Background: Chlamydia and gonorrhea are common sexually transmitted infections (STIs) that can cause multiple problems, and can be easily treated, but frequently present without symptoms. Because of this, commonly used syndromic diagnosis misses a majority of infected persons. Previously, diagnostic tests were expensive and invasive, but newer nucleic-acid amplification tests (NAATs) are available that use urine to non-invasively test for these infections. Methods and materials: These analyses used data from seroprevalence studies conducted in five militaries. Data included self-reported current symptoms of STIs as well as chlamydia and gonorrhea NAAT results. Results: A total of 4923 men were screened for chlamydia and gonorrhea from these 5 militaries during April 2016 to October 2017. The combined prevalence of chlamydia and gonorrhea in these five militaries ranged from 2.3% in Burundi to 11.9% in Belize. These infections were not successfully identified by symptomology; for example, only 2% of cases in Belize reported symptoms. In three of the five countries there was no statistical association between symptoms and positive NAAT results. The majority of individuals with these infections (81%–98%) would be undiagnosed and untreated using only symptomology. Conclusion: Therefore, using symptoms alone to diagnose cases of chlamydia and gonorrhea is not an effective way to control these infections. We propose that automated, cartridge-based NAATs, be considered for routine use in diagnosing those at risk for STIs.

Chlamydia and gonorrhea are common sexually transmitted infections (STIs) that can cause multiple problems, and can be easily treated, but frequently present without symptoms. Because of this, commonly used syndromic diagnosis misses a majority of infected persons. Previously, diagnostic tests were expensive and invasive, but newer nucleic-acid amplification tests (NAATs) are available that use urine to non-invasively test for these infections. These analyses used data from seroprevalence studies conducted in five militaries. Data included self-reported current symptoms of STIs as well as chlamydia and gonorrhea NAAT results. A total of 4923 men were screened for chlamydia and gonorrhea from these 5 militaries during April 2016 to October 2017. The combined prevalence of chlamydia and gonorrhea in these five militaries ranged from 2.3% in Burundi to 11.9% in Belize. These infections were not successfully identified by symptomology; for example, only 2% of cases in Belize reported symptoms. In three of the five countries there was no statistical association between symptoms and positive NAAT results. The majority of individuals with these infections (81% to 98%) would be undiagnosed and untreated using only symptomology. Therefore, using symptoms alone to diagnose cases of chlamydia and gonorrhea is not an effective way to control these infections. We propose that automated, cartridge-based NAATs, be considered for routine use in diagnosing those at risk for STIs.

Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits.

Background With suicide rising in the United States, identifying and preventing suicides is increasingly important. To provide a valuable step toward achieving effective suicide risk assessment, this study examines the agreement between self-report measures and psychiatrist documentation of suicidal ideation and behaviors (SI) at a Veterans Administration (VA) psychiatric emergency clinic. Methods A total of 377 veterans presenting at a VA psychiatric emergency clinic completed a self-report survey on SI and other acute risk factors for suicidal behavior. We examined agreement between veterans’ self-reported SI and psychiatrists’ clinical notes regarding SI. Results A total of 199 veterans (53%) self-reported SI; 80 psychiatrist notes (21%) indicated SI. Psychiatrists and veterans differed in 44% (164/377) of cases. Among the discordant cases, the veterans’ self-report was more severe than the psychiatrists’ in 97% of cases. Of the 120 veterans with SI and documented as having no SI by psychiatrists, 31 (26%) reported having a suicide plan and 18 (15%) plan preparations. Findings were similar when controlling for presenting problem, current depression, presence of a standardized suicide risk assessment, psychiatrist training level, past suicide attempt, homelessness, diagnosis of personality, or substance use disorder. Conclusions Agreement between veterans' self-reports and psychiatrists’ documentation of SI was generally low, with veterans self-reporting SI significantly more often than psychiatrists documented SI in their clinical notes. This suggests that inclusion of a self-report questionnaire provides an additional source of data to complement information gleaned from the clinical interview for a more comprehensive risk assessment, but only if actually examined by the clinician.

Background: No study has evaluated whether genetic factors are associated with longevity in African Americans or Hispanics, and it is unclear whether genetic factors are associated with healthy aging.Methods: In this prospective study, we determined whether 14 genetic variants previously associated with longevity in genome-wide association studies were associated with survival to ages 85 and 90 in 11,053 postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. The associations of these variants with healthy aging, defined as survival to age 85 without chronic diseases or disability, were also determined.Results: Among white women, three single nucleotide polymorphisms (SNPs) (rs2075650 [TOMM40], rs4420638 [APOC1], and rs429358 [APOE]) were significantly associated with survival to 90 years after correction for multiple testing (p < .001); rs4420638 and rs429358 were also significantly associated with healthy aging (p =.02). In African American women, no SNP was associated with longevity. In Hispanic women, 7 SNPs in linkage disequilibrium with a novel SNP, rs2149954, recently identified as being associated with increased longevity in a European population, were significantly associated with decreased survival to age 85 for carriers of the T versus C allele (p =.04). The association with decreased longevity was explained by higher risk of coronary heart disease in carriers of the T allele. There were no associations between FOXO3A SNPs and longevity in the analyses. In a meta-analysis, rs2075650 and rs429358 were significantly associated with longevity.Conclusions: Future studies are needed to identify novel loci associated with longevity in African American and Hispanic women to determine biologic pathways regulating life span in these groups.

Background: Shortened leukocyte telomere length (LTL), a purported marker of cellular aging, is associated with morbidity and mortality. However, the association of physical activity, a modifiable lifestyle behavior, with LTL has not been adequately studied among older adults.Methods: In this cross-sectional study, we examined associations of various intensity levels of leisure-time physical activity with LTL among 1476 older white and African American women from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study. Self-reported physical activity was assessed by questionnaire, and LTL was measured by Southern blot. The association between physical activity and LTL was evaluated using multiple linear regression models adjusted for demographic characteristics, lifestyle behaviors, and health-related variables.Results: Women were on average aged 79.2 (standard deviation 6.7) years old. In the final model adjusted for age, race/ethnicity, education, marital status, smoking, alcohol, body mass index, a history of chronic diseases, and hormone therapy use, LTL was on average 110 (95% confidence interval, 20-190) base pairs longer among women in the highest (17.00 MET-hours/week) compared with the lowest (<1.25 MET-hours/week) level of total leisure-time physical activity (P for trend = 0.02). Higher levels of moderate-to-vigorous physical activity (P for trend = 0.04) and faster walking speed (P for trend = 0.03) were also associated with longer LTL in the fully-adjusted models.Conclusion: Older women participating in greater amounts of total leisure-time physical activity and moderate to -vigorous physical activity had longer LTL. (C) 2017 Elsevier Inc. All rights reserved.

INTRODUCTION:Strong scientific evidence supports voluntary medical male circumcision as part of an overall HIV prevention strategy, but self-report information on circumcision status may be inaccurate. The study objectives were to obtain estimates of male circumcision within the Rwanda Defense Force (RDF), to assess the ability of soldiers to correctly report their own circumcision status, and to document the uptake of voluntary medical male circumcision (VMMC) in the RDF.METHODS:Data were collected from members of the Rwandan military during their annual physical examination. A self-administered questionnaire collected demographic and circumcision characteristics. Self-reported circumcision status was compared with the medical exam evaluation.RESULTS:Using questionnaires with complete data (n = 579), 69% of the study participants were circumcised by physical examination and there was a strong agreement with self-reported circumcision status (κ = 0.97). Almost half (44%) of all circumcisions had been performed within the past 2 years.DISCUSSION:These results suggest that self-report is an appropriate method to collect information on circumcision status in the Rwandan military. Many of the circumcisions occurred within the last 2 years, possibly as an effect of the successful scale-up of voluntary medical male circumcision in the Rwandan military utilizing effective messaging, demand creation, and positive news reported by the media.

Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.

BACKGROUND:Characterizing HIV infection and associated risk behaviors within military populations is critical for understanding the epidemic and informing prevention activities. However, the prevalence of HIV and related risk behaviors is often unknown. Further, militaries may not have the systems in place or the staff expertise to conduct HIV surveillance and risk behavior studies.METHODS:The Department of Defense HIV/AIDS Prevention Program (DHAPP), funded by the President's Emergency Plan for AIDS Relief and the US Department of Defense, provides technical assistance, management and administrative support for HIV/AIDS prevention, care and treatment for approximately 65 partner militaries. Collaborating with partner militaries in conducting Seroprevalence and Behavioral Epidemiology Risk Surveys (SABERS) and using the data to monitor the epidemic and inform activities is a key component of DHAPP.CONCLUSION:This paper describes the methodology used to plan, adapt, implement and report SABERS studies.

Objectives. To examine associations of maternal age at childbirth and parity with survival to age 90 years (longevity).Methods. We performed a prospective study among a multiethnic cohort of postmenopausal US women in the Women's Health Initiative recruited from 1993 to 1998 and followed through August 29, 2014. We adjusted associations with longevity for demographic, lifestyle, reproductive, and health-related characteristics.Results. Among 20 248 women (mean age at baseline, 74.6 years), 10 909 (54%) survived to age 90 years. The odds of longevity were significantly higher in women with later age at first childbirth (adjusted odds ratio = 1.11; 95% confidence interval = 1.02, 1.21 for age 25 years or older vs younger than 25 years; P for trend = .04). Among parous women, the relationship between parity and longevity was significant among White but not Black women. White women with 2 to 4 term pregnancies compared with 1 term pregnancy had higher odds of longevity.Conclusions. Reproductive events were associated with longevity among women. Future studies are needed to determine whether factors such as socioeconomic status explain associations between reproductive events and longevity.

Few studies have assessed the association of sedentary time with leukocyte telomere length (LTL). In a cross-sectional study conducted in 2012-2013, we examined associations of accelerometer-measured and self-reported sedentary time with LTL in a sample of 1,481 older white and African-American women from the Women's Health Initiative and determined whether associations varied by level of moderate- to vigorous-intensity physical activity (MVPA). The association between sedentary time and LTL was evaluated using multiple linear regression models. Women were aged 79.2 (standard deviation, 6.7) years, on average. Self-reported sedentary time was not associated with LTL. In a model adjusting for demographic characteristics, lifestyle behaviors, and health-related factors, among women at or below the median level of accelerometer-measured MVPA, those in the highest quartile of accelerometer-measured sedentary time had significantly shorter LTL than those in the lowest quartile, with an average difference of 170 base pairs (95% confidence interval: 4, 340). Accelerometer-measured sedentary time was not associated with LTL in women above the median level of MVPA. Findings suggest that, on the basis of accelerometer measurements, higher sedentary time may be associated with shorter LTL among less physically active women.

Background: Hypertensive disorders of pregnancy are among the leading causes of maternal morbidity and mortality. Studies suggest that the use of folic acid may lower the risk of hypertensive disorders in pregnant women. Aim: The aim of this study was to assess the effects of timing and duration of folic acid-containing supplement use on the risk for gestational hypertension and preeclampsia. Methods: Exposures and outcomes data were obtained through interviews and review of participant's medical records from the MotherToBaby cohort studies across the United States and Canada. Demographics, medical history, lifestyle factors, substance use, and fetal sex were assessed as potential confounders. Unadjusted and adjusted risks for gestational hypertension and preeclampsia were examined using odds ratios and 95% confidence intervals. Findings: 3247 women were included in the study. Compared to non-supplement use, early and late supplement use were not significantly associated with the development of gestational hypertension or preeclampsia. The odds of developing gestational hypertension and preeclampsia were significantly reduced as the duration of folic acid-containing supplement use increased. Conclusion: Findings from this study suggest that the use of folic acid-containing supplements may mitigate the risk for gestational hypertension and preeclampsia. (C) 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Military HIV prevention programs and healthy living programs were developed in the mid-1980s to manage and support newly HIV-positive military personnel in the US military. Since then, a program developed by the Centers for Disease Control and Prevention with support from the Department of Defense HIV/AIDS Prevention Program (DHAPP), called Positive Health, Dignity and Prevention (PHDP), is currently being rolled out by DHAPP in partner militaries. The program, designed to reduce HIV transmission, is a package of interventions for people living with HIV (PLHIV), including risk reduction counseling, condom provision, disclosure counseling, testing of sexual partner(s) and children, adherence counseling, diagnosis and treatment of sexually transmitted infections, and provision of family planning services.METHODS:DHAPP has trained military and civilian personnel caring for military personnel, their families, and the civilians seen at military installations in sub-Saharan Africa, such as Rwanda, Democratic Republic of the Congo, Malawi, and Zambia. These programs have varying degrees of implementing the program with innovative ways of engaging PLHIV.RESULTS/CONCLUSIONS:Many successes are being achieved through the training of military and civilian personnel working for or at military health care settings. In 2015, one of DHAPP's goals for the PHDP program is to enhance the monitoring, evaluation, and reporting of PHDP to demonstrate PHDP service provision to at least 90% of HIV-positive patients over the next 5 years.

Background: Continued surveillance of the HIV epidemic is critical to monitor changes in trends and risk behaviors. A 2005 study in the Cameroonian Armed Forces (CAF) found an HIV prevalence of 11.3% among male and female service members. The purpose of the current study is to determine the 5-year change in the HIV prevalence, estimate the prevalence of syphilis, and examine factors associated with infection in the CAF.Methods: Participants were male and female service members 18 years of age or older who were stationed at one of the 10 military garrisons selected for participation. The military garrisons included in this study were proportionally representative of the CAF by geographic region. Military companies and individuals within the selected garrisons were randomly chosen to participate in the study. Demographic and behavioral risk data were collected from September-November 2011 using personal interviews. Blood was collected for HIV and syphilis testing.Results: Of 2,523 participants tested, 6.0% screened positive for HIV [includes 5.3% who screened positive for HIV only and 0.7% who screened positive for both HIV and syphilis], and 3.1% screened positive for syphilis only. Analyses examining risk factors associated with HIV/syphilis infection (i.e., infected with HIV, infected with syphilis, or co-infected with both HIV and syphilis) were restricted to 2,255 men who reported ever having sex. In a multivariate logistic regression model, the odds of testing positive for HIV/syphilis were higher among men who were separated, divorced, or widowed (adjusted odds ratio [AOR]=3.13, 95% confidence interval [CI]: 1.24-7.89), had sex with sex workers (AOR=1.64, 95% CI: 1.19-2.27), and reported a genital sore/ulcer in the past 12 months preceeding the survey (AOR=1.73, 95% CI: 1.05-2.86). Higher HIV knowledge was protective against HIV/syphilis infection (AOR=0.73, 95% CI: 0.54-0.99). While the overall HIV prevalence in this sample of military personnel was lower than previously reported (6.0% [95% CI: 5.12-6.97] in 2011 vs. 11.3% [95% CI: 10.01-12.68] in 2005; confidence intervals do not overlap), several factors associated with HIV/syphilis infection were identified including being separated, divorced, or widowed, having sex with a sex worker, and reporting a genital sore/ulcer in the past 12 months.Conclusion: HIV and syphilis education among all military personnel as they enter service and proceed forward is important to reinforce prevention methods and practices.

Objective: The aim of the present study was to investigate associations between reproductive factors and survival to age 90 years.Methods: This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993 to 1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 16,251 women born on or before August 29, 1924 for whom survival to age 90 during follow-up was ascertained. Women were classified as having survived to age 90 (exceptional longevity) or died before age 90. Multivariable logistic regression models were used to evaluate associations of ages at menarche and menopause (natural or surgical) and reproductive lifespan with longevity, adjusting for demographic, lifestyle, and reproductive characteristics.Results: Participants were on average aged 74.7 years (range, 69-81 y) at baseline. Of 16,251 women, 8,892 (55%) survived to age 90. Women aged at least 12 years at menarche had modestly increased odds of longevity (odds ratio [OR], 1.09; 95% CI, 1.00-1.19). There was a significant trend toward increased longevity for later age at menopause (natural or surgical; P-trend = 0.01), with ORs (95% CIs) of 1.19 (1.04-1.36) and 1.18 (1.02-1.36) for 50 to 54 and at least 55 compared with less than 40 years, respectively. Later age at natural menopause as a separate exposure was also significantly associated with increased longevity (P-trend = 0.02). Longer reproductive lifespan was significantly associated with increased longevity (P-trend = 0.008). The odds of longevity were 13% (OR 1.13; 95% CI, 1.03-1.25) higher in women with more than 40 compared with less than 33 reproductive years.Conclusions: Reproductive characteristics were associated with late-age survival in older women.

We examined human papillomavirus vaccine awareness and acceptance between U.S.-born and U.S. foreign-born women by utilizing California Health Interview Survey data from 1,672 women (ages 18-27) and 2,994 mothers (ages 28-65). Foreign-born women and mothers had lower vaccine awareness. Foreign-born young adult Latinas had greater vaccine acceptance than U.S.-born Latinas. Other factors associated with young adult women's vaccine acceptability were being younger, unmarried, and sexually active in the past year; having poorer self-reported health; and having heard of the vaccine. Variables associated with mothers' vaccine acceptability were being White, insured, and unmarried; having had a Pap test in past 3years; being less educated; and being impoverished.

Introduction: Pre-existing chronic conditions (PECs) pose a unique problem for the care of aging trauma populations. However, the relationships between specific conditions and outcomes after injury are relatively unknown. Evaluation of trauma patients is further complicated by their discharge to care facilities, where mortality risk remains high. Traditional approaches for evaluating in-hospital mortality do not account for the discharge of at-risk patients, which constitutes a competing risk event to death. The objective of this study was to evaluate associations between 40 PECs and two clinical outcomes in the context of competing risks among older trauma patients.Methods: This retrospective study evaluated blunt-injured patients aged 55 years and older admitted to a level I trauma centre in 2006-2012. Outcomes were hospital length of stay (HLOS) and in-hospital mortality. Survivors were classified as discharges home or discharges to care facilities. Competing risks regression was used to evaluate each PEC with in-hospital mortality, accounting for discharges to care facilities as competing events. Competing risk estimates were compared to Cox model estimates, for which all survivors to discharge were non-events. Analyses were stratified using injury-based mortality risk at a 50% cutpoint (high versus low).Results: Among 4653 patients, 176 died in-hospital, 3059 were discharged home, and 1418 were discharged to a care facility. Most patients (98%) were classified with a low mortality risk. Only haemophilia and coagulopathy were consistently associated with longer HLOS. In the low-risk subgroup, in-hospital mortality was most strongly associated with liver diseases, haemophilia, and coagulopathy. In the high-risk group, Parkinson's disease, depression, and cancers showed the strongest associations. Accounting for the competing event altered estimates for 12 of 19 significant conditions.Conclusions: Excess mortality among patients expected to survive their injuries may be attributable to complications resulting from PECs. Discharges to care facilities constitute a bias in the evaluation of in-hospital mortality and should be considered for the accurate calculation of risk. In conjunction with injury measures, consideration of PECs provides physicians with a foundation to plan clinical decisions in older trauma patients. (C) 2015 Elsevier Ltd. All rights reserved.