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BackgroundMany public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive.This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production.MethodsQualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial.ResultsA prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition.The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings.ConclusionsEmploying strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims.

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common in patients with chronic heart failure (HF) and are associated with poor outcomes. However, the impact of multimorbidity due to DM and CKD on outcomes, relative to comorbidity due to DM alone, has not been well studied in these patients. Of the 7788 patients with chronic HF in the Digitalis Investigation Group trial, 2218 had DM. We categorized these patients into those with DM alone (DM-only; n=1123) and those with both DM and CKD (DM-CKD; n=1095). Propensity scores for DM-CKD, calculated for each of the 2218 patients, were used to match 699 pairs of DM-only and DM-CKD patients. Matched Cox regression models were used to estimate associations between DM-CKD and outcomes. All-cause mortality occurred in 44% (rate, 1648/10000 person-years) of DM-CKD patients and 39% (rate, 1349/10000 person-years of follow-up) of DM-only patients (hazard ratio when DM-CKD was compared with DM-only, 1.34; 95% confidence interval {CI}, 1.11-1.62; p=0.003). All-cause hospitalization occurred in 76% (rate, 5799/10000 person-years) and 73% (rate, 4909/10000 personyears) of DM-CKD and DM-only patients respectively (hazard ratio, 1.16; 95% CI, 0.99-1.36; p=064). Respective hazard ratios (95% CI) for other outcomes were: cardiovascular mortality (1.33; 1.07-1.66; p=0.010), HF mortality (1.41; 1.02-1.96; p=0.040), cardiovascular hospitalization (1.17; 0.99-1.39; p=0.064) and HF hospitalization (1.26; 1.03-1.55; p=0.026). In conclusion, compared to comorbidity due to DM alone, the presence of multimorbidity due to DM and CKD was associated with increased mortality and morbidity in patients with chronic HF. Keywords heart failure; multimorbidity; diabetes; chronic kidney disease; outcomes Diabetes mellitus (DM) and chronic kidney disease (CKD) are common comorbidities in HF and are known to be associated with poor outcomes. 1-4 However, the effect of multimorbidity with DM and CKD (versus DM alone) on outcomes in chronic HF has not been well studied. We used a public-use copy of the Digitalis Investigation Group (DIG) trial dataset, obtained from the National Heart, Lung, and Blood Institute, to study the effect of DM and CKD in a propensity-matched population of patients with chronic HF and DM. MethodsThe DIG was a multicenter randomized clinical trial of digoxin in patients with chronic HF in normal sinus rhythm and receiving ACE inhibitors conducted in the United States and Canada. 5,6 Of the7788 DIG participants, 2218 (26%) had a history of DM, of whom 1095 (49%) had CKD. 2 Data on DM were collected at baseline from medical history and CKD was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m 2 body surface area. 4,7,8 Based on the presence of CKD, we categorized these 2218 patients into DM-only (n=1123) and DM-CKD (n=1095) groups. Our primary outcomes were mortality and hospitalization due to all causes, and secondary outcomes were those due to cardiovascular causes and HF. Data on vital status were known for 99% of DIG participants. 9To e...

Purpose Although a number of studies have demonstrated an association between alcohol use frequency and sexual risk behavior, few have used longitudinal data. This study examined alohol use frequency in adolescence as a predictor of HIV sexual risk behavior in adulthood. Methods We collected data among 1368 participants in Colorado. During adolescence (Time 1), respondents were asked about the frequency of using alcohol during the previous 12 months. In adulthood (Time 2), the same respondents were asked about their sexual risk behavior during the previous 12 months. Sexual risk behavior items were used to construct an index, which was categorized to indicate low, medium and high risk study participants. The relationship between alcohol use patterns and risky sexual behavior was modeled using ordinal regression. Results Compared to individuals who drank no alcohol in the past 12 months at Time 1, the odds of being in a higher risk group of sexual behavior as opposed to a lower one at Time 2 were 1.56 (95% CI, 1.04-2.35) among those who drank 6-19 times. Similarly, the odds of being in a higher risk group relative to a lower one among those who drank ≥20 times or were 1.78 (95% CI, 1.05-3.02). Conclusion Alcohol use patterns in adolescence may be useful markers for programs that aim to prevent risky sexual behavior. Based on alcohol intake patterns, it may be possible to identify frequent alcohol users that need to be targeted with appropriate alcohol use and HIV risk reduction messages.

IntroductionWe evaluated antiviral therapy (AVT) eligibility in a population-based sample of adults with chronic hepatitis B virus (HBV) infection in Zambia. Materials and methodsUsing a household survey, adults (18+ years) were tested for hepatitis B surface antigen (HBsAg). Sociodemographic correlates of HBsAg-positivity were identified with multivariable regression. HBsAg-positive individuals were referred to a central hospital for physical examination, elastography, and phlebotomy for HBV DNA, hepatitis B e antigen, serum transaminases, platelet count, and HIV-1/2 antibody. We determined the proportion of HBV monoinfected adults eligible for antiviral therapy (AVT) based on European Association for the Study of the Liver (EASL) 2017 guidelines. We also evaluated the performance of two alternative criteria developed for use in sub-Saharan Africa, the World Health Organization (WHO) and Treat-B guidelines. ResultsAcross 12 urban and 4 rural communities, 4,961 adults (62.9% female) were tested and 182 (3.7%) were HBsAg-positive, 80% of whom attended hospital follow-up. HBsAg-positivity was higher among men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 0.99-1.87) and with decreasing income (AOR, 0.89 per household asset; 95% CI, 0.81-0.98). Trends toward higher HBsAg-positivity were also seen at ages 30-39 years (AOR, 2.11; 95% CI, 0.96-4.63) and among pregnant women (AOR, 1.74; 95% CI, 0.93-3.25). Among HBV monoinfected individuals (i.e., HIV-negative) evaluated for AVT, median age PLOS ONE | https://doi.