Development of an Optimally Reliable Short Form for Judgment of Line Orientation

Standard and short forms of Judgment of Line Orientation-Form V (JLO; Benton, Sivan, Hamsher, Varney, & Spreen, 1994) were examined for internal consistency (coefficient alpha) in a diagnostically mixed neuropsychiatric sample (N = 230). Equivalence of internally consistent short forms was assessed by correlating them with the full form of the test. Internal consistency for the full 30-item form of JLO (alpha = .84) approximated the optimal level of .80 (Nunnally, 1978). Two 20-item short forms of JLO (items V1-V20 and items V11-V30) also reached comparable alpha levels (alpha = .75 and .80, respectively). These two JLO short forms correlated .90 and .97, respectively, with the full 30-item form. We recommend the JLO short form based on items V11-V30 for clinical use in situations in which employment of the full form may not be advisable and offer a short-to-long-form conversion table for clinical use.     

The feasibility of using mobile phone technology for sexual behaviour research in a population vulnerable to HIV: a prospective survey with female sex workers in South India

Sexual behaviour studies are often challenged by sampling, participation and measurement biases, and may be unacceptable to participants. We invited 293 randomly selected female sex workers (FSWs) in Bangalore, India, to participate in a telephone survey, with condom breakage as the main outcome. Free cell phones were supplied and trained interviewers telephoned FSWs daily to ask about all sex acts the previous day. Later, we undertook focus groups to discuss the methodology with the participants. We evaluated technical and operational feasibility; data reliability and measurement error; emotional and fatigue effects; interviewer bias; survey reactivity effects; and user acceptability. Response rates were high, with 84% of invited participants complying fully with the protocol. The study ran smoothly, with little evidence of biases. The methodology was highly acceptable; the respondents enjoyed using a new telephone and being interviewed at times convenient to them. Other reasons for the success of the method were that the study was sanctioned and supported by the sex worker collective, and the interviewers were well trained and developed a strong rapport with the participants. The success of this methodology, and the wealth of data produced, indicates that it can be an important tool for conducting sexual behaviour research in low literacy, high sex volume populations.     

Rates and determinants of HIV-attributable mortality among rural female sex workers in Northern Karnataka, India

Female sex workers (FSWs) have among the highest rates of HIV infection in India. However, little is known about their HIV-specific mortality rates. In total, 1561 FSWs participated in a cohort study in Karnataka. Outcome data (mortality) were available on 1559 women after 15 months of follow-up. To gather details on deaths, verbal autopsy (VA) questionnaires were administered to key informants. Two physicians reviewed the VA reports and assigned underlying causes of death. Forty-seven deaths were reported during the follow-up (overall mortality rate was 2.44 per 100 person-years), with VA data available on 45 women. Thirty-five (75.6%) of these women were known to be HIV-positive, but only 42.5% were on antiretroviral therapy (ART). Forty deaths were assessed to be HIV-related, for an HIV-attributable mortality rate of 2.11 deaths per 100 person-years. Absence of a current regular partner (incidence rate ratio: 2.79; 95% confidence interval [CI]: 1.39-5.60) and older age (1.06; 1.01-1.11) were associated with increased HIV-attributable mortality. Reported duration in sex work was not related to HIV-attributable mortality. We found a high HIV-related mortality rate among this cohort of FSWs; nearly 10 times that of national mortality rates among women of a similar age group. Older age, but not reported duration in sex work, was associated with increased mortality, and suggests HIV acquisition prior to self-reported initiation into sex work. Despite significant efforts, there remain considerable gaps in HIV prevention near or before entry into sex work, as well as access and uptake of HIV treatment among FSWs.     

Thinking outside the box: meeting the sexual health needs of women presenting for emergency contraception

This was a retrospective audit of sexual health screening and advice for long-term contraception in 174 and 993 women attending genitourinary (GU) medicine and contraceptive services (CS), respectively, for emergency hormonal contraception (EHC) over a 21-month period (April 2007-September 2008). Assessment and screening for sexually transmitted infection (including HIV) were more comprehensive at GU medicine (78% offered screening at GU medicine versus 17% at CS) while contraceptive management was more complete at CS (ongoing contraception discussed in 99% at CS versus 78% at GU medicine). Follow-up was seldom recommended or attended. Local HIV prevalence necessitates a more pro-active approach to HIV testing. Women requesting EHC present to a variety of clinical settings, each with their own areas of expertise. In an age of integrated sexual and reproductive health, these women deserve a holistic approach to care.     

A survey of the sexual and reproductive health of HIV-positive women in Leicester

This project reports results from a questionnaire survey of sexual practices, contraception use and pregnancy plans in HIV-positive women in Leicester, UK, in order to establish the need for a dedicated sexual and reproductive health (SRH) clinic. The majority (96%) of women were aware of the benefits of antiretroviral therapy (ART) in pregnancy and 39% were planning a future pregnancy. Most (74%) used condoms consistently but their use decreased with the addition of another contraceptive method. Condoms were mostly obtained from non-National Health Service (NHS) settings. Long-acting reversible contraception (LARC) use was higher in this group of women than the general population and mainly provided by family planning services. A dedicated SRH clinic was thought to be useful by 79% of women. Data also identified some limitations of the existing service and need to provide holistic and integrated care.     

Improving Participant Understanding of Informed Consent in an HIV-Prevention Clinical Trial: A Comparison of Methods

Empirical research on informed consent has shown that study participants often do not fully understand consent information. This study assessed participant understanding of three mock consent approaches describing an HIV-prevention clinical trial in Lilongwe, Malawi prior to trial implementation. Pregnant women (n?=?297) were systematically selected from antenatal-care waiting lines and sequentially allocated to receive an enhanced standard consent form (group 1), a context-specific consent form (group 2), or context-specific counseling cards (group 3). Understanding of research concepts and study procedures was assessed immediately postintervention and at 1-week follow-up. At postintervention, participants in groups 2 and 3 understood more about research concepts and study procedures compared with group 1. Group 3 participants also understood more about study procedures compared with group 2. At follow-up, participants in groups 2 and 3 continued to understand more about research concepts and study procedures. Context-specific approaches improved understanding of consent information in this study.     

Achieving a clinically relevant composite outcome of an HbA1c of <7% without weight gain or hypoglycaemia in type 2 diabetes: a meta-analysis of the liraglutide clinical trial programme

Aim: Effective type 2 diabetes management requires a multifactorial approach extending beyond glycaemic control. Clinical practice guidelines suggest targets for HbA1c, blood pressure and lipids, and emphasize weight reduction and avoiding hypoglycaemia. The phase 3 clinical trial programme for liraglutide, a human glucagon‐like peptide 1 analogue, showed significant improvements in HbA1c and weight with a low risk of hypoglycaemia compared to other diabetes therapies. In this context, we performed a meta‐analysis of data from these trials evaluating the proportion of patients achieving a clinically relevant composite measure of diabetes control consisting of an HbA1c <7% without weight gain or hypoglycaemia. Methods: A prespecified meta‐analysis was performed on 26‐week patient‐level data from seven trials (N = 4625) evaluating liraglutide with commonly used therapies for type 2 diabetes: glimepiride, rosiglitazone, glargine, exenatide, sitagliptin or placebo, adjusting for baseline HbA1c and weight, for a composite outcome of HbA1c <7.0%, no weight gain and no hypoglycaemic events. Results: At 26 weeks, 40% of the liraglutide 1.8 mg group, 32% of the liraglutide 1.2 mg group and 6–25% of comparators (6% rosiglitazone, 8% glimepiride, 15% glargine, 25% exenatide, 11% sitagliptin, 8% placebo) achieved this composite outcome. Odds ratios favoured liraglutide 1.8 mg by 2.0‐ to 10.5‐fold over comparators. Conclusions: As assessed by the composite outcome of HbA1c <7%, no hypoglycaemia and no weight gain, liraglutide was clearly superior to the other commonly used therapies. However, the long‐term clinical impact of this observation remains to be shown.