Volume 7, Number 11
2 April 2007

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FAMILY PLANNING/REPRODUCTIVE HEALTH RESEARCH

Sex workers' accounts of condom use: Implications for condom production, promotion and health policy
(Abstract; subscription needed for full text; Europe)
Journal of Family Planning and Reproductive Health Care. 2007 Apr;33(2):107-111.
Free C | Roberts I | McGuire M
Objectives: To explore sex workers' accounts of condom use and their recommendations about how condoms might be improved. Methods: In-depth interviews were conducted with 22 female sex workers in sex work premises in London, UK and Amsterdam, The Netherlands. Results: The consistent and effective use of condoms was dependent upon client selection, sex worker control of the condom, communication skills and on condom and sex-related skills. The design of facilities, the way the encounter was structured and alarm call systems were key to generating an environment in which sex worker control of the interaction was feasible. A wide range of practices used for 'safer sex', including the use of simulated vaginal sex, skills in fitting the condom in a sexually arousing way, checking the condom placement during intercourse and holding onto the condom during withdrawal, were described but awareness of such practices was piecemeal. Several sex workers said that particular care is needed when using condoms in men with a small penis and pointed out to the authors that a smaller condom would be useful. Conclusions: The sex workers told us about the importance of environmental factors and a range of sex and condom-related skills in 'safer sex'. Environmental 'safety' features could be addressed through a licensing system for sex work premises. Communication, condom and sex-related skills should be more broadly disseminated through health promotion initiatives with sex workers. The issue of condom fit deserves further attention. (author's)

Prevention strategies for sexually transmitted infections: The importance of sexual network structure and epidemic phase
(Abstract; subscription needed for full text; Global)
Sexually Transmitted Infections. 2007 Mar 27;Online access March 27 2007.
Ward H
In this article I explore the relationship between sexual network structure and epidemic phase in sexually transmitted disease epidemiology, and discuss how this may be used to inform prevention strategies at the population level. There are relatively few empirical studies of sexual networks, and even fewer that track the evolution of networks over time. Most studies focus on networks in the context of disease transmission and will miss the network structure in the wider population. Results from disease-related studies in the early epidemic phase show densely connected networks with multiple short loops. In later hyperendemic phases, networks appear more loosely connected with a dominance of long branching structures. The latter structure has also been described from non-diseased populations. These structures evolve over time, both of the epidemic curve and as a cohort ages and undergoes demographic change. Population strategies for prevention should vary depending on network structure and epidemic phase. In early and late epidemic phases, interventions focussing on high risk polulations, i.e. dense areas of a sexual network, will have a large population effect. In contrast, for established endemic diseases a smaller change (of behaviour or interruption of transmission through screening) in a larger proportion of the population could have the largest population impact. Further empirical work on the way network structures relate to epidemic phase, and how this changes with age and social development will help to inform intervention strategies at the population level.

Comparison of diaphragm and combined oral contraceptive pill users in the Australian family planning setting
(Abstract; subscription needed for full text; Oceania)
European Journal of Contraception and Reproductive Health Care. 2007 Mar;12(1):24-29.
Bateson D | Weisberg E
Objectives: To determine the number of women fitted with a diaphragm or cervical cap at family planning clinics across the Australian State of New South Wales (NSW) from 2000 to 2005. To compare the demographic characteristics of women fitted with this form of contraceptive with women prescribed the combined oral contraceptive pill (COCP). Method: An audit of women presenting for contraceptive services between 2000 and 2005 was undertaken. The demographic characteristics of women fitted with a barrier method or prescribed the COCP between 1st April, 2002, and 31st October, 2004, were obtained from the Family Planning NSW Activity Data Set (FADS). Results: The proportion of women fitted with a diaphragm or cap remained constant between 2001 and 2005 at approximately 5%. During the 31 months that the study period lasted, 793 women were fitted with a diaphragm or cervical cap compared with 8047 women prescribed the COCP during the same time frame (including 76 women who received both a diaphragm and COCP prescription during this period). Women fitted with the barrier contraceptive were significantly more likely to be older, to have received a tertiary level education and to have private health insurance than their counterparts prescribed the COCP. They were less likely to come from a non-English speaking background. Discussion: The diaphragm and cervical cap are viable contraceptive methods for a specific group of older, well-educated women. The possible benefits of female-controlled barrier devices in the prevention of sexually transmissible infections may result in a wider demographic use in the future. (author's)

FAMILY PLANNING/REPRODUCTIVE HEALTH NEWS

Communist party officials in central China warned no promotion if they have too many children
(News Article; Asia)
29 Mar 2007
The Associated Press

India: Ashley, Akshay & Dr. Digamber Singh launch emergency contraception program in Rajasthan
(News Article; Asia)
28 Mar 2007
India Infoline News Services

Modified rhythm method shown to be as effective as the pill—but who has that kind of self-control?
(Feature Article; Europe)
Scientific American 26 Mar 2007
Mims C

FAMILY PLANNING/REPRODUCTIVE HEALTH LAW AND POLICY

Contraception: A social revolution
(Abstract; subscription needed for full text; Global)
European Journal of Contraception and Reproductive Health Care . 2007 Mar;12(1):3-12.
Benagiano G | Bastianelli C | Farris M
Modern contraceptive technology is more than a technical advance: it has brought about a true social revolution, the 'first reproductive revolution' in the history of mankind. This latter was followed in rapid succession by other major changes in human reproductive strategies. In the human species, sexual activity began to lose its exclusive reproductive meaning at an early stage of its evolution. Human beings must have practiced non-conceptive sex from the outset and therefore must have had a need to avoid, rather than to seek conception during intercourse from time immemorial. The search for methods to control fertility went on for millennia, but a valid solution was only found during the twentieth century, when the population explosion had forever changed the shape of humanity: in only one century the total population of the planet had grown from some 1.6 billion to more than 6 billion. That increase will remain unique in the history of Homo sapiens. At the global level, contraception provided a tool to deal with overpopulation and, in only 50 years, went a long way towards its resolution. However, to solve the problem, national and international family planning initiatives were required. For individuals, contraception also meant a revolution. It allowed sexual intercourse without reproduction. Only 25 years later, in vitro fertilisation permitted childbearing without sexual intercourse. Other advances followed and now cloning, that is, reproduction without the two gametes, looms on the horizon. Such a series of rapid, major changes in human reproductive strategies has confused many. For this reason, a constructive dialogue between sociology and biology is mandatory. Contraception is a powerful tool to promote equity between sexes; it improves women's status in the family and in the community. Avoiding pregnancy during the teens increases opportunities for a young woman's education, training and employment. By controlling their fertility, women get a chance to contribute economically to their household, which in turn may give them a greater share in decision-making. There are other specific areas in which contraception has produced beneficial social effects, first and foremost in reducing the need for induced abortion. It has also helped avoiding sexually-transmitted infections and is a very useful tool for educating youngsters to adopt more responsible sexual behaviors. Interventions in the field of family planning are among the most cost-effective health interventions. (author's)

HIV/AIDS RESEARCH

Drug abuse, HIV/AIDS and stigmatisation in a Dai community in Yunnan, China
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 Apr;Online access March 30, 2007. 64(8):1560-1571.
Deng R | Li J | Sringernyuang L | Zhang K
The latest data indicate that between 540,000 and 760,000 people are infected with HIV in China. Although minority nationalities represent 8.1% of China's total population, they account for more than 30% of the reported HIV/AIDS cases. This study examined stigma and discrimination against drug abusers and people living with HIV/AIDS (PLHA) in a Dai minority nationality community in Yunnan, China. The study used qualitative research methods, which included participatory observations, in-depth interviews, focus-group discussions, transect walking and community mapping. A combination of different sampling strategies was used to maximise diversity of the initially selected sample. The data revealed deeply entrenched stigma and overt discrimination against drug abusers and PLHA that manifested in familial, work, civil and institutional contexts. The stigma reflected pre-existing cultural, religious sanctions against "deviant behaviours". Intervention programmes that were insensitive to the local culture and religion may have also contributed in part to the stigmatisation of drug abusers and PLHA. The major impact of stigma was that it created a vicious cycle of social isolation, marginalisation and thus addiction relapse. This in turn reinforced the stigmatisation and discrimination against drug abusers and thus hindered efforts towards prevention and control of HIV/AIDS.

An information-motivation-behavioral skills (IMB) model-based HIV prevention intervention for truck drivers in India
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2007 Apr;Online access March 30, 2007. 64(8):1572-1584.
Cornman DH | Schmiege SJ | Bryan A | Benziger TJ | Fisher JD
The incidence of HIV/AIDS in India is increasing drastically, and truck drivers are seen as critical sources of HIV transmission due to their high rates of unprotected sex with multiple partners. An intervention based on the Information-Motivation-Behavioral Skills (IMB) model was compared to an information-only control condition in a randomized trial. IMB constructs were assessed among 250 male truck drivers immediately prior to and following implementation of the intervention, and sexual and condom use behaviors were assessed approximately 10 months later. The intervention consisted of a single-session group workshop with 5 interactive activities designed to address HIV prevention-related IMB constructs and to motivate condom use. Findings showed mixed support for the effectiveness of the intervention. There was an effect of the IMB intervention on attitudes, norms, behavioral skills, and intentions specific to condom use with marital partners, but no effects on constructs related to non-marital partners. There was some evidence of greater condom use with marital and non-marital partners at behavioral follow-up for participants in the IMB condition, and effects on condom use with marital partners were mediated by changes in IMB constructs. These findings provide initial evidence for the effectiveness of theoretically-based approaches to HIV prevention in India.

Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
European Journal of Contraception and Reproductive Health Care. 2007 Mar;Online access March 30, 2007. 12(1):76-85.
Ijadunola KT | Ijadunola MY | Abiona TC | Odu OO | Akinyemi AA
Objectives: The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria. Methods: A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted. Results: Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p less than 0.05). Conclusions: Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.

The political economy of AIDS leadership in developing countries: An exploratory analysis
(Abstract; subscription needed for full text; Global | Asia | Central America and the Caribbean | South America | Middle East | Sub-Saharan Africa)
Social Science and Medicine. 2007 Apr;Online access March 30, 2007. 64(8):1585-1599.
Bor J
The commitment of high-level government leaders is widely recognized as a key factor in curbing national AIDS epidemics. But where does such leadership come from? This paper presents a quantitative analysis of the determinants of AIDS leadership in 54 developing countries, using the 2003 AIDS Program Effort Index "political support" score as an indicator of political commitment. Explanatory variables include measures of political institutions as well as economic development and integration. Models developed in the analysis explain over half of the variation in commitment across the countries in the sample. In particular, press freedoms, income equality, and HIV prevalence stand out as determinants of political commitment.

Prevalence of urinary schistosomiasis and HIV in females living in a rural community of Zimbabwe: Does age matter?
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 May;Online access March 30, 2007. 101(5):433-438.
Ndhlovu PD | Mduluza T | Kjetland EF | Midzi N | Nyanga L
A cross-sectional study was conducted on 544 women living in Mupfure rural area of Zimbabwe to determine whether infection with urinary schistosomiasis is associated with HIV infection. Schistosoma haematobium infection was examined in urine samples and HIV infection was determined in sera. The prevalence of S. haematobium infection was highest (60%) in women below 20 years of age and declined to 29% in the oldest age group (test for trends, P less than 0.001). Overall, women infected with urinary schistosomiasis had an HIV prevalence of 33.3%, whilst women without urinary schistosomiasis had an HIV prevalence of 25.6% (X2, P = 0.053). Women above the age of 35 years and infected with urinary schistosomiasis had a significantly higher HIV prevalence (37.5%) than those without urinary schistosomiasis (16.8%; X2, P less than 0.001).

Reaction time in patients with HIV/AIDS and correlation with CD4 count: A case-control study
(Abstract; subscription needed for full text; Global)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 May;Online access March 30, 2007. 101(5):517-522.
Ogunrin AO | Odiase FE | Ogunniyi A
There are conflicting reports on the presence of neurocognitive dysfunction during the initial, medically asymptomatic stage of HIV infection. This study aimed to assess the psychomotor speed and attention ability of antiretroviral treatment-naive Nigerian Africans with HIV/AIDS and the impact of CD4 levels on their cognitive performance. Two hundred and eighty-eight randomly selected age-, sex- and level of education-matched subjects participated, comprising 96 HIV-positive asymptomatic and 96 HIV-positive symptomatic patients and 96 HIV-negative controls. The simple reaction and binary choice reaction time tasks were used for cognitive assessment. The binary choice reaction time indicated that the HIV-positive patients had impaired attention ability and significant psychomotor slowing compared with the controls (P less than 0.05), but psychomotor slowing was obvious among the symptomatic HIV-positive patients only using the simple reaction time tasks. Significant psychomotor retardation was observed in HIV-positive patients with CD4 levels of 200-499 cells/mm3 (P = 0.02) and less than 200 cells/mm3 (P less than 0.001), and impaired ability for sustained attention was present irrespective of the CD4 level (P less than 0.001). We conclude that psychomotor retardation and impaired attention are significantly worse in HIV-positive subjects compared with controls and are adversely affected by decreasing CD4 levels. The sensitivity of the neuropsychological tool used can affect the degree of impairment measured.

HIV/AIDS NEWS

Historic HIV/AIDS Initiative "Live Up" Launched Across the Caribbean
(News Article; Central America and the Caribbean)
27 Mar 2007
St. John Tradewinds

S.Africa Insurers to Pay Out HIV/AIDS Claims
(News Article; Sub-Saharan Africa)
27 Mar 2007
Reuters

South Africa: Balfour gives prisoner HIV tally
(News Article; Sub-Saharan Africa)
27 Mar 2007
iAfrica

South Africa: Satellite Health Channel Reaches Nearly 300 Clinics
(News Article; Sub-Saharan Africa)
26 Mar 2007
BuaNews

MATERNAL AND CHILD HEALTH RESEARCH

Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings
(Abstract; subscription needed for full text; Global)
International Journal of Gynecology and Obstetrics. 2007 Apr;97(1):52-56.
Bradley SE | Prata N | Young-Lin N | Bishai DM
Objective: To test the cost-effectiveness of training traditional birth attendants (TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal dose of misoprostol in areas with low access to modern delivery facilities. Method: A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000 women each giving birth with TBAs: one under standard treatment (TBA referral to hospital after blood loss greater than or equal to 500 ml), and one attended by TBAs trained to recognize PPH and to administer 1000 µg of misoprostol at blood loss greater than or equal to 500 ml. Result: The misoprostol strategy could prevent 1647 cases of severe PPH (range: 810-2920) and save $115,335 in costs of referral, IV therapy and transfusions (range: $13,991-$1,563,593) per 10,000 births. By preventing severe disease and saving money, it dominates the standard approach. Conclusion: Training TBAs to administer misoprostol to treat PPH has the potential to both save money and improve the health of mothers in low-resource settings. (author's)

Antiretroviral therapy for children in the routine setting in Malawi
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2007 May;101(5):511-516.
Malawi Paediatric Antiretroviral Treatment Group
Malawi is scaling up antiretroviral therapy (ART) for HIV-infected patients. Using a fixed-dose combination of stavudine + lamivudine + nevirapine ('Triomune') as the first-line regimen, split tablets are given to children with doses according to body weight. By March 2006, a total of 46 702 patients had been started on ART, of whom 2718 (5.8%) were children aged <15 years. In a subset of 935 children, comprising 486 boys and 449 girls, 1.5% were aged less than 1 year, 26% were aged 1-4 years, 39% were aged 5-9 years and 33% were aged 10-14 years. Between July and September 2005, 7905 patients started ART, comprising 7469 adults and 436 children. Six-month cohort outcomes censored on 31 March 2006 showed significantly more children alive and significantly fewer children dead or defaulted compared with adults. Between January and March 2005, 4580 patients started ART, comprising 4347 adults and 233 children. Twelve-month cohort outcomes censored on 31 March 2006 showed significantly more children alive compared with adults. The results of this national study should encourage other programmes to invest in ART for children and particularly to monitor their treatment outcomes. (author's)

Abuse during pregnancy in Mexico City
(Abstract; subscription needed for full text; Central America and the Caribbean)
International Journal of Gynecology and Obstetrics . 2007 Apr;97(1):57-64.
Diaz-Olavarrieta C | Paz F | Abuabara K | Martinez Ayala HB | Kolstad K
Objective: Measure the prevalence of physical and sexual abuse during pregnancy, determine the nature and severity of abuse, and assess correlates with abuse. Method: A total of 1314 women seeking prenatal care between July 2000 and January 2003 were approached at three public hospitals in Mexico City. An original composite case record form was created to measure physical and sexual abuse before and during pregnancy. Result: Forty-one percent of respondents had a history of physical or sexual abuse, with current abuse reported by 11.1%, and abuse during pregnancy by 7.6%. Among abused women, 71% reported an increase in the severity of abuse since becoming pregnant. Logistic regression revealed physically fighting with a partner and a history of abuse best predict violence during pregnancy. Conclusion: The severity of abuse among abused women appears to increase during pregnancy. Prenatal care visits in Mexico are an important opportunity for violence screening and intervention. (author's)

Complications associated with caesarean delivery in a setting with high HIV prevalence rates
(Abstract; subscription needed for full text; Sub-Saharan Africa)
European Journal of Obstetrics and Gynecology and Reproductive Biology. 2007 Apr;131(2):138-145.
Moodliar S | Moodley J | Esterhuizen TM
Objective: This study was designed to determine the prevalence of complications associated with abdominal delivery in a setting of high caesarean section (C/S) and HIV rates. Method: A detailed review of the records of 737 C/S performed over a three-month period was conducted in a tertiary teaching hospital in Durban, South Africa. Results: The overall complication rate was 14.2%. Major complications included endometritis, wound sepsis, post-partum haemorrhage and bladder injury. HIV infection may have a negative impact on morbidity rates. Disimpacting the fetal head vaginally had a significant association with endometritis ( p = 0.021). The use of a corrugated drain did not prevent wound sepsis ( p less than 0.001). Conclusion: Complications associated with C/S are common is a setting of high C/S rates and HIV infection. (author's)

MATERNAL AND CHILD HEALTH NEWS

Solely breastfeeding babies cuts HIV toll
(News Article; Global)
2007 Mar 30;
Bosely S

MEN'S HEALTH RESEARCH

The role of men in family planning decision-making in rural and urban Nigeria
(Abstract; subscription needed for full text; Sub-Saharan Africa)
European Journal of Contraception and Reproductive Health Care . 2007 Mar;12(1):70-75.
Orji EO | Ojofeitimi EO | Olanrewaju BA
Objectives: To determine the role of men in family planning decision-making in both rural and urban areas of Nigeria. Methods: A total number of 370 married men (244 rural and 126 urban) were interviewed using a pre-tested, semi-structured interviewer based questionnaire. The study was conducted in the Iwaro community in Atakumosa West Local Government area (rural men) and the Oranfe Community in Ife East Local government area (urban men), both in Osun State, South West Nigeria. Results: The results showed a high level of awareness of family planning among both study groups (98.3% rural and 98.4% urban). Most men in both groups believe that a decision about family planning should be made jointly by the spouses instead of being the prerogative of either. This contrasts with the generally held belief that men are opposed to family planning and a take predominant role in contraceptive decision-making. The condom was the most commonly known and used method with a preponderance among urban (81.1%) over rural men (69.4%). Many men would use family planning if their wives demanded it. However, most respondents in both study groups believed that men should not accompany their wives to the family planning centre to obtain contraceptive supplies and advice. Conclusion: Deciding about contraception should be done jointly by men and women in South West Nigeria. (author's)

Outcome of vasectomies performed at a Turkish metropolitan maternity hospital
(Abstract; subscription needed for full text; Europe)
European Journal of Contraception and Reproductive Health Care. 2007 Mar;12(1):19-23.
Dilbaz B | Cil AP | Gultekin IB | Caliskan E | Kahyaoglu Z
Objective: To determine prospectively the outcome of vasectomies performed by two trained surgeons over a 9-month period at the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital Family Planning Centre. Methods: The demographic data, source of information concerning the method, sexual function before and after voluntary no-scalpel vasectomy, compliance with the postvasectomy follow-up program of men applying for a vasectomy were analyzed. All patients were contacted by telephone and invited for follow-up visits for counseling, inquiry regarding sexual dysfunction, and performance of a semen analysis. Results: The patients were married men, mostly primary school graduates, with more than one child. Sources of information were health services and/or health personnel for 89% of the patients. Of the 279 men who underwent a vasectomy and who were later contacted by phone, 131 (47%) came for a follow-up assessment. There was only one post-vasectomy pregnancy (0.8%). The incidence of reported sexual problems did not change after the procedure. Vasectomy did not affect the sexual function of men in our study. Conclusion: Compliance with follow-up after vasectomy, which is extremely important for assessment of its successful outcome, is low.

Comparison of outcomes of different varicocelectomy techniques: Open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: A randomized clinical trial
(Abstract; subscription needed for full text; North America)
Urology. 2007 Mar;69(3):417-420.
Al-Kandari AM | Shabaan H | Ibrahim HM | Elshebiny YH | Shokeir AA
Objectives: To compare the outcomes of the different surgical techniques used in varicocelectomy. Methods: The study included 120 patients with 147 clinically palpable varicoceles who underwent varicocelectomy. The patients were randomly allocated to one of three equal groups according to the varicocelectomy technique, which included the open inguinal approach, a laparoscopic approach, and subinguinal microscopic varicocelectomy. The assessment included operative and postoperative parameters, together with semen analysis and pregnancy rate. The mean follow-up was 18 months (range 11 to 26). Results: The operative time in the microscopic group was significantly longer than that for the other two groups. At follow-up, none of the patients of the microscopic group had developed postoperative hydrocele; however, it was observed in 7 (13%) of 52 varicoceles in the open group and 10 (20%) of 50 in the laparoscopic group. This difference was statistically significant in favor of the microscopic group only. Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups, respectively. This difference was statistically significant in favor of the microscopic group only. Improvement in sperm motility and/or concentration was comparable and observed in 65%, 67%, and 76% of the open, laparoscopic, and microscopic groups, respectively. Also, the pregnancy rate at 1 year was not significantly different and was 28%, 30%, and 40% in three groups, respectively. Conclusions: The findings of our study have demonstrated that, compared with open inguinal and laparoscopic varicocelectomy, subinguinal microsurgical varicocelectomy offers the best outcome.

Penile carcinoma: The role of koilocytosis in groin metastasis and the association with disease specific survival
(Abstract; subscription needed for full text; Global)
Journal of Urology. 2007 Apr;Online access March 30, 2007. 177(4):1339-1343.
de Paula AA | Netto JC | Freitas R Jr | de Paula LP | Mota ED
Purpose: We evaluated the influence of koilocytosis, and other clinical and pathological variables in the risk of groin metastasis and death in penile cancer patients. Materials and Methods: From January 1994 to January 2004, 172 patients with squamous cell carcinoma of the penis were treated at a single cancer center. Of these patients 144 were retrospectively studied to analyze prognostic factors and establish the role of koilocytosis in penile cancer. Univariate and multivariate analyses were performed, and Kaplan-Meier survival curves were generated. Results: A total of 102 patients (71%) underwent groin dissection, of whom 84 (58.3%) had inguinal metastasis. Koilocytosis was present in 91 patients (63.1%) and it was associated with low and moderate primary tumor grade on univariate analysis (p = 0.0005). Although koilocytosis statistically correlated with Jackson stage (p = 0.017) and tumor grade (p = 0.002), it had no impact on disease specific survival (p = 0.912). Metastatic inguinal disease correlated with patient age, Jackson and disease specific survival. Only Jackson stage and inguinal relapse after groin dissection influenced overall survival on multivariate analysis (each p = 0.001). Conclusions: According to all studied variables only patient age and Jackson stage correlated with an increased risk of groin disease. Koilocytosis was rarely found in high grade penile tumors and it did not correlate with a high risk of metastatic groin disease or death.

MEN'S HEALTH NEWS

Uganda: Male circumcision may not reduce HIV
(News Article; Sub-Saharan Africa)
26 Mar 2007
New Vision (Kampala)

Circumcision is recommended to fight HIV
(News Article; Global)
28 Mar 2007
Associated Press

FDA advisers ok prostate cancer vaccine
(News Article; Global | North America)
29 Mar 2007
The Associated Press

Eat a lot of beef? It may affect your son's sperm
(News Article; Global)
28 Mar 2007
Reuters

POPULATION RESEARCH

Developing a nursing database system in Kenya
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Health Services Research. 2007 Mar;Online access March 30, 2007. :17 p.
Riley PL | Vindigni SM | Arudo J | Waudo AN | Kamenju A | Ngoya J | et al
Objective: To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. Principal Findings: Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified. Conclusions: The Kenya nursing database is a first step toward facilitating evidence based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

Evaluation of a village-informant driven demographic surveillance system in Karonga, northern Malawi
(Research Article; Sub-Saharan Africa)
(You need Adobe Acrobat Reader to access this document)
Demographic Research. 2007 Mar 23;Online access March 30, 2007. 16(8):219-248.
Jahn A | Crampin AC | Glynn JR | Mwinuka V | Mwaiyeghele E
This paper describes and evaluates the first demographic surveillance system (DSS) in Malawi, covering a rural population of 30,000. Unlike others, the Karonga DSS relies on trained village informants using formatted registers for the primary notification of vital events and migrations. Seven project enumerators subsequently collect detailed data on events notified by the village informants, using stringent identification procedures for households and individuals. Internal movements are traced systematically to augment event registration and data quality. Continuous evaluation of data collection is built into the methods. A re-census conducted after 2 years indicated that the routine system had registered 97% of 1,588 births, 99% of 521 deaths and 92% of 13,168 movements.

International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care
(Abstract; subscription needed for full text; Global)
Human Reproduction. 21 Mar 2007;:1-7.
Boivin J | Bunting L | Collins J | Nygren K
The purpose of the present study was to review existing population surveys on the prevalence of infertility and proportion of couples seeking medical help for fertility problems. Population surveys, reporting the prevalence of infertility and proportion of couples seeking help in more and less developed countries, were reviewed. Estimates on the prevalence of infertility came from 25 population surveys sampling 172 413 women. The 12-month prevalence rate ranged from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less-developed nations, with an estimated overall median prevalence of 9%. In 17 studies sampling 6410 women, the proportion of couples seeking medial care was, on average, 56.1% (range 42–76.3%) in more developed countries and 51.2% (range 27–74.1%) in less developed countries. The proportion of people actually receiving care was substantially less, 22.4%. Based on these estimates and on the current world population, 72.4 million women are currently infertile; of these, 40.5 million are currently seeking infertility medical care. The current evidence indicates a 9% prevalence of infertility (of 12 months) with 56% of couples seeking medical care. These estimates are lower than those typically cited and are remarkably similar between more and less developed countries.

The effect of unusual social experience on the global health of North Korean asylum seekers
(Abstract; subscription needed for full text; Asia)
Public Health. 2007 Apr;Online access March 30, 2007. 121(4):287-295.
Kim DS | Cho Y | Moon OR
Objectives: This study examined the risk factors associated with a negative self-rating of subjective health among North Korean asylum seekers, paying particular attention to the unusual social experiences of this population. Study design: This study utilized the North Korean Health Care System Data Set (NKHCS). This data set is comprised of information on 221 North Korean asylum seekers (aged 20 years and over) who were housed in Hanawon, a South Korean government facility. We specifically examined the effect of three separate risk factors (major country of residence after exiting North Korea, duration of stay in country, and whom they were accompanied by during their migration event) associated with the unusual social experiences of North Korean asylum seekers on their global health. Methods: Multivariate logistic regression analyses were carried out in order to assess the consistency and validity of extant hypotheses and general expectations. Results: North Korean asylum seekers who entered South Korea within one year of their defection or were accompanied by non-family members tended to negatively self-report their health status. However, major intermediate country of residence after exiting North Korea showed no effect. Higher educational attainment and membership of the Labour Party of North Korea were negatively associated with the global health of this population, though this was not statistically significant. Conclusions: We found that the unusual social experiences of North Korean asylum seekers, particularly intermediate country duration and companionship characteristics, were significantly associated with their health. Future studies need to examine the relationship between diverse social experiences during residence in intermediate countries and the health of this population.

POPULATION NEWS

Singapore woos immigrants to boost population
(News Article; Asia)
23 Mar 2007
Reuters

Council of advisers meets: Dhaka to ratify UN convention on cultural expression
(News Article; Asia)
24 Mar 2007
The New Nation

India: Curse this sonic mania
(Feature Article; Asia)
27 Mar 2007
DNA India

WOMEN'S HEALTH RESEARCH

Domestic violence: The Lebanese experience
(Abstract; subscription needed for full text; Middle East)
Public Health. 2007 Mar;Online access March 30, 2007. 121(3):208-219.
Usta J | Farver JM | Pashayan N
Objectives: To estimate the prevalence of domestic violence among women presenting to primary health care facilities in Lebanon; to identify presenting symptoms and responses to varied forms of violence;and to examine variables associated with domestic violence. Study design/methods: A cross-sectional survey of all women presenting to four primary health care centres in different geographic areas of Lebanon from September 2002 to October 2002. A questionnaire was administered in interview format. The following information was collected from participants: demographic characteristics, perceived health status, prior exposure and responses to domestic violence, and characteristics of the perpetrators. Results: Of the 1418 participants, 494 (35%) reported experiencing domestic violence and 307 (22%) had family members who had been exposed to domestic violence. Among the women exposed to violence, verbal abuse or insult was most common (88%) followed by physical violence (66%); 57% reported their experiences to family, friends or authorities, whereas the remainder kept silent. Women who were exposed to domestic violence had higher frequencies of reported physical symptoms than those who were not exposed. Generally, the perpetrators were spouses who had demographic backgrounds comparable to their wives. Multiple regression analyses showed that women's education levels, work status, health status, and familial violence predicted domestic violence. Conclusions: Women readily talk about their abuse when asked. The rate of domestic violence is high among Lebanese women and is a significant health issue. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.

Clinical aspects and luteal phase assessment in patients with recurrent vulvovaginal candidiasis
(Abstract; subscription needed for full text; Global)
European Journal of Obstetrics and Gynecology and Reproductive Biology. 2007 Apr;Online access March 30, 2007. 131(2):198-202.
Spacek J | Buchta V | Jilek P | Forstl M
Objective: This study was undertaken to characterize the patients with recurrent vulvovaginal candidiasis. Study design: Basic data of personal history and history of recurrent vulvovaginal candidiasis, lower genital tract symptoms and signs in 50 patients were analyzed in this longitudinal follow-up study including the determination of midluteal serum progesterone and urinary pregnanediol levels during the luteal phase in 84 cycles (recurrent vulvovaginal candidiasis) and 60 cycles (healthy controls). Results: All patients suffered primary idiopathic form of recurrent vulvovaginal candidiasis. Frequently, there was a striking discrepancy between severe symptoms and clinical finding, which was often negligible or normal. There was no redness and no or minimum discharge in 52% of culture documented attacks. In contrast to the healthy controls, the patients had significantly lower levels of progesterone (p less than 0.01) as well as those of urinary pregnanediol (p less than 0.05). Conclusion: Culture positive attacks in patients with recurrent vulvovaginal candidiasis represented rather a form of vulvovaginal discomfort than attacks of vulvovaginal candidiasis with typical inflammatory changes. Significantly lower progesterone levels in the RVVC patients as compared to the healthy controls suggest a link between an altered hormonal status and one of possible causes of RVVC in these women.

WOMEN'S HEALTH NEWS

Nepal: Uterus prolapse women to get free treatment
(News Article; Asia)
30 Mar 2007
The Rising Nepal

Beyond stillbirth, shame: Women with a fistula
(Feature Article; Sub-Saharan Africa)
30 Mar 2007
Reuters

Female circumcision is violence against women
(Editorial; Sub-Saharan Africa)
29 Mar 2007
New Vision

YOUTH HEALTH RESEARCH

Brief report: Methods for collecting sexual behaviour information from South African adolescents--A comparison of paper versus personal digital assistant questionnaires
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Adolescence. 2007 Apr;Online access March 30, 2007. 30(2):353-359.
Jaspan HB | Flisher AJ | Myer L | Mathews C | Seebregts C
Reporting bias in adolescent behavioural research may be overcome with the use of personal digital assistants (PDA) or other computer based technologies. However, there is little insight into the use of these tools among adolescents in low resource settings. We compared self-administered paper questionnaires with PDA questionnaires to collect sexual behaviour data from a sample of 11-19 year olds living in a periurban, Xhosa-speaking community in South Africa. There was a high level of agreement between sexual risk behaviour data collected via each method (kappas greater than or equal to 0.50). Data collected from the PDA questionnaires were more complete. Subjectively, adolescents found the use of PDA to be simple and confidential. PDAs may be a useful method to collect sensitive, self-reported information from adolescents in resource-limited settings.

The relationship between monogamous/polygamous family structure and the mental health of bedouin Arab adolescents
(Abstract; subscription needed for full text; Middle East)
Journal of Adolescence. 2007 Apr;Online access March 30, 2007. 30(2):213-230.
Elbedour S | Bart W | Hektner J
Previous studies of polygamy and child mental health have primarily focused on younger children. The present studies are among the first to focus on adolescents. The first study involved 210 randomly selected Bedouin Arab adolescents (mean age 15.9), who were administered instruments assessing their family environment and mental health. The second study involved 182 Bedouin Arab adolescents in which the student participants completed a single instrument about themselves and in which the teachers of the students completed the Teachers' Report Form of the Child Behaviour Checklist by Achenbach. The Bedouin Arab adolescents fell into two groups: (a) adolescents in monogamous family structures and (b) adolescents in polygamous family structures. The findings of the first study suggest that the two groups did not differ significantly in the majority of the assessed variables, even though there were significant differences obtained between groups for 4 of the 13 assessed variables. The two groups did not differ significantly in the second study. Results were discussed in terms of their cultural and developmental significance.

YOUTH HEALTH NEWS

Nepal: Projects on Youths in Shadow: RHIYA
(News Article; Asia)
27 Mar 2007
The Himalayan Times

India: Horatti rules out sex education in schools
(News Article; Asia)
28 Mar 2007
The Hindu

Uganda: Boys ignore sex education
(News Article; Sub-Saharan Africa)
27 Mar 2007
New Vision

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Volume 7, Number 11 2 April 2007