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Volume 3, Number 40
6 October 2003

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

A Prospective Study of Time and Number of Ejaculations to Azoospermia After Vasectomy by Ligation and Excision (research abstract)
Related press release: Study Suggests that Recommendations for Relying on Vasectomy May Need Revision
Typical recommendations on how long men should wait before relying on the most common type of vasectomy in developing countries may need to be revised, new research suggests. Men who have had a vasectomy usually are counseled to use a back-up method of contraception either for 12 weeks (three months) following the vasectomy or until they have ejaculated 20 times. Results from the study show that after use of the ligation and excision method of vasectomy (in which a short segment of the vas—the tube that carries sperm from the testicles to the penis—is cut and removed and the remaining two ends are tied), 12 weeks is a more reliable waiting period than 20 ejaculations. However, neither guideline is ideal, the study reports.

Truth and Consequences: Using the Bogus Pipeline to Examine Sex Differences in Self-reported Sexuality (PubMed abstract)
Related news article: Fake Lie-detector Reveals Women's Sex Lies
This research reveals that women are more likely than men to lie about their sex lives. In surveys since the 1960s, men typically report having more sexual partners and than do women - a statistically impossible feat. Scientists previously explained this anomaly by suggesting men were exaggerating their tally, while women were understating their total. New research suggests that men are in fact more truthful in such surveys. The researchers found that women change their answers depending on whether or not they believe they will be caught out not telling the truth. The number of sexual partners a woman reported nearly doubled when women thought they were hooked up to a lie detector machine.

Facility-Level Reproductive Health Interventions and Contraceptive Use in Uganda (research article)
Data from the 1999 DISH Evaluation Surveys were used in multivariate logistic regressions to assess the independent relationships of five indicators of the family planning service environment with individual-level use of a modern contraceptive in rural and urban areas. After women's social and demographic characteristics were controlled for, none of the service environment factors was independently associated with current use of a modern method in rural areas. By contrast, in urban areas, the proximity of a private health facility (which likely reflects an increased availability of methods) was positively associated with current use, as was the presence of a higher number (three or more) of DISH-trained service providers.

The Impact of Household Delivery of Family Planning Services on Women's Status in Bangladesh (research article)
Longitudinal and cross-sectional data from 3,783 women using doorstep services in two rural districts of Bangladesh were used to assess the effect of doorstep services on changes in women's status between 1988 and 1993. Researchers found that household outreach is associated with increases in women's status; however, this effect is largely attributable to the impact of doorstep services on women's ability to regulate their fertility rather than to the home visits themselves.

Pharmacogenetic Aspects of the Use of Oral Contraceptives and the Risk of Thrombosis (research abstract)
This review illustrates the risk of thrombosis, particularly venous thromboembolism, associated with the use of oral contraceptives, underlines the crucial role of the interaction of these drugs with other risk factors for the disease, and gives suggestions on the utility of thrombophilia screening before prescription.

Condom Use for Preventing HIV Infection/AIDS in Sub-Saharan Africa: A Comparative Multilevel Analysis of Uganda and Tanzania (research abstract)
This study explored the relationships between individual-, household-, and community-level variables and condom use to prevent HIV infection in women and men in Uganda and Tanzania using multilevel modeling. Findings indicated heterogeneity in condom use among different clusters for both women and men. Specifically, women and men living in clusters with higher indicators of development were more likely to use condoms to prevent HIV infection. Condom use was also much more prevalent in areas where health care services were nearby (0-5 km) and more common among women (but not men) who lived in clusters where HIV/AIDS testing, counseling, and treatment were provided.

The Impact of Quality of Care on Contraceptive Use: Evidence from Longitudinal Data from Rural Bangladesh (report)
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Using prospective data from approximately 7,000 reproductive-aged Bangladeshi women, this study evaluated the relative impact of service quality and client characteristics on contraceptive adoption and method continuation. The study employed new, more methodologically rigorous analytical approaches— specifically, multi-level analysis— and measures
of fieldworker and clinic service access and quality, which are largely free from the biases of endogeneity (ie, the inter-correlation of key variables) and unobserved heterogeneity which characterize many existing analyses of this issue. The results provide new and persuasive empirical evidence on the importance of service quality for contraceptive behavior.

Improving Quality of Care for Family Planning Services in Uganda (report)
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This study developed a package of interventions that sought to increase the readiness of clinics to offer basic family planning services, to improve provider motivation, and to empower clients to request quality services. The project then tested the feasibility of implementing these interventions, and evaluated their effect on the quality of client-provider interactions.

'Rehabilitating' the IUD (feature article)
A pilot initiative to reintroduce the intrauterine device (IUD) in Kenya, launched in February 2003 by the Kenya Ministry of Health in collaboration with some 15 partner organizations, is a potential model for activities to promote research utilization. This article highlights the importance of Ministry of Health commitment to the initiative, and how building capacity depends on systematic provider training and attention to supply issues. It also describes advocacy efforts to dispel myths about the IUD and plans for continuous monitoring and evaluation of the initiative. The need to foster strong partnerships with key implementing and policy organizations, as well as professional associations, is emphasized.

Pivotal Points of Change (feature article)
Many factors can facilitate the speed and ease with which research results are incorporated into practice. This article highlights four such factors: straightforward research findings; extensive dissemination of findings; supportive economic, political, or programmatic environments in which the research is conducted and implemented; and increased interactions among researchers, policy-makers, and practitioners. Examples of successful utilization of research findings are given in four case studies: Nevirapine Results Quickly Put into Practice, Community-Based Distribution Project Expands beyond Mali, IUD Insertion by Nurse-Midwives Increases Use, and A Single-Visit Approach for Cervical Cancer Prevention. These examples serve to illustrate that successful utilization of research is most likely when various facilitating factors exist.

Pros and Cons of Condom Use among Gay and Bisexual Men as Explored Via the Internet (PubMed abstract)
Researchers conducted a survey using Internet technology related to gay and bisexual men's condom use behavior as an expression of safer sexual practices. A total of 241 self-identified gay and bisexual men responded to the questionnaire in a 3-month period of time. The study was conceptually guided by the use of the Transtheoretical Model of Behavioral Change and the pros and cons of condom of use were explored. Fifty-six percent of the participants reported that one advantage (pro) of using condoms with casual partners was that it would make them safer from disease. About half of the respondents (n = 119, 49%) reported a history of one or more sexually transmitted diseases. Findings from this study corresponded to results obtained by more traditional data collection methods.

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Male Birth Control Pill Soon a Reality (news article)
The article relates that, for the first time, a safe, effective, and reversible hormonal male contraceptive appears to be within reach. Several formulations are expected to become commercially available within the near future. Men may soon have the options of a daily pill to be taken orally, a patch or gel to be applied to the skin, an injection given every three months or an implant placed under the skin every 12 months.

How Are 'Best Practices' Identified and Adopted (feature article)
This article describes various systematic efforts to classify and encourage the adoption of "best practices" in reproductive health, ranging from specific training techniques or medical procedures to entire programs.

Male Contraceptive Pill Next Step as Australian Trials Prove Successful (news article)
A male pill is potentially the next step after the successful Australian trial of a treatment that switches off sperm production. The five-year study, led by Professor David Handelsman from the ANZAC Research Institute in Sydney, involved 55 Australian couples. None of the women became pregnant while on the trial.

Uganda: 'Noisy' Female Condoms too Costly, Say Women (news article)
According to this news report, Ugandan women are not buying the female condom because they have complained it is too expensive, too bulky, and too noisy during sex.

Uganda: Threat of Condom Shortage (news article)
There may be fears of a worldwide shortage of condoms, but Kampala is yet to feel the pinch. However, some drug shops, bars and retail shops which sell condoms say stocks are low.

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

US Senate Confirms Tobias to Head AIDS Fight (news article)
The Senate confirmed President Bush's selection of Randall Tobias, a retired chairman and chief executive officer of Eli Lilly and Co., to head the administration's global battle against AIDS. With the rank of ambassador, Tobias will oversee a $15 billion plan that Bush signed into law in May to combat the disease, primarily in Africa and the Caribbean, with treatment as well as prevention.

The White House Initiative to Combat AIDS: Learning from Uganda (policy brief)
This policy backgrounder, from the conservative Heritage Foundation, describes the Bush Administration's AIDS initiative and suggests where future efforts might be best spent, considering the serious challenges that face the people and governments of the African continent.

Uganda: First Lady Cautions On Condom Use (news article)
Uganda's First Lady Janet Museveni says that Africa's future cannot depend on a sheath of rubber - a condom - in the fight against HIV/AIDS. Uganda has cut AIDS infections from 30% to less than 8% by teaching abstinence (A), being faithful (B) and use of condoms (C). Many AIDS activists believe that the ABC model is outdated in the fight against the disease, however.

HIV/AIDS RESEARCH

AIDS Vaccines That Allow HIV-1 to Infect and Escape Immunologic Control: A Mathematic Analysis of Mass Vaccination (news article)
The authors designed a mathematic model that correlates the level of viremia to both infectiousness and disease progression in order to evaluate the potential efficacy of vaccines that cannot prevent HIV-1 to infect and escape immunologic control. Their model shows that a sexually active population can ultimately be reduced to 26% of its initial size as a result of AIDS-related mortality in the absence of treatment or vaccination. Start of vaccination when HIV-1 prevalence is still low might postpone the peak incidence of infection and the dramatic decline in population size by up to 22 years.

Understanding the Uneven Spread of HIV Within Africa: Comparative Study of Biologic, Behavioral, and Contextual Factors in Rural Populations in Tanzania and Zimbabwe (research abstract)
A comparative study between two rural populations in sub-Saharan Africa with a three-fold difference in HIV prevalence shows no contemporary differences in biological or behavioral determinants. However, spatial mobility was more extensive and spousal cohabitation less common in the high HIV prevalence population, which may facilitate more extensive early spread of HIV within populations.

Who Infects Whom? HIV-1 Concordance and Discordance among Migrant and Non-migrant Couples in South Africa (research abstract)
Researchers measured HIV-1 discordance among migrant and non-migrant men and their rural partners to estimate the relative risk of infection from inside versus outside primary relationships. A total of 70% (117 of 168) of couples were negatively concordant for HIV, 9% (16 of 168) were positively concordant and 21% (35 of 168) were discordant. Migrant couples were more likely than non-migrant couples to have one or both partners infected and to be HIV-1 discordant. In the mathematical model, migrant men were 26 times more likely to be infected from outside their regular relationships than from inside; non-migrant men were 10 times more likely to be infected from outside their regular relationships than inside.

Public Health Considerations for the Use of a First Generation HIV Vaccine: Report from a WHO-UNAIDS-CDC Consultation, Geneva, 20-21 November 2002 (research abstract)
This report summarizes the discussions from a consultation held in Geneva (20-21 November 2002) organized by the World Health Organization (WHO), the joint United Nations Programme on HIV/AIDS (UNAIDS) and the US Centers for Disease Control and Prevention (CDC). The group identified a number of logistic issues that need to be addressed to accelerate the development and future availability of HIV vaccines, and made broad recommendations in four different areas: (a) Vaccine manufacturing and licensing; (b) vaccination acceptability and social marketing; (c) immunisation strategies and delivery; and (d) access and economic issues.

Accelerating Action against AIDS in Africa (report)
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This report, from UNAIDS, provides a snapshot of the action being taken across the African continent in response to the challenge of AIDS. It highlights governments working with all their ministries to deliver a full-scale response and demonstrates progress in closing the gaps in the provision of HIV prevention and treatment.

The Saadhan Helpline: HIV/AIDS Information and Counseling in Mumbai, A Case Study (report)
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Population Services International (PSI) published this case study on its Saadhan Helpline for HIV/AIDS prevention in Mumbai, India, which gives recommendations for replicating a similar helpline and offers a lessons learned section. The study found that a helpline must be flexible, able to adapt, provide on-going training for its counselors, and generate awareness through communication campaigns. The Saadhan helpline works synergistically with PSI/India's HIV/AIDS prevention campaigns to enable individuals to adopt healthier behaviors. The helpline employs qualified counselors, uses customized software to better assist callers, and serves as a referral service.

Peer HIV/AIDS Education With Volunteer Trishaw Drivers in Yaan, People's Republic of China: Process Evaluation (research abstract)
The findings presented here are from a process evaluation of a peer-led demonstration project with self-employed trishaw drivers in Yaan, China. This study examines sexual health message diffusion from 150 volunteers in a direct training group to 705 peers in an indirect training group. A key finding was that success in diffusing sexual health messages was significantly related to drivers' attachment to their subculture.

If HIV Prevention Works, Why are Rates of High-risk Sexual Behavior Increasing among MSM? (research abstract)
This paper addresses the question: If HIV prevention works, why are rates of high-risk sexual behavior increasing among men who have sex with men (MSM) in major European, Australian, Canadian, and US cities? The authors suggest that the evidence generated by systematic reviews alone may not provide a clear answer to that question because (a) it is uncertain whether experimental interventions shown to be effective in one setting, place, or moment in time can be repeated successfully in another; (b) we have limited understanding of the processes that underlie the interventions; and (c) interventions shown to work in an experimental study may not necessarily be effective in everyday life. To answer the question, they suggst we need to be alert to the changing risk environment in which men have sex with other men. In addition, there is a need to develop a new program of research addressing the transferability, sustainability, and effectiveness of sexual health promotion among MSM.

HIV/AIDS NEWS

India Minister Hugs HIV Children (news article)
India's health minister has publicly hugged two HIV positive children in an attempt to dispel myths and remove some of the stigma attached to the condition.

Kenya: Study Confirms Voluntary Counseling and Testing Evokes Risk Reduction Behavior (news article)
Although HIV serologic tests have been around since 1985, reports from most of African countries indicate reservations about testing. The article describes a growing consensus that Voluntary Counseling and Testing (VCT) may be one of the best interventions for preventing spread of the virus.

Uganda: Country Continues Clinical Trials of HIV Prevention Jelly (feature article)
This feature article focuses on the efforts currently underway to develop a new drug to prevent the transmission of sexual HIV/AIDS. The introduction of microbicides, jelly-like substances that are applied in the vagina to prevent HIV transmission, will mark a new phase in the HIV/AIDS control. According to the article, a London-based pharmaceutical company has announced the start of a second phase of clinical trials of microbicides in Kampala to assess the safety of a microbicide being tested in Uganda.

Women Fighting AIDS in Kenya (feature article)
The article highlights the program WOFAK (Women Fighting AIDS in Kenya), which works at both community and political levels to help women deal with the burden of care-taking for sick family members and the social stigma associated with the pandemic. It runs a variety of programs including feeding programs for orphans and vulnerable children, home-based care training, counseling services, the development of traditional alternative therapies, and educational outreach programs for girls to help reduce the disease’s profound effect on women.

Papua New Guinea: HIV/AIDS - A National Threat (letter to the editor)
The letter draws attention to the worsening situation regarding HIV/AIDS in Papua New Guinea. According to figures collected in 2003, more than 7,000 people are reported to be infected with the AIDS virus and, additionally, an estimated 60,000 to 70,000 infected people still remain unidentified.

MATERNAL AND CHILD HEALTH RESEARCH

Reproductive Health in Rural Malawi: A Population-based Survey (research abstract)
Researchers interviewed women in 20,649 households using structured questionnaires to measure pregnancy outcome, the effect of women's education, distance from a health center and household type on pregnancy outcome, maternal morbidity and estimates of maternal and perinatal mortality. They found that successful pregnancy outcome was more likely with increased education and if the woman lived closer to the health center. Despite living an average of 5 km from the health centre, over 90% of women attended antenatal clinic with a mean of five visits. Assistance at delivery by a trained health care worker was more likely as education increased and was less likely as distance from the health centre increased.

Maternal Mortality and Access to Obstetric Services in West Africa (PubMed abstract)
Researchers used data on maternal mortality and access to obstetric services from two population-based studies conducted in 16 sites in eight West African countries. In rural areas, maternal mortality, excluding early pregnancy deaths, was 601 per 100,000 live births, compared with 241 per 100,000 for urban areas. In urban areas, most births took place in a health facility (83%) or with a skilled provider (69%), while 80% of the rural women gave birth at home without any skilled care.

Experience LINKAGES: Behavior Change Communication (research review)
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This issue of "Experience LINKAGES" (from the Academy of Education Development) describes essential infant feeding behaviors, priority audiences, simple and direct messages, and supportive materials and media that feature in the project’s communication strategy.

Determinants of Children's Health Services Utilization in the Philippines (research abstract)
Researchers used the 1998 Philippines National Demographic and Health Survey dataset to understand the service utilization patterns of children under 5 with diarrhea and/or respiratory illness. Their results indicate that maternal education and number of illnesses determine the decision to seek care. Once the decision has been made to seek care, the choice between a public or private provider is affected by the family's economic status and size of the household.

Comparing the Quality of Three Models of Postabortion Care in Public Hospitals in Mexico City (research article)
Researchers surveyed women treated for abortion complications in six Mexico City hospitals, analyzing the data for three models of care. They found that a significantly greater proportion of women treated under the postabortion care models than of those treated under the sharp curettage standard model received information about their health status before treatment, the uterine evacuation procedure, signs of postabortion complications, and care at home. In addition, a greater proportion of women treated under the postabortion care models accepted a contraceptive method before leaving the facility.

MEN'S HEALTH RESEARCH

Effect of Sildenafil Citrate on an Orthotopic Prostate Cancer Growth and Metastasis Model (research abstract)
Related news article: Viagra Doesn't Promote Prostate Cancer Growth
Viagra (sildenafil), the popular drug for impotence, does not cause prostate cancers to grow and spread, findings from an animal study suggest.

MEN'S HEALTH NEWS

Zimbabwe: Male Circumcision, HIV's Missing Link? (news article)
The perceived correlation between low HIV infection and male circumcision is one area that AIDS researchers are yet to be convinced about. The article describes the debate and presents several data from recent research in developing countries.

POPULATION RESEARCH

Combining Endogenous and Exogenous Spatial Variability in Analytical Population Models (research abstract)
The authors used spatial moment equations in combination with simulation models to analyze the combined effects of endogenous and exogenous variability on population viability in a simple single-population model where landscape heterogeneity and local population density both affect mortality rate. The equations partition the effects of heterogeneity into an effect of local crowding and an effect of habitat association caused by differential mortality. Exogenous heterogeneity in mortality rate increases population viability through habitat association and decreases it through increased crowding; the net effect of exogenous heterogeneity is generally to improve population viability. This result is contrary to some (but not all) conclusions in the literature, which usually focus on the effects of fragmentation rather than the benefits of refuges to short-dispersing individuals.

Sex Ratios in the Two Germanies: A Test of the Economic Stress Hypothesis (research abstract)
Related news article: Economics and Baby's Gender
This study suggests that difficult economic conditions in a country may result in fewer male than female births.

Diffusion-limited Friendship Network: A Model for Six Degrees of Separation (PubMed abstract)
The authors studied a dynamic model of a society, where each person is an uncorrelated and noninteracting random walker. A dynamical random graph represents the acquaintance network of the society whose nodes are the individuals and links are the pairs of mutual friendships. This network exhibits a different percolationlike phase transition in all dimensions. On introducing simultaneous death and birth rates in the population, the authors show that the friendship network shows the six degrees of separation for ever after where the precise value of the network diameter depends on the death/birth rate. A susceptible-infected-susceptible-type model of disease spreading shows that this society always remains healthy if the population density is less than certain threshold value.

POPULATION NEWS

Italy Baby-cash Aims to Boost Births (news article)
Last week the Italian government announced in its annual budget a cash bonus for the birth of a second child.

The Century of Aging: A Graying Europe Wonders How to Pay Its Pensioners (news article)
The article explores implications of the dramatic increase of aged in many European countries, especially those with low fertility rates such as Italy. The United Nations predicts the percentage of the global population aged 65 or over will soar to 16% by 2050 from the current 7%. In some countries, more than a third of the population will be 65 or older by then.

Is Russia in for a Baby Boom? (news article)
The birth rate in Russia is growing steadily. In 2001 the number of new-borns was 1,300,000 and in 2002 it was 1,400,000. Demographers expect that this year's figure will increase by at least 100,000. Meanwhile, infant mortality has decreased from 16.9 for every 1,000 new-borns in 1999 to 13.9 in 2002. Surveys show that 35% of young mothers under 24 want to have three children.

WOMEN'S HEALTH RESEARCH

Cervical Human Papillomavirus Infection in the Female Population in Barcelona, Spain (research abstract)
A study of the female general population in metropolitan Barcelona, Spain identified a low prevalence of HPV infection in concordance with the low rates of invasive cervical cancer in the country. Major determinants of HPV infection were place of birth, history of multiple sexual partners, marital status, and smoking marijuana and/or related substances. Use of condoms with regular partners was protective.

Bone Mineral Density in Adolescent and Young Adult Women on Injectable or Oral Contraception (research abstract)
This report critically reviews recent original research articles that pertain to bone mineral density in young adult women utilizing injectable depot medroxyprogesterone acetate or oral contraceptives.

Hysterectomy and Sexual Well-being: Prospective Observational Study of Vaginal Hysterectomy, Subtotal Abdominal Hysterectomy, and Total Abdominal Hysterectomy (research abstract)
In a prospective observational study of 413 women, researchers compare the effects of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy on sexual well being. The data collected suggest that sexual pleasure significantly improved in all patients, independent of the type of hysterectomy.

The Women's Health Questionnaire (WHQ): Frequently Asked Questions (FAQ) (review article)
This article answers frequently asked questions about the Women's Health Questionnaire (WHQ), a measure of mid-aged women's emotional and physical health. Since its publication in 1992 the WHQ has been widely used in multinational clinical trials, in epidemiological studies as well as in the evaluation of non-medical treatments. In particular the WHQ has been included as a quality of life measure in trials of hormonal preparations for peri and post menopausal women and in studies using a variety of preventative interventions for mid-aged and older women. The questionnaire was developed in English and standardised on a sample of women aged 45–65 years.

WOMEN'S HEALTH NEWS

Global Breast Cancer Prevention Trial Launched (news article)
Scientists launched an international trial last week to determine if a drug used to treat breast cancer can prevent the disease in high-risk women.

Experts Recommend Fewer Pap Smears (news article)
The American College of Obstetricians and Gynecologists (ACOG) has issued important new recommendations concerning the Pap smear, the screening for cervical cancer. The article outlines why the group is recommending fewer screenings for women of most age groups as well as a later starting date for screenings to begin.

New Techniques May Reduce Cervical Cancer's Toll (news article)
Cancer screenings usually search for abnormal cells that have multiplied to form a small tumor. This news report explains how new screening techniques may have a chance to prevent cervical and other cancers before they start.

Infertility Treatment As a Form of Women Empowerment (news article)
The article suggests that addressing infertility could be a way to empower women in Africa and improve their sexual and reproductive health. Infertility rates among married couples in Africa range from 15% to 30% against reported rates of 5% to 10% in developed countries.

YOUTH HEALTH RESEARCH

YouthLens: Research That Guides Reproductive Health Efforts for Youth (feature article)
Several specific conclusions concerning young people's reproductive health that were based on 39 rigorously evaluated programmatic interventions are described in this article. The interventions were identified by the FOCUS on Young Adults Program, which operated from 1995 to 2001. The FOCUS End of Program Report has been synthesized into a 32-page summary, and information for obtaining a copy of that summary is given here.

Sexual Knowledge, Attitudes, and Risk Behaviors of Students in Turkey (PubMed abstract)
The purpose of this survey was to produce baseline information about student knowledge of STDs, their sexual attitudes, and their behavior in order to help establish control and education programs. A total of 2,217 first- and fourth-year students were surveyed at Ege University, Izmir, Turkey, during the 1999-2000 academic year. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females. Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal.

YOUTH HEALTH NEWS

US: Parents Fret Over New Sex-ed Law (news article)
California Governor Gray Davis has signed a bill that allows sex education to be taught to kindergartners and eliminates a previous requirement that parents give written permission before sex education may be taught.

Australia: Call for New Sex Education Program (news article)
Health experts in Australia are calling for sex education to begin in primary school after a national survey found that most year 10 students were sexually active. The survey, of 2,388 secondary students in years 10 and 12, found that more than 75% of year 10 students had experienced some form of sexual activity, including "deep" kissing, genital touching, oral sex, and intercourse.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 3, Number 40 6 October 2003