Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho

Background

Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data.

Methods and Findings

During Lesotho Defence Force applicant screening in 2009, 241 (77%) of 312 men, aged 18–25 y, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC) to 4 (complete MC). MC was self-reported by 27% (n = 64/239) of participants. Of the 64 men self-reporting being circumcised, physical exam showed that 23% had no evidence of circumcision, 27% had partial circumcision, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were seven times higher among those reportedly circumcised by initiation school personnel (odds ratio = 7.22; 95% CI = 2.29–22.75).

Conclusions

Approximately 27% of participants self-reported being circumcised. However, only 50% of these men had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up voluntary medical MC (VMMC) should obtain physical-exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting VMMC should provide comprehensive education regarding the definition of VMMC.     

Factors influencing body composition in persons with spinal cord injury: a cross-sectional study.

To determine the body composition differences across age, 133 men with chronic spinal cord injury (SCI) (66 with tetraplegia, 67 with paraplegia) were compared with an age-, height-, and ethnicity-matched able-bodied male reference population (n = 100) using two different dual-energy X-ray absorptiometry densitometers. The effects of duration of injury, level, and completeness of lesion were analyzed in the SCI population. Independent of age, total body and regional lean mass were lower and fat mass was higher in persons with SCI compared with controls. The SCI group was 13 +/- 1% (means +/- SE) fatter per unit of body mass index (kg/m2) compared with the control group (P < 0.0001). Advancing age was strongly associated with less lean mass and greater adiposity in those with SCI, whereas it was mildly related in the controls. Total body and regional arm and trunk, but not leg, lean tissues were lower in subjects with SCI, across all ages, than in the controls. In summary, persons with SCI were fatter for any body mass index and demonstrated significantly less lean and more adipose tissues for any given age compared with controls.     

Factors affecting intention to breastfeed among Syrian and Jordanian mothers: a comparative cross-sectional study

Background

Breastfeeding remains normative and vital for child survival in the developing world. However, knowledge of the risk of Human Immunodeficiency Virus (HIV) transmission through breastfeeding has brought to attention the controversy of whether breastfeeding can be safely practiced by HIV positive mothers. Prevention of mother to child transmission (PMTCT) programs provide prevention services to HIV positive mothers including infant feeding counseling based on international guidelines. This study aimed at exploring infant feeding choices and how breastfeeding and the risk of HIV transmission through breastfeeding was interpreted among HIV positive mothers and their counselors in PMTCT programs in Addis Ababa, Ethiopia.

Methods

The study was conducted in the PMTCT clinics in two governmental hospitals in Addis Ababa, Ethiopia, using qualitative interviews and participant observation. Twenty two HIV positive mothers and ten health professionals working in PMTCT clinics were interviewed.

Results

The study revealed that HIV positive mothers have developed an immense fear of breast milk which is out of proportion compared to the evidence of risk of transmission documented. The fear is expressed through avoidance of breastfeeding or, if no other choice is available, through an intense unease with the breastfeeding situation, and through expressions of sin, guilt, blame and regret. Health professionals working in the PMTCT programs seemed to largely share the fear of HIV positive mother's breast milk, and their anxiety was reflected in the counseling services they provided. Formula feeding was the preferred infant feeding method, and was chosen also by HIV positive women who had to beg in the streets for survival.

Conclusions

The fear of breast milk that seems to have developed among counselors and HIV positive mothers in the wake of the HIV epidemic may challenge a well established breastfeeding culture and calls for public health action. Based on strong evidence of the risks when infants are not exclusively breastfed, there is a great need to protect breastfeeding from pressures of replacement feeding and to promote exclusive breastfeeding as the best infant feeding option for HIV positive and HIV negative mothers alike.     

Factors associated with practice of colorectal cancer screening among primary care physicians in a Chinese population: A cross-sectional study

Objectives: Primary care physicians (PCPs) are influential in colorectal cancer (CRC) screening uptake in the community. This study aims to evaluate the factors associated with PCPs’ practice of CRC screening among asymptomatic patients in a Chinese population. Methods: A validated postal questionnaire was sent to all practicing PCPs who were members of a community-based network in Hong Kong. Three separate rounds of reminder letters were sent to non-respondents. Binary logistic regression analysis was used with ever-referral for CRC screening in the past 12 months as the outcome variable. Predictor variables include physicians’ gender, clinical experience, types of practice, and attitudes towards CRC screening. Results: Of 428 eligible physicians, 263 (61.4%) responded. A total of 187 physicians (71.1%) had referred patients for CRC screening in the past 1 year. Among all asymptomatic patients aged 50 years or older, physicians reported referring only 3.0% (1.0–10.0%) [median (interquartile range)] of patients. Colonoscopy (57.0%) and fecal occult blood testing (FOBT) (46.4%) were the most commonly recommended tests for these asymptomatic patients. Family history of CRC (58.6%) and patients’ concern about CRC (50.2%) were major reasons for referral. PCPs in private practice (adjusted odds ratio [aOR] 2.60, 95% C.I. 1.21–5.59) and those with positive attitude towards CRC screening (aOR 2.27, 95% C.I. 1.15–4.48) were more likely to recommend CRC screening. Conclusions: PCPs’ attitude towards CRC screening is a significant determinant of its practice. Future studies should identify and strengthen the influencers of PCPs’ attitude to enhance CRC screening rates.     

Factors influencing genetic counseling attendance rate: a geographically based study

A study of factors influencing genetic counseling attendance rate has been conducted in the Bouches-du-Rh?ne area, in the south of France. In this area, a birth defects monitoring system (Eurocat n. 22) annually covers 23,000 births. All the genetic services are delivered by only one genetic center located in Marseilles, and the data collected are computerized. The comparison of these two data bases gives an opportunity to estimate the rate of genetic counseling attendance after the occurrence of an affected stillbirth or live birth. Among the parents of 358 infants born in 1983-84 in this area with a pathology requiring genetic counseling, 226 (63 per cent) attended the Genetic Center within the first year after birth. The rate of attendance is statistically higher (p less than 0.01) for the parents who had a stillbirth (78 per cent) than for those who had a live birth (57 per cent). It is also higher (p less than 0.01) for the Marseilles maternities group (68 per cent) than for the group outside Marseilles (50 per cent). The referral delays are also analyzed according to malformation etiology and to viability of the child by the eighth day of life. Besides evaluating a particular genetic center's effectiveness in diffusing information to the public concerned, this work shows that couples' request is strongly dependent on a psychological need.     

Breaking Dawn: Factors influencing mammalian habitat usage in western Assam following socio-political instability

The impacts of conflict on nature are devastatingly adverse but differ widely in different socio-economic-political regimes. Armed conflict often facilitates illegal plunder and unsustainable use of natural resources. We studied the response of mammals in Ripu (605.27 sq.km, westernmost part of Manas Tiger Reserve) Reserved Forest (RF) in Assam, India that suffers prolonged anthropogenic pressures due to armed conflict instigated by social unrest. We used standard single-season occupancy models using sign survey to assess factors affecting the space use of mammals. Our study revealed that Ripu RF has a high proportion of area occupied by prey species of large carnivores. Asian elephant, barking deer, and wild pig occupied most of the habitat, whereas gaur, sambar and spotted deer restricted themselves to selected patches. The probability of a site being occupied by the majority of ungulates declines with an increase in anthropogenic activities, including distance to human settlement (measure of prolonged disturbance) and an increase in the proportion of secondary degraded forest. Common leopard was found to be positively associated with prey occupancy and increase in semievergreen and moist-mixed deciduous forest. Our ground efforts to strengthen community patrolling and operational execution of various alternative livelihoods has helped to improve the economic condition of patrolling staff. Strategic implementation of law enforcement could support dispersal of tigers from Phibsoo Wildlife Sanctuary (Bhutan), potentially linked to the larger tiger and elephant landscape far west (Buxa Tiger Reserve in West Bengal) in the Terai region of India. Various community-based conservation initiatives and strategies with sustained support from various agencies, including national, international, and local bodies, is required to restore this critical habitat.     

Factors influencing phylogenetic inference: a case study using the mammalian carnivores

Phylogenetic reconstruction has undergone numerous developments in tree selection criteria (e.g., phenetics, cladistics, maximum-likelihood), available data sources (morphology versus molecules, and subsets of the latter), and practical limits on study size. Together with study age, I examined the effects of these variables on inferences of phylogeny for the mammalian order Carnivora. The raw data comprised 274 source trees spread among 13 carnivore taxa (generally families), which I divided into categories for each variable and combined using the supertree technique matrix representation with parsimony analysis. Incongruence between the resultant tree topologies or the underlying data was assessed using four comparison measures, each with slightly different properties: the triplet measures "do not conflict" and "explicitly agree," the partition metric, and the incongruence length difference metric. Except for a few cases reflecting historical problem areas in carnivore systematics, no significant differences in incongruence levels were found among the different categories within each variable, between the variables themselves, or between the taxa. Thus, most estimates of carnivore phylogeny cannot be distinguished from one another (and may even point toward the same solution) regardless of the methodology or data source employed. This conclusion held regardless of the comparison measure used.     

Factors affecting farmers' willingness to pay for adopting vegetable residue compost in North China

The random disposal of vegetable residues in north China has become an important obstacle for the sustainable development of vegetable industry. The composting treatment technology has been transformed into organic fertilizer by high temperature fermentation, which has become a widely promoted agricultural clean production technology. However, due to the voluntary nature of farmers' adoption and their reluctance to adopt, this study aimed at assessing the factors that influence their adoption will and evaluate the value of willingness to pay (WTP) for composting technology. Data were collected from 142 respondents through a household survey in Gaocheng District by using structural questionnaire of contingent valuation method (CVM). Some qualitative response models (Probit, Logistic and multiple linear regression models) were applied for examining the main factors influencing the vegetable residue compost adoption and estimating the WTP value. The findings showed that social resource factors play an important role in the respondents' behaviors toward composting technology adoption. The empirical results indeed highlighted that subsidy policy, top dressing time, age, scale, investment of irrigation and net income have significant positive influences on the WTP of compost, while work time and information sources have a negative impact. Government subsidy is a necessary premise for implementing the composting program. The governments should subsidize the remaining 97% of the construction costs to ensure the smooth implementation of composting technology. The findings specifically mentioned that the subsidy object should be the disadvantaged peasant groups with lower household income but more environmentally conscious. This paper is believed to not only assess the technical externality of vegetable residues for the first time but also provide decision reference for policymakers, especially in the background of rapid development of agricultural clean production technology, the accuracy and efficiency of subsidies should be improved.     

Endothelial function in migraine: a cross-sectional study

Background  

Migraine has been associated with cardiovascular disorders. Endothelial dysfunction may be a mechanism underlying this association. The present study tested the hypothesis that endothelium-dependent vasodilation, basal endothelial nitric oxide release and endothelial fibrinolytic capacity are impaired in migraine patients.     

国家公园农户对野生动物肇事保险购买意愿及其影响因素——以大熊猫国家公园为例

国家公园内人与野生动物冲突严重,建立野生动物肇事保险机制是减缓冲突的重要举措。以大熊猫国家公园周边社区为例,分析建立国家公园以及农户风险偏好对野生动物肇事保险购买意愿的影响,并探讨冲突程度和制度信任的中介效应。研究结果表明建立国家公园显著增加了农户野生动物肇事保险购买意愿,而农户风险偏好对保险购买意愿会产生负向显著影响。冲突程度和制度信任是重要的中介变量,冲突程度和制度信任均对农户保险购买意愿产生正向显著影响。建立国家公园显著增加了人与野生动物冲突严重程度,进而对保险购买意愿产生正向影响。此外,建立国家公园显著降低了农户制度信任,进而对保险购买意愿产生负向影响。农户风险偏好对野生动物肇事损失程度产生正向显著影响,进而对保险购买意愿产生正向影响。农户风险偏好对制度信任影响并不显著。基于此,研究提出吸纳社会资本参与,拓宽野生动物肇事保险资金来源,开展社区共管、地役权补偿等措施提升社区信任以及建立基于农户自主防护行为的野生动物肇事保险机制等政策建议。     

国家公园原住民对野生动物肇事的认知、意愿及其影响因素——以武夷山国家公园为例

国家公园原住民对野生动物肇事的态度直接影响野生动物保护政策有效实施以及人与野生动物共存机制。迄今,学术界鲜有从原住民认知与意愿角度探讨野生动物肇事的成果,基于自然保护地国家公园的相关研究尚未见报道。根据449份有效调查问卷及深度访谈数据,论文采用有序多分类Logistic回归方法,探讨武夷山国家公园原住民对野生动物肇事的认知、意愿及其影响因素。结果表明：（1）多数原住民经历过野生动物肇事,其农作物及牲畜受到严重损害,野猪（Sus scrofa）为研究区域主要的肇事动物。（2）种群数量增加、食物短缺和生存空间受限是野生动物肇事的主要原因。（3）学历、经历及认可政府应对肇事的方式对原住民防范野生动物肇事意愿的影响显著。在此基础上,提出遵循生态规律、保护栖息地、提升认知与意愿、实行社区共管、建立野生动物致害补偿机制以及引入野生动物致害赔偿保险等对策,希望能够深化对野生动物肇事特征及机理的科学认识,为有效缓解人与野生动物冲突、推进国家公园人与野生动物和谐提供政策参考。     

Factors influencing wild boar damage in Taohongling National Nature Reserve in China: a model approach

Conflicts between humans and wildlife, especially wild boar (Sus scrofa), have caused serious problems across the world in recent years. It is necessary to effectively control wild boar agricultural damage that may be influenced by many factors. In this study, we collected data on agricultural damage caused by wild boars from November 2009 to October 2010 using field surveys and social interviews in Taohongling National Nature Reserve of Jiangxi Province, China. We constructed models using binary logistic regression analysis to predict damage risks and to identify the factors influencing damage risks. About 8.1 % of croplands were damaged by wild boars, and the damage to rice, cotton, and other crops were not distributed based on their respective availability as shown by the result of a chi-square goodness-of-fit test. Five factors (Japanese silvergrass, soil conditions, terrain, distances to settlements, and water sources) were explained in a model based on damage area (area-based model) with the prediction accuracy being 72.1 %. In addition to these five factors, one additional factor (i.e. distance to forest edge) was retained in a model based on damage frequency (frequency-based model) with the prediction accuracy being 83.1 %. Caution is needed when we apply these two models to predict boar damage to crops, and it is recommended that both models be used in combination to predict the damage probabilities more accurately.     

Glucocorticoid-induced osteoporosis: a cross-sectional study.

We studied 70 patients (48 women and 22 men) with either rheumatic disease (n = 25) or lung disease (n = 45) who had been treated with glucocorticoids for at least 6 months (mean cumulative dose, 24.2 +/- 27.1 g of prednisone; mean current dose, 11.0 +/- 8.6 mg/d, mean duration of therapy, 8.1 years. We measured bone mineral density (BMD) of the hip (femoral neck) and spine (L2-L4) using dual-photon absorptiometry and BMD of the distal one third radius using single-photon absorptiometry. Compared with age-matched controls, the study population had decreased BMD of the spine (87.0%), hip (87.2%), and radius (90.6%). Current dose, cumulative dose, and duration of therapy were not correlated with BMD in the spine or hip in the total study population. The most significant correlations with low bone mass at the hip and spine were short height and low weight. There was a high incidence of hypercalciuria (30%) as compared with an age- and sex-matched control group (6.4%). Glucocorticoids are known to decrease vertebral and radial bone density. We conclude that glucocorticoids also decrease hip bone density as measured at the femoral neck. The high incidence of hypercalciuria may have implications for therapy of glucocorticoid-induced osteoporosis.     

Factors associated with prelacteal feeding in the rural population of northwest Ethiopia: a community cross-sectional study

Background

Prelacteal feeding has continued as a deep-rooted nutritional malpractice in developing countries. Prelacteal feeding is a barrier for implementation of optimal breastfeeding practices, and increases the risk of neonatal illness and mortality. However, its determinants are not well studied, which are essential to design intervention. This study aimed to assess the prevalence and determinants of prelacteal feeding among mothers with children aged 6–24 months in the rural population of northwest Ethiopia.

Methods

A community based cross-sectional study was conducted in Dabat Health and Demographic Surveillance System site, Dabat district, northwest Ethiopia from May 01 to June 29, 2015. Eight hundred and twenty-two mother-child pairs were included in the study. A pretested and structured questionnaire was used to collect data. Multivariable logistic regression analysis was carried out to identify the determinants of prelacteal feeding.

Results

In this community, about 26.8 % of children were given prelacteal feeds. The odds of prelacteal feeding was higher among mothers with a poor knowledge of Infant and Young Child Feeding (IYCF) (Adjusted Odds Ratio [AOR]?=?3.82; 95 % Confidence Interval [CI] 2.42, 6.04), who gave birth at home (AOR?=?3.74; 95 % CI 2.12, 6.60), and who were in the lowest wealth status (AOR?=?2.11; 95 % CI 1.35, 3.31).

Conclusions

Prelacteal feeding was common in the study area, and significantly associated with a poor household wealth status, poor maternal knowledge of IYCF, and giving birth at home. Thus, emphasis should be given to improve mothers IYCF knowledge and utilization of institutional delivery. Moreover, special attention should be given to mothers with poor socio-economic status to reduce the practice of prelacteal feeding.

     

Smoking among young rural to urban migrant women in China: a cross-sectional survey

Background

Rural-to-urban migrant women may be vulnerable to smoking initiation as they are newly exposed to risk factors in the urban environment. We sought to identify correlates of smoking among rural-to-urban migrant women in China.

Methods/Principal Findings

A cross-sectional survey of rural-to-urban migrant women working in restaurants and hotels (RHW) and those working as commercial sex workers (CSW) was conducted in ten provincial capital cities in China. Multiple logistic regression was conducted to identify correlates of smoking. We enrolled 2229 rural-to-urban migrant women (1697 RHWs aged 18–24 years and 532 CSWs aged 18–30 years). Of these, 18.4% RHWs and 58.3% CSWs reported ever tried smoking and 3.2% RHWs and 41.9% CSWs reported current smoking. Participants who first tried smoking after moving to the city were more likely to be current smokers compared to participants who first tried smoking before moving to the city (25.3% vs. 13.8% among RHWs, p = 0.02; 83.6% vs. 58.6% among CSWs, p = <0.01). Adjusting for other factors, “tried female cigarette brands” had the strongest association with current smoking (OR 5.69, 95%CI 3.44 to 9.41) among participants who had ever tried smoking.

Conclusions/Significance

Exposure to female cigarette brands may increase the susceptibility to smoking among rural-to-urban migrant women. Smoke-free policies and increased taxes may be effective in preventing rural-to-urban migrant women from smoking initiation.     

中国公众的国际野生动物保护意愿调查: 以非洲象为例

我国高度重视野生动物保护事业, 认真履行野生动物保护国际义务, 积极鼓励公众参与, 以扩大野生动物保护事业的公众基础。已有文献多关注了公众的国内野生动物保护意愿, 鲜有文献关注公众对国际野生动物的保护意愿, 难以为促进公众参与国际野生动物保护事业提供决策参考。本研究以全球旗舰物种非洲象(Loxodonta africana)为例, 结合非洲象保护的相关研究与实践, 构建拓展的计划行为理论框架, 通过线下和线上调研获取数据, 运用结构方程模型, 从态度、规范、知觉行为控制、过去经验及个体特征五个方面, 分析了我国公众的非洲象保护意愿及影响因素。结果表明: (1) 68.5%的公众具有非洲象保护愿意; (2)公众规范(系数为0.422)、过去经验(系数为0.253)、知觉行为控制(系数为0.160)、保护态度(系数为0.156)对保护意愿存在显著的正向影响; 男性公众(系数为-0.054)的保护意愿低于女性公众; 居住在西部地区的公众(系数为0.066)保护意愿更高; (3)模型整体通过了拟合检验, 表明研究结果具有稳健性。本研究的政策建议如下: (1)明确政策导向作用, 提升公众的道德义务感和社会责任感; (2)加强宣传教育, 丰富公众知识经验, 培育公众积极的保护态度; (3)拓宽保护参与渠道, 提高公众知觉行为控制; (4)制定合理方案, 提升保护宣教等实践活动成效。     

Factors influencing genetic counseling attendance rate: A geographically based study

Abstract

A study of factors influencing genetic counseling attendance rate has been conducted in the Bouches‐du‐Rhône area, in the south of France. In this area, a birth defects monitoring system (Eurocat n°22) annually covers 23,000 births. All the genetic services are delivered by only one genetic center located in Marseilles, and the data collected are computerized. The comparison of these two data bases gives an opportunity to estimate the rate of genetic counseling attendance after the occurrence of an affected stillbirth or live birth. Among the parents of 358 infants born in 1983–84 in this area with a pathology requiring genetic counseling, 226 (63 per cent) attended the Genetic Center within the first year after birth. The rate of attendance is statistically higher (p < 0.01) for the parents who had a stillbirth (78 per cent) than for those who had a live birth (57 per cent). It is also higher (p < 0.01) for the Marseilles maternities group (68 per cent) than for the group outside Marseilles (50 per cent). The referral delays are also analyzed according to malformation etiology and to viability of the child by the eighth day of lue. Besides evaluating a particular genetic center's effectiveness in diffusing information to the public concerned, this work shows that couples’ request is strongly dependent on a psychological need.     

Factors influencing soay sheep survival: a Bayesian analysis

This article presents a Bayesian analysis of mark-recapture-recovery data on Soay sheep. A reversible jump Markov chain Monte Carlo technique is used to determine age classes of common survival, and to model the survival probabilities in those classes using logistic regression. This involves environmental and individual covariates, as well as random effects. Auxiliary variables are used to impute missing covariates measured on individual sheep. The Bayesian approach suggests different models from those previously obtained using classical statistical methods. Following model averaging, features that were not previously detected, and which are of ecological importance, are identified.