| 1. Title: Women's empowerment and the intention to continue the practice of female genital cutting in Egypt. Author: Afifi M Source: Archives of Iranian Medicine. 2009 Mar;12(2):154-60. Abstract: BACKGROUND: The study aimed to (dis)prove the association of the level of women's empowerment with their future intention to perpetuate female genital cutting for their daughters. METHODS: In a national representative community-based sample of 14,393 currently-married women in Egypt, the level of empowerment, intention to continue the practice, and other socio- demographic variables were collected in the 2000 Egypt Demographic and Health Survey. Secondary in-depth analysis was conducted on data downloaded from MEASURE Demographic Health Surveys (MEASURE DHS) website.RESULTS: About 14% of the women intended to discontinue the practice. Twenty-six percent of the women were empowered in all household decisions. Levels of women's empowerment adjusted for age, residence, education, interaction between empowerment and education, work status, and female genital cutting status of currently-married women were entered in six logistic regression models in a sequential way.CONCLUSION: In the last model, those of high levels of empowerment and education were 8.06 times more likely not intending to perpetuate female genital cutting for their daughters than low- empowered low-educated women. Language: English Keywords: EGYPT | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | STATISTICAL REGRESSION | CURRENTLY MARRIED | WOMEN | FEMALE GENITAL CUTTING | WOMEN'S EMPOWERMENT | DECISION MAKING | EDUCATIONAL STATUS | OCCUPATIONAL STATUS | ATTITUDES | AGE FACTORS | Developing Countries | Africa, North | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Data Analysis | Research Methodology | Marital Status | Nuptiality | Harmful Traditional Practices | Traditional Health Practices | Culture | Sociocultural Factors | Women's Status | Socioeconomic Factors | Economic Factors | Behavior | Socioeconomic Status | Employment Status | Psychological Factors | Population Characteristics Document Number: 342003 |
2.  Peer Reviewed Title: Biological Validation of Self-Reported Condom Use Among Sex Workers in Guinea. Author: Aho J; Koushik A; Diakite SL; Loua KM; Nguyen VK; Rashed S Source: AIDS and Behavior. 2009 Aug 13; Abstract: Self-reported condom use may be prone to social desirability bias. Our aim was to assess the validity of self-reported condom use in a population of female sex workers using prostate specific antigen (PSA) as a gold standard biomarker of recent unprotected vaginal intercourse. We collected data on 223 sex-workers in Conakry, Guinea in order to assess the sensitivity and specificity of self-reported condom use as well as to examine the predictors of discordance between self-report and PSA presence. PSA was detected in 38.4% of samples. Sensitivity of self-reported condom use was 14.6% and its specificity was 94.7%. Self-perceived high risk of HIV infection was the only significant independent predictor of misreported condom use. PSA could be useful to validate self-reported condom use in surveys and to allow a better understanding of factors associated with social desirability in sexual behaviour reporting. Language: English Keywords: GUINEA | RESEARCH REPORT | STATISTICAL REGRESSION | SEX WORKERS | CONDOM USE | BIAS | DATA REPORTING | VALIDITY | VAGINA | SEMEN | ANTIGENS | SEXUALLY TRANSMITTED DISEASES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | Sex Behavior | Behavior | Risk Reduction Behavior | Error Sources | Measurement | Data Collection | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Seminal Vesicles | Genitalia, Male | Immunologic Factors | Immunity | Immune System | Reproductive Tract Infections | Infections | Diseases Document Number: 342486 |
| 3. 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 |
| 4. Peer Reviewed Title: Education gender gaps in Pakistan: Is the labor market to blame? Author: Aslam M Source: Economic Development and Cultural Change. 2009 Jul;57(4):747-784. Abstract: Differential labor market returns to male and female education are one potential explanation for large gender gaps in education in Pakistan. We empirically test this explanation by estimating private returns to education separately for male and female wage earners. This article contributes to the literature by using a variety of methodologies (ordinary least squares, Heckman correction, two-stage least squares, and household fixed effects) in order to estimate economic returns to education. The latest nationally representative data-the Pakistan Integrated Household Survey (2002)-are used. Earnings function estimates consistently reveal a sizable gender asymmetry in economic returns to education, with returns to women's education being substantially and statistically significantly higher than men's. The return to an additional year of schooling ranges between 7% and 11% for men and between 13% and 18% for women. There are also large, direct returns to women's education at low levels of schooling, and the education-earnings profile is more convex for women than for men. However, a decomposition of the gender wage gap (into the component "explained" by differing male and female endowments and the residual component) suggests that there is highly differentiated treatment by employers. We conclude that the total labor market returns are much higher for men, despite returns to education being higher for women. This suggests that parents may have an investment motive in allocating more resources to boys than to girls within households. Language: English Keywords: PAKISTAN | RESEARCH REPORT | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | MATHEMATICAL MODEL | LABOR FORCE | SPOUSE | EDUCATIONAL STATUS | GENDER ISSUES | SEX FACTORS | INEQUALITIES | INCOME | PARENTAL INVOLVEMENT | Developing Countries | Asia, Southern | Asia | Data Analysis | Research Methodology | Theoretical Models | Human Resources | Economic Factors | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Population Characteristics | Demographic Factors | Population | Child Rearing | Behavior Document Number: 341095 |
| 5. Peer Reviewed Title: Increased access to emergency contraception: why it may fail. Author: Baecher L; Weaver MA; Raymond EG Source: Human Reproduction. 2009 Apr;24(4):815-9. Abstract: BACKGROUND: To explore why increased access to emergency contraception (EC) failed to reduce pregnancies in a recent randomized controlled trial. METHODS: We used multivariable logistic regression to identify risk factors for unintended pregnancy using data from a trial involving sexually active women (n = 1490, aged 14-24 years) randomly assigned to either increased access or standard access to EC. We used predictive modeling to generate estimated pregnancy risk scores for each participant. We then examined EC use among women at low or high baseline risk of pregnancy. RESULTS: Gravidity, recent history of unprotected sex (within 14 days of enrollment to study) and lower aversion to pregnancy predicted unintended pregnancy. Women in the increased access group were more likely than women in the standard access group to use EC repeatedly. This difference was significantly stronger (P = 0.03) among low risk women than high risk women [Relative risk (RR) 10.0, 95% confidence interval (CI) 6.5-15.4 and RR 5.5, 95% CI 3.8-7.9, respectively]. CONCLUSIONS: Increased access to EC had a greater impact on women who were at lower baseline risk of pregnancy. This may explain in part why increased access to EC has had no measurable benefit in clinical trials. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PREGNANCY, UNPLANNED | INCIDENCE | RISK FACTORS | PSYCHOSOCIAL FACTORS | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Measurement | Health | Behavior Document Number: 341661 |
| 6. Title: Inadequate use of prenatal services among brazilian women: the role of maternal characteristics. Author: Bassani DG; Surkan PJ; Olinto MT Source: International Perspectives On Sexual and Reproductive Health. 2009 Mar;35(1):15-20. Abstract: CONTEXT: To improve the uptake of prenatal care, it is important to know how the use of prenatal care varies by maternal attitudes and social and demographic factors. METHODS: Information about social and demographic variables, prenatal care, parity, pregnancy planning, abortion attempts, satisfaction with pregnancy and satisfaction with the relationship with the child's father was collected from 611 postpartum women in Porto Alegre in southern Brazil. Multinomial logistic regression was used to evaluate associations between these variables and whether the women's use of prenatal care was adequate, partially inadequate or inadequate. RESULTS: About 40% of women had inadequate or partially inadequate prenatal care. After adjustment for other covariates, including satisfaction with the pregnancy, women having an unplanned pregnancy were significantly more likely to have had inadequate care than women who had planned their pregnancy (odds ratio, 2.0). Not living with the child's father (2.8) and dissatisfaction with pregnancy (2.1) were also associated with inadequate use of prenatal care. Women having their second or higher order birth were significantly more likely to report inadequate use of prenatal care than women having their first birth (3.9-9.0). Household income was inversely associated with inadequate use of care. CONCLUSIONS: The study suggests that maternal attitudes may be important for adequate prenatal care. Interventions should be created to encourage women with negative maternal attitudes to use prenatal care and to ensure that they have access to the care they need. Language: English Keywords: BRAZIL | RESEARCH REPORT | STATISTICAL REGRESSION | POSTPARTUM WOMEN | ANTENATAL CARE | UTILIZATION OF HEALTH CARE | ATTITUDES | SOCIOECONOMIC STATUS | PARITY | LIVING ARRANGEMENTS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Data Analysis | Research Methodology | Puerperium | Reproduction | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Psychological Factors | Behavior | Socioeconomic Factors | Economic Factors | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors Document Number: 341412 |
| 7. Peer Reviewed Title: Sexual risk-taking among adult dating couples in the United States. Author: Billy JO; Grady WR; Sill ME Source: Perspectives On Sexual and Reproductive Health. 2009 Jun;41(2):74-83. Abstract: CONTEXT: Knowledge of sexual and contraceptive behaviors as risk factors for STDs is largely based on women's or men's separate reports of their attitudes and behaviors. Little research has been based on couples. METHODS: Data from the 2005-2006 National Couples Survey were used to examine the sexual risk-taking behavior of 335 dating couples. Associations between each partner's characteristics and the couple's probability of recently having had anal sex and of having done something to protect themselves from STDs were assessed using logistic regression analyses. Models included measures of power dynamics and partners' perceptions of who controls sexual and contraceptive decisions. RESULTS: Couples in which the female partner reported that her male partner made the decisions about sex and contraception had increased probability of having had anal sex during the four weeks prior to the interview. In addition, partners' relationship power and their perception of control over sex and contraception moderated associations between couples' behavior and partners' characteristics, experiences and beliefs. For example, although couples in which the male partners had known someone with AIDS were less likely than others to engage in anal sex, that association was much greater for males with high income-and thus greater power-than for those with low income. CONCLUSIONS: Sexual behaviors are not controlled by any one individual in a relationship; characteristics of each partner are important. Couples-based interventions that take into consideration relationship-especially power-dynamics may enable individuals to initiate and sustain safer-sex practices. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | ADULTS | COUPLES | SEX BEHAVIOR | POWER | ANAL SEX | CONDOM USE | CONTRACEPTIVE USAGE | SEXUALLY TRANSMITTED DISEASE PREVENTION | PERCEPTION | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | Behavior | Political Factors | Risk Reduction Behavior | Contraception | Family Planning | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Psychological Factors Document Number: 342624 |
| 8. Peer Reviewed Title: Trends in prenatal care settings: Association with medical liability. Author: Coco AS; Cohen D; Horst MA; Gambler AS Source: BMC Public Health. 2009 Jul 22;9(1):257. Abstract: ABSTRACT: BACKGROUND: Medical liability concerns centered around maternity care have widespread public health implications, as restrictions in physician scope of practice may threaten quality of and access to care in the current climate. The purpose of this study was to examine national trends in prenatal care settings based on medical liability climate. METHODS: Analysis of prenatal visits in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1997 to 2004 (N = 21,454). To assess changes in rates of prenatal visits over time, we used the linear trend test. Multivariate logistic regression modeling was developed to determine characteristics associated with visits made to hospital outpatient departments. RESULTS: In regions of the country with high medical liability (N = 11,673), the relative number, or proportion, of all prenatal visits occurring in hospital outpatient departments increased from 11.8% in 1997-1998 to 19.4% in 2003-2004 (p < .001 for trend); the trend for complicated obstetrical visits (N = 3,275) was more pronounced, where the proportion of prenatal visits occurring in hospital outpatient departments almost doubled from 22.7% in 1997-1998 to 41.6% in 2003-2004 (p = .004 for trend). This increase did not occur in regions of the country with low medical liability (N = 9,781) where the proportion of visits occurring in hospital outpatient departments decreased from 13.3% in 1997-1998 to 9.0% in 2003-2004. CONCLUSIONS: There has been a shift in prenatal care from obstetrician's offices to safety net settings in regions of the country with high medical liability. These findings provide strong indirect evidence that the medical liability crisis is affecting patterns of obstetric practice and ultimately patient access to care. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | PHYSICIANS | HIGH RISK WOMEN | ETHNIC GROUPS | ANTENATAL CARE | MEDICAL LIABILITY | OBSTETRICS | PHYSICIAN'S OFFICE | HOSPITALS | PROGRAM ACCESSIBILITY | HEALTH INSURANCE | TITLE 19 MEDICAL ASSISTANCE | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Health Personnel | Delivery of Health Care | Health | Reproduction | Cultural Background | Population Characteristics | Demographic Factors | Population | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Medicine | Health Facilities | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Public Assistance | Grants Document Number: 342287 |
| 9. Peer Reviewed Title: Association of attitudes and beliefs towards antiretroviral therapy with HIV-seroprevalence in the general population of Kisumu, Kenya. Author: Cohen CR; Montandon M; Carrico AW; Shiboski S; Bostrom A; Obure A; Kwena Z; Bailey RC; Nguti R; Bukusi EA Source: PLoS One. 2009;4(3):e4573. Abstract: BACKGROUND: Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment. METHODS: We conducted a general population-based survey in Kisumu, Kenya. Participants completed an interview that included demographics as well as ART-related attitudes and beliefs (AB) and then underwent HIV serological testing. Exploratory and confirmatory factor analyses of AB about ART indicated two factors: 1) ART-related risk compensation (increased sexual risk taking now that ART is available); and 2) a perception that HIV is more controllable now that ART is available. Logistic regression was used to determine associations of these factors with HIV-seroprevalence after controlling for age. FINDINGS: 1,655 (90%) of 1,844 people aged 15-49 contacted, including 749 men and 906 women, consented to participate in the study. Most participants (n = 1164; 71%) had heard of ART. Of those who had heard of ART, 23% believed ART was a cure for HIV. ART-related risk compensation (Adjusted (A)OR = 1.45, 95% CI 1.16-1.81), and a belief that ART cures HIV (AOR = 2.14, 95% CI 1.22-3.76) were associated with an increased HIV seroprevalence in men but not women after controlling for age. In particular, ART-related risk compensation was associated with an increased HIV-seroprevalence in young (aged 15-24 years) men (OR = 1.56; 95% CI 1.12-2.19). CONCLUSIONS: ART-related risk compensation and a belief that ART cures HIV were associated with an increased HIV seroprevalence among men but not women. HIV prevention programs in sub-Saharan Africa that target the general population should include educational messages about ART and address the changing beliefs about HIV in the era of greater ART availability. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | PERSONS LIVING WITH HIV/AIDS | ATTITUDES | BELIEFS | HIV INFECTIONS | PREVALENCE | DEMOGRAPHIC FACTORS | ANTIRETROVIRAL THERAPY | RISK BEHAVIOR | SEX BEHAVIOR | SEX FACTORS | KNOWLEDGE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Viral Diseases | Diseases | Psychological Factors | Behavior | Culture | Sociocultural Factors | Measurement | Population | HIV | Population Characteristics Document Number: 331237 |
| 10. Title: Cerebral venous and sinus thrombosis in women. Author: Coutinho JM; Ferro JM; Canhao P; Barinagarrementeria F; Cantu C; Bousser MG; Stam J Source: Stroke. 2009 Jul;40(7):2356-61. Abstract: BACKGROUND AND PURPOSE: Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men. METHODS: We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis. RESULTS: Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l P=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4). CONCLUSIONS: Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients. Language: English Keywords: GLOBAL | RESEARCH REPORT | PROSPECTIVE STUDIES | STATISTICAL REGRESSION | CLIENTS | WOMEN | CEREBROVASCULAR EFFECTS | THROMBOSIS | RISK FACTORS | SEX FACTORS | SIGNS AND SYMPTOMS | Studies | Research Methodology | Data Analysis | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Physiology | Biology | Thromboembolism | Embolism | Vascular Diseases | Diseases | Health | Population Characteristics Document Number: 342314 |
| 11. Peer Reviewed Title: Is phosphodiesterase type 5 inhibitor use associated with condom breakage? Author: Crosby R; Yarber WL; Sanders SA; Graham CA Source: Sexually Transmitted Infections. 2009 Sep;85(5):404-5. Abstract: We tested the hypothesis that phosphodiesterase type 5 inhibitor (PDE5i) use would be associated with increased likelihood of condom breakage using an event-specific analysis. A convenience sample of 440 men completed an internet-based questionnaire that assessed variables pertaining to the last time they used condoms for penile-vaginal intercourse (PVI). A bivariate (screening) analysis was performed to identify covariates for a multivariate analysis using logistic regression. Altogether, 5.9% of the men reported breakage and 9.5% reported PDE5i use during the last time a condom was used for PVI. Among men who had used PDE5i during the last condom-protected occasion of PVI, 11.9% reported breakage compared with 5.3% of those not reporting PDE5i use. Adjusting for men's age, ethnic minority status, marital status, reported duration of PVI and alcohol use at last PVI, those using PDE5i were about four times more likely to also report condom breakage (AOR 4.02; 95% CI 1.20 to 13.48; p = 0.04). Of note, duration of PVI was independently associated with breakage (AOR 1.36; CI 1.02 to 1.83; p = 0.04). Findings suggest that PDE5i use may potentially be associated with increased odds of condom breakage among some men. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | MEN | CONDOM FAILURE | RISK FACTORS | DRUGS | GENITAL EFFECTS, MALE | ALCOHOL USE AND ABUSE | MARITAL STATUS | Developed Countries | North America | Americas | Studies | Research Methodology | Data Analysis | Demographic Factors | Population | Condoms | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Health | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Behavior | Nuptiality Document Number: 342845 |
| 12. Title: Traffic-related air pollution and perinatal mortality: a case-control study. Author: de Medeiros AP; Gouveia N; Machado RP; de Souza MR; Alencar GP; Novaes HM; de Almeida MF Source: Environmental Health Perspectives. 2009 Jan;117(1):127-32. Abstract: BACKGROUND: Ambient levels of air pollution may affect the health of children, as indicated by studies of infant and perinatal mortality. Scientific evidence has also correlated low birth weight and preterm birth, which are important determinants of perinatal death, with air pollution. However, most of these studies used ambient concentrations measured at monitoring sites, which may not consider differential exposure to pollutants found at elevated concentrations near heavy-traffic roadways. OBJECTIVES: Our goal was to examine the association between traffic-related pollution and perinatal mortality. METHODS: We used the information collected for a case-control study conducted in 14 districts in the City of Sao Paulo, Brazil, regarding risk factors for perinatal deaths. We geocoded the residential addresses of cases (fetal and early neonatal deaths) and controls (children who survived the 28th day of life) and calculated a distance-weighted traffic density (DWTD) measure considering all roads contained in a buffer surrounding these homes. RESULTS: Logistic regression revealed a gradient of increasing risk of early neonatal death with higher exposure to traffic-related air pollution. Mothers exposed to the highest quartile of the DWTD compared with those less exposed exhibited approximately 50% increased risk (adjusted odds ratio = 1.47; 95% confidence interval, 0.67-3.19). Associations for fetal mortality were less consistent. CONCLUSIONS: These results suggest that motor vehicle exhaust exposures may be a risk factor for perinatal mortality. Language: English Keywords: BRAZIL | RESEARCH REPORT | STATISTICAL REGRESSION | PERINATAL MORTALITY | ENVIRONMENTAL POLLUTION | TRANSPORTATION | RISK FACTORS | POPULATION PRESSURE | Developing Countries | South America, Eastern | South America | Latin America | Americas | Data Analysis | Research Methodology | Mortality | Population Dynamics | Demographic Factors | Population | Environmental Degradation | Environment | Economic Factors | Biology | Carrying Capacity | Natural Resources Document Number: 330469 |
| 13. Title: Determinants of condom use: results of the Canadian Community Health Survey 3.1. Author: Dhalla S; Poole G Source: Canadian Journal of Public Health / Revue Canadienne De Sante Publique. 2009 Jul-Aug;100(4):299-303. Abstract: OBJECTIVES: To examine the independent effects of mood disorder, age, race/ethnicity, personal income, being a current student, having a regular medical doctor and substance use in relationship to condom use at last intercourse in a Canadian population stratified by sex. METHODS: We used Cycle 3.1 of the 2006 Canadian Community Health Survey (CCHS 3.1), a population-based, voluntary, cross-sectional survey of subjects ages 12-85 years. Data collection took place between January and December 2005. From the survey, a study sample of 20,975 people was drawn, consisting of individuals providing valid responses (yes/no) to mood disorder and last-time condom use. The question of sexual behaviours was asked only of those ages 15-49 years. Logistic regression was used to examine individual variables as potential determinants of last-time condom use stratified by sex. RESULTS: The relationship between mood disorder and condom use was non-significant in both males (AOR = 0.85, 95% CI = 0.70-1.04) and females (AOR = 0.90, 95% CI = 0.78-1.03). Increasing age was found to be inversely associated with last-time condom use in both males and females. Male factors significantly associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.64-0.79) and being a current student (AOR = 1.28, 95% CI =1.16-1.42). Female factors associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.63-0.79) and being a former drinker (AOR = 2.25, 95% CI = 1.63-3.11). CONCLUSION: Our results identify important determinants of last-time condom use in both males and females in the CCHS 3.1. These findings may have important implications for the devising and implementation of safe sex programs in a Canadian population ages 15-49 years. Language: English Keywords: CANADA | RESEARCH REPORT | HEALTH SURVEYS | STATISTICAL REGRESSION | ETHNIC GROUPS | SEXUALLY TRANSMITTED DISEASES | CONDOM USE | MENTAL DISORDERS | SEX FACTORS | AGE FACTORS | ALCOHOL USE AND ABUSE | Developed Countries | North America, Northern | Americas | Health | Data Analysis | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Reproductive Tract Infections | Infections | Diseases | Risk Reduction Behavior | Behavior Document Number: 342618 |
| 14. Peer Reviewed Title: The Relationship Between Rejection Sensitivity and Compliant Condom Use. Author: Edwards GL; Barber BL Source: Archives of Sexual Behavior. 2009 Sep 4; Abstract: Those who are rejection sensitive anxiously expect and readily perceive rejection. Rejection sensitivity is hypothesized to predict behavior; however, this link may be more evident in some contexts than others. The current study examined the link between rejection sensitivity and condom use. Australian young adults in romantic (n = 649, 70% female) and casual (n = 144, 76.2% female) relationship contexts completed measures on rejection sensitivity, condom use preferences, and condom use. Regression analysis showed that rejection sensitivity predicted condom use when participants' condom use preferences were at odds with those they thought their partner held. Specifically, highly rejection-sensitive individuals who preferred more frequent condom use reported using condoms less often, if that was what they thought their partners wanted. The results lend support to the model of rejection sensitivity in that individuals comply more with their perceived partner's preferences if they are more rejection-sensitive. The results also highlight the need to take the situational context into consideration when examining links between personality dispositions and behavior. Language: English Keywords: AUSTRALIA | RESEARCH REPORT | STATISTICAL REGRESSION | YOUTH | CONDOM USE | SEX BEHAVIOR | DECISION MAKING | INTERPERSONAL RELATIONS | PERCEPTION | QUESTIONNAIRES | Oceania | Developed Countries | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Risk Reduction Behavior | Behavior | Psychological Factors Document Number: 342840 |
| 15. Peer Reviewed Title: Assessment of insecticide-treated bednet use among children and pregnant women across 15 countries using standardized national surveys. Author: Eisele TP; Keating J; Littrell M; Larsen D; Macintyre K Source: American Journal of Tropical Medicine and Hygiene. 2009 Feb;80(2):209-14. Abstract: Impact of insecticide-treated bednets (ITNs) on preventing malaria may be minimized if they are not used by vulnerable populations. Among ITN-owning households from 15 standardized national surveys from 2003 to 2006, we identify factors associated with ITN use among children younger than 5 years of age and make comparisons of ITN use among children and pregnant women across countries. Within ITN-owning households, many children and pregnant women are still not using them. Between-country analysis with linear regression showed child ITN use increases as intra-household access to ITNs increases (P = 0.020, R2 = 0.404), after controlling for season and survey year. Results from within-country logistic regression analyses were consistent with between-country analysis showing intra-household access to ITNs is the strongest and most consistent determinant of use among children. The gaps in ITN use and possession will likely persist in the absence of achieving a ratio of no more than two people per ITN. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | KAP SURVEYS | CROSS-CULTURAL COMPARISONS | STATISTICAL REGRESSION | CHILDREN | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PESTICIDES | BED NETS | MALARIA PREVENTION | CHILD SURVIVAL | Surveys | Sampling Studies | Studies | Research Methodology | Comparative Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Ingredients and Chemicals | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics Document Number: 330299 |
| 16. Peer Reviewed Title: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan. Author: Emmanuel F; Archibald C; Razaque A; Sandstrom P Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):85-90. Abstract: BACKGROUND: During a routine surveillance round, an extremely high prevalence of 51.3% was found among injecting drug users (IDUs) in Sargodha, a small town in Pakistan. This sharp increase of HIV among this group warranted an urgent need to explore the factors leading toward this explosion of HIV infection among IDUs at this very location to direct the policy makers in designing preventive activities, especially in the context of HIV prevention. METHODS: In 2007, 400 current IDUs were recruited through multistage cluster sampling based on mapping studies. Participants provided dried blood spot samples for HIV testing and completed a questionnaire on demographic characteristics and sexual/drug injecting behaviors. Logistic regression was used to examine the independent association of multiple variables with HIV infection. RESULTS: Of the 400 IDUs tested, 205 (51.3%) were HIV positive confirmed through enzyme-linked immunosorbent assay and Western blot. In multivariate analysis, geographical location of IDUs [adjusted odds ratio (aOR) 2.4 for IDUs located in the northern zone vs southern zone, 95% confidence interval (CI) 1.5 to 3.7], injected in groups (aOR 1.8, 95% CI 1.1 to 3.1), and sharing injecting paraphernalia with other IDUs (aOR 1.5, 95% CI 1.0 to 2.4) were strong correlates of HIV infection. CONCLUSIONS: Effective outreach programs need to be developed to provide a comprehensive package of HIV prevention services to IDUs not reached by existing services, entry into drug abuse treatment and medical care needs to be facilitated, and essential legal and social services need to be provided with community participation. Language: English Keywords: PAKISTAN | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | IV DRUG USERS | HIV INFECTIONS | EPIDEMICS | PREVALENCE | RISK FACTORS | NEEDLE SHARING | SEX BEHAVIOR | QUESTIONNAIRES | KNOWLEDGE | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Data Analysis | Drug Use and Abuse | Behavior | Viral Diseases | Diseases | Measurement | Health | Risk Behavior | Sociocultural Factors Document Number: 342369 |
| 17. Peer Reviewed Title: Multiple sexual partnership mediates the association between early sexual debut and sexually transmitted infection among adolescent and young adult males in Nigeria. Author: Fatusi A; Wang W Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):134-43. Abstract: The study was cross-sectional analytical in design and involved 1,278 Nigerian males aged 15-24 years. Logistic regression was used in assessing the statistical relationship between early sexual debut (<16 years) and self-reported STIs (history of at least one of three symptoms-painful urination, genital discharge, and genital ulcer/sore within the past 12 months), with demographic factors, sexual behaviors, and psychosocial measures controlled for. The prevalence of self-reported symptoms was 4.2% for genital discharge, 4.1% for painful urination, and 2.0% for genital sore/ulcer. Overall, 6.8% had STI symptoms. At bivariate analysis, early sexual debut (p = 0.021), multiple partners (p < 0.001), concurrent partners (p = 0.002), and sex with casual/commercial partners (p = 0.013) were associated with STIs. At multivariate analysis, early sexual debut (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.17-3.84) remained significantly associated with STIs. Multiple sexual partnership (OR = 2.00, 95% CI = 1.13-3.52) was also significantly associated with STIs and is a mediator of the association between early debut and STI. Language: English Keywords: NIGERIA | RESEARCH REPORT | HEALTH SURVEYS | STATISTICAL REGRESSION | ADOLESCENTS, MALE | YOUTH | MULTIPLE PARTNERS | FIRST INTERCOURSE | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Health | Data Analysis | Research Methodology | Adolescents | Age Factors | Population Characteristics | Demographic Factors | Population | Sexual Partners | Sex Behavior | Behavior | Reproductive Tract Infections | Infections | Diseases Document Number: 341447 |
| 18. Peer Reviewed Title: The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya. Author: Feikin DR; Nguyen LM; Adazu K; Ombok M; Audi A; Slutsker L; Lindblade KA Source: Tropical Medicine and International Health. 2009 Jan;14(1):54-61. Abstract: OBJECTIVE: To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya. METHODS: As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55,000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10,973 DSS-resident children < 5 years of age. RESULTS: Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer. CONCLUSION: Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation. Language: English Keywords: KENYA | RESEARCH REPORT | DEMOGRAPHIC SURVEYS | STATISTICAL REGRESSION | RURAL POPULATION | CHILDREN | DISTANCE | HEALTH FACILITIES | UTILIZATION OF HEALTH CARE | HUMAN GEOGRAPHY | SOCIOECONOMIC STATUS | EDUCATIONAL STATUS | AGE FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Population Dynamics | Demographic Factors | Population | Data Analysis | Research Methodology | Population Characteristics | Youth | Geographic Factors | Delivery of Health Care | Health | Health Services | Geography | Social Sciences | Science | Sociocultural Factors | Socioeconomic Factors | Economic Factors Document Number: 330260 |
| 19. Peer Reviewed Title: Opportunity for natural selection among the Indian population: secular trend, covariates and implications. Author: Gautam RK Source: Journal of Biosocial Science. 2009 Jul 23;:1-41. Abstract: Crow's index is widely used for indirect quantitative estimation of natural selection using birth and death rates. The present investigation is based on 179 studies among 144 different endogamous communities belonging to nineteen states and six geographical regions of India, categorized into six social groups. These studies appeared in 33 different years over six decades (1956 to 2007). The secular trend in Crow's index (It) and its mortality and fertility components (Im and If) shows a gradual decline in It and radical shift in the relative contributions of Im and If. Before 1990 the opportunity for natural selection was mainly determined by differential pre-reproductive mortality (Im), whereas after 1990 it has been determined by differential fertility (If). To find out the covariates of It, Im and If sixteen socio-demographic variables were considered, and nine were found to be significantly correlated with It: total dependency ratio, decadal growth rate 1991-2001, young age dependency ratio, crude death rate, total fertility rate, child mortality rate, under-5 mortality rate, old age dependency ratio and decadal growth rate 1981-1991. On the basis of multivariate stepwise regression analysis, female literacy emerged as one of the most important predictors of It. The declining trend of It, Im and If shows that the Indian population is passing through the demographic transition. Language: English Keywords: INDIA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | DATA COLLECTION | STATISTICAL REGRESSION | TRIBES | MOTHERS | CASTE | POPULATION GENETICS | FERTILITY | MORTALITY | DEPENDENCY BURDEN | SOCIOCULTURAL FACTORS | DEMOGRAPHIC TRANSITION | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Research Methodology | Data Analysis | Cultural Background | Population Characteristics | Demographic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Genetics | Biology | Population Dynamics | Microeconomic Factors Document Number: 342293 |
| 20. Peer Reviewed Title: Self-medication prevalence for sexually transmitted diseases: meta-analysis and meta-regression of population level determinants. Author: Gomez GB; Garnett GP; Ward H Source: Sexually Transmitted Diseases. 2009 Feb;36(2):112-9. Abstract: BACKGROUND: Estimated prevalence of self-medication for sexually transmitted diseases (STDs) in observational studies differs between studies and it may vary according to population characteristics. METHODS: We investigated the extent of self-medication use for STD and explored population and study level factors correlated to the variability observed between populations. Medical databases were systematically searched for published studies. Crude prevalence data were extracted. Pooled estimates were calculated using random effects models. Univariate and multivariate meta-regression models with categorical population level covariates were constructed. RESULTS: Of the 35 studies that met the inclusion criteria for all self-medication use, 20 were also included in the analysis of antibiotic only use. There was significant heterogeneity present across prevalence estimates for all self-medication, Q = 3954.82, P <0.001; and among antibiotic only self-medication, Q = 3797.94, P <0.001. In meta-regression analyses, publication year seemed to explain 22.5% of variation among studies of self-medication with antibiotic only. No other significant associations with population or study characteristics were found. CONCLUSIONS: No population level factors leading to high levels of self-medication use for STD were identified. Publications before year 2000 seem to present a higher prevalence of antibiotic use for self-medication. Greater risk awareness of antibiotic misuse and improved control of antibiotic availability at population level might explain this result. An analysis of individual level characteristics should indicate which are influential and whether their local prevalence can explain the observed heterogeneity better. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | KAP SURVEYS | EPIDEMIOLOGIC METHODS | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | TARGET POPULATION | SEXUALLY TRANSMITTED DISEASES | PREVALENCE | SELF CARE | ANTIBIOTICS | DEMOGRAPHIC FACTORS | Developed Countries | North America | Americas | Research Methodology | Theoretical Models | Surveys | Sampling Studies | Studies | Data Analysis | Program Design | Programs | Organization and Administration | Reproductive Tract Infections | Infections | Diseases | Measurement | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Population Document Number: 330365 |
| 21. 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 |
| 22. Peer Reviewed Title: Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. Author: Helleringer S; Kohler HP; Frimpong JA; Mkandawire J Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):185-93. Abstract: BACKGROUND: Uptake of HIV testing and counseling (HTC) is lower among members of the poorest households in sub-Saharan countries, thereby creating significant inequalities in access to HTC and possibly antiretroviral treatment. OBJECTIVES: To measure uptake of home-based HTC and estimate HIV prevalence among members of the poorest households in a sub-Saharan population. METHODS: Residents of 6 villages of Likoma Island (Malawi) aged 18-35 and their spouses were offered home-based HTC services. Socioeconomic status, HIV testing history, and HIV risk factors were assessed. Differences in HTC uptake and HIV infection rates between members of households in the lowest income quartile and the rest of the population were estimated using logistic regression. RESULTS: Members of households in the lowest income quartile were significantly less likely to have ever used facility-based HTC services than the rest of the population (odds ratio = 0.60, 95% confidence interval (CI): 0.36 to 0.97). In contrast, they were significantly more likely to use home-based HTC services provided during the study (adjusted odds ratio = 1.70, 95% CI: 1.04 to 2.79). Socioeconomic differences in uptake of home-based HTC were not due to underlying differences in socioeconomic characteristics or HIV risk factors. The prevalence of HIV was significantly lower among members of the poorest households tested during home-based HTC than among the rest of the population (adjusted odds ratio = 0.37, 95% CI: 0.14 to 0.96). CONCLUSIONS: HTC uptake was high during a home-based HTC campaign on Likoma Island, particularly among the poorest. Home-based HTC has the potential to significantly reduce existing socioeconomic gradients in HTC uptake and help mitigate the impact of AIDS on the most vulnerable households. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | STATISTICAL REGRESSION | LOW INCOME POPULATION | COUNSELING | HIV TESTING | HOME VISITS | UTILIZATION OF HEALTH CARE | HIV INFECTIONS | PREVALENCE | ANTIRETROVIRAL THERAPY | INEQUALITIES | Africa | Developing Countries | Data Analysis | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Clinic Activities | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Communication | Viral Diseases | Diseases | Measurement | HIV Document Number: 341774 |
| 23. Peer Reviewed Title: Sexual partnerships in britain: characteristics differ by gender and predict likelihood of condom use. Author: Hollander D Source: Perspectives on Sexual and Reproductive Health. 2009 Mar;41(1):64-5. Abstract: Men and women in Britain report many differences in the characteristics of their heterosexual partnerships, and some differences in partnership characteristics are reflected in the likelihood of risky behavior. For example, men are more likely than women to have casual partners, and they are less likely than women to have partners of roughly their own age. Condom use is more likely in casual partnerships than within marriage; even so, the level of use in casual relationships suggests that many men and women are inadequately protected against the risk of STD infection. Additionally, condom use the first time a couple has sex is more likely if the partners are about the same age than if the male is five or more years older than the female. In nearly one-quarter of men's new partnerships, but only one in 10 of women's, first sex with a new partner occurs within 24 hours after the couple's meeting. These are among the findings of an analysis based on data from Britain's 1999-2001 National Survey of Sexual Attitudes and Lifestyles.1 The survey was based on a stratified probability sample of more than 11,000 British residents aged 16-44, who participated in face-to-face interviews and computer-assisted self-interviews. A total of 9,598 respondents reported having had at least one heterosexual partner in the past year; investigators used data on this subsample to study partnership formation, and they employed logistic regression to assess associations between partnership characteristics and condom use. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | SEXUAL PARTNERS | CONDOM USE | SEX FACTORS | SEX BEHAVIOR | MARITAL STATUS | AGE FACTORS | CONTRACEPTIVE PREVALENCE | Developed Countries | Europe, Western | Europe | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Behavior | Risk Reduction Behavior | Population Characteristics | Demographic Factors | Population | Nuptiality | Contraceptive Usage | Contraception | Family Planning Document Number: 330702 |
| 24. Peer Reviewed Title: Sex preference as a determinant of contraceptive use in matrilineal societies: a study on the Garo of Bangladesh. Author: Islam MA; Islam MR; Banowary B Source: European Journal of Contraception and Reproductive Health Care. 2009 Aug;14(4):301-6. Abstract: OBJECTIVES: This paper explores the presence of sex preference and its influence on contraceptive use among the Garo, a matrilineal community, of Bangladesh. METHODS: In this study, 223 currently married Garo women were interviewed, selected purposively from two districts of Bangladesh, where most of the Garo people live. A binary logistic regression model was fitted to explore the determinants of current use of contraceptives among the Garo community. RESULTS: About 80% of the Garo women were currently using contraceptive methods, which was much higher than the contraceptive prevalence at the national level (55.8%). However, the use of modern male methods was very low in that community. Regression analysis revealed that the strong preference for girls was a significant determinant of contraceptive use. CONCLUSIONS: Even though the Garo apply contraception more than the Bangladeshi community in general, their strong preference for girls may restrain its success. Family planning information can be designed so as not to challenge the matrilineal structure of the society and both spouses counselled together to promote also modern male methods. Language: English Keywords: BANGLADESH | RESEARCH REPORT | STATISTICAL REGRESSION | ETHNIC GROUPS | CURRENTLY MARRIED | WOMEN | SEX PREFERENCE | CONTRACEPTIVE USAGE DETERMINANTS | MATRIARCHY | INTERVIEWS | SOCIOECONOMIC STATUS | Developing Countries | Asia, Southern | Asia | Data Analysis | Research Methodology | Cultural Background | Population Characteristics | Demographic Factors | Population | Marital Status | Nuptiality | Value Orientation | Psychological Factors | Behavior | Contraceptive Usage | Contraception | Family Planning | Family Characteristics | Family and Household | Sociocultural Factors | Data Collection | Socioeconomic Factors | Economic Factors Document Number: 342129 |
| 25. Peer Reviewed Title: Social stigma and knowledge of tuberculosis and HIV among patients with both diseases in Thailand. Author: Jittimanee SX; Nateniyom S; Kittikraisak W; Burapat C; Akksilp S; Chumpathat N; Sirinak C; Sattayawuthipong W; Varma JK Source: PloS One. 2009;4(7):e6360. Abstract: INTRODUCTION: Disease-related stigma and knowledge are believed to be associated with patients' willingness to seek treatment and adherence to treatment. HIV-associated tuberculosis (TB) presents unique challenges, because TB and HIV are both medically complex and stigmatizing diseases. In Thailand, we assessed knowledge and beliefs about these diseases among HIV-infected TB patients. METHODS: We prospectively interviewed and examined HIV-infected TB patients from three provinces and one national referral hospital in Thailand from 2005-2006. At the beginning of TB treatment, we asked patients standardized questions about TB stigma, TB knowledge, and HIV knowledge. Responses were grouped into scores; scores equal to or greater than the median score of study population were considered high. Multiple logistic regression analysis was used to identify factors associated with scores. RESULTS: Of 769 patients enrolled, 500 (65%) reported high TB stigma, 177 (23%) low TB knowledge, and 379 (49%) low HIV knowledge. Patients reporting high TB stigma were more likely to have taken antibiotics before TB treatment, to have first visited a traditional healer or private provider, to not know that monogamy can reduce the risk of acquiring HIV infection, and to have been hospitalized at enrollment. Patients with low TB knowledge were more likely to have severe TB disease, to be hospitalized at enrollment, to be treated at the national infectious diseases referral hospital, and to have low HIV knowledge. Patients with low HIV knowledge were more likely to know a TB patient and to have low TB knowledge. DISCUSSION: We found that stigma and low disease-specific knowledge were common among HIV-infected TB patients and associated with similar factors. Further research is needed to determine whether reducing stigma and increasing TB and HIV knowledge among the general community and patients reduces diagnostic delay and improves patient outcomes. Language: English Keywords: THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | STATISTICAL REGRESSION | CLIENTS | HIV INFECTIONS | TUBERCULOSIS | STIGMA | KNOWLEDGE | INTERVIEWS | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | Data Analysis | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | Social Problems | Sociocultural Factors | Data Collection Document Number: 342222 |
| 26. Peer Reviewed Title: Misclassification of first-line antiretroviral treatment failure based on immunological monitoring of HIV infection in resource-limited settings. Author: Kantor R; Diero L; Delong A; Kamle L; Muyonga S; Mambo F; Walumbe E; Emonyi W; Chan P; Carter EJ; Hogan J; Buziba N Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):454-62. Abstract: BACKGROUND: The monitoring of patients with human immunodeficiency virus (HIV) infection who are treated with antiretroviral medications in resource-limited settings is typically performed by use of clinical and immunological criteria. The early identification of first-line antiretroviral treatment failure is critical to prevent morbidity, mortality, and drug resistance. Misclassification of failure may result in premature switching to second-line therapy. METHODS: Adult patients in western Kenya had their viral loads (VLs) determined if they had adhered to first-line therapy for >6 months and were suspected of experiencing immunological failure (ie, their CD4 cell count decreased by 25% in 6 months). Misclassification of treatment failure was defined as a 25% decrease in CD4 cell count with a VL of <400 copies/mL. Logistic and tree regressions examined relationships between VL and 4 variables: CD4 T cell count (hereafter CD4 cell count), percentage of T cells expressing CD4 (hereafter CD4 cell percentage), percentage decrease in the CD4 T cell count (hereafter CD4 cell count percent decrease), and percentage decrease in the percentage of T cells expressing CD4 (hereafter CD4% percent decrease). RESULTS: There were 149 patients who were treated for 23 months; they were identified as having a 25% decrease in CD4 cell count (from 375 to 216 cells/microL) and a CD4% percent decrease (from 19% to 15%); of these 149 patients, 86 (58%) were misclassified as having experienced treatment failure. Of 42 patients who had a 50% decrease in CD4 cell count, 18 (43%) were misclassified. In multivariate logistic regression, misclassification odds were associated with a higher CD4 cell count, a shorter duration of therapy, and a smaller CD4% percent decrease. By combining these variables, we may be able to improve our ability to predict treatment failure. CONCLUSIONS: Immunological monitoring as a sole indicator of virological failure would lead to a premature switch to valuable second-line regimens for 58% of patients who experience a 25% decrease in CD4 cell count and for 43% patients who experience a 50% decrease in CD4 cell count, and therefore this type of monitoring should be reevaluated. Selective virological monitoring and the addition of indicators like trends CD4% percent decrease and duration of therapy may systematically improve the identification of treatment failure. VL testing is now mandatory for patients suspected of experiencing first-line treatment failure within the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya, and should be considered in all resource-limited settings. Language: English Keywords: KENYA | RESEARCH REPORT | CLASSIFICATION | STATISTICAL REGRESSION | ADULTS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | MONITORING | ANTIRETROVIRAL DRUGS | TIME FACTORS | DRUG RESISTANCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 342630 |
| 27. Peer Reviewed Title: HPV infection in women with and without cervical cancer in Conakry, Guinea. Author: Keita N; Clifford GM; Koulibaly M; Douno K; Kabba I; Haba M; Sylla BS; van Kemenade FJ; Snijders PJ; Meijer CJ; Franceschi S Source: British Journal of Cancer. 2009 Jul 7;101(1):202-8. Abstract: BACKGROUND: Cervical cancer incidence in western Africa is among the highest in the world. METHODS: To investigate human papillomavirus (HPV) infection in Guinea, we obtained cervical specimens from 831 women aged 18-64 years from the general population of the capital Conakry and from 77 locally diagnosed invasive cervical cancers (ICC). Human papillomavirus was detected using a GP5+/6+ PCR-based assay. RESULTS: Among the general population, the prevalence of cervical abnormalities was 2.6% by visual inspection and 9.5% by liquid-based cytology. Fourteen of 15 high-grade squamous intraepithelial lesions were visual inspection-negative. Human papillomavirus prevalence was 50.8% (32.1% for high-risk types) and relatively constant across all age groups. Being single or reporting > or =3 sexual partners was significantly associated with HPV positivity. HPV16 was the most common type, both among the general population (7.3%) and, notably in ICC (48.6%). HPV45 (18.6%) and HPV18 (14.3%), the next most common types in ICC, were also more common in ICC than in HPV-positive women with normal cytology from the general population. CONCLUSION: The heavy burden of HPV infection and severe cervical lesions in Guinean women calls for new effective interventions. Sixty-three per cent of cervical cancers are theoretically preventable by HPV16/18 vaccines in Guinea; perhaps more if some cross-protection exists with HPV45. Language: English Keywords: GUINEA | RESEARCH REPORT | STATISTICAL REGRESSION | WOMEN | HPV | CERVICAL CANCER | PREVALENCE | PELVIC EXAM | CYTOLOGY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | Demographic Factors | Population | Viral Diseases | Diseases | Cancer | Neoplasms | Measurement | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology Document Number: 341991 |
| 28. Title: Risk-taking behaviour is more frequent in teenage girls with multiple sexual partners. Author: Kuortti M; Kosunen E Source: Scandinavian Journal of Primary Health Care. 2009;27(1):47-52. Abstract: OBJECTIVE: To investigate associations between sexual behaviour and risk-taking health behaviour among adolescent females in our changing sexual culture. DESIGN: A questionnaire study. Girls who had had multiple sexual partners (at least five in their lifetime or four during the last six months) were compared with those with fewer partners. Logistic regression was applied. SETTING: The Adolescent Clinic, a primary healthcare unit in the city of Tampere, Finland. SUBJECTS: A sample of 247 female clients aged 15-18 years who had experienced sexual intercourse. MAIN OUTCOME MEASURES: Contraceptive practices, substance use, and sexual attitudes. RESULTS: Girls with multiple sexual partners (n = 69) and the reference group (n = 178) did not differ from each other significantly by age, age at menarche, or educational status. In univariate analysis, age at sexual debut, contraceptive practices, and various substance uses were strongly associated with having multiple sexual partners. Ever-use of emergency contraception was marginally associated, while ever-use of conventional hormonal contraception or condoms was not. In multivariate analysis, low age at sexual debut (OR 8.75 for age 11-13), omitting contraception at the most recent intercourse (OR 3.48), ever-use of withdrawal as a contraceptive method (OR 2.34), and repeated use of drugs (OR 4.10) were associated with having multiple sexual partners. CONCLUSION: Different types of risk-taking behaviour are still interlinked. In discussions with adolescents showing one type of risk behaviour health service providers should make an effort to identify other modes of risk-taking. Language: English Keywords: FINLAND | RESEARCH REPORT | KAP SURVEYS | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | CASE CONTROL STUDIES | ADOLESCENTS, FEMALE | MULTIPLE PARTNERS | SEX BEHAVIOR | RISK BEHAVIOR | FIRST INTERCOURSE | ATTITUDES | DRUG USE AND ABUSE | CONTRACEPTIVE USAGE | CONDOM USE | Europe, Northern | Europe | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sexual Partners | Behavior | Psychological Factors | Contraception | Family Planning | Risk Reduction Behavior Document Number: 330352 |
| 29. Peer Reviewed Title: HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey. Author: Kyobutungi C; Ezeh AC; Zulu E; Falkingham J Source: BMC Public Health. 2009 May 27;9(1):153. Abstract: ABSTRACT: BACKGROUND: The proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums. METHODS: Data were collected from residents of the Nairobi Urban Health and Demographic Surveillance area, who on 1st October 2006, were 50 years and older. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures - self-rated health and a composite health score - were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: "How have you been personally affected by HIV/AIDS?" was asked. Ordinal logistic regression was used in models with self-rated health and linear regression in models with the health score. RESULTS: About 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9). Females reported worse health outcomes than males. Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t=3.21), and an adjusted odds ratio of reporting "poor health" of 1.42 (95%CI: 1.12-1.80). CONCLUSION: Poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional roles. Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | STATISTICAL REGRESSION | KAP SURVEYS | HEALTH SURVEYS | OLDER ADULTS | SLUMS | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | SEX FACTORS | SELF-PERCEPTION | AIDS | HIV INFECTIONS | HEALTH POLICY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Surveys | Sampling Studies | Studies | Health | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Viral Diseases | Diseases | Perception | Psychological Factors | Behavior | Policy | Political Factors | Sociocultural Factors Document Number: 341484 |
| 30. Peer Reviewed Title: Retroviral infection in Peruvian men who have sex with men. Author: La Rosa AM; Zunt JR; Peinado J; Lama JR; Ton TG; Suarez L; Pun M; Cabezas C; Sanchez J Author: Peruvian HIV Sentinel Surveillance Working Group Source: Clinical Infectious Diseases. 2009 Jul 1;49(1):112-7. Abstract: We tested 2655 Peruvian men who have sex with men for the presence of |