1.  Peer Reviewed Title: Safety analysis of the diaphragm in combination with lubricant or acidifying microbicide gels: effects on markers of inflammation and innate immunity in cervicovaginal fluid. Author: Anderson DJ; Williams DL; Ballagh SA; Barnhart K; Creinin MD; Newman DR; Bowman FP; Politch JA; Duerr AC; Jamieson DJ Source: American Journal of Reproductive Immunology. 2009 Feb;61(2):121-9. Abstract: OBJECTIVE: Diaphragms are being considered for use with vaginal microbicide gels to provide enhanced protection against sexually transmitted pathogens. The purpose of this study was to determine whether use of a diaphragm with microbicide or placebo gel causes cervicovaginal inflammation or perturbations in cervicovaginal immune defense. METHOD OF STUDY: Eighty-one non-pregnant women were randomized into three groups and instructed to use Milex (CooperSurgical, Inc., Trumbull, CT, USA)diaphragms overnight for 14 days in combination with one of the two acid-buffering microbicide gels [ACIDFORM (Instead Inc., La Jolla, CA, USA) or BufferGel(trade mark) (BG; ReProtect Inc., Baltimore, Maryland)] or placebo gel (K-Y Jelly); Personal Products Inc., Raritan, NJ, USA). Cervicovaginal lavages (CVLs) were performed prior to study entry and on days 8 and 16. Nine soluble mediators of vaginal inflammation or immune defense were measured in CVLs by Bio-Plex or ELISA. RESULTS: Use of diaphragms with placebo ormicrobicide gel was not associated with increased levels of inflammation markers. Concentrations of secretory leukocyte protease inhibitor (SLPI) were markedly reduced in the BG group. CONCLUSION: Daily use of a diaphragm with placebo or acidifying microbicide gel did not cause cervicovaginal inflammation. However, diaphragm/BG use was associated with markedly reduced levels of SLPI, an important mediator of innate immune defense. Further studies are warranted to establish the safety of diaphragm/microbicide gel combinations. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | CASE CONTROL STUDIES | MICROBICIDES | VAGINAL GEL | LUBRICANTS | IMMUNITY, NATURAL | CONTRACEPTIVE SAFETY | VAGINAL DIAPHRAGM | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Studies | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Ingredients and Chemicals | Immunity | Immune System | Physiology | Biology | Safety | Public Health | Vaginal Barrier Methods | Barrier Methods Document Number: 330234 |
| 2. Peer Reviewed Title: High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits. Author: Cohee L; Mills LA; Kagaayi J; Jacobs I; Galiwango R; Ludigo J; Ssekasanvu J; Reynolds SJ Source: Malaria Journal. 2009;8:76. Abstract: BACKGROUND: Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized. METHODS: 142 randomly selected adults were interviewed in July-August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda. RESULTS: Among all participants, 102 (72%, CI: 65%-79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given >or= 1 ITN, 128 (98%, CI: 96%-100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%-96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%-94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes. CONCLUSION: There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources. Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | HOUSEHOLDS | RURAL POPULATION | PESTICIDES | BED NETS | HOME VISITS | HIV INFECTIONS | MALARIA PREVENTION | KNOWLEDGE | PARTICIPATION | PROGRAM EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Population Characteristics | Demographic Factors | Population | Ingredients and Chemicals | Parasite Control | Public Health | Health | Communication | Malaria | Parasitic Diseases | Social Behavior | Behavior | Programs | Organization and Administration Document Number: 341152 |
| 3. 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 |
| 4. Peer Reviewed Title: In vitro testing of rationally designed spermicides for selectively targeting human sperm in vagina to ensure safe contraception. Author: Jain RK; Jain A; Maikhuri JP; Sharma VL; Dwivedi AK; Kumar ST; Mitra K; Bajpai VK; Gupta G Source: Human Reproduction. 2009 Mar;24(3):590-601. Abstract: BACKGROUND: Rational synthesis of novel structures resulted in two unique molecules (DSE-36 and DSE-37, disulphide esters of carbothioic acid) that killed sperm 25 times more strongly and with a precisely targeted action than nonoxynol-9 (N-9). We examine the effects of DSE-36 and DSE-37 on human spermatozoa versus HeLa cells to establish specificity and safety compared with N-9. METHODS AND RESULTS: At spermicidal EC(100) (20 microg/ml) DSE-36 and DSE-37 killed 100% sperm in <30 s (Sander-Cramer assay) and at EC(50) induced apoptosis in sperm (Annexin-V-fluorescein isothiocyanate and JC-1 labelling and Flow Cytometry) in 3 h. However, at EC(100) these molecules had no effect on HeLa cells by 24 h or on cell viability [3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay], surface ultrastructure (scanning electron microscopy), Annexin-V and JC-1 labelling pattern and reactive oxygen species (ROS) generation. N-9, with a spermicidal EC(100) of 500 microg/ml, decreased HeLa cell viability at 20 microg/ml in 24 h (P < 0.001), accompanied by acute damage to cell surface ultrastructural topography, induction of apoptosis and ROS generation. Unlike DSE-36 and DSE-37, N-9 also significantly induced mRNA levels (RT-PCR) of pro-inflammatory biomarkers (interleukin (IL)-1 alpha, IL-6, IL-8, RANTES) in HeLa cells and increased IL-6 and IL-8 secretion (P < 0.001, enzyme-linked immunosorbent assay). Furthermore, DSE-36 and DSE-37 did not inhibit Lactobacillus growth at EC(100) and exhibited mild microbicidal activity against Trichomonas vaginalis, while N-9 inhibited Lactobacillus and Trichomonas growth but had a lower prophylactic index. CONCLUSIONS: The ability of these novel spermicides to kill sperm almost instantaneously at innocuously low concentration indicates their worth as improved active ingredients for vaginal contraceptive preparations compared with N-9. Language: English Keywords: INDIA | RESEARCH REPORT | WOMEN | SPERMICIDAL CONTRACEPTIVE AGENTS | CONTRACEPTION | NONOXYNOL | CONTRACEPTIVE SAFETY | VAGINAL APPROACH | PROGRAM EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Demographic Factors | Population | Contraceptive Agents | Family Planning | Alcohols | Organic Chemicals | Ingredients and Chemicals | Safety | Public Health | Health | Female Sterilization | Sterilization, Sexual | Program Evaluation | Programs | Organization and Administration Document Number: 342583 |
| 5. Peer Reviewed Title: Marked increase in child survival after four years of intensive malaria control. Author: Kleinschmidt I; Schwabe C; Benavente L; Torrez M; Ridl FC; Segura JL; Ehmer P; Nchama GN Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):882-8. Abstract: In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with Plasmodium falciparum. Four years after high coverage, multiple malaria control interventions were introduced on Bioko Island, Equatorial Guinea, changes in infection with malarial parasites, anemia, and fever history in children were estimated and assessed in relation to changes in all-cause under-5 mortality. There were reductions in prevalence of infection (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.2-0.46), anemia (OR = 0.11, 95% CI = 0.07-0.18), and reported fevers (OR = 0.41, 95% CI = 0.22-0.76) in children. Under-5 mortality fell from 152 per 1,000 births (95% CI = 122-186) to 55 per 1,000 (95% CI = 38-77; hazard ratio = 0.34 [95% CI = 0.23-0.49]). Effective malaria control measures can dramatically increase child survival and play a key role in achieving millennium development goals. Language: English Keywords: EQUATORIAL GUINEA | RESEARCH REPORT | SAMPLING STUDIES | CHILD SURVIVAL | INTERVENTIONS | MALARIA PREVENTION | ANTIMALARIAL DRUGS | PESTICIDES | BED NETS | IEC | MONITORING | CHILD MORTALITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration | Malaria | Parasitic Diseases | Diseases | Ingredients and Chemicals | Parasite Control | Public Health | Health | Program Activities | Evaluation Document Number: 341764 |
| 6. Peer Reviewed Title: Insecticide-treated net coverage in Africa: mapping progress in 2000-07. Author: Noor AM; Mutheu JJ; Tatem AJ; Hay SI; Snow RW Source: Lancet. 2009 Jan 3;373(9657):58-67. Abstract: BACKGROUND: Insecticide-treated bednets (ITNs) provide a means to improve child survival across Africa. Sales figures of these nets and survey coverage data presented nationally mask inequities in populations at biological and economic risk, and do not allow for precision in the estimation of unmet commodity needs. We gathered subnational ITN coverage sample survey data from 40 malaria-endemic countries in Africa between 2000 and 2007. METHODS: We computed the projected ITN coverage among children aged less than 5 years for age-adjusted population data that were stratified according to malaria transmission risks, proximate determinants of poverty, and methods of ITN delivery. FINDINGS: In 2000, only 1.7 million (1.8%) African children living in stable malaria-endemic conditions were protected by an ITN and the number increased to 20.3 million (18.5%) by 2007 leaving 89.6 million children unprotected. Of these, 30 million were living in some of the poorest areas of Africa: 54% were living in only seven countries and 25% in Nigeria alone. Overall, 33 (83%) countries were estimated to have ITN coverage of less than 40% in 2007. On average, we noted a greater increase in ITN coverage in areas where free distribution had operated between survey periods. INTERPRETATION: By mapping the distribution of populations in relation to malaria risk and intervention coverage, we provide a means to track the future requirements for scaling up essential disease-prevention strategies. The present coverage of ITN in Africa remains inadequate and a focused effort to improve distribution in selected areas would have a substantial effect on the continent's malaria burden. Language: English Keywords: AFRICA | RESEARCH REPORT | LONGITUDINAL STUDIES | HEALTH SURVEYS | CHILDREN | HUMAN GEOGRAPHY | BED NETS | PESTICIDES | CHILD SURVIVAL | INEQUALITIES | MALARIA PREVENTION | MAPS | Developing Countries | Studies | Research Methodology | Health | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Geography | Social Sciences | Science | Sociocultural Factors | Parasite Control | Public Health | Ingredients and Chemicals | Survivorship | Length of Life | Mortality | Population Dynamics | Socioeconomic Factors | Economic Factors | Malaria | Parasitic Diseases | Diseases Document Number: 330036 |
| 7. Peer Reviewed Title: Free distribution of insecticide treated bed nets to pregnant women in Kinshasa: an effective way to achieve 80% use by women and their newborns. Author: Pettifor A; Taylor E; Nku D; Duvall S; Tabala M; Mwandagalirwa K; Meshnick S; Behets F Source: Tropical Medicine and International Health. 2009 Jan;14(1):20-8. Abstract: OBJECTIVE: To determine whether long lasting insecticide treated bed nets (LLINs) distributed free of charge to pregnant women at their first antenatal clinic visit in Kinshasa, DRC are used from the time of distribution to delivery and 6 months after delivery. METHODS: Women were enrolled into a cohort study at their first antenatal care (ANC) visit and provided LLINs free of charge. Reported use of these nets was then measured at the time of delivery (n = 328) and in a random sample of women (n = 100) 6 months post-delivery using an interviewer administered, structured questionnaire. RESULTS: At baseline, only 25% of women reported having slept under a bed net the night before the interview. At the time of delivery, after being provided an LLIN for free, this increased to 79%. Six months post-delivery (n = 100), 80% of women reported sleeping under a net with a child under the age of 5 the night before the interview. CONCLUSIONS: Freely distributed bed nets are acceptable, feasible and result in high usage. Free distribution of bed nets during antenatal clinic visits may be a highly effective way to rapidly increase the use of bed nets among both pregnant women and their newborn infants in areas with high levels of ANC attendance. Language: English Keywords: REPUBLIC OF THE CONGO | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | INFANT | MOTHERS | PREGNANT WOMEN | PESTICIDES | BED NETS | PRICES | DISTRIBUTIONAL ACTIVITIES | ANTENATAL CARE | PREVALENCE | MALARIA PREVENTION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Ingredients and Chemicals | Parasite Control | Public Health | Health | Commerce | Macroeconomic Factors | Program Activities | Programs | Organization and Administration | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Measurement | Malaria | Parasitic Diseases | Diseases Document Number: 330250 |
| 8. Title: Young women's use of a vaginal microbicide surrogate: the role of individual and contextual factors in acceptability and sexual pleasure. Author: Tanner AE; Zimet G; Fortenberry JD; Reece M; Graham C; Murray M Source: Journal of Sex Research. 2009 Jan-Feb;46(1):15-23. Abstract: Currently in clinical trials, microbicides have historically been promoted as a woman-controlled (although more recently woman initiated) method of sexually transmitted infection (STI) prevention. The contradicition that exists in this rationale is that women's bodies, specifically the genitals, have been constructed as a negotiated space within sexual interactions. This study qualitatively explored the factors influencing 40 young women's use of a vaginal moisturizer (VM), utilized as a microbicide surrogate. The results indicated that use of the VM was dependent upon product characteristics (i.e., the lubricating qualities affect on sexual pleasure, timing of insertion), individual factors (i.e., reproductive health goals, experiences with side effects of existing contraceptive methods), and contextual factors (i.e., social norms). An understanding of these bodily and social issues may be beneficial in designing targeted educational campaigns and effective instructional materials as well as in facilitating positive dialogue around women's bodies and their sexuality. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | WOMEN | URBAN POPULATION | MICROBICIDES | ACCEPTANCE PROCESS | SATISFACTION | SEX BEHAVIOR | LUBRICANTS | VAGINAL GEL | TIME FACTORS | SIDE EFFECTS | VALUE ORIENTATION | SEXUALITY | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Population Characteristics | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Decision Making | Behavior | Psychological Factors | Ingredients and Chemicals | Vaginal Spermicides | Contraceptive Methods | Contraception | Family Planning | Population Dynamics | Personality Document Number: 341137 |
9.  Title: Plasmodium falciparum containment strategy. Author: Agrawal VK Source: MJAFI. Medical Journal Armed Froces India. 2008;64(1):57-60. Abstract: World Health Organization (WHO) estimates 1.7-2.5 million deaths and 300-500 million cases of malaria each year globally. As an initiative WHO has announced Roll Back Malaria (RBM) programme aimed at 50% reduction in deaths due to malaria by 2010. The RBM strategy recommends combination approach with prevention, care, creating sustainable demand for insecticide treated nets (ITNs) and efficacious antimalarials in order to achieve sustainable malaria control. Malaria control in India has travelled a long way from National Malaria Control Programme launched in 1953 to National Vector Borne Diseases Control Programme in 2003. In India, the malaria eradication concept was based on indoor residual spraying to interrupt transmission and mop up cases by vigilance. This programme was successful in reducing the malaria cases from 75 million in 1953 to 2 million but subsequently resulted in vector and parasite resistance as well as increase in P falciparum from 30-48%. In view of rapidly growing resistance of Plasmodium falciparum to conventional monotherapies and its spread in newer areas, the programme was modified with inclusion of RBM interventions and revision of treatment guidelines for malaria. Early case detection and prompt treatment, selective vector control, promotion of personal protective measures including ITNs and information, education, communication to achieve wider community participation will be the key interventions in the revised programme. (author's) Language: English Keywords: INDIA | PROGRESS REPORT | EVALUATION | TARGET POPULATION | MALARIA PREVENTION | WHO | VECTOR CONTROL | INSECTS | PESTICIDES | PARASITE CONTROL | DRUG RESISTANCE | LABORATORY EXAMINATIONS AND DIAGNOSES | PROMOTION | HEALTH EDUCATION | ANTIMALARIAL DRUGS | Developing Countries | Asia, Southern | Asia | Program Design | Programs | Organization and Administration | Malaria | Parasitic Diseases | Diseases | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Ingredients and Chemicals | Public Health | Health | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Examinations and Diagnoses | Marketing | Economic Factors | Education Document Number: 325623 |
| 10. Peer Reviewed Title: Malaria transmission and rice cultivation in Lagdo, northern Cameroon. Author: Antonio-Nkondjio C; Atangana J; Ndo C; Awono-Ambene P; Fondjo E Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Apr;102(4):352-359. Abstract: Cross-sectional entomological surveys were carried out during the 2006 dry and rainy seasons in Lagdo, Cameroon to measure the impact of rice cultivation on malaria transmission and to monitor vector susceptibility to insecticides. Adult anopheline mosquitoes were captured on human volunteers and by pyrethrum spray collections. A total of 4740 mosquitoes was collected during the study. Anopheles arabiensis was the major species and the main malaria vector in all study sites, followed by A. funestus. Malaria transmission was high in the non-irrigated zone of Mayo Mbocki, whereas in the irrigated area of Gounougou it was below detection level during the dry season and high during the rainy season. Insecticide susceptibility tests performed on A. gambiae s.l. populations detected resistance to lambdacyhalothrin and to a lower extent to deltamethrin. All survivors were A. arabiensis. None of the surviving mosquitoes carried the kdr mutation, suggesting an alternative resistance mechanism. (author's) Language: English Keywords: CAMEROON | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | AGRICULTURAL WORKERS | MALARIA | TRANSMISSION | AGRICULTURE | INSECTS | PESTICIDES | DRUG RESISTANCE | VECTOR CONTROL | IRRIGATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Labor Force | Human Resources | Economic Factors | Parasitic Diseases | Diseases | Infections | Macroeconomic Factors | Disease Transmission Control | Prevention and Control | Ingredients and Chemicals | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 325274 |
| 11. Peer Reviewed Title: Assessment of human health risk from organochlorine pesticide residues in Cidade dos Meninos, Duque de Caxias, Rio de Janeiro, Brazil. Author: Asmus CI; Alonzo HG; Palacios M; Silva AP; Filhote MI Source: Cadernos de Saude Publica. 2008 Apr;24(4):755-766. Abstract: This article presents the results of a heath risk assessment in Cidade dos Meninos, an area contaminated with organochlorine pesticide residues located in the county (municipality) of Duque de Caxias, Rio de Janeiro State, Brazil. The Agency for Toxic Substances and Disease Registry (ATSDR) risk assessment methodology was applied. The following organochlorine compounds exceeded the established limits and were considered target pollutants: HCH and its isomers (in eggs, milk, and soil); DDT and its metabolites; trichlorobenzenes; trichlorophenols; dioxins and furans (eggs and soil). For all the substances studied (with the exception of trichlorophenols), the estimated doses exceeded the minimum risk levels for chronically exposed children and adults. According to the ATSDR classification, the area was considered an "urgent public health hazard" because of its high and serious exposure to substances that are dangerous to human health. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | POPULATION | PESTICIDES | EXPOSURE | ENVIRONMENTAL POLLUTION | RISK ASSESSMENT | HEALTH | TOXICITY | South America, Eastern | South America | Latin America | Americas | Developing Countries | Ingredients and Chemicals | Risk Factors | Biology | Environmental Degradation | Environment | Evaluation | Physiology Document Number: 326494 |
| 12. Peer Reviewed Title: Gay community to test HIV prevention pill. Author: Bateman C Source: South African Medical Journal. 2008 Sep;98(9):660-1. Abstract: The recruiting of 200 HIV-negative Capetonian men who have sex with men (MSM) has begun for a (unique in Africa) clinical trial of a once-daily preexposure prophylactic ARV pill. The 'proof of concept' study which kicked off locally in August this year, is part of a 2-year global study of 3 000 high-risk volunteers that hopes to add the 'HIV prevention pill' as a potent weapon to the woefully inadequate traditional prevention arsenal. The multicentre international study has already commenced in South and North America. (excerpt) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | PILOT PROJECTS | MEN HAVING SEX WITH MEN | MULTIPLE PARTNERS | LABORATORY ANIMALS | HIV PREVENTION | VACCINES | ANTIRETROVIRAL DRUGS | SAFER SEX | PREVALENCE | LUBRICANTS | CONDOM USE | SEXUALLY TRANSMITTED DISEASES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Studies | Sex Behavior | Behavior | Sexual Partners | HIV Infections | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Measurement | Ingredients and Chemicals | Risk Reduction Behavior | Reproductive Tract Infections | Infections Document Number: 330316 |
| 13. Peer Reviewed Title: Use of insecticide treated nets by pregnant women and associated factors in a pre-dominantly rural population in northern Ethiopia. Author: Belay M; Deressa W Source: Tropical Medicine and International Health. 2008 Oct;13(10):1303-13. Abstract: OBJECTIVE: To describe the use of insecticide treated nets (ITNs) among pregnant women and examine factors associated with its access and use. METHODS: Community-based cross-sectional study of 815 pregnant women in eight malarious kebeles in northern Ethiopia based on two-stage cluster design from May to June 2006. Knowledge on malaria, its cause and preventive measures; treatment seeking behaviour; possession and use of ITNs by pregnant women and under-five children were ascertained through interview and observation. Logistic regression was used to determine factors associated with ITNs use. RESULTS: Knowledge about the cause, transmission and preventive measures of malaria was relatively good; 90.2% of women associated malaria with mosquito bites and 94.2% with living near water ponds. Ten per cent reported malaria illness within the 14 days before the survey, and sought treatment mainly from public health facilities (56.5%) and community health workers (37.6%). Of 815 households surveyed, 59% owned at least one non-long lasting or long-lasting ITN (59.5% rural vs. 54.5% urban; P = 0.401). Lack of access to ITNs (68.3%) and the perception that nets could not prevent malaria (27%) were the main reasons for non-ownership of nets. A total of 58.4% of 481 pregnant women from households owning at least one ITN had slept under it during the previous night. Fewer rural (56.7%) than urban women (76.2%) used ITNs (P = 0.001). In 57.6% of households with at least one ITN, under-five children had used it the night before. Higher educational attainment was an important predictor of ITNs use (OR = 3.1, 95% CI = 2.1, 4.6). CONCLUSIONS: Household ownership of ITNs and their use by pregnant women is promising with the current efforts to scale-up ITNs implementation, but the gap between ownership and use remains high. Consistent and proper use of nets by pregnant women should be ensured through information campaigns. Rapid expansion of access to long lasting ITNs requires that government and NGOs supply them in adequate numbers. Language: English Keywords: ETHIOPIA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | CHILDREN | MALARIA PREVENTION | BED NETS | PESTICIDES | UTILIZATION OF HEALTH CARE | CHILD SURVIVAL | ENVIRONMENT | PERCEPTION | COMMUNITY HEALTH SERVICES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Malaria | Parasitic Diseases | Diseases | Parasite Control | Public Health | Health | Ingredients and Chemicals | Health Services | Delivery of Health Care | Survivorship | Length of Life | Mortality | Population Dynamics | Psychological Factors | Behavior | Primary Health Care Document Number: 329363 |
| 14. Title: Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. Author: Cayan F; Dilek U; Pata O; Dilek S Source: Journal of Sexual Medicine. 2008 Jan;5(1):132-138. Abstract: Sexual dysfunction is more prevalent in postmenopausal women. The aims were to prospectively evaluate and compare the effects of hormone therapy (HT) regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. The study included 169 consecutive healthy postmenopausal women, and the women were divided into two groups: 111 women received HT, and 58 women received no treatment and served as a control group. As an HT, 23 women with surgically induced menopause received oral 17-b estradiol. The rest of the women with natural menopause were prospectively randomized: 22 received oral 17-b estradiol + drospirenone daily, 42 received oral tibolone, and 24 received vaginal 17-b estradiol. Sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index, including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. The differences in sexual function were compared before and 6 months after the treatment in all women. Total sexual function score increased from 19.81 +or- 7.15 to 22.9 +or- 6.44 in the HT group and decreased from 21.6 +or- 8.69 to 17.6 +or- 5.7 in the control group, revealing a significant difference from baseline to post-treatment between the two groups (P = 0.000). The highest improvement in total score and arousal was achieved with the oral 17-Beta estradiol (P = 0.000 and P = 0.000, respectively). The highest improvement in lubrication was achieved with the oral and vaginal 17-Beta estradiol groups (P = 0.000). The highest improvement in orgasm was achieved with the tibolone group (P = 0.000). The highest improvement in pain was achieved with the oral and vaginal 17-Beta estradiol groups (P = 0.000). HT provided significant improvement in sexual function compared to women receiving no treatment, and therefore, HT regimens should be suggested for improvement in sexual functioning of postmenopausal women. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | PROSPECTIVE STUDIES | CASE CONTROL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | KAP SURVEYS | WOMEN | HORMONE REPLACEMENT THERAPY | MENOPAUSE | ESTRADIOL | SEX BEHAVIOR | LUBRICANTS | SATISFACTION | PAIN | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Estrogens | Hormones | Endocrine System | Physiology | Biology | Behavior | Ingredients and Chemicals | Psychological Factors | Signs and Symptoms | Diseases Document Number: 323235 |
| 15. Peer Reviewed Title: Can intrauterine contraceptive devices be a Candida albicans reservoir? Author: Chassot F; Negri MF; Svidzinski AE; Donatti L; Peralta RM Source: Contraception. 2008 May;77(5):355-359. Abstract: The in vitro adherence of Candida albicans isolated from vaginal exudates of patients with vulvovaginal candidiasis (VVC) to intrauterine contraceptive devices (IUDs) and biofilm formation capacity were evaluated. This research was conducted with two vaginal C. albicans isolates. The adherence on IUD by both radiomarked adhesion assay and scanning electron microscopy, and the biofilm production capacity by spectrophotometric method were determined. The yeasts adhered strongly to different parts of the IUD (covered with copper wire, without copper wire and tail), and there was no significant difference in the rates of adhesion to the different parts (p=.7771). The vaginal yeasts showed a high capacity to produce biofilm. Two vaginal yeasts evaluated showed a high capacity to produce biofilm on IUD. It was confirmed that all parts of the IUD allow the adherence of yeasts. The adherence of C. albicans to different parts of the IUD and its formation of biofilm seems to be important attributes influencing the occurrence of VVC and recurrent VVC. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | IUD, COPPER RELEASING | CANDIDIASIS | VAGINA | LABORATORY PROCEDURES | IN VITRO | IUD COMPLICATIONS | POLYETHYLENE | South America, Eastern | South America | Latin America | Americas | Developing Countries | IUD | Contraceptive Methods | Contraception | Family Planning | Bacterial and Fungal Diseases | Infections | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinical Research | Research Methodology | Polymers | Ingredients and Chemicals Document Number: 325973 |
| 16. Peer Reviewed Title: Factors determining the heterogeneity of malaria incidence in children in Kampala, Uganda. Author: Clark TD; Greenhouse B; Njama-Meya D; Nzarubara B; Maiteki-Sebuguzi C Source: Journal of Infectious Diseases. 2008 Aug 1;198:393-400. Abstract: Background. Malaria risk may be heterogeneous in urban areas of Africa. Identifying those at highest risk for malaria may lead to more targeted approaches to malaria control. Methods. A representative sample of 558 children aged 1-10 years were recruited from a census population in a single parish of Kampala and followed up for 2 years. Malaria was diagnosed when a child presented with a new episode of fever and a thick blood smear positive for parasites. Multivariate analysis was used to identify independent predictors of malaria incidence. Results. A total of 695 episodes of uncomplicated malaria were diagnosed after 901 person years of follow-up. Sickle cell trait (relative risk [RR], 0.68 [95% confidence interval {CI}, 0.52-0.90]), glucose-6-phosphate dehydrogenase deficiency in female children (RR, 0.48 [95% CI, 0.31-0.75]), and use of an insecticide-treated bed net (RR, 0.52 [95% CI, 0.32-0.83]) were associated with a lower risk of malaria. The distance of the subject's residence from a swamp bordering the parish showed a strong "dose-response" relationship; living in the swamp was the strongest predictor of malaria risk (RR, 3.94 [95% CI, 2.61-5.97]). Conclusion. Malaria incidence was highly heterogeneous in this urban cohort of children. Malaria control interventions in urban areas should target populations living in pockets of high malaria risk. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | LONGITUDINAL STUDIES | MULTIVARIATE ANALYSIS | CHILDREN | URBAN POPULATION | PREVALENCE | MALARIA | ANEMIA | INCIDENCE | RISK FACTORS | RESIDENCE CHARACTERISTICS | BED NETS | PESTICIDES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Data Analysis | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Measurement | Parasitic Diseases | Diseases | Biology | Population Distribution | Geographic Factors | Parasite Control | Public Health | Health | Ingredients and Chemicals Document Number: 327788 |
| 17. Title: Operational impact of DDT reintroduction for malaria control on Anopheles arabiensis in Mozambique. Author: Coleman M; Casimiro S; Hemingway J; Sharp B Source: Journal of Medical Entomology. 2008 Sep;45(5):885-90. Abstract: ABSTRACT With the increase in indoor residual spraying in many internationally and nationally funded malaria control programs, and affirmation by World Health Organization (WHO) that DDT is appropriate for use in the absence of longer lasting insecticide formulations in some malaria endemic settings, DDT has been reintroduced as a major malaria control intervention in Africa. Indoor residual spraying with DDT was reintroduced into Mozambique for malaria control in 2005, and it is increasingly becoming the main insecticide used for malaria vector control in Mozambique. The selection of DDT in Mozambique is evidence-based, taking account of the susceptibility of Anopheles arabiensis (Patton) and Anopheles gambiae (Giles) s.s. to all the available insecticide choices, as well as relative costs of the insecticide and the logistical costs of spraying. Before this time in Mozambique, DDT was replaced by h-cyhalothrin in 1993. Resistance occurred quickly to this insecticide, and in 2000 the pyrethroid was phased out and the carbamate bendiocarb was introduced. Low-level resistance was detected by biochemical assay to bendiocarb in 1999 in both Anopheles funestus (Giles) and An. arabiensis, although this was not evident in WHO bioassays of the same population. In the 2000-2006 surveys the levels of bendiocarb resistance had been selected to a higher level in An. arabiensis, with resistance detectable by both biochemical and WHO bioassay. The insecticide resistance monitoring program includes assessment of field populations by standard WHO insecticide susceptibility assays and biochemical assays. Monitoring was established in 1999, and it was maintained as part of an operational monitoring and evaluation program thereafter. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | EVALUATION | ANIMALS | MALARIA PREVENTION | PESTICIDES | VECTOR CONTROL | TIME FACTORS | COST EFFECTIVENESS | GENETICS | INSECTS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Natural Resources | Environment | Malaria | Parasitic Diseases | Diseases | Ingredients and Chemicals | Disease Transmission Control | Prevention and Control | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Quantitative Evaluation | Biology Document Number: 328901 |
| 18. Peer Reviewed Title: Utilization of a basic care and prevention package by HIV-infected persons in Uganda. Author: Colindres R; Mermin J; Ezati E; Kambabazi S; Buyungo P Source: AIDS Care. 2008 Feb;20(2):139-145. Abstract: Opportunistic infections are the leading cause of mortality among HIV-infected people. Several simple interventions prevent illness, prolong life, or prevent HIV transmission from HIV-infected people in Africa. These include: cotrimoxazole prophylaxis; insecticide-treated bed nets; supplies for household water treatment and safe storage; materials promoting family voluntary counselling and testing (VCT); and condoms. We provided these interventions to adults and children with HIV who were members of the AIDS Support Organization in Uganda. To evaluate use of this basic care and prevention package, we surveyed a representative sample of 112 clients of TASO in their homes. Among respondents, 95% reported taking cotrimoxazole everyday, 89% said they had slept under a bednet the night before, 65% reported current treatment of household drinking water, 89% of sexually active respondents reported using condoms, and 96% reported family use of VCT. Household observations verified that use of cotrimoxazole, bednets, and water treatment products were consistent with reported use. This evaluation suggests successful distribution and use of basic care and prevention services at an AIDS organization in Uganda. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | SUPPORT GROUPS | UTILIZATION OF HEALTH CARE | AIDS PREVENTION | BED NETS | PESTICIDES | HIV TESTING | COUNSELING | CONDOM USE | SANITATION | CONTRACEPTIVE PREVALENCE | HYGIENE | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Social Networks | Friends and Relatives | Family and Household | Sociocultural Factors | Health Services | Delivery of Health Care | Health | AIDS | Parasite Control | Public Health | Ingredients and Chemicals | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Clinic Activities | Program Activities | Programs | Organization and Administration | Risk Reduction Behavior | Behavior | Contraceptive Usage | Contraception | Family Planning Document Number: 324764 |
| 19. Peer Reviewed Title: Influence of mode of delivery at term on the neonatal respiratory morbidity. Author: Dehdashtian M; Riazi E; Aletayeb MH Source: Pakistan Journal of Medical Sciences. 2008 Jul-Sep;24(4):556-559. Abstract: Objective: Respiratory morbidity is an important complication of elective cesarean section. Our objective was to find out the incidence of respiratory distress in term neonates delivered by elective cesarean section and compare it with neonates delivered vaginally. Methodology: We evaluated one thousands infants delivered by elective cesarean section and normal vaginal delivery for respiratory distress. Results: Among 500 cesarean done, 27 (5.4%) neonates had respiratory distress and among 500 vaginal delivery infants, 8(1.6%) developed respiratory Distress (P<0.001). Conclusions: The odd ratio for neonatal respiratory distress was 3.38, almost threefold higher in cesarean section group than those delivered vaginally. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | INFANT | NEONATAL DISEASES AND ABNORMALITIES | RESPIRATORY INSUFFICIENCY | PREVALENCE | CESAREAN SECTION | CATECHOLAMINES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Pulmonary Effects | Physiology | Biology | Measurement | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Organic Chemicals | Ingredients and Chemicals Document Number: 341295 |
| 20. Peer Reviewed Title: Implementation of an oxygen concentrator system in district hospital paediatric wards throughout Malawi. Author: Enarson P; La Vincente S; Gie R; Maganga E; Chokani C Source: Bulletin of the World Health Organization. 2008 May;86(5):344-348. Abstract: Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in Malawi. The Child Lung Health Programme in Malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals' paediatric wards. Five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained. The setting was the paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi. Main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered. It is feasible to implement an oxygen system using concentrators throughout a low-income country. Oxygen delivery requires trained staff with necessary equipment and supplies. Regular maintenance and supervision are essential to ensure optimal utilization. (author's) Language: English Keywords: MALAWI | EVALUATION REPORT | CHILDREN | HOSPITAL PERSONNEL | HOSPITALS | PNEUMONIA | OXYGEN | EQUIPMENT AND SUPPLIES | TRAINING PROGRAMS | DISTRIBUTIONAL ACTIVITIES | LOGISTICS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Health Facilities | Pulmonary Effects | Physiology | Biology | Inorganic Chemicals | Ingredients and Chemicals | Medical Procedures | Medicine | Health Services | Education | Program Activities | Programs | Organization and Administration | Management Document Number: 326553 |
| 21. Title: Effect of dengue vector control interventions on entomological parameters in developing countries: a systematic review and meta-analysis. Author: Erlanger TE; Keiser J; Utzinger J Source: Medical and Veterinary Entomology. 2008 Sep;22(3):203-21. Abstract: The aim of this review was to compare the effects of different dengue vector control interventions (i.e. biological control, chemical control, environmental management and integrated vector management) with respect to the following entomological parameters: Breteau index (BI), container index (CI), and house index (HI). We systematically searched PubMed, ISI Web of Science, Science Direct, the Dengue Bulletin of the World Health Organization and reference lists of retrieved articles on dengue vector control interventions in developing countries. We extracted data on the effectiveness of different dengue vector control interventions (defined as the relative reduction of an entomological measure caused by the intervention compared with the control or pre-intervention phase) and calculated a measure of combined relative effectiveness, with 95% confidence intervals (95% c.i.). We identified 56 publications covering 61 dengue vector control interventions. Integrated vector management was found to be the most effective method to reduce the CI, HI and BI, resulting in random combined relative effectiveness values of 0.12 (95% c.i. 0.02-0.62), 0.17 (95% c.i. 0.02-1.28) and 0.33 (95% c.i. 0.22-0.48), respectively. Environmental management showed a relatively low effectiveness of 0.71 (95% c.i. 0.55-0.90) for the BI, 0.49 (95% c.i. 0.30-0.79) for the CI and 0.43 (95% c.i. 0.31-0.59) for the HI. Biological control (relative effectiveness for the CI: 0.18) usually targeted a small number of people (median population size: 200; range 20-2500), whereas integrated vector management focused on larger populations (median: 12 450; range: 210-9 600 000). In conclusion, dengue vector control is effective in reducing vector populations, particularly when interventions use a community-based, integrated approach, which is tailored to local eco-epidemiological and sociocultural settings and combined with educational programmes to increase knowledge and understanding of best practice. New research should assess the density-dependent effectiveness of each control measure in order to estimate whether reducing vector numbers has an impact on dengue transmission when populations are at a critical threshold. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | INSECTS | VECTOR CONTROL | DENGUE | PESTICIDES | INTEGRATED PROGRAMS | ENVIRONMENT | PROGRAM EFFECTIVENESS | COMMUNITY HEALTH SERVICES | Research Methodology | Disease Transmission Control | Prevention and Control | Diseases | Viral Diseases | Ingredients and Chemicals | Programs | Organization and Administration | Program Evaluation | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 329159 |
| 22. Peer Reviewed Title: Community factors affecting long-lasting impregnated mosquito net use for malaria control in Sri Lanka. Author: Fernando SD; Abeyasinghe RR; Galappaththy GN; Gunawardena N; Rajapakse LC Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Nov;102(11):1081-8. Abstract: The Anti Malaria Campaign distributed approximately 300,000 long-lasting impregnated nets (LLINs) to malaria-endemic areas in Sri Lanka during the years 2005 to 2007. We conducted a community-based cross-sectional survey among 2467 households distributed among the three major ethnic groups of Sri Lanka to study the perceptions and practices with regard to the use of LLINs in order to improve their use. In a majority of households the number of LLINs available was not sufficient for the number of people, although there was a small percentage of households that had excess nets. The information and advice given at the time of distribution regarding use of the nets differed amongst the three groups and was not consistent. Dissemination of this knowledge within the family was not observed. A relationship between knowledge regarding LLINs and reported practices on washing and drying of LLINs was found. It was noted that net shape may influence net use, with cone shaped nets being more popular. Efforts to increase knowledge on LLINs using behaviour change communication techniques would have more effectively contributed to achieve planned outcomes. Proper use of LLINs will undoubtedly contribute to further reduction of malaria in Sri Lanka. Language: English Keywords: SRI LANKA | RESEARCH REPORT | KAP SURVEYS | LONGITUDINAL STUDIES | CROSS SECTIONAL ANALYSIS | COMMUNITY | HOUSEHOLDS | MALARIA PREVENTION | BED NETS | PESTICIDES | LONGTERM EFFECTS | PERCEPTION | BEHAVIOR | KNOWLEDGE | ATTITUDES | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | Family and Household | Sociocultural Factors | Malaria | Parasitic Diseases | Diseases | Parasite Control | Public Health | Health | Ingredients and Chemicals | Time Factors | Population Dynamics | Demographic Factors | Psychological Factors Document Number: 330407 |
| 23. Title: Environmental contaminants and human infertility: Hypothesis or cause for concern? Author: Foster WG; Neal MS; Han MS; Dominguez MM Source: Journal of Toxicology and Environmental Health. 2008;11 Pt B:162-176. Abstract: Throughout the 1980s and 1990s the crude human birth rate (live births per 1000 population) declined, indicating reduced fertility and suggesting a potential decline in fecundity (the potential to conceive). Detection of environmental contaminants in human tissues, together with reports of a global decline in semen quality, further fueled speculation that human infertility rates are increasing and environmental toxicants are potentially important causal agents associated with this change. However, there is little compelling evidence to suggest that infertility rates amongst the general population have changed over time. Moreover, recent studies suggest a rise in the fertility rates. While several studies documented increased time to pregnancy (TTP) in exposed study populations, other investigators were not able to replicate these findings. Nevertheless, studies involving occupational exposure together with results from animal experiments lend support to the conclusion that environmental contaminants potentially adversely affect fertility. Consequently, the impact of exposure to environmental contaminants on human fertility remains controversial. To test the hypothesis that environmental contaminant exposure was associated with enhanced risk of infertility, data concerning trends in fertility and infertility rates were examined to assess the impact of exposure of developing gametes to environmental contaminants. The relationship between exposure and reproductive outcomes was then examined to illustrate the range of adverse effects for reproductive toxicants with data sets of divergent depth and reliability. Data showed that only a weak association between exposure to environmental contaminants and adverse effects on human fertility exists. However, it is postulated that evidence of chemical exposure and potential health consequences of these exposures highlight the need for further research in this area. (author's) Language: English Keywords: CANADA | LITERATURE REVIEW | INFERTILITY | RISK FACTORS | ENVIRONMENTAL POLLUTION | FERTILITY RATE | FECUNDITY | GERM CELLS | PESTICIDES | ORGANIC CHEMICALS | TOXICITY | TOBACCO USE | North America, Northern | Americas | Developed Countries | Reproduction | Biology | Environmental Degradation | Environment | Birth Rate | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population | Genitalia | Urogenital System | Physiology | Ingredients and Chemicals | Behavior Document Number: 326262 |
| 24. Peer Reviewed Title: A randomized crossover trial of the impact of additional spermicide on condom failure rates. Author: Gabbay MB; Thomas J; Gibbs A; Hold P Source: Sexually Transmitted Diseases. 2008 Oct;35(10):862-8. Abstract: OBJECTIVE: Opinions remain divided concerning the potential for additional water-based lubricant to reduce condom breaks and slips. We sought to explore impact of externally applied additional lubrication on condom failure rates among regular users in stable heterosexual relationships. GOAL: To compare condom failure rates with and without additional spermicide. STUDY DESIGN: Couples randomized to use up to 70 condoms alone (control) or with additional spermicide (intervention), with midpoint crossover. Couple demographic and failure risk data collected at baseline. Follow ups at three and six months recorded condom failure events, spermicide acceptability, side-effects and adverse events. Condom failure rates were compared using an intention to treat analysis. RESULTS: Altogether 12,530 condoms were used by 145 couples completing the trial, There were 45/6,463:0.70% (95% CI 0.51%-0.93%) clinical and nonclinical failures in the additional spermicide arm, compared to 111/6,067:1.83% (95% CI 1.51%-2.20%) during the control arm. The clinical condom failure rate was 0.53% (95% CI 0.41%-0.66%), with 19 (0.31%: 95% CI 0.18%-0.43%) during the additional spermicide arm, compared to 46 (0.77%: 95% CI 0.56%-0.99%) during the control arm. Couples experienced significantly lower total (P = 0.017) and clinical (P = 0.042) condom failure rates during the additional spermicide arm. Furthermore additional spermicide significantly reduced clinical failures among the 101 couples who'd experienced a previous condom failure (P = 0.002). There were 22 urinary tract infections, equally divided between the control and additional spermicide arms, however 10 of the 12 genital irritation episodes occurred with additional spermicide (P = 0.021). CONCLUSIONS: Additional water-based external lubricant significantly reduced condom failures despite low failure rates among this stable, experienced group of condom users. Our results suggest that this may be a useful supplement to condom use, particularly among couples who experienced condom failures previously. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | HETEROSEXUALS | COUPLES | CONDOM FAILURE | SPERMICIDAL CONTRACEPTIVE AGENTS | LUBRICANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREVALENCE | UROGENITAL EFFECTS | United Kingdom | Europe, Western | Europe | Developed Countries | Clinical Research | Research Methodology | Sex Behavior | Behavior | Family Characteristics | Family and Household | Sociocultural Factors | Condoms | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents | Ingredients and Chemicals | Measurement | Urogenital System | Physiology | Biology Document Number: 328938 |
| 25. Peer Reviewed Title: Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. Author: Geibel S; Luchters S; King'Ola N; Esu-Williams E; Rinyiru A; Tun W Source: Sexually Transmitted Diseases. 2008 Aug;35(8):746-52. Abstract: OBJECTIVES:: To identify social and behavioral characteristics associated with sexual risk behaviors among male sex workers who sell sex to men in Mombasa, Kenya. METHODS:: Using time-location sampling, 425 men who had recently sold, and were currently willing to sell sex to men were invited to participate in a cross-sectional survey. A structured questionnaire was administered using handheld computers. Factors associated with self-reported unprotected anal sex with male clients in the past 30 days were identified and subjected to multivariate analysis. RESULTS:: Thirty-five percent of respondents did not know HIV can be transmitted via anal sex, which was a significant predictor of unprotected anal sex [adjusted odds ratio (AOR) 1.92; 95% confidence interval (95% CI), 1.16-3.16]. Other associated factors included drinking alcohol 3 or more days per week (AOR, 1.63; 95% CI, 1.05-2.54), self-report of burning urination within the past 12 months (AOR, 2.07; 95% CI, 1.14-3.76), and having never been counseled or tested for HIV (AOR, 1.66; 95% CI, 1.07-2.57). Only 21.2% of respondents correctly knew that a water-based lubricant should be used with latex condoms. CONCLUSIONS:: Male sex workers who sell sex to men in Mombasa are in acute need of targeted prevention information on anal HIV and STI transmission, consistent condom use, and correct lubrication use with latex condoms. HIV programs in Africa need to consider and develop specific prevention strategies to reach this vulnerable population. Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | MEN HAVING SEX WITH MEN | SEX WORKERS | ANAL SEX | RISK BEHAVIOR | HIV TRANSMISSION | KNOWLEDGE | ALCOHOL USE AND ABUSE | UROGENITAL EFFECTS | LUBRICANTS | COUNSELING | HIV TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Sociocultural Factors | Urogenital System | Physiology | Biology | Ingredients and Chemicals | 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 Document Number: 328623 |
| 26. Peer Reviewed Title: Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya. Author: Gikandi PW; Noor AM; Gitonga CW; Ajanga AA; Snow RW Source: Tropical Medicine and International Health. 2008 Feb;13(2):208-217. Abstract: The objectives were to evaluate barriers preventing pregnant women from using insecticide-treated nets (ITN) and intermittent presumptive treatment (IPT) with sulphadoxine-pyrimethamine (SP) 5 years after the launch of the national malaria strategy promoting these measures in Kenya. All women aged 15-49 years were interviewed during a community survey in four districts between December 2006 and January 2007. Women pregnant in the last 12 months were asked about their age, parity, education, use of nets, ITN, antenatal care (ANC) services and sulphadoxine-pyrimethamine (SP) (overall and for IPT) during pregnancy. Homestead assets were recorded and used to develop a wealth index. Travel time to ANC clinics was computed using a geographic information system algorithm. Predictors of net and IPT use were defined using multivariate logistic regression. Overall 68% of pregnant women used a net; 52% used an ITN; 84% attended an ANC clinic at least once and 74% at least twice. Fifty-three percent of women took at least one dose of IPT-SP, however only 22% took two or more doses. Women from the least poor homesteads (OR = 2.53, 1.36-4.68) and those who used IPT services (OR = 1.73, 1.24-2.42) were more likely to sleep under any net. Women who used IPT were more likely to use ITNs (OR = 1.35, 1.03-1.77), while those who lived more than an hour from an ANC clinic were less likely (OR = 0.61, 0.46-0.81) to use ITN. Women with formal education (1.47, 1.01-2.17) and those who used ITN (OR: 1.68, 1.20-2.36) were more likely to have received at least one dose of IPT-SP. Although the use of ITN had increased 10-fold and the use of IPT fourfold since last measured in 2001, coverage remains low. Provider practices in the delivery of protective measures against malaria must change, supported by community awareness campaigns on the importance of mothers' use of IPT. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | RURAL POPULATION | PROGRAM ACCESSIBILITY | PREGNANCY COMPLICATIONS | BED NETS | ANTENATAL CARE | PARITY | EDUCATIONAL STATUS | PESTICIDES | MALARIA PREVENTION | SOCIOECONOMIC STATUS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Program Evaluation | Programs | Organization and Administration | Diseases | Parasite Control | Public Health | Health | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Fertility Measurements | Fertility | Population Dynamics | Socioeconomic Factors | Ingredients and Chemicals | Malaria | Parasitic Diseases Document Number: 324984 |
| 27. Peer Reviewed Title: Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings. Author: Graham SM; English M; Hazir T; Enarson P; Duke T Source: Bulletin of the World Health Organization. 2008 May;86(5):349-355. Abstract: Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child healthcare practices. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | CHILDREN | HEALTH FACILITIES | PNEUMONIA | SYNDROMIC MANAGEMENT | ON-THE-JOB TRAINING | ANTIBIOTICS | OXYGEN | |