A role for depression in sexual risk reduction for women? A meta-analysis of HIV prevention trials with depression outcomes

Rates of HIV/AIDS and depression in women are significant public health concerns. The current meta-analysis tested the hypothesis that depression levels moderate change in sexual risk behavior in women participating in HIV prevention interventions. Features of the interventions were also explored as possible factors in decreasing levels of depression and sexual risk behavior. Included were HIV primary prevention interventions that measured sexual risk behavior and depression at baseline and follow-up and reported separate results for women. Ten studies (fourteen intervention groups and ten control groups; N = 4,195 women) met the inclusion criteria. The majority of participants were African American; mean age was 28-years old. Both depression and sexual risk behavior decreased significantly in treatment and control groups from baseline to follow-up. Sexual risk decreased more to the extent that interventions sampled (a) participants with higher baseline levels of depression, (b) older women, (c) Hispanics/Latinas, and/or (d) members of risk groups (e.g., drug users, homeless). Interventions that included (e) condom provision, (f) information about condoms, and/or (g) HIV counseling and testing were also more successful in decreasing sexual risk. Finally (h), interventions were more likely to reduce sexual risk behavior when they decreased depression to a large extent relative to baseline levels. Interventions were more likely to decrease depression when they (a) had samples of only women, (b) targeted risk groups, and/or (c) provided self-management and coping skills. Reducing depression appears to play a role in decreasing sexual risk behavior, suggesting that interventions should actively address depression.     

Are women with self-reported cognitive limitations at risk for underutilization of mammography?

Functional limitations (namely, limitations in activities of daily living and instrumental activities of daily living) have previously been demonstrated to exert a negative influence on mammography utilization. This study examines self-reported cognitive limitation in addition to sociodemographic, functional, and other health-related factors to determine their relationship with self-reported mammography use in the previous year. Data from the 1998 National Health Interview Survey was analyzed for 6,053 women, ages 50 years and older. Just over 44% of women with self-reported cognitive impairment (n = 351) reported a mammogram in the previous year, compared with 55% of unimpaired women (n = 5,702). Logistic regression analysis indicates that the presence of a cognitive limitation significantly reduced the likelihood of a mammography in the previous year (p < 0.05) after controlling for other sociodemographic, functional, and health-related factors. Women with self-reported cognitive limitations were 30% less likely than unimpaired women to utilize mammography after controlling for various forms of disability and other factors. Thus, women with cognitive impairments may be at risk for underutilization of mammography and therefore at risk for later-stage breast cancer diagnoses.     

Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy

OBJECTIVES: We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. METHODS: Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. RESULTS: Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. CONCLUSIONS: Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.     

“Why doesn't she seek help for partner abuse?” An exploratory study with South Asian immigrant women

This study explores why South Asian immigrant women with experiences of partner abuse delay seeking help from professionals. Three focus groups were conducted in Hindi language with South Asian immigrant women in Toronto. Twenty-two women participated with a mean age of 46 years (range 29–68 years). Thematic analysis was conducted on the transcribed data using constant comparison techniques within and across the groups. We found that three major themes emerged from the discussions: reasons for delayed help-seeking, turning points and talking to professionals. Women expressed delaying help-seeking to the point when “Pani sar se guzar jata he” (water crosses over your head). Their dominant reasons for delayed help-seeking were social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support after migration and limited knowledge about available resources and myths about partner abuse. Women usually turned for help only after experiencing pronounced mental and physical health problems.     

What goes wrong with the allocation of domestic and international resources for HIV?

This paper examines how domestic and international financing for HIV is, and ought to be, distributed. We build a theoretical framework that decomposes domestic and international financing for HIV into nonlinear functions of national income, HIV prevalence, and government effectiveness. We test this model, paying particular attention to nonlinearities and to problems of bad controls, multicollinearity, and reverse causality. Finally, we use the fitted values of quartile regressions to study how much countries could reasonably pay domestically and how much they should receive from donors. Worryingly, countries with higher financial means receive on average more aid per PLHIV than very poor ones, and countries with higher HIV prevalence receive on average less aid per people living with HIV. The normative analysis concludes that US$3.08 billion of fiscal space could be created in LIC and MIC. We identify the countries that could be allocated more aid.     

Community group participation: can it help young women to avoid HIV? An exploratory study of social capital and school education in rural Zimbabwe

The lifetime risk of acquiring HIV infection in many rural as well as urban areas of southern Africa is currently as high as two-in-three. For women, much of this risk still accrues rapidly at young ages despite high levels of knowledge about HIV/AIDS. Thus, programmes that are more participatory and address underlying structural and community-level factors appear to be essential. We use cross-sectional data from a large-scale, population-based survey in rural eastern Zimbabwe to describe the relationships between membership of different forms of community group and young women's chances of avoiding HIV. Our results show that participation in local community groups is often positively associated with successful avoidance of HIV, which, in turn, is positively associated with psychosocial determinants of safer behaviour. However, whether or not these relationships hold depends on a range of factors that include how well the group functions, the purpose of the group, and the education level of the individual participant. We identify factors that may influence the social capital value of community groups in relation to HIV prevention at the individual, group, and community levels. Young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate. Longitudinal studies are needed: (i) to establish whether community group membership supports the development of safer lifestyles or merely has greater appeal to individuals already predisposed towards such lifestyles, and (ii) to pinpoint directions of causality between hypothesised mediating factors. In-depth research is needed on the specific qualities of community groups that enhance their contribution to HIV control. However, our findings suggest that promotion of and organisational development and training among community groups could well be an effective HIV control strategy.     

Should women at increased risk for breast and ovarian cancer be randomized to prophylactic surgery? An ethical and empirical assessment

More information is needed about the relative effectiveness of prophylactic surgery, chemoprevention, and surveillance in reducing breast and ovarian cancer risk in women with an inherited susceptibility mutation. We assessed practical and ethical barriers to conducting randomized clinical trials (RCTs) to compare preventive interventions for breast and ovarian cancer. Eighty-seven at-risk women who attended an education and counseling session about BRCA1/2 testing were asked about their willingness to participate in hypothetical research studies for breast and ovarian cancer risk reduction. In addition, 247 Maryland physicians from five specialties completed a mail survey including a question about their likelihood of recommending RCT participation to an at-risk woman. Nineteen percent of at-risk women reported willingness to participate in a hypothetical RCT for breast cancer risk reduction and 17% for ovarian cancer risk reduction. Women with children and women likely to have a prophylactic mastectomy if found to have a susceptibility mutation were significantly more willing to participate in an RCT. A majority of women would be willing to participate in nonrandomized trials or registries. Fifty-two percent of physicians responded that they would be likely to recommend RCT participation to a woman carrying a breast cancer susceptibility mutation. Oncologists were the most likely to recommend an RCT. Although the results of nonrandomized trials may be difficult to interpret because of such issues as selection bias. Greater feasibility combined with fewer ethical concerns make nonrandomized trials a more viable alternative to randomized trials for evaluation of preventive interventions for breast and ovarian cancer when prophylactic surgery is one of the treatments being evaluated.     

What happens during antenatal visits? An ethnographic study of pregnant women’s experiences with midwives in Benin

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women’s experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives’ good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.     

What makes things happen? An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities

The Swedish municipalities offer important environments for health promotion. However, national actors need increased knowledge on how to support the development of public health measures in the municipalities. The aims of this study were to describe the development of municipal health-promoting measures directed at children and adolescents and to identify factors that might explain the development of such measures. Fifty semi-structured interviews and written documentation gathered from three municipalities in Stockholm County resulted in nine case studies. A policy process matrix, based on the actor-structural approach, was constructed to categorise the data. Five aspects contributing to the trajectory of municipal health-promoting measures aimed at children and adolescents were often mentioned in the data set. These are financial problems, perceived local needs, access to external funding, statements in national and international policy documents and the presence of a local public health sector. Politicians, public officials, and non-governmental organisations were the most mentioned actors, with heavy commitment, professional skills, and powerful position referred to as prevalent characteristics. Public health core concepts such as epidemiological statistics and evidence-based measures were rarely mentioned. The health care sector did not seem to have had any direct influence on municipal health-promoting measures. The dissemination of knowledge about public health related international and national policy documents and support for the institutionalisation of a local public health sector might be useful ways to support municipal public health measures.     

'What does it take to be a man? What is a real man?': ideologies of masculinity and HIV sexual risk among Black heterosexual men

Research documents the link between traditional ideologies of masculinity and sexual risk among multi-ethnic male adolescents and White male college students, but similar research with Black heterosexual men is scarce. This exploratory study addressed this gap through six focus groups with 41 Black, low- to middle-income heterosexual men aged 19 to 51 years in Philadelphia, PA. Analyses highlighted two explicit ideologies of masculinity: that Black men should have sex with multiple women, often concurrently, and that Black men should not be gay or bisexual. Analyses also identified two implicit masculinity ideologies: the perception that Black heterosexual men cannot decline sex, even risky sex, and that women should be responsible for condom use. The study's implications for HIV prevention with Black heterosexual men are discussed.     

An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: Does it make a difference?

IntroductionHealth technology appraisal agencies often rely on cost-effectiveness analyses to inform coverage decisions for new treatments. These assessments, however, frequently measure a treatment’s value from the payer’s perspective, and may not capture value generated from reduced caregiving costs, increased productivity, value based on patient risk preferences, option value or the insurance value to non-patients.MethodsTo examine how using a broader societal perspective of treatment value affects cost-effectiveness estimates, this case study analyzed the net monetary benefit (NMB) of second-line nivolumab treatment of patients with squamous non-small cell lung cancer (NSCLC) in Canada. The comparator was treatment with docetaxel. NMB was measured from three perspectives: (i) traditional payer, (ii) traditional societal and (iii) broad societal.ResultsNivolumab was more effective (increased quality-adjusted life years by 0.66 versus docetaxel), but also increased costs by $100,168 CAD. When valuing a quality-adjusted life year at $150,000, the net monetary benefit from the payer perspective suggested that costs modestly exceed benefits (NMB: −$1031). Adopting a societal perspective, however, nivolumab’s benefits outweighed its costs (NMB: +$6752 and +$91,084 from the traditional and broad societal perspectives, respectively).ConclusionBroadening cost-effectiveness analysis beyond the traditional payer perspective had a significant impact on the result and should be considered in order to capture all treatment benefits and costs of societal relevance.     

Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? secondary analysis of a cluster randomized NELLI study in Finland

ABSTRACT: BACKGROUND: Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity (PA) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA (LTPA) among pregnant women at risk of gestational diabetes. METHODS: Fourteen municipalities were randomized to intervention (INT) and usual care group (UC). Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists. In UC conventional practices were continued. Feasibility evaluation included safety (incidence of PA-related adverse events; questionnaire), realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists) and applicability (nurses' views; telephone interview). Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8-12 (baseline), 26-28 and 36-37 weeks' gestation. Multilevel analysis with adjustments was used in testing for between-group differences in PA changes. RESULTS: The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT (N = 219) than in UC (N = 180) from baseline to the first follow-up (0.1 vs. -1.2, p = 0.040 and -0.2 vs. -1.3, p = 0.016). A similar trend was seen in meeting the PA recommendation (-11%-points vs. -28%-points, p = 0.06). INT did not experience more adverse events classified as warning signs to terminate exercise than UC, counseling was implemented as planned and viewed positively by the nurses. CONCLUSIONS: Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practices.Trial registrationISRCTN 33885819 (www.isrctn.org).     

Are neck flexion,neck rotation,and sitting at work risk factors for neck pain? Results of a prospective cohort study

OBJECTIVE—To study the relation between neck pain and work related neck flexion, neck rotation, and sitting.
METHODS—A prospective cohort study was performed with a follow up of 3 years among 1334 workers from 34 companies. Work related physical load was assessed by analysing objectively measured exposure data (video recordings) of neck flexion, neck rotation, and sitting posture. Neck pain was assessed by a questionnaire. Adjustments were made for various physical factors that were related or not related to work, psychosocial factors, and individual characteristics.
RESULTS—A significant positive relation was found between the percentage of the working time in a sitting position and neck pain, implying an increased risk of neck pain for workers who were sitting for more than 95% of the working time (crude relative risk (RR) 2.01, 95% confidence interval (95% CI) 1.04 to 3.88; adjusted RR 2.34, 95% CI 1.05 to 5.21). A trend for a positive relation between neck flexion and neck pain was found, suggesting an increased risk of neck pain for people working with the neck at a minimum of 20° of flexion for more than 70% of the working time (crude RR 2.01, 95% CI 0.98 to 4.11; adjusted RR 1.63, 95% CI 0.70 to 3.82). No clear relation was found between neck rotation and neck pain.
CONCLUSION—Sitting at work for more than 95% of the working time seems to be a risk factor for neck pain and there is a trend for a positive relation between neck flexion and neck pain. No clear relation was found between neck rotation and neck pain.


Keywords: neck pain; physical risk factors; longitudinal cohort study     

The effects of metallothionein 2A polymorphism on lead metabolism: are pregnant women with a heterozygote genotype for metallothionein 2A polymorphism and their newborns at risk of having higher blood lead levels?

Objectives

Numerous studies indicate that certain genetic polymorphisms modify lead toxicokinetics. Metallothioneins are protective against the toxicity of many metals, including lead. The aim of this study was to determine whether the maternal metallothionein 2A (MT2A) -5 A/G single-nucleotide polymorphism is related to the lead levels in maternal blood, placental tissue and cord blood in 91 pregnant women and their newborns.

Methods

Venous blood from the mother was collected to investigate lead levels and MT2A polymorphism. Cord blood and placenta were collected for lead levels. Analyses were made using an Atomic Absorption Graphite Furnace Spectrophotometer. Standard PCR–RFLP technique was used to determine MT2A polymorphism.

Results

Blood lead levels of heterozygote genotype (AG) mothers were statistically higher than those of homozygote genotype (AA) (P?P?Conclusion This study suggests that pregnant women with AG genotype for MT2A polymorphism might have high blood lead levels and their newborns may be at risk of low-level cord blood lead variation.     

Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study

BACKGROUND: It remains controversial whether body mass index (BMI), waist circumference (WC), or waist-hip ratio (WHR) is a better risk predictor of type 2 diabetes. OBJECTIVE: The objective was to examine the sex-specific relevance of WC, WHR, and BMI to the development of type 2 diabetes. DESIGN: The prospective population-based cohort study was based on 3055 men and 2957 women aged 35-74 y who participated in the second (1989-1990) or third (1994-1995) MONICA (Monitoring Trends and Determinants on Cardiovascular Diseases) Augsburg survey. The subjects were free of diabetes at baseline. Hazard ratios (HRs) were estimated from Cox proportional hazards models. RESULTS: During a mean follow-up of 9.2 y, 243 cases of incident type 2 diabetes occurred in men and 158 occurred in women. Multivariable-adjusted HRs across quartiles of BMI were 1.0, 1.37, 2.08, and 4.15 in men and 1.0, 3.77, 4.95, and 10.58 in women; those of WC were 1.0, 1.15, 1.57, and 3.40 in men and 1.0, 3.21, 3.98, and 10.70 in women; those of WHR were 1.0, 1.14, 1.80, and 2.84 in men and 1.0, 0.82, 2.06, and 3.51 in women. In joint analyses, the highest risk was observed in men and women with a high BMI in combination with a high WC and a high WHR. CONCLUSIONS: Both overall and abdominal adiposity were strongly related to the development of type 2 diabetes. Because there was an additive effect of overall and abdominal obesity on risk prediction, WC should be measured in addition to BMI to assess the risk of type 2 diabetes in both sexes.