Cross-Generational Relationships in Kenya: Couples' Motivations, Risk Perception for STIs/HIV and Condom Use

Objectives: To understand women's and men's motivations for entering into cross-generational relationships and to examine how their risk perception for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) affects sexual decision-making and condom use.Methods: A total of eight focus groups were conducted with women aged 15 -- 19 and 28 indepth interviews were carried out with men aged 30 years and older in Nairobi, Mombasa, Kisumu, and Meru. Participants discussed motivations for entering into non-marital, crossgenerational relationships, perceived risks, relationship dynamics, and circumstances under which older men and younger women meet. Data analysis highlighted common and divergent themes on cross-generational relationships and the risks associated with them. Results: According to study participants, Kenyan men who pursue younger women do not fit a "sugar daddy" stereotype; rather they come from a variety of social and professional backgrounds. Young women actively seek partners who are willing to spend money on them whereas men look for partners who are well mannered, need money and have certain physical attributes. Women's primary incentive for engaging in cross-generational relationships is financial and material gain while men seek younger partners for sexual gratification. Pressure from peers to fit in and some family members to secure financial assistance from older partners can compel women to engage in cross-generational relationships. Although some peer groups support and encourage such relationships, other groups, especially wives, same-aged boyfriends and parents, disapprove of them. As a result, cross-generational couples are often preoccupied by the threat of discovery. Risk perception for STIs/HIV is low and couples rarely use condoms.Conclusions: Most cross-generational couples underestimate their risk for infection from STIs/ HIV. Young women believe that older men are low-risk partners because they are less likely to be promiscuous and more likely to remain faithful to younger partners and wives. Men believe that young partners are innocent and sexually inexperienced. Material gain, emotional factors, sexual gratification, and recognition from peers override the risk for STIs and HIV infection. Condom use is low and young women's ability to negotiate use is compromised by age disparities and economic dependence. Study findings suggest several programmatic strategies for targeting young women and older men. Behavior change communication campaigns should educate women and men about the increased risk of STIs/HIV associated with cross-generational relationships. Programs should also promote safer sexual practices, such as consistent condom use, within relationships. Campaigns could employ positive role models to encourage young women to seek safer alternatives to cross-generational relationships and decrease peer pressure among men to pursue such relationships. Long-term interventions include improving young women's access to educational and career opportunities, and working with communities to determine the best approach for changing social norms and the acceptability of cross-generational relationships

Atomic interferometer measurements of Berry's and Aharonov-Anandan's phases for isolated spins S > 1/2 non-linearly coupled to external fields

The aim of the present paper is to propose experiments for observing the significant features of Berry's phases for S>1, generated by spin-Hamiltonians endowed with two couplings, a magnetic dipole and an electric quadrupole one with external B and E fields, as theoretically studied in our previous work. The fields are assumed orthogonal, this mild restriction leading to geometric and algebraic simplifications. Alkali atoms appear as good candidates for interferometric measurements but there are challenges to be overcome. The only practical way to generate a suitable E-field is to use the ac Stark effect which induces an instability of the dressed atom. Besides atom loss, this might invalidate Berry's phase derivation but this latter problem can be solved by an appropriate detuning. The former puts an upper limit to the cycle duration, which is bounded below by the adiabatic condition. By relying upon our previous analysis of the non-adiabatic corrections, we have been able to reach a compromise for the $^{87}$Rb hf level F=2, m=0 state, which is our candidate for an interferometric measurement of the exotic Berry's phase generated by a rotation of the E-field around the fixed B-field. By a numerical simulation we have shown that the non-adiabatic corrections can be kept below the 0.1% level. As an alternative candidate, we discuss the chromium ground state J=S=3, where the instability problem is easily solved. We make a proposal to extend the measurement of Aharonov-Anandan's phase beyond S=1/2 to the $^{87}$Rb hf level F=m=1, by constructing, with the help of light-shifts, a Hamiltonian able to perform a parallel transport along a closed circuit upon the density matrix space, without any adiabatic constraint. In Appendix A, Berry's phase difference for S=3/2 and 1/2, m=1/2 states is used to perform an entanglement of 3 Qbits.Comment: 23 pages, 6 figures, modifications in the introduction, two paragraphs adde

Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009-10, and assessment of progress since 2003.

BACKGROUND: Tracking of financial resources to maternal, newborn, and child health provides crucial information to assess accountability of donors. We analysed official development assistance (ODA) flows to maternal, newborn, and child health for 2009 and 2010, and assessed progress since our monitoring began in 2003. METHODS: We coded and analysed all 2009 and 2010 aid activities from the database of the Organisation for Economic Co-operation and Development, according to a functional classification of activities and whether all or a proportion of the value of the disbursement contributed towards maternal, newborn, and child health. We analysed trends since 2003, and reported two indicators for monitoring donor disbursements: ODA to child health per child and ODA to maternal and newborn health per livebirth. We analysed the degree to which donors allocated ODA to 74 countries with the highest maternal and child mortality rates (Countdown priority countries) with time and by type of donor. FINDINGS: Donor disbursements to maternal, newborn, and child health activities in all countries continued to increase, to $6511 million in 2009, but slightly decreased for the first time since our monitoring started, to$6480 million in 2010. ODA for such activities to the 74 Countdown priority countries continued to increase in real terms, but its rate of increase has been slowing since 2008. We identified strong evidence that targeting of ODA to countries with high rates of maternal mortality improved from 2005 to 2010. Targeting of ODA to child health also improved but to a lesser degree. The share of multilateral funding continued to decrease but, relative to bilaterals and global health initiatives, was better targeted. INTERPRETATION: The recent slowdown in the rate of funding increases is worrying and likely to partly result from the present financial crisis. Tracking of donor aid should continue, to encourage donor accountability and to monitor performance in targeting aid flows to those in most need. FUNDING: Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK

What do we know about alcohol internet interventions aimed at employees?—A scoping review

BackgroundInternet interventions are a promising avenue for delivering alcohol prevention to employees. The objective of this scoping review was to map all research on alcohol internet interventions aimed at employees regardless of design, to gain an overview of current evidence and identify potential knowledge gaps.MethodsWe conducted a literature search in three data bases (PsycInfo, PubMed, and Web of Science). Eligibility criteria were that (1) the study targeted employees age ≥18 years; (2) the intervention was delivered predominantly online; (3) the study focused specifically or in part on alcohol use; and (4) the study was published in English in a peer-reviewed academic journal. Two reviewers independently screened, reviewed, and extracted data.ResultsTwenty studies were included, of which 10 were randomized controlled trials, five were secondary analyses, three were feasibility trials, one was a cohort study and one described the rationale and development of an intervention. No qualitative studies were found. Randomized trials tended to show effects when interventions were compared to waitlists but not when more intensive interventions were compared to less intensive ones. We identified two design-related aspects where studies differed; (1) whether all applicants were included regardless of alcohol use level and (2) whether the intervention was explicitly framed as alcohol-focused or not. Significant recruitment problems were noted in several studies.ConclusionsAlcohol internet interventions hold promise in delivering alcohol prevention to employees, but heterogeneity in study design and difficulties in recruitment complicate interpretation of findings.Systematic review registrationhttps://osf.io/25x7e/, Open Science Framework

Virtual patients in a behavioral medicine massive open online course (MOOC) : a case-based analysis of technical capacity and user navigation pathways

BACKGROUND: Massive open online courses (MOOCs) have been criticized for focusing on presentation of short video clip lectures and asking theoretical multiple-choice questions. A potential way of vitalizing these educational activities in the health sciences is to introduce virtual patients. Experiences from such extensions in MOOCs have not previously been reported in the literature. OBJECTIVE: This study analyzes technical challenges and solutions for offering virtual patients in health-related MOOCs and describes patterns of virtual patient use in one such course. Our aims are to reduce the technical uncertainty related to these extensions, point to aspects that could be optimized for a better learner experience, and raise prospective research questions by describing indicators of virtual patient use on a massive scale. METHODS: The Behavioral Medicine MOOC was offered by Karolinska Institutet, a medical university, on the EdX platform in the autumn of 2014. Course content was enhanced by two virtual patient scenarios presented in the OpenLabyrinth system and hosted on the VPH-Share cloud infrastructure. We analyzed web server and session logs and a participant satisfaction survey. Navigation pathways were summarized using a visual analytics tool developed for the purpose of this study. RESULTS: The number of course enrollments reached 19,236. At the official closing date, 2317 participants (12.1% of total enrollment) had declared completing the first virtual patient assignment and 1640 (8.5%) participants confirmed completion of the second virtual patient assignment. Peak activity involved 359 user sessions per day. The OpenLabyrinth system, deployed on four virtual servers, coped well with the workload. Participant survey respondents (n=479) regarded the activity as a helpful exercise in the course (83.1%). Technical challenges reported involved poor or restricted access to videos in certain areas of the world and occasional problems with lost sessions. The visual analyses of user pathways display the parts of virtual patient scenarios that elicited less interest and may have been perceived as nonchallenging options. Analyzing the user navigation pathways allowed us to detect indications of both surface and deep approaches to the content material among the MOOC participants. CONCLUSIONS: This study reported on first inclusion of virtual patients in a MOOC. It adds to the body of knowledge by demonstrating how a biomedical cloud provider service can ensure technical capacity and flexible design of a virtual patient platform on a massive scale. The study also presents a new way of analyzing the use of branched virtual patients by visualization of user navigation pathways. Suggestions are offered on improvements to the design of virtual patients in MOOCs