Motivated Reasoning and HIV Risk? Views on Relationships,Trust, and Risk from Young Women in Cape Town,South Africa,and Implications for Oral PrEP

In high prevalence environments relationship characteristics are likely to be associated with HIV risk, yet evidence indicates general underestimation of risk. Furthermore uncertainty about partner‘s risk may challenge PrEP demand among young African women. We conducted quantitative and qualitative interviews with women before and after HIV discussions with partners, to explore how partner’s behavior affected risk perceptions and interest in PrEP. Twenty-three women were interviewed once; twelve had a follow-up interview after speaking to their partners. Fourteen women were willing to have their partner contacted; yet two men participated. Several themes related to relationships and risk were identified. These highlighted that young women’s romantic feelings and expectations influenced their perceptions of risk within their relationships, consistent with the concept of motivated reasoning. Findings emphasize challenges in using risk to promote HIV prevention among young women. Framing PrEP in a positive empowering way that avoids linking it to relationship risk may ultimately encourage greater uptake.     

Effect of Cricoid Pressure on the Success of Endotracheal Intubation with a Lightwand

Background: The lightwand may be useful as an alternative for tracheal intubation during a rapid-sequence induction of anesthesia in the presence of a full stomach. This study was undertaken to assess the effect of application of cricoid pressure on the success of lightwand intubation.

Methods: Sixty adult female patients presenting for abdominal hysterectomy were randomly allocated to lightwand intubation with and without cricoid pressure. The time to successful intubation and number of attempts were recorded.

Results: All 30 patients allocated to intubation without cricoid pressure were intubated successfully at the first attempt within a median time of 28 s (95% confidence interval, 18-77 s). Lightwand intubation with cricoid pressure was successful in 26 of 30 patients at the first attempt, but the median time to successful intubation was significantly longer at 48.5 s (95% confidence interval, 36-78 s;P = 0.001). Three patients required two attempts for successful intubation, and one could not be intubated with the lightwand while cricoid pressure was being applied.     

Genetic Analysis of PARK2 and PINK1 Genes in Brazilian Patients with Early-Onset Parkinson's Disease

Parkinson''s disease is the second most frequent neurodegenerative disorder in the world, affecting 1-2% of individuals over the age of 65. The etiology of Parkinson''s disease is complex, with the involvement of gene-environment interactions. Although it is considered a disease of late manifestation, early-onset forms of parkinsonism contribute to 5–10% of all cases. In the present study, we screened mutations in coding regions of PARK2 and PINK1 genes in 136 unrelated Brazilian patients with early-onset Parkinson''s disease through automatic sequencing. We identified six missense variants in PARK2 gene: one known pathogenic mutation, two variants of uncertain role, and three nonpathogenic changes. No pathogenic mutation was identified in PINK1 gene, only benign polymorphisms. All putative pathogenic variants found in this study were in heterozygous state. Our data show that PARK2 point mutations are more common in Brazilian early-onset Parkinson''s disease patients (2.9%) than PINK1 missense variants (0%), corroborating other studies worldwide.     

Job stress,job satisfaction and stress‐related illnesses among South African educators

The aim of this study was to explore the relationship between self‐reported job stress and job satisfaction, and the prevalence of stress‐related illnesses and risk factors among educators. A cross‐sectional survey was conducted in a representative sample of 21,307 educators from public schools in South Africa. Results indicate that the prevalence of stress‐related illnesses were 15.6 per cent for hypertension, 9.1 per cent stomach ulcer, 4.5 per cent diabetes, 3.3 per cent minor mental distress, 3.1 per cent major mental distress and 3.5 per cent asthma. The study found considerably high stress levels among educators. Job stress and lack of job satisfaction were associated with most stress‐related illnesses (hypertension, heart disease, stomach ulcer, asthma, mental distress, tobacco and alcohol misuse). From three components of the demand‐control model, two, namely work stress from teaching methods and low peer support, were related to hypertension but not to heart disease. The components of the effort‐reward model of low socio‐economic status and lack of career advancement were both not related to heart disease, and only lack of career advancement was inversely related to hypertension. Most components assessed here of the demand‐control model (including stress with teaching methods and educational system and low peer support) and effort‐reward model (including job insecurity and lack of career advancement) were related to stomach ulcer and mental distress. Copyright © 2008 John Wiley & Sons, Ltd.     

Vaginal wetness: an underestimated problem experienced by progestogen injectable contraceptive users in South Africa

This paper reports on the common experience of vaginal wetness amongst South African users of progestogen-only injectable contraceptives. The observations emerged in the course of a community-based cross-sectional household survey undertaken in a rural district of KwaZulu-Natal in South Africa. The purpose of the survey was to elicit self-reporting on side effects of injectable contraceptive methods. Eight hundred and forty-eight women aged 15-49 were interviewed and 22.1% reported current use of an injectable contraceptive method, either depot medroxyprogesterone acetate (Depo-Provera) or norethisterone oenanthate (Nur-Isterate). Other modern methods used were oral hormonal contraceptives (4.5%), male condoms (1.3%), the intrauterine device (0.1%), and tubal ligation (0.1%). Vaginal wetness was reported by 18.4% of users and was one of the most common side effects, second only to amenorrhoea (62.5%). It was also what 17.5% of the women liked least about using this method. According to almost half the respondents, men regard women who use the injectable contraceptive as "wet", "cold" and/or "tasteless". These survey findings were supported by participants of 14 focus group interviews held in the sub-district. Since some South African men may prefer dry sex the perception that the injectable contraceptive increases vaginal wetness may be problematic for women who use it. Whilst vaginal wetness can only be classified as a subjective side effect at this stage, further investigations are needed as many South African women opt to use this method.     

National HIV incidence measures--new insights into the South African epidemic.

BACKGROUND AND OBJECTIVES: Currently South Africa does not have national HIV incidence data based on laboratory testing of blood specimens. The 2005 South African national HIV household survey was analysed to generate national incidence estimates stratified by age, sex, race, province and locality type, to compare the HIV incidence and HIV prevalence profiles by sex, and to examine the relationship between HIV prevalence, HIV incidence and associated risk factors. METHOD: The detection of recent infections was performed on confirmed HIV-positive samples, using the BED capture enzyme immunoassay optimised for dried blood spot (DBS) specimens. BED HIV incidence calculations applied adjustment procedures that were recently revised and approved by the Centers for Disease Control and Prevention for subtype C blood specimens. RESULTS: HIV incidence in the study population aged 2 years and older was 1.4% per year, with 571,000 new HIV infections estimated for 2005. An HIV incidence rate of 2.4% was recorded for the age group 15-49 years. The incidence of HIV among females peaked in the 20-29-year age group at 5.6%, more than six times the incidence found in 20-29-year-old males (0.9%). Among youth aged 15-24 years, females account for 90% of the recent HIV infections. Non-condom use among youth, current pregnancy and widowhood were the socio-behavioural factors associated with the highest HIV incidence rates. CONCLUSIONS: The HIV incidence estimates reflect the underlying transmission dynamics that are currently at work in South Africa. The findings suggest that the current prevention campaigns are not having the desired impact, particularly among young women.     

Risk factors of sexually transmitted infections among migrant and non-migrant sexual partnerships from rural South Africa

In October 1998, cohorts of circular migrant men and their non-migrant sexual partners, and non-migrant men and their non-migrant sexual partners from rural South Africa were recruited and followed-up every 4 months until October 2001. At each visit, information on sociodemographic, sexual behaviour, sexually transmitted infections (STIs) and HIV was collected. In total, 553 individuals aged between 18 and 69 years were recruited. A man and his sexual partner(s) form a sexual partnership. Migration status, age, marital status, age at sexual debut, recent sexual partners and HIV status were found to be important determinants of STI. The risk of STI varies (sigma2 = 1.45, P < 0.001) significantly across sexual partnerships even after controlling for important determinants. The variance implies substantial correlation (0.59) between members of the same sexual partnership. Ignoring this correlation leads to incorrect inference. Migration contributes significantly to the spread of STIs. Community interventions of HIV/STI should target co-transmitter sexual partnerships rather than high-risk individuals.