriatric Depression Scale (GDS) was used to detect the possible presence of depressive symptoms. In addition, cognitive and functional status was assessed using the Mini-Mental State Examination, the Clock Drawing Test, as well as the Basic and Instrumental Activities of Daily Living test.Results
Depressed subjects (DS) (GDS score≥5, 43.8%) were older, females and widows, than non-depressed subjects (NDS). DS reported a slightly but not statistically significant lower MD score than NDS (33.9±3.9 vs. 34.6±3.3, p=0.149). Subjects who reported to consume a greater amount of olive oil and fruit were associated with a lower risk of depression (OR=0.35, 95%CI=0.20–0.59, p<0.001 and OR=0.46, 95%CI=0.26–0.84, p=0.011, respectively) after adjustment for many possible confounders. Similar results were obtained for women, while no statistically significant differences emerged for men.Conclusion
Our results support the hypothesis that a diet rich in olive oil and fruit, characteristics of MD, may protect against the development of depressive symptoms in older age.14.
Background
This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice.Methods
A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location.Results
Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas.Conclusion
Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.15.
Caterina Tsiata Vassilis Tsekouras Antonis Karokis John Starakis Harry P. Bassaris Mihalis Maragoudakis Athanasios T. Skoutelis 《Disease Management & Health Outcomes》2001,9(1):23-32
Objective
To compare various strategies for antibacterial administration in terms of patient outcomes, overall costs and quality of care provided.Design
Prospective, nonblind, randomized, clinical study.Setting
Tertiary care hospital in Greece from November 1995 to June 1996.Patients and participants
458 patients admitted to the internal medicine department who received antibacterial therapy for infectious diseases.Methods
Patients were randomized into 4 different antibacterial administration policies defined by various levels of restriction control. Efficacy and resource use data were obtained from clinical study case report forms, the hospital financial database and physician expert opinion. Outcomes included complete infection control, disease improvement, unchanged patient condition, infection needing surgical treatment, and death. Direct medical costs were estimated. The perspective adopted was that of the healthcare system (hospital budget; third-party payor). Cost-minimisation analysis was based on cost per patient treated.Results
382 eligible patient records examined showed no significant difference in clinical outcomes among patient groups. Baseline analysis showed the strict antibacterial control policy to produce statistically significant differences (p < 0.05) in various resource parameters. Accordingly, compared with all other patient groups, total cost per patient for that strategy was reduced by 26 to 30%. Also, patients in that group received fewer drug doses and underwent fewer treatment days, and antibacterial treatment was modified in fewer cases for these patients.Conclusion
Strict control of antibacterial administration in this hospital setting achieved lower direct medical costs with no harmful effect on patient outcomes or quality of care provided. Such a policy appears to be a useful option for both physicians and administrators.16.
Background
The nursing sector is characterized by high sick leave and fluctuation rates due to work-related stress. There is a need to raise manager’s awareness in the care sector for goal-oriented operational health management.Objectives
Is a serious game a suitable instrument to change nursing care managers’ behaviors and attitudes and increase their knowledge regarding prevention and health promoting management behavior?Materials and methods
Preliminary investigation into the stress of care providers, evaluation of the initial situation in nursing care services, conception of a serious game including training concept, testing and evaluation in the field.Results
In most companies health promotion is not perceived as important (74%); thus, it is expected that “Serious Games for Health” (SGH) will be an effective and suitable instrument to train managers regarding preventive and health promoting management behavior.Conclusions
Operational health management should be anchored as a management task in the nursing care sector. The innovative educational concept “Stress-Rekord” can counteract multifactorial stress in the workplace.17.
Objectives
Variation in repeated blood pressure measurements may represent a decline in homeostatic mechanisms in blood pressure regulation in response to various internal or external stressors, indicating a frail state. We tested this hypothesis by examining the association between variability in repeated blood pressure measurements (BPV) and frailty status, adjusting for other confounding factors.Design
A longitudinal cohort study.Setting
Community centres in all three regions of Hong Kong.Participants
1156 community-living older adults aged 60 years and over participated in a community geriatric screening program with blood pressure measurements three times a week over one year. Participants were divided into three groups based on variability of repeated blood pressure measurements (low, medium, high) using machine learning methods.Measurements
Frailty status was assessed using the FRAIL scale. Logistic regression was used to examine cross sectional association between frailty status and BPV adjusting for confounding factors, and also frailty transition with BPV.Results
In multi-variate models adjusting for co-variates, high BPV was associated with frailty (OR 1.57; 95% CI 1.05-2.37) among all participants; however, this was only significant in women in subgroup analysis. Similar findings were observed when transition to a more frail state was examined over a twelve month period.Conclusions
The findings of this study support the concept of physiological dysregulation underlying the frail state, and that BPV calculated using machine learning methods may be used as a biomarker of such dysregulation.18.
Douglas G. Manuel Philippe Finès Christina Bancej William Flanagan Karen Tu Kim Reimer Larry W. Chambers 《Population health metrics》2016,14(1):37
Background
Worldwide, there is concern that increases in the prevalence of dementia will result in large demands for caregivers and supportive services that will be challenging to address. Previous dementia projections have either been simple extrapolations of prevalence or macrosimulations based on dementia incidence.Methods
A population-based microsimulation model of Alzheimer’s and related dementias (POHEM:Neurological) was created using Canadian demographic data, estimates of dementia incidence, health status (health-related quality of life and mortality risk), health care costs and informal caregiving use. Dementia prevalence and 12 other measures were projected to 2031.Results
Between 2011 and 2031, there was a projected two-fold increase in the number of people living with dementia in Canada (1.6-fold increase in prevalence rate). By 2031, the projected informal (unpaid) caregiving for dementia in Canada was two billion hours per year, or 100 h per year per Canadian of working age.Conclusions
The projected increase in dementia prevalence was largely related to the expected increase in older Canadians, with projections sensitive to changes in the age of dementia onset.19.
Diego F. Cuadros Benn Sartorius Chris Hall Adam Akullian Till Bärnighausen Frank Tanser 《International journal of health geographics》2018,17(1):27
Background
Large geographical variations in the intensity of the HIV epidemic in sub-Saharan Africa call for geographically targeted resource allocation where burdens are greatest. However, data available for mapping the geographic variability of HIV prevalence and detecting HIV ‘hotspots’ is scarce, and population-based surveillance data are not always available. Here, we evaluated the viability of using clinic-based HIV prevalence data to measure the spatial variability of HIV in South Africa and Tanzania.Methods
Population-based and clinic-based HIV data from a small HIV hyper-endemic rural community in South Africa as well as for the country of Tanzania were used to map smoothed HIV prevalence using kernel interpolation techniques. Spatial variables were included in clinic-based models using co-kriging methods to assess whether cofactors improve clinic-based spatial HIV prevalence predictions. Clinic- and population-based smoothed prevalence maps were compared using partial rank correlation coefficients and residual local indicators of spatial autocorrelation.Results
Routinely-collected clinic-based data captured most of the geographical heterogeneity described by population-based data but failed to detect some pockets of high prevalence. Analyses indicated that clinic-based data could accurately predict the spatial location of so-called HIV ‘hotspots’ in?>?50% of the high HIV burden areas.Conclusion
Clinic-based data can be used to accurately map the broad spatial structure of HIV prevalence and to identify most of the areas where the burden of the infection is concentrated (HIV ‘hotspots’). Where population-based data are not available, HIV data collected from health facilities may provide a second-best option to generate valid spatial prevalence estimates for geographical targeting and resource allocation.20.