1.  Title: [Global Burden of Diseases, Injuries and Risk Factors Study] operations manual. Final draft. Author: Harvard University; University of Washington. Institute for Health Metrics and Evaluation; Johns Hopkins University; University of Queensland; World Health Organization [WHO] Source: [Cambridge, Massachusetts, Harvard University, 2009 Jan 20 142 p. Abstract: The final draft of the Global Burden of Diseases, Injuries and Risk Factors Study Operations Manual is intended to serve as a guide for the Expert Groups working on the GBD Study. There are opportunities to provide input and feedback, and instructions to do so are included in the operations manual. The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization WHO). It is the first major effort since the GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. By November 2010 the project will produce a final set of estimates. (Excerpts) Language: English Keywords: GLOBAL | MANUAL | DATA ANALYSIS | ESTIMATION TECHNIQUES | DISABLED PERSONS AND DISABILITIES | DISEASES | ACCIDENTS AND INJURIES | MORTALITY | RISK FACTORS | EPIDEMIOLOGY | INCIDENCE | PREVALENCE | RISK ASSESSMENT | BIAS | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Population Dynamics | Public Health | Measurement | Evaluation | Error Sources Document Number: 331797 |
2.  Title: Oral contraceptives and the risk of multiple sclerosis: A review of the epidemiologic evidence. Author: Alonso A; Clark CJ Source: Journal of the Neurological Sciences. 2009 May 7; Abstract: Multiple sclerosis (MS) is more frequent in women than in men, suggesting that sex hormones could play a role in the development of MS. For this reason, several studies have assessed whether use of oral contraceptives modifies the risk of MS. In this article, we review the methodology and results of published epidemiologic studies addressing this issue. On the whole, the existing epidemiologic evidence does not support an important effect of oral contraceptive use on the risk of MS, though it does suggest that oral contraceptives might delay the onset of the disease. Language: English Keywords: UNITED KINGDOM | UNITED STATES OF AMERICA | LITERATURE REVIEW | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | CENTRAL NERVOUS SYSTEM EFFECTS | RISK ASSESSMENT | EPIDEMIOLOGY | Developed Countries | Europe, Western | Europe | North America | Americas | Research Methodology | Demographic Factors | Population | Safety | Public Health | Health | Central Nervous System | Physiology | Biology | Evaluation Document Number: 341145 |
| 3. Title: High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur, Pakistan. Author: Altaf A; Saleem N; Abbas S; Muzaffar R Source: JPMA. Journal of the Pakistan Medical Association. 2009 Mar;59(3):136-40. Abstract: OBJECTIVE: To estimate size of injection drug users (IDU), determine their high risk behaviours and assess the prevalence of HIV. METHOD: As part of second generation surveillance (SGS), we investigated specific demographic and behavioural characteristics of IDUs in Hyderabad and Sukkur in 2005. It was a cross sectional study. The survey was preceded by geographic mapping to determine size estimation and to define sampling procedures prior to integrated behavioural and biological survey (IBBS). A sample size of at least 400 was calculated for each city. Besides calculating frequencies, chi square was used for comparing variables among HIV positive and negative IDUs like time elapsed as IDU, number of injections, sharing needles and self perception of acquiring HIV infection. RESULTS: A total of 800 (Hyderabad 398; Sukkur 402) questionnaires and DBS samples were collected. The estimated number of IDUs in both cities was 3,225 (Hyderabad 975 and Sukkur 2250 respectively). Average age of IDUs in Hyderabad was 36.5 years and 34.6 years in Sukkur. Sharing of injection equipment for last injection was reported by 34 (8.5%) in Hyderabad and 135 (33.6%) in Sukkur. In both cities behaviours such as injecting drugs for more than 10 years (p = 0.00) and injecting four or more times in a day (p = 0.11) were significantly associated with seropositivity of HIV infection. In Hyderabad the seroprevalence of HIV was 25.4% (101/398) and in Sukkur it was 19.2% (77/402). CONCLUSION: The burden of HIV among IDUs in Hyderabad and Sukkur is extremely high and can play a significant role in transmitting the infection to other vulnerable groups. Language: English Keywords: PAKISTAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | IV DRUG USERS | URBAN POPULATION | PREVALENCE | HIV INFECTIONS | RISK BEHAVIOR | HUMAN GEOGRAPHY | NEEDLE SHARING | SELF-PERCEPTION | RISK ASSESSMENT | DEMOGRAPHIC FACTORS | Developing Countries | Asia, Southern | Asia | Research Methodology | Viral Diseases | Diseases | Drug Use and Abuse | Behavior | Population Characteristics | Population | Measurement | Geography | Social Sciences | Science | Sociocultural Factors | Perception | Psychological Factors | Evaluation Document Number: 330915 |
| 4. Peer Reviewed Title: Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala. Author: Anderson MR; Samayoa B; O'Sullivan LF; Fletcher J; Arathoon E Source: International Journal of STD and AIDS. 2009 Jan;20(1):30-4. Abstract: The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection. Language: English Keywords: GUATEMALA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | MATHEMATICAL MODEL | STATISTICAL REGRESSION | HIV TESTING | HOSPITALS | DECISION MAKING | RISK ASSESSMENT | PROBABILITY | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Theoretical Models | Data Analysis | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Behavior | Evaluation | Statistical Studies Document Number: 330715 |
| 5. Title: Reproductive and hormonal factors, and ovarian cancer risk for BRCA1 and BRCA2 mutation carriers: results from the International BRCA1/2 Carrier Cohort Study. Author: Antoniou AC; Rookus M; Andrieu N; Brohet R; Chang-Claude J Source: Cancer Epidemiology, Biomarkers and Prevention. 2009 Feb;18(2):601-10. Abstract: BACKGROUND: Several reproductive and hormonal factors are known to be associated with ovarian cancer risk in the general population, including parity and oral contraceptive (OC) use. However, their effect on ovarian cancer risk for BRCA1 and BRCA2 mutation carriers has only been investigated in a small number of studies. METHODS: We used data on 2,281 BRCA1 carriers and 1,038 BRCA2 carriers from the International BRCA1/2 Carrier Cohort Study to evaluate the effect of reproductive and hormonal factors on ovarian cancer risk for mutation carriers. Data were analyzed within a weighted Cox proportional hazards framework. RESULTS: There were no significant differences in the risk of ovarian cancer between parous and nulliparous carriers. For parous BRCA1 mutation carriers, the risk of ovarian cancer was reduced with each additional full-term pregnancy (P trend = 0.002). BRCA1 carriers who had ever used OC were at a significantly reduced risk of developing ovarian cancer (hazard ratio, 0.52; 95% confidence intervals, 0.37-0.73; P = 0.0002) and increasing duration of OC use was associated with a reduced ovarian cancer risk (P trend = 0.0004). The protective effect of OC use for BRCA1 mutation carriers seemed to be greater among more recent users. Tubal ligation was associated with a reduced risk of ovarian cancer for BRCA1 carriers (hazard ratio, 0.42; 95% confidence intervals, 0.22-0.80; P = 0.008). The number of ovarian cancer cases in BRCA2 mutation carriers was too small to draw definitive conclusions. CONCLUSIONS: The results provide further confirmation that OC use, number of full-term pregnancies, and tubal ligation are associated with ovarian cancer risk in BRCA1 carriers to a similar relative extent as in the general population. Language: English Keywords: DEVELOPED COUNTRIES | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | CROSS-CULTURAL COMPARISONS | CLINICAL RESEARCH | WOMEN | PREVALENCE | RISK ASSESSMENT | OVARIAN CANCER | CHROMOSOME ABNORMALITIES | PARITY | RISK FACTORS | ORAL CONTRACEPTIVES, SIDE EFFECTS | TUBAL LIGATION | Research Methodology | Comparative Studies | Studies | Demographic Factors | Population | Measurement | Evaluation | Cancer | Neoplasms | Diseases | Neonatal Diseases and Abnormalities | Fertility Measurements | Fertility | Population Dynamics | Health | Contraceptive Safety | Safety | Public Health | Female Sterilization | Sterilization, Sexual | Family Planning Document Number: 331025 |
| 6. Title: Consanguinity and reproductive wastage in the Palestinian Territories. Author: Assaf S; Khawaja M; DeJong J; Mahfoud Z; Yunis K Source: Paediatric and Perinatal Epidemiology. 2009 Mar;23(2):107-15. Abstract: Many studies have found that consanguinity poses a threat to child mortality and health and can also pose a threat to offspring survival before birth. However, there are conflicting findings with some studies having found no increased risk on offspring survival associated with consanguinity. Data from a population-based survey conducted in 2004 in the Palestinian Territories was used to assess the risk of consanguinity on offspring survival. The analysis was conducted on 4418 women aged 15-49 who were asked whether or not they had experienced a stillbirth or a spontaneous abortion. These two outcomes were combined together for the analysis of reproductive wastage. Multivariable negative binomial regression was conducted to calculate the incidence risk ratios (IRR) for each region in the Palestinian Territories separately. The strongest risk factors for reproductive wastage, after controlling for other variables, were found to be consanguinity, age and parity with age presenting the highest IRRs. Standard of living, locality type, education level, women's employment and past intrauterine device use were not found to be significant risk factors for reproductive wastage. In the West Bank only first cousin level of consanguinity was found to be significant and 'hamola' level (or from same family clan) lost its significance after adjusting for other variables. In the Gaza Strip both the first cousin and 'hamola' levels of consanguinity were significant and presented almost equal IRRs of 1.3. In conclusion, consanguinity was found to be a significant risk factor for reproductive wastage. Language: English Keywords: MIDDLE EAST | RESEARCH REPORT | RISK ASSESSMENT | ABORTION, SPONTANEOUS | FETAL DEATH | MATERNAL AGE | CONSANGUINITY | RISK FACTORS | CHILD MORTALITY | Evaluation | Pregnancy Complications | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Parental Age | Age Factors | Population Characteristics | Genetics | Biology | Health Document Number: 331057 |
| 7. Title: Water safety plan manual: Step-by-step risk management for drinking-water suppliers. Author: Bartram J; Corrales L; Davison A; Deere D; Drury D Source: Geneva, Switzerland, World Health Organization [WHO], 2009. 101 p. Abstract: The most effective means of consistently ensuring the safety of a drinking-water supply is through the use of a comprehensive risk assessment and risk management approach that encompasses all steps in water supply from catchment to consumer. In these Guidelines, such approaches are called water safety plans (WSPs). The aim of this Manual is to provide that practical guidance to facilitate WSP development focusing particularly on organized water supplies managed by a water utility or similar entity. (Excerpts) Language: English Keywords: GLOBAL | MANUAL | CASE STUDIES | WATER SUPPLY | SAFETY | PLANNING | QUALITY CONTROL | RISK ASSESSMENT | STANDARDS | MONITORING | MANAGEMENT | PROCEDURES | Studies | Research Methodology | Natural Resources | Environment | Public Health | Health | Organization and Administration | Evaluation Document Number: 331413 |
| 8. Title: Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country. Author: Bernabe-Ortiz A; White PJ; Carcamo CP; Hughes JP; Gonzales MA; Garcia PJ; Garnett GP; Holmes KK Source: CMAJ. 2009 Feb 3;180(3):298-304. Abstract: BACKGROUND: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS: We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion. Language: English Keywords: LATIN AMERICA | RESEARCH REPORT | INCIDENCE | PREVALENCE | WOMEN | RISK FACTORS | ABORTION | ABORTION, SPONTANEOUS | SEX EDUCATION | RISK ASSESSMENT | Americas | Developing Countries | Measurement | Research Methodology | Demographic Factors | Population | Biology | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Education | Evaluation Document Number: 330468 Notification |
| 9. Title: Combined oral contraceptive use and the risk of systemic lupus erythematosus. Author: Bernier MO; Mikaeloff Y; Hudson M; Suissa S Source: Arthritis and Rheumatism. 2009 Mar 30;61(4):476-481. Abstract: OBJECTIVE: To assess whether the risk of incident systemic lupus erythematosus (SLE) is associated with the use of combined oral contraceptives (COCs), because studies of the link between exogenous hormonal exposure and the risk of SLE have produced conflicting results. METHODS: We conducted a population-based nested case-control study among women ages 18-45 years, using the UK's General Practice Research Database. All incident cases of SLE from 1994-2004 (n = 786) were identified in the database and matched with up to 10 controls (n = 7,817) among women without SLE at the time of the case's diagnosis. RESULTS: The adjusted rate ratio (RR) of incident SLE associated with any use of COC was 1.19 (95% confidence interval [95% CI] 0.98-1.45), whereas with current use it was 1.54 (95% CI 1.15-2.07). The rate was particularly increased in current users who had only recently started COC use (RR 2.52, 95% CI 1.14-5.57) compared with longer-term current users (RR 1.45, 95% CI 1.06-1.99). The risk appearedto be particularly elevated with current exposure to first- or second-generation contraceptives (RR 1.65, 95% CI 1.20-2.26), and increasing with the dose of ethinyl estradiol (RR 1.42, 1.63, and 2.92 for Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CASE CONTROL STUDIES | LONGITUDINAL STUDIES | WOMEN | ORAL CONTRACEPTIVES, COMBINED | SYSTEMIC LUPUS ERYTHEMATOSUS | PREVALENCE | RISK FACTORS | RISK ASSESSMENT | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Diseases | Measurement | Health | Evaluation Document Number: 330926 |
| 10. Title: Progestogen-only contraceptives and the risk of stroke: a meta-analysis. Author: Chakhtoura Z; Canonico M; Gompel A; Thalabard JC; Scarabin PY; Plu-Bureau G Source: Stroke; A Journal of Cerebral Circulation. 2009 Apr;40(4):1059-62. Abstract: BACKGROUND AND PURPOSE: The association between combined oral contraceptives (OC) use and increased risk of stroke has been reported. While progestogen-only contraceptives (POC) are commonly used worldwide, their impact on cardiovascular disease remains unclear. METHODS: A meta-analysis based on EMBASE and MEDLINE referenced literature corresponding to OCs marketed since 1960 was carried out. Eligible articles assessing the risk of stroke in relation to OC or POC were reviewed, and relevant studies were extracted. All types of POC and routes of administration were taken into account in the meta-analysis. RESULTS: Six case-control studies were identified. The combined odd ratio (OR) showed no increase in the risk of stroke among POC users (OR=0.96; 95% confidence interval: 0.70 to 1.31). This result was similar according to the route of administration (either implant or injectable or oral POC). CONCLUSIONS: Data from observational studies show that POC use is not associated with an increased risk of stroke. However, these results are based on limited data. Further investigations are needed in women with risk factors of stroke. Language: English Keywords: FRANCE | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | COMPARATIVE STUDIES | WOMEN | PREVALENCE | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE AGENTS, PROGESTIN | RISK ASSESSMENT | CEREBROVASCULAR EFFECTS | CONTRACEPTIVE IMPLANTS | INJECTABLES | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Demographic Factors | Population | Measurement | Contraceptive Safety | Safety | Public Health | Health | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Evaluation | Physiology | Biology | Contraceptive Methods Document Number: 331085 |
| 11. Peer Reviewed Title: Two-months-off, four-months-on antiretroviral regimen increases the risk of resistance, compared with continuous therapy: A randomized trial involving West African adults. Author: Danel C; Moh R; Chaix ML; Gabillard D; Gnokoro J; Diby CJ; Toni T; Dohoun L; Rouzioux C; Bissagnene E; Salamon R; Anglaret X Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):66-76. Abstract: A randomized trial was launched in Côte d'Ivoire in 2002 to compare continuous antiretroviral treatment (hereafter, "C-ART") to an ART regimen of 2 months off and 4 months on therapy (hereafter, "2/4-ART"). We report the final analysis. A total of 435 adults who were receiving successful ART ((median CD4 cell count prior to ART, 272 cells/mm3; 88% were receiving a zidovudine-lamivudine-efavirenz regimen) were randomized to receive C-ART or 2/4-ART. The main primary end point was the percentage of patients with <350 CD4 cells/mm3 at 24 months. The sample size ensured 80% power to demonstrate noninferiority (noninferiority bound, -15%), assuming that 30% of the patients in the C-ART arm would have <350 CD4 cells/mm3. Other end points were mortality, morbidity, cost of care, genotypic resistance, adherence, and toxicity. The percentage of patients with <350 CD4 cells/mm3 at 24 months was 5.6% (6 of 107) in the C-ART arm and 14.6% (46 of 315) in the 2/4-ART arm (lower bound of the 95% CI for the difference, -14%). Cost was 18% higher in the C-ART arm, and resistance to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) was 20% higher in the 2/4-ART arm. Other end points were nonconclusive. Although 2/4-ART met the predetermined criteria for noninferiority, the percentage of patients with <350 CD4 cells/mm3 in the C-ART arm was lower than anticipated, which makes the clinical significance of this noninferiority uncertain. In addition, 2/4-ART led to an unacceptable additional risk of selecting for drug-resistant virus. This new argument against episodic ART strategies is also a caveat against any unplanned ART interruptions in Africa, where most patients receive NNRTIs. Language: English Keywords: COTE D'IVOIRE | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | ADULTS | TIME FACTORS | ADMINISTRATION AND DOSAGE | RISK ASSESSMENT | DRUG RESISTANCE | ANTIRETROVIRAL DRUGS | IMMUNITY, CELLULAR | GENETICS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Studies | Age Factors | Population Characteristics | Demographic Factors | Population | Population Dynamics | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Immunity | Immune System | Physiology | Biology Document Number: 328597 |
| 12. Peer Reviewed Title: Pill scare: communication conundrum. Author: Edouard L Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):121-2. Abstract: Adverse publicity for combined oral contraceptives (COCs) has led to pill scares on numerous occasions such as reproductive cancers in 1983 and venous thromboembolism (VTE) in 1995. Misinformation should be avoided, especially through the correct interpretation of relative risk to avoid confusion and decrease unnecessary anxiety. Reassurance is usually important, as the absolute risk is infinitely small. The popular media are very effective for the prompt dissemination of information, and authoritative statements are useful for improving communications with providers, patients and public. Language: English Keywords: ALGERIA | HISTORICAL REVIEW | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | MISINFORMATION | FEAR | RISK ASSESSMENT | CANCER | THROMBOEMBOLISM | INFORMATION DISTRIBUTION | PUBLIC HEALTH | Africa, North | Africa | Developing Countries | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Contraceptive Safety | Safety | Health | Communication | Emotions | Psychological Factors | Behavior | Evaluation | Neoplasms | Diseases | Embolism | Vascular Diseases Document Number: 341650 |
| 13. Title: Previous abortion and risk of pre-term birth: a population study. Author: Freak-Poli R; Chan A; Tucker G; Street J Source: Journal of Maternal-Fetal and Neonatal Medicine. 2009 Jan;22(1):1-7. Abstract: OBJECTIVE: This population study was undertaken to determine whether previous abortion is an independent risk factor for pre-term birth and to calculate population-attributable risks for risk factors. METHODS: All South Australian first singleton births in 1998-2003 (n = 42 269) were included in a multivariable logistic regression analysis, comparing pre-term births with term births. RESULTS: Risk factors for pre-term birth were found to be: being indigenous, single, a smoker [adjusted odds ratio (AOR) 1.28, 95% confidence interval 1.17-1.41], age 40 years or older, reproductive technology assistance, threatened miscarriage, antepartum haemorrhage, urinary tract infection, pregnancy hypertension and suspected intra-uterine growth restriction. A previous spontaneous abortion was of borderline statistical significance, whereas a previous induced abortion (AOR 1.25, 1.13-1.40) was an independent risk factor. A dose-response relationship was found with increasing number of previous spontaneous or induced abortions. Population-attributable risks were highest for pregnancy hypertension (12.4%) and antepartum haemorrhage (9.2%). Smoking and previous induced abortion had risks of 4.7% and 2.7%, respectively. Among indigenous women, 51% of whom smoked, 16.4% of pre-term birth could be attributed to smoking. CONCLUSIONS: A previous induced abortion and smoking during pregnancy (particularly among indigenous women) are preventable risk factors for pre-term birth. Their population-attributable risks are likely to be under-estimates from under-reporting. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PREGNANT WOMEN | INDIGENOUS POPULATION | PREVALENCE | ABORTION | RISK ASSESSMENT | PREMATURE BIRTH | RISK FACTORS | REPRODUCTIVE TECHNOLOGIES | ABORTION, SPONTANEOUS | MATERNAL AGE | PREECLAMPSIA | Oceania | Developed Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Measurement | Fertility Control, Postconception | Family Planning | Evaluation | Pregnancy Outcomes | Pregnancy | Reproduction | Health | Pregnancy Complications | Diseases | Parental Age | Age Factors Document Number: 330718 Notification |
| 14. Peer Reviewed Title: A framework of sexual partnerships: Risks and implications for HIV prevention in Africa. Author: Green EC; Mah TL; Ruark A; Hearst N Source: Studies in Family Planning. 2009 Mar;40(1):63-70. Abstract: The global diversity of HIV epidemics can be explained in part by types and patterns of sexual partnerships. We offer a typology of sexual partnerships that corresponds to varying levels of HIVtransmission risk to help guide thinking about appropriate behavioral interventions, particularly in the epidemics of sub-Saharan Africa. Declines in HIV prevalence have been associated with reductions in numbers of sex partners, whereas many other prevention strategies have not been demonstrated to reduce HIV transmission at a population level. We suggest a reorientation of current prevention efforts, based on the epidemiology of sexually transmitted HIV epidemics and trends in sexual behavior change. Concurrent sexual partnerships are likely to play a large role in transmission dynamics in the generalized epidemics of East and Southern Africa, and should be addressed through improved behavior-change interventions. Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | CLASSIFICATION | EPIDEMIOLOGIC METHODS | SEXUAL PARTNERS | MULTIPLE PARTNERS | HIV PREVENTION | RISK ASSESSMENT | BEHAVIOR CHANGE COMMUNICATION | EPIDEMIOLOGY | SEX BEHAVIOR | SAFER SEX | HUMAN GEOGRAPHY | Africa | Developing Countries | Studies | Research Methodology | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation | Communication Programs | Communication | Behavior Change | Public Health | Health | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 341082 |
| 15. Title: Letter to the editor of AIDS based on a recent paper by Rollins et al. 'there is no evidence for any specific age at which HIV-positive mothers in Africa should be advised to stop breastfeeding' [letter] Author: Greiner T Source: AIDS. 2009 Feb 20;23(4):547-8. Abstract: The authors attempted to convince sample mothers that they should stop breastfeeding at 6 months, implying that all had access to nutritious foods for their infants. The assumption that doing so would lead to increased rates of HIV-free survival seems to be justified by their data. However, if poorer mothers are the ones who opt to breastfeed longer, wemust be very careful in assuming that their infants will have the same outcomes as those who opt to breastfeed for shorter periods. This is especially true in South Africa where fears of stigma may be less of a factor explaining the continuation of breastfeeding beyond 6 months than poverty, at least compared with other African countries. Thus, WHO no longer recommends attempting to convince all HIVþ mothers to stop breastfeeding at 6months: 'At 6months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe, continuation of breastfeeding with additional complementary foods is recommended, while the mother and baby continue to be regularly assessed (http://whqlibdoc. who.int/publications/2007/9789241595964_eng.pdf). Finally, while both the article and editorial mention, respectively, that HAART treatment of eligible mothers and antiretroviral therapy (ART) prophylaxis are likely to reduce postnatal HIV transmission, the former is now increasingly available in Africa, making generalization from this study even more difficult. (excerpt) Language: English Keywords: AFRICA | CRITIQUE | CLINICAL RESEARCH | MOTHERS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | BREASTFEEDING | TIME FACTORS | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING, EXCLUSIVE | RISK ASSESSMENT | COUNSELING | SOCIOECONOMIC STATUS | POVERTY | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Evaluation | Clinic Activities | Program Activities | Programs | Organization and Administration | Socioeconomic Factors Document Number: 341158 |
| 16. Peer Reviewed Title: A 15-Minute Interactive, Computerized Condom Use Intervention With Biological Endpoints. Author: Grimley DM; Hook EW 3rd Source: Sexually Transmitted Diseases. 2009 Feb;36(2):73-78. Abstract: BACKGROUND:: Brief face-to-face-behavioral interventions have been shown to be efficacious, but are costly to sustain and to widely disseminate. This study evaluated the efficacy of a 15-minute theory-based behavioral intervention designed to increase condom use and reduce new cases of Neisseria gonorrhoeae and Chlamydia trachomatis. METHODS:: Participants were randomly assigned via the computer to the intervention or the comparison group stratified by gender and their baseline stage of change (motivational readiness) for using condoms consistently (100%) with their main partners. Behavioral data and biologic specimens for testing of Neisseria gonorrhoeae and Chlamydia trachomatis were obtained at baseline and at 6 months post intervention. The intervention was delivered via an audio, multimedia, computerized application that provided individualized interventions to patients based on their responses to assessment items; comparison patients interacted with a 15-minute, computerized, multiple health risk assessment with no intervention. RESULTS:: The majority of the sample (N = 430) was black (88%); 54.5% women; with a mean age = 24.5. Assuming all participants who did not return to the clinic at 6 months were not using condoms consistently, 32% of the treatment group versus 23% in the comparison group reported consistent condom use (P = 0.03). The combined Neisseria gonorrhoeae and Chlamydia trachomatis incidence declined to 6% in the intervention group versus 13% in the comparison group (P = 0.04). Results from a regression analysis revealed that the only statically significant predictor of sexually transmitted diseases infection at the follow-up was group assignment (OR = 1.91, 95% confidence index = 1.09-3.34; P = 0.043). CONCLUSIONS:: These findings suggest that brief, interactive, computer-delivered interventions provided at the evaluation visit increase condom use and reduce sexually transmitted diseases without putting additional burden on clinicians or staff. Language: English Keywords: ALABAMA | RESEARCH REPORT | KAP SURVEYS | CASE CONTROL STUDIES | STATISTICAL REGRESSION | THEORETICAL MODELS | BLACKS | COMPUTER PROGRAMS AND PROGRAMMING | GONORRHEA | CHLAMYDIA | CONDOM USE | AUDIOVISUAL AIDS | TIME FACTORS | RISK ASSESSMENT | CONTRACEPTIVE PREVALENCE | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Information Processing | Information | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Risk Reduction Behavior | Behavior | Educational Methods | Educational Activities | Education | Population Dynamics | Evaluation | Contraceptive Usage | Contraception | Family Planning Document Number: 329674 |
| 17. Peer Reviewed Title: Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents. Author: Guimaraes EM; Guimaraes MD; Vieira MA; Bontempo NM; Seixas MS; Garcia MS; Daud LE; Cortes RL; Alves Mde F Source: BMC Medicine. 2009;7:8. Abstract: BACKGROUND: Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiania, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. METHODS: A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6%) were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. RESULTS: The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2) and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7). Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. CONCLUSION: The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | CROSS SECTIONAL ANALYSIS | ADOLESCENTS, FEMALE | URBAN POPULATION | RISK ASSESSMENT | SEX BEHAVIOR | GYNECOLOGY | CERVICAL EFFECTS | PREVALENCE | CHLAMYDIA | GONORRHEA | SIGNS AND SYMPTOMS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Evaluation | Behavior | Medicine | Health Services | Delivery of Health Care | Health | Cervix | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases Document Number: 331079 |
| 18. Peer Reviewed Title: Non - contraceptive benefits and risks of contraception Author: Haider Z; D'Souza R Source: Best Practice and Research: Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):249-262. Abstract: Contraception is primarily used to prevent pregnancy. However, a user should be aware of both the possible non-contraceptive benefits she/he may experience and any potential risks to her/his health. These issues should be discussed as fully as possible, using current, evidence-based information prior to commencing a method. Some methods may be prescribed solely for their noncontraceptive benefits for a woman who does not require it for contraception. Potential risks to a woman?s health may make certain methods unacceptable if concurrent medical problems or lifestyle issues exist. This chapter discusses the main non-contraceptive benefits and risks for each contraceptive method in turn. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | CONTRACEPTIVE AGENTS, SIDE EFFECTS | RISK ASSESSMENT | COUNSELING | FAMILY PLANNING EDUCATION | CONTRAINDICATIONS | CONTRACEPTIVE METHODS | Developed Countries | Europe, Western | Europe | Research Methodology | Demographic Factors | Population | Contraceptive Agents | Contraception | Family Planning | Evaluation | Clinic Activities | Program Activities | Programs | Organization and Administration | Education | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341507 |
| 19. Title: Conceptions of mental health among Ugandan youth orphaned by AIDS. Author: Harms S; Kizza R; Sebunnya J; Jack S Source: African Journal of AIDS Research. 2009 Apr;8(1):7-16. Abstract: The AIDS epidemic has disproportionately affected developing or low-income sub-Saharan African countries. Within the context of the epidemic, children and youth are at risk of losing their parents at an early age. The experience of orphanhood due to AIDS has the potential to negatively impact on a child's mental health. A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. We conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were also affiliated with a non-governmental organisation providing support to orphans. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term 'mental health,' however they easily identified factors associated with good or poor mental health. In general, good mental health was associated with social conduct that is culturally appropriate. Poor mental health was perceived as a form of madness or insanity and it was associated with a loss of basic life necessities, such as access to food, education or shelter. The youths also identified factors that promote more successful orphans. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context. There are several clinical implications, including the development of a mental health intervention paradigm that emphasises resilience. Language: English Keywords: UGANDA | RESEARCH REPORT | QUALITATIVE RESEARCH | ORPHANS AND VULNERABLE CHILDREN | YOUTH | MENTAL HEALTH | AIDS | RISK ASSESSMENT | EMOTIONS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Family and Household | Sociocultural Factors | Age Factors | Population Characteristics | Demographic Factors | Population | Health | HIV Infections | Viral Diseases | Diseases | Evaluation | Psychological Factors | Behavior Document Number: 341283 |
| 20. Peer Reviewed Title: Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection. Author: Harris TG; Miller L; Kulasingam SL; Feng Q; Kiviat NB; Schwartz SM; Koutsky LA Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):489.e1-8. Abstract: OBJECTIVE: The objective of the study was to examine the relationship of depot-medroxyprogesterone acetate (DMPA) and combined oral contraceptive (COC) use with cervical intraepithelial neoplasia (CIN). STUDY DESIGN: Two case-control studies of women who presented for gynecologic care and underwent cytologic and human papillomavirus (HPV) testing were performed. The first included oncogenic HPV-positive women grouped based on histology: negative (n = 152), CIN1 (n = 133), and CIN2-3 or greater (n = 173). For the second, 2 groups were identified: negative HPV/negative histology (n = 107) and positive oncogenic HPV/negative histology (n = 152). RESULTS: Among oncogenic HPV-positive women, DMPA use was inversely associated with CIN2-3 or greater (adjusted odds ratio [OR(adj)], 0.4; 95% confidence interval [CI], 0.2-1.1) and CIN1 (OR(adj), 0.1; 95% CI, 0.01-0.6); COC use was not associated with either. Among histologically negative women, DMPA use was associated with oncogenic HPV (OR(adj), 4.7; 95% CI, 1.4-15.8). CONCLUSION: Among women with oncogenic HPV, hormonal contraceptive use was not associated with an increased risk of CIN2-3 or greater. Longer-term DMPA use may attenuate the colposcopic and histologic features of CIN because women reporting such use were more likely than others to have cervical oncogenic HPV without evidence of CIN. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | WOMEN | PREVALENCE | HPV | CERVICAL CANCER | RISK FACTORS | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | RISK ASSESSMENT | COLPOSCOPY | HISTOLOGY | Developed Countries | North America | Americas | Research Methodology | Studies | Demographic Factors | Population | Measurement | Viral Diseases | Diseases | Cancer | Neoplasms | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods | Evaluation | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Biology Document Number: 331078 |
| 21. Peer Reviewed Title: Factors associated with tuberculosis treatment default among HIV-infected tuberculosis patients in Thailand. Author: Kittikraisak W; Burapat C; Kaewsa-ard S; Watthanaamornkiet W; Sirinak C; Sattayawuthipong W; Jittimanee S; Pobkeeree V; Varma JK Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jan;103(1):59-66. Abstract: Ensuring completion of tuberculosis (TB) treatment remains a major public health problem. In HIV-infected patients, TB is the most common severe opportunistic infection. Few studies have evaluated risk factors for TB treatment default in HIV-infected patients. We conducted a prospective, observational study of HIV-infected TB patients in Thailand. Patients underwent standardised evaluations at the beginning of TB treatment, at the end of the intensive phase and at the end of TB treatment. TB treatment outcomes were assessed according to WHO guidelines. The analysis was limited to patients who defaulted or who had treatment success. Of the 554 patients analysed, 61 (11%) defaulted. In multivariate analysis, factors associated with TB treatment default included incarceration history [adjusted odds ratio (AOR) 2.0, 95% CI 1.1-3.7), smoking (AOR 2.3, 95% CI 1.3-4.1) and having a symptom complaint score >15 (AOR 3.4, 95% CI 1.4-8.0); one marker of wealth, namely owning a refrigerator, was protective (AOR 0.4, 95% CI 0.2-0.8). Default during TB treatment was a significant problem in HIV-infected patients. Reducing default may require enhancing services for patients with a history of incarceration or smoking and designing patient-centred systems to address poverty and patient wellness. Language: English Keywords: THAILAND | RESEARCH REPORT | RISK ASSESSMENT | PERSONS LIVING WITH HIV/AIDS | HIV | AIDS | TUBERCULOSIS | DIRECTLY OBSERVED THERAPY SHORT-COURSE (DOTS) | Developing Countries | Asia, Southeastern | Asia | Evaluation | HIV Infections | Viral Diseases | Diseases | Infections | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330836 |
| 22. Peer Reviewed Title: Sexual risk behaviour for women working in recreational venues in Mwanza, Tanzania: considerations for the acceptability and use of vaginal microbicide gels. Author: Lees S; Desmond N; Allen C; Bugeke G; Vallely A; Ross D Source: Culture, Health and Sexuality. 2009 May 14;:1. Abstract: Qualitative research was conducted to explore the social context of sexual-risk behaviour among women working in recreational occupations, during a feasibility study in preparation for the Phase III clinical trial of vaginal microbicides in Mwanza, Tanzania. Participant observation was conducted in 68 recreational venues. Six focus group discussions were conducted with women working in recreational occupations and two with male customers at these venues. Findings revealed that these women are at risk of HIV due their dependence on sexual transactions to improve their economic circumstances, which take place in environments and relationships where condom use is difficult. However, the findings revealed that, in spite of constraints, women did take actions to prevent HIV by negotiating for condom use or avoiding perceived risky practices or partnerships, in particular moving to more casual partnerships where condom negotiation is more acceptable. This indicates that, given their perception of their own risk, women working in recreational occupations will welcome an effective microbicide. However, sustained use will depend on how formulations overcome the difficulties women currently experience with condom negotiation and the specific environments and relationships in which they engage in sex. Language: English Keywords: TANZANIA | RESEARCH REPORT | FOCUS GROUPS | WOMEN IN DEVELOPMENT | WORKERS | PARKS AND RECREATIONAL FACILITIES | MICROBICIDES | VAGINAL GEL | CONDOM USE | HIV PREVENTION | SEX BEHAVIOR | RISK ASSESSMENT | PERCEPTION | PARTNER COMMUNICATION | SELF-PERCEPTION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Economic Development | Economic Factors | Labor Force | Human Resources | Natural Resources | Environment | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Risk Reduction Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation | Psychological Factors | Interpersonal Relations Document Number: 341493 |
| 23. Title: Assessment of Kenyan sexual networks: Collecting evidence for interventions to reduce HIV / STI risk in Garissa, North Eastern Province, and Eastleigh, Nairobi. Author: Macintyre K; Eymoy HA; Hassan I; Adriance D; Nouga A Source: Nairobi, Kenya, Pathfinder International, AIDS, Population and Health Integrated Assistance North Eastern Province [APHIA], [2009]. 7 p. (USAID Associate Cooperative Agreement No. 623-A-00-07-00023-00) Abstract: It is clear from the data gathered in this assessment that HIV prevention messages have reached Garissa, but more must be done to clarify and refine these messages and improve knowledge and behaviors regarding risky sex. Though this sample should not be viewed as representative of the NEP population as a whole, these data can be used by APHIA II NEP to create a targeted, evidence-based prevention strategy. APHIA II NEP plans to work with partners to improve knowledge, attitudes, and practices through a strategic behavior change campaign with the following objectives: targeting key populations, leveraging the endorsement and influence of religious leaders, projecting familiar social settings and "our face" in all communication materials, [and] intensifying school-based programs. (Excerpt) Language: English Keywords: KENYA | SOMALIA | RESEARCH REPORT | KAP SURVEYS | SEX WORKERS | SOCIAL NETWORKS | ETHNIC GROUPS | INFLUENTIALS | ISLAM | NOMADS | FOREIGN AID | TECHNICAL ASSISTANCE | PERCEPTION | RISK ASSESSMENT | HIV TRANSMISSION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Sex Behavior | Behavior | Friends and Relatives | Family and Household | Sociocultural Factors | Cultural Background | Population Characteristics | Demographic Factors | Population | Knowledge Sources | Communication | Religion | Migrants | Migration | Population Dynamics | Financial Activities | Economic Factors | Programs | Organization and Administration | Psychological Factors | Evaluation | HIV Infections | Viral Diseases | Diseases Document Number: 331344 |
| 24. Peer Reviewed Title: Demographic and personality factors as predictors of HIV/STD partner-specific risk perceptions: implications for interventions. Author: Mehrotra P; Noar SM; Zimmerman RS; Palmgreen P Source: AIDS Education and Prevention. 2009 Feb;21(1):39-54. Abstract: Although risk perception as a motivator of precautionary behavior is a key component of several health behavior theories, this motivational hypothesis has found mixed support in the HIV/AIDS area. This may be, in part, because risk perceptions are more complex than they are treated in many studies of the motivational hypothesis. The current study examines demographic, personality, and sexual risk factors as predictors of partner-specific (main vs. casual) HIV/STD risk perceptions in a sample of 1,489 young adults. As expected, perceptions of HIV/STD risk were higher in the context of "casual" as compared with "main" partnerships. Although univariate analyses demonstrated that gender, race/ethnicity, sensation seeking, impulsivity, number of partners, and condom use all influenced HIV/STD risk perceptions, only gender, condom use, and race/ethnicity remained significant in multivariate analyses. Implications of these results for the design of efficacious HIV prevention interventions are discussed. Language: English Keywords: KENTUCKY | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | SEXUAL PARTNERS | YOUTH | DEMOGRAPHIC FACTORS | PERSONALITY | HIV PREVENTION | PERCEPTION | RISK ASSESSMENT | SEXUALLY TRANSMITTED DISEASE PREVENTION | SEX BEHAVIOR | MOTIVATION | RISK BEHAVIOR | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Behavior | Age Factors | Population Characteristics | Population | Psychological Factors | HIV Infections | Viral Diseases | Diseases | Evaluation | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections Document Number: 331082 |
| 25. Peer Reviewed Title: Emergency contraceptive use among 5677 women seeking abortion in Shanghai, China. Author: Meng CX; Gemzell-Danielsson K; Stephansson O; Kang JZ; Chen QF; Cheng LN Source: Human Reproduction. 2009 Apr 9;1(1):1-7. Abstract: BACKGROUND The increasing use of emergency contraceptive pills (ECPs) does not seem to reduce the number of induced abortions as would be expected, indicating that women use ECPs might also be a strong factor affecting their final efficacy. The study aimed to understand the attitude towards, and use of, ECPs among women seeking an abortion. METHODS A cohort study was conducted via face-to-face questionnaire interview among women seeking abortion in Shanghai, China. Logistic regression analysis and chi(2) test were performed for statistical analysis. RESULTS The response rate was 99.3%. Among all 5677 respondents aged 15-48 years, 48.8% were ECP ever-users. Compared with ever-users, ECP never-users were less likely to have used contraception during the present cycle of conception (P < 0.001). In response to the question on the main reason for non-use of contraception, ECP never-users were less likely to realize the risk of pregnancy and had less contraceptive knowledge (P < 0.001). Among 2773 ECP ever-users, 72.7% did not use ECPs to prevent the current pregnancy, mainly due to lack of awareness of pregnancy risk. Out of 757 women, 437 (57.7%) repeated unprotected sex after taking ECPs during the current pregnant cycle. A pharmacy was the preferred source to access ECPs, for the reason of convenience. CONCLUSIONS Non-use of ECPs was correlated to less knowledge on fertility and a lower rate of contraceptive use among abortion-seeking women. Women of reproductive age should have access to ECPs and receive sufficient information on their use. Health care providers and pharmacists should also be trained in contraceptive counselling, including ECPs. Language: English Keywords: CHINA | RESEARCH REPORT | COHORT ANALYSIS | KAP SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | WOMEN IN DEVELOPMENT | ABORTION | EMERGENCY CONTRACEPTION | ATTITUDES | CONTRACEPTIVE PREVALENCE | RISK ASSESSMENT | PERCEPTION | CONDOM USE | PHARMACY DISTRIBUTION | Asia, Eastern | Asia | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Family Planning Surveys | Family Planning | Economic Development | Economic Factors | Fertility Control, Postconception | Contraception | Psychological Factors | Behavior | Contraceptive Usage | Evaluation | Risk Reduction Behavior | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration Document Number: 331002 Notification |
| 26. Title: The role of partner reduction and faithfulness in HIV prevention in Sub-Saharan Africa: evidence from Cameroon, Rwanda, Uganda, and Zimbabwe. Author: Mishra V; Hong R; Assche SB; Barrere B Source: Calverton, Maryland, Macro International, MEASURE DHS, 2009 Jan. 31 p. (USAID Contract No. GPO-C-00-03-00002-00DHS Working Papers No. 61) Abstract: Objectives. We examine patterns of multiple sexual partnerships and partner faithfulness among men, women, and cohabiting couples in four countries in sub-Saharan Africa and assess the association between these behaviors and the risk of HIV infection. Methods. Our data are from nationally-representative surveys conducted during 2004-2006 in Cameroon, Rwanda, Uganda, and Zimbabwe that included HIV testing of adult men and women, using blood specimens analyzed with standard laboratory and quality control procedures. Men and women in a marital/cohabiting union who reported never having had sex with any person other than their current partner(s) are defined as lifetime faithful. Men and women in a marital/cohabiting union who ever had sex with a person other than current their partner(s) but not in the previous 12 months are defined as recently faithful. Lifetime and recent mutual faithfulness among cohabiting couples are similarly defined. Data are analyzed using descriptive and multivariate statistical methods after adjusting for potential confounding factors. Results. Multiple sexual partnerships are common in sub-Saharan Africa. In all four countries considered, the adjusted odds of being HIV-infected increase with the number of lifetime sexual partners and decrease with the level of spousal faithfulness. Similarly, in couples where the partners are not mutually faithful, either or both partners are more likely to be HIV-infected than in couples where both partners are lifetime faithful. Our study finds that men report having more lifetime partners and being less faithful to their spouse(s) than women report. Conclusions. Having fewer lifetime sexual partners and being faithful to spousal partner(s) are strongly associated with reduced risk of HIV infection. Thus, in addition to promoting abstinence until marriage and condom use, especially in higher-risk sex, HIV prevention programs should focus more on promoting partner reduction and partner faithfulness, especially for men. KEYWORDS: faithfulness, multiple sexual partnerships, partner reduction, HIV, AIDS, sub-Saharan Africa. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | KAP SURVEYS | CROSS-CULTURAL COMPARISONS | DEMOGRAPHIC AND HEALTH SURVEYS | MULTIPLE PARTNERS | SEXUAL PARTNERS | EXTRAMARITAL SEX BEHAVIOR | SAFER SEX | HIV PREVENTION | SEX BEHAVIOR | RISK ASSESSMENT | RISK BEHAVIOR | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Comparative Studies | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation Document Number: 329991 |
| 27. Title: Reproductive factors, exogenous hormone use and risk of lymphoid neoplasms among women in the National Institutes of Health-AARP Diet and Health Study Cohort. Author: Morton LM; Wang SS; Richesson DA; Schatzkin A; Hollenbeck AR; Lacey JV Jr Source: International Journal of Cancer. 2009 Jun 1;124(11):2737-43. Abstract: Reasons for higher incidence of lymphoid neoplasms among men than women are unknown. Because female sex hormones have immunomodulatory effects, reproductive factors and exogenous hormone use may affect risk for lymphoid malignancies. Previous epidemiologic studies on this topic have yielded conflicting results. Within the National Institutes of Health-AARP Diet and Health Study cohort, we prospectively analyzed detailed, questionnaire-derived information on menstrual and reproductive factors and use of oral contraceptives and menopausal hormone therapy among 134,074 US women. Using multivariable proportional hazards regression models, we estimated relative risks (RRs) for 85 plasma cell neoplasms and 417 non-Hodgkin lymphomas (NHLs) identified during follow-up from 1996 to 2002. We observed no statistically significant associations between plasma cell neoplasms, NHL, or the 3 most common NHL subtypes and age at menarche, parity, age at first birth, oral contraceptive use or menopausal status at baseline. For menopausal hormone therapy use, overall associations between NHL and unopposed estrogen and estrogen plus progestin were null, with the potential exception of an inverse association (RR = 0.49, 95% CI, 0.25-0.96) between use of unopposed estrogen and diffuse large B-cell lymphoma (DLBCL), the most common NHL subtype, among women with a hysterectomy. These data do not support an important role for reproductive factors or exogenous hormones in modulating lymphomagenesis. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | MULTIVARIATE ANALYSIS | WOMEN | PREVALENCE | CANCER | ORAL CONTRACEPTIVES | HORMONE REPLACEMENT THERAPY | MENOPAUSE | MENSTRUATION | REPRODUCTIVE HEALTH | RISK ASSESSMENT | RISK FACTORS | Developed Countries | North America | Americas | Research Methodology | Data Analysis | Demographic Factors | Population | Measurement | Neoplasms | Diseases | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Evaluation Document Number: 330982 |
| 28. Peer Reviewed Title: Heterogeneity in host HIV susceptibility as a potential contributor to recent HIV prevalence declines in Africa. Author: Nagelkerke N; de Vlas SJ; Jha P; Luo M; Plummer FA; Kaul R Source: AIDS. 2009 Jan 2;23(1):125-30. Abstract: BACKGROUND: HIV prevalence has recently declined in several African countries, and prior to this the risk of HIV acquisition per unprotected sex contact also declined in Kenyan sex workers. We hypothesized that heterogeneity in HIV host susceptibility might underpin both of these observations. METHODS: A compartmental mathematical model was used to explore the potential impact of heterogeneity in susceptibility to HIV infection on epidemic behavior, in the absence of other causative mechanisms. RESULTS: Studies indicated that a substantial heterogeneity in susceptibility to HIV infection may lead to an epidemic that peaks and then declines due to a depletion of the most susceptible individuals, even without changes in sexual behavior. This effect was most notable in high-risk groups such as female sex workers and was consistent with empirical data. DISCUSSION: Declines in HIV prevalence may have other causes in addition to behavior change, including heterogeneity in host HIV susceptibility. There is a need to further study this heterogeneity and its correlates, particularly as it confounds the ability to attribute HIV epidemic shifts to specific interventions, including behavior change. Language: English Keywords: KENYA | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | MATHEMATICAL MODEL | SEX WORKERS | PREVALENCE | HIV TRANSMISSION | SEX BEHAVIOR | RISK REDUCTION BEHAVIOR | RISK ASSESSMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Theoretical Models | Behavior | Measurement | HIV Infections | Viral Diseases | Diseases | Evaluation Document Number: 330257 |
| 29. Peer Reviewed Title: Confronting the legal risks of prescribing the contraceptive patch with ongoing litigation. Author: Phelps JY; Kelver ME Source: Obstetrics and Gynecology. 2009 Mar;113(3):712-6. Abstract: Recent changes in U.S. Food and Drug Administration (FDA) labeling and news reports of lawsuits resulting in million-dollar settlements understandably may deter gynecologists from prescribing the transdermal contraceptive patch Ortho Evra (Ortho-McNeil Pharmaceutical, Inc., Titusville, NJ). Gynecologists who, with all good intentions, prescribe an FDA-approved drug such as the contraceptive patch potentially could find themselves liable for an adverse drug reaction. Although much of the current focus by plaintiff attorneys and the news media is on the contraceptive patch, no prescription contraceptive method is without medical risks to the patient or legal risks to the prescribing gynecologist. The purpose of this commentary is to provide an overview of the medical-legal controversies and pitfalls in prescribing the contraceptive patch as well as to outline how gynecologists can avert legal liability by providing proper informed consent. Despite FDA labeling changes and ongoing litigation, with proper informed consent, the contraceptive patch still may be the best choice for many patients who prefer the convenience of a weekly patch over a daily oral contraceptive. Also, regardless of the contraceptive option chosen, the principles of providing and documenting proper informed consent in medical records are applicable not only to providing quality care to patients, but also to protecting the legal interests of the prescribing gynecologist. By documenting proper informed consent in medical records, gynecologists should feel more at ease in prescribing the contraceptive method that best fits their individual patients' needs, even in the presence of ongoing litigation. Language: English Keywords: UNITED STATES OF AMERICA | CRITIQUE | RECOMMENDATIONS | EVALUATION | PHYSICIANS | LITIGATION | RISK ASSESSMENT | PRESCRIPTIONS | CONTRACEPTIVE AGENTS, FEMALE | ADMINISTRATION AND DOSAGE | USFDA | SIDE EFFECTS | INFORMED CONSENT | RECORDS | Developed Countries | North America | Americas | Health Personnel | Delivery of Health Care | Health | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Agents | Contraception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | USPHS | Government Agencies | Organizations | Information Processing | Information Document Number: 330700 |
| 30. Title: HIV/AIDS and disability in Southern Africa: a review of relevant literature. Author: Rohleder P; Braathen SH; Swartz L; Eide AH Source: Disability and Rehabilitation. 2009;31(1):51-9. Abstract: Purpose. HIV/AIDS has grown to become the biggest epidemic in modern history. Southern Africa is at the epicentre of the global epidemic, with just of a third of the world's HIV-positive population living here. It is known that HIV/AIDS affect vulnerable population groups. It is surprising then, that persons with disabilities, one of the world's most vulnerable population groups, particularly in southern Africa, have been largely overlooked with regards to HIV/AIDS. This review sought to establish the state of the knowledge at present. Method. This article reports on findings of a literature review conducted as an initial step in a research project currently underway in South Africa. This article focuses on HIV/AIDS as it affects persons with disabilities in southern Africa, as it is in this region that the majority of people living with HIV live. However, as fewer studies exist that have as its focus southern Africa (particularly looking at HIV/AIDS and persons with disabilities), relevant articles from the international literature were used as indications of what we may find through future research also in the southern African countries. Given the paucity of published literature dealing with HIV/AIDS and persons with disabilities, the review looked at various risk factors associated with HIV infection, and how it affects persons with disabilities. Results. Findings from the literature review suggest that persons with disabilities, particularly in southern Africa, are at significant risk for HIV infection. Conclusions. There is an urgent need for more research on HIV/AIDs and sexuality among persons with disabilities in Africa. Language: English Keywords: AFRICA, SOUTHERN | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | DISABLED PERSONS AND DISABILITIES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | AIDS | COMPLICATIONS | RISK ASSESSMENT | POVERTY | SEX BEHAVIOR | RISK BEHAVIOR | EDUCATIONAL STATUS | SEX EDUCATION | PROGRAM ACCESSIBILITY | |