Can a Short Film Impact HIV-Related Risk and Stigma Perceptions? Results from an Experiment in Abuja,Nigeria

HIV/AIDS-related stigma is believed to result in negative social consequences for people with the disease and to be a deterrent to HIV serostatus testing. The ability of communicators to change people's stigma perceptions and subsequently impact decisions to test, however, is not well understood. Based on the entertainment–education approach, this article presents the results of a field experiment conducted in Abuja, Nigeria, testing a mediated intervention designed to reduce HIV-related stigma and risk perceptions. The results indicate that the intervention was effective relative to a control in impacting perceptions of the severity of HIV and some stigma-related attitudes, particularly for male participants; and that for this sample, risk and stigma perceptions significantly impact intentions to test for HIV. It also showed that severity perceptions mediated the relationship between viewing the film and testing intent.     

What influences participation in genetic carrier testing? Results from a discrete choice experiment

This study explores factors that influence participation in genetic testing programs and the acceptance of multiple tests. Tay Sachs and cystic fibrosis are both genetically determined recessive disorders with differing severity, treatment availability, and prevalence in different population groups. We used a discrete choice experiment with a general community and an Ashkenazi Jewish sample; data were analysed using multinomial logit with random coefficients. Although Jewish respondents were more likely to be tested, both groups seem to be making very similar tradeoffs across attributes when they make genetic testing choices.     

Can stories reduce abortion stigma? Findings from a longitudinal cohort study

Women often hide or selectively disclose abortion experiences due to stigma. Secrecy can help women avoid stigma but may also result in isolation and a lack of social support and contribute to broader social silence. This study assesses whether a book-club intervention can support abortion disclosure among book club participants and improve participants’ affective responses towards women who have abortions and abortion providers. A total of 109 women from 13 all-female book clubs located in 9 US states read and discussed a non-fiction book that included stories about pregnancy and abortion, participated in a book club discussion and completed baseline, immediate post-intervention and endline surveys. In 10 out of the 13 book club discussions, at least one member disclosed having had a previous abortion. Overall, 15 of the 19 women who privately reported having a previous abortion self-disclosed one or more abortions during the book club discussion. Following the book club intervention, women reported having more positive feelings toward women who have abortions and abortion providers. Greater improvement and longer lasting effects were seen in groups where there was also an in-person disclosure of abortion experience. Findings suggest that exposure to the stories of women who have had abortions can reduce abortion stigma.     

Can an intervention on clinical inertia have an impact on the perception of pain,functionality and quality of life in patients with hip and/or knee osteoarthritis? Results from a cluster randomised trial

ObjectivesEvaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis.DesignThis was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not.SettingPrimary Care Health centers representative of the entire Spanish territory.Participants329 general practitioners of primary healthcare centre.InterventionsThe intervention consists of a motivational session to propose a proactive care, based on current recommendations.MeasurementsVisual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart.ResultsA total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p < 0.001), WOMAC (p < 0.0001) and SF-12v2 (p < 0.001) questionnaires in Visit 2 compared to Visit 1.ConclusionsThe results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL.     

Is advice for breakfast consumption justified? Results from a short-term dietary and metabolic experiment in young healthy men

Short-term (2 weeks) effects of the consumption of a high-energy (2920 kJ (700 kcal)) or low-energy (418 kJ (100 kcal)) breakfast on dietary patterns, blood variables and energy expenditure (indirect calorimetry) were compared in ten free-living healthy young men in a crossover study. During the high-energy breakfast, total energy intake was increased, the intake of protein and lipids was unchanged but the intake of carbohydrates was increased. Thus, 48 (sd 4)% of energy came from carbohydrates in the high-energy breakfast compared with 42 (sd 5)% in the low-energy breakfast. Excluding breakfast, the macronutrient composition of the diet remained identical in the two situations. After the high-energy breakfast, fasting serum triacylglycerol concentration was higher and HDL-cholesterol concentration was lower than after the low-energy breakfast. A high glycaemic response was observed in the morning after the high-energy breakfast period, while there was a peak of free fatty acids after the low-energy breakfast. The high-energy breakfast induced a strong inhibition of fat oxidation throughout the day. Although long-term adaptation to a high-energy breakfast cannot be excluded, the high-energy breakfast in this study did not appear to be favourable to health. Our results do not support the current advice to consume more energy at breakfast.     

Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools

BACKGROUND: Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism. METHODS: This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component. RESULTS: This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism. CONCLUSIONS: This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.     

Does women's education affect breast cancer risk and survival? Evidence from a population based social experiment in education

Breast cancer is a notable exception to the well documented positive education gradient in health. A number of studies have found that highly educated women are more likely to be diagnosed with the disease. Breast cancer is therefore often labeled as a “welfare disease”. However, it has not been established whether the strong positive correlation holds up when education is exogenously determined. We estimate the causal effect of education on the probability of being diagnosed with breast cancer by exploiting an education reform that extended compulsory schooling and was implemented as a social experiment. We find that the incidence of breast cancer increased for those exposed to the reform.     

HIV-related high risk sexual behaviors and practices among women in Bogotá, Colombia

Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.     

Occupational mobility and risk factors in working men: selection,causality or both? Results from the GAZEL study

OBJECTIVE: To explore the relation between risk factors (RF) and occupational mobility in working men. SETTING: 20 000 volunteers working at the French National Electricity and Gas Company (GAZEL cohort). PARTICIPANTS: Men aged 43 to 53 years in 1992. DESIGN: Three designs were used for analysis. (1) The association between occupational mobility experienced before 1992 and RF reported at that date was analysed among 10 383 men. (2) The predictive role of RF on occupational mobility over 1992-1999 was studied in a subsample of 4715 men. (3) Reciprocally, occupational mobility in 1985-1992 was analysed in relation to RF changes over 1993-1999. MAIN OUTCOME MEASURES: Self reported smoking status, excessive alcohol consumption, arterial hypertension, and overweight. Occupational mobility defined by any upward transition between senior executives and professionals/middle executives/employees, and workers. RESULTS: (1) Cross sectionally, non-mobile men as their entry into the company had a higher risk of being smokers, excessive alcohol drinkers, and overweight in 1992 than mobile men. (2) Longitudinally, smokers and excessive alcohol drinkers in 1992 had a higher risk of non-mobility than, respectively, non-smokers and non-excessive alcohol drinkers. (3) Non-mobile men in 1985-1992 had a higher risk of becoming smokers, excessive alcohol drinkers, and hypertensive in 1993-1999 than upwardly mobile men. CONCLUSION: These results suggest a complex relation between RF and occupational mobility. A high level of RF, particularly health behaviours, might account for a selection process reducing upward occupational mobility. In turn, a lack of upward occupational mobility might be associated with an increased incidence of RF.     

Can air pollution affect tear film stability? a cross-sectional study in the aftermath of an explosion accident

Background  

After an explosion and fire in two tanks containing contaminated oil and sulphur products in a Norwegian industrial harbour in 2007, the surrounding area was polluted. This caused an intense smell, lasting until the waste was removed two years later. The present study reports examinations of tear film break up time among the population. The examinations were carried out because many of the people in the area complained of sore eyes. The purpose of the study was to assess the relationship between living or working close to the polluted area and tear film stability one and a half years after the explosion.     

Are measles,mumps and rubella a public health issue in young adults? Results from a seroprevalence survey in university students in Italy

Aims  

A survey was conducted amongst university students to assess their level of susceptibility to and knowledge about measles, mumps and rubella (MMR) and their prevention, and to find factors associated to their seropositivity for MMR viruses.     

Who is at risk of irregular meal intake? Results from a population-based study

Aim  

Irregular meal intakes have several harmful effects on health and yet it is largely unknown which factors are related to irregular meal intakes. In order to understand variations in regularity of meal intakes, associations between sociodemographics, health conditions, health behaviours, work characteristics and meal intakes were studied.     

Does the number of choice sets matter? Results from a web survey applying a discrete choice experiment

Optimising the design of discrete choice experiments (DCE) involves maximising not only the statistical efficiency, but also how the nature and complexity of the experiment itself affects model parameters and variance. The present paper contributes by investigating the impact of the number of DCE choice sets presented to each respondent on response rate, self‐reported choice certainty, perceived choice difficulty, willingness‐to‐pay (WTP) estimates, and response variance. A sample of 1053 respondents was exposed to 5, 9 or 17 choice sets in a DCE eliciting preferences for dental services. Our results showed no differences in response rates and no systematic differences in the respondents' self‐reported perception of the uncertainty of their DCE answers. There were some differences in WTP estimates suggesting that estimated preferences are to some extent context‐dependent, but no differences in standard deviations for WTP estimates or goodness‐of‐fit statistics. Respondents exposed to 17 choice sets had somewhat higher response variance compared to those exposed to 5 choice sets, indicating that cognitive burden may increase with the number of choice sets beyond a certain threshold. Overall, our results suggest that respondents are capable of managing multiple choice sets – in this case 17 choice sets – without problems. Copyright © 2010 John Wiley & Sons, Ltd.     

Demographics,epidemiology and the impact of vaccination campaigns in a measles-free world – Can elimination be maintained?

IntroductionAll six WHO regions currently have goals for measles elimination by 2020. Measles vaccination is delivered via routine immunization programmes, which in most sub-Saharan African countries reach children around 9 months of age, and supplementary immunization activities (SIAs), which target a wider age range at multi-annual intervals. In the absence of endemic measles circulation, the proportion of individuals susceptible to measles will gradually increase through accumulation of new unvaccinated individuals in each birth cohort, increasing the risk of an epidemic. The impact of SIAs and the financial investment they require, depend on coverage and target age range.Materials and methodsWe evaluated the impact of target population age range for periodic SIAs, evaluating outcomes for two different levels of coverage, using a demographic and epidemiological model adapted to reflect populations in 4 sub-Saharan African countries.ResultsWe found that a single SIA can maintain elimination over short time-scales, even with low routine coverage. However, maintaining elimination for more than a few years is difficult, even with large (high coverage/wide age range) recurrent SIAs, due to the build-up of susceptible individuals. Across the demographic and vaccination contexts investigated, expanding SIAs to target individuals over 10 years did not significantly reduce outbreak risk.ConclusionsElimination was not maintained in the contexts we evaluated without a second opportunity for vaccination. In the absence of an expanded routine program, SIAs provide a powerful option for providing this second dose. We show that a single high coverage SIA can deliver most key benefits in terms of maintaining elimination, with follow-up campaigns potentially requiring smaller investments. This makes post-campaign evaluation of coverage increasingly relevant to correctly assess future outbreak risk.     

Does an interaction between smoking and drinking influence the risk of Alzheimer's disease? Results from three Canadian data sets

Investigation of the relationship of smoking and drinking to Alzheimer's disease (AD) may advance research on the cause of AD and provide a basis for treatment. Pharmacological mechanisms for an involvement of smoking and drinking are plausible but epidemiologic reports are inconsistent. Evidence of behavioural and physiological interactions suggests that tobacco and alcohol use may not only individually affect AD, but may also modify each other's effects. A modelling strategy was developed to examine the interaction between smoking and drinking on the risk of AD. Three Canadian data sets were analysed: the University of Western Ontario Dementia Study (UWODS) (n=363); the Canadian Study of Health and Aging (CSHA) (n=516), and the database from the Clinic for Alzheimer Disease and Related Disorders at the Vancouver Hospital and Health Sciences Centre, University of British Columbia site (UBC) (n=843). Multiple logistic regression models were adjusted for the potential confounders age, age squared, sex, education, family history of dementia, head injury and hypertension. Analysis of the CSHA provided evidence consistent with the hypothesis that smoking and drinking influence each other's effects on AD, with smoking reducing the risk of AD among drinkers. A similar interaction was marginally significant (p=0.052) in the UWODS data set, but not significant in the UBC data. Extension of these analyses, particularly in longitudinal studies and within genetic risk groups, is needed to determine whether this interaction can be replicated. If so, research on the biological interactions of nicotine and alcohol may provide a basis for the development of therapeutic interventions as well as providing clues to the cause of this disorder.     

Economic empowerment and AIDS-related stigma in rural Kenya: a double-edged sword?

Economic empowerment, HIV risk and AIDS-related stigma appear intricately intertwined for women in Kenya. Their interaction must be understood in order to implement effective economic interventions that also decrease HIV risk and stigma. We conducted a qualitative study amongst women in a rural Kamba-speaking community of southeastern Kenya to pursue whether engagement in an economic empowerment initiative (a basket weaving cooperative) influences women's perspectives and experiences with HIV risk and AIDS-related stigma. We conducted seven women's focus groups: participants in the local basket-weaving cooperative comprised four focus groups and non-participants comprised the remaining three groups. The HIV status of the women was not known. Three dominant themes emerged from the focus groups: empowerment, pervasive vulnerability and unanticipated social paradoxes. Contradictions found in these themes suggest that economic empowerment can become a double-edged sword. Economic empowerment enhanced perceived individual, domestic and social community status. However, this enhancement was not protective of domestic violence and perceived HIV risk. Social perceptions may have paradoxically contributed barriers to HIV testing and treatment putting women at greater HIV risk. In conclusion, economic empowerment initiatives for women in developing countries in the context of the HIV epidemic should be coupled with peer mediated support and HIV-risk education.     

Can thermostable vaccines help address cold-chain challenges? Results from stakeholder interviews in six low- and middle-income countries

IntroductionThis study captures the perspectives of stakeholders at multiple levels of the vaccine supply chain regarding their assessment of challenges with storing vaccines within recommended temperature ranges and their perceptions on the benefits of having vaccines with improved stability, including the potential short-term storage and transport of vaccines in a controlled-temperature chain.MethodsSemi-structured interviews were undertaken with 158 immunization stakeholders in six countries. Interviewees included national decision-makers and advisors involved in vaccine purchasing decisions, national Expanded Programme on Immunization managers, and health and logistics personnel at national, subnational, and health facility levels.ResultsChallenges with both heat and freeze-exposure of vaccines were recognized in all countries, with heat-exposure being a greater concern. Conditions leading to freeze-exposure including ice build-up due to poor refrigerator performance and improper icepack conditioning were reported by 53% and 28% of participants, respectively. Respondents were interested in vaccine products with improved heat/freeze-stability characteristics. The majority of those involved in vaccine purchasing indicated they would be willing to pay a US$0.05 premium per dose for a freeze-stable pentavalent vaccine (68%) or a heat-stable rotavirus vaccine (59%), although most (53%) preferred not to pay the premium for a heat-stable pentavalent vaccine if the increased stability required changing from a liquid to a lyophilized product. Most respondents (73%) were also interested in vaccines labeled for short-term use in a controlled-temperature chain. The majority (115/158) recognized the flexibility this would provide during outreach or should cold-chain breaks occur. Respondents were also aware that possible confusion might arise and additional training would be required if handling conditions were changed for some, but not all vaccines.ConclusionParticipating immunization stakeholders recognized the benefits of vaccine products with improved stability characteristics and of labeling vaccines for controlled-temperature chain use as a means to help address cold-chain issues in their immunization programs.     

Can a Gender Equity and Family Planning Intervention for Men Change Their Gender Ideology? Results from the CHARM Intervention in Rural India

We assess the effect of CHARM, a gender equity and family planning counseling intervention for husbands in rural India, on men's gender ideology. We used a two‐armed cluster randomized control trial design and collected survey data from husbands (n=1081) at baseline, 9 months, and 18 months. We used a continuous measure of support for gender equity and a dichotomous measure of equitable attitudes toward women's role in household decision‐making. To assess differences on these outcomes, we used generalized linear mixed models. After controlling for socio‐demographic factors, men who received the CHARM intervention were significantly more likely than men in the control group to have equitable attitudes toward household decision‐making at 9‐months follow‐up; there was a non‐significant difference between the groups for the measure of support for gender equity. For household decision‐making, differences were not sustained at 18‐months follow‐up. Given the role of husbands’ gender ideology in women's contraceptive use, the CHARM intervention represents a promising approach for challenging root causes of women's unmet need for contraception.