Analysis of Bacterial vaginosis, the vaginal microbiome, and sexually transmitted infections following the provision of menstrual cups in Kenyan schools: results of a nested study within a cluster randomized controlled trial

Abstract Background: Non-hygienic products for managing menstruation are reported to cause reproductive tract infections. Menstrual cups are a potential solution. We assessed whether menstrual cups would reduce Bacterial vaginosis (BV), vaginal microbiome (VMB), and sexually transmitted infections (STIs) as studies have not evaluated this. Methods and Findings: A cluster-randomized controlled trial was performed in 96 Kenyan secondary schools, randomized (1:1:1:1) to control, menstrual cup, cash transfer, or menstrual cup plus cash transfer. This sub-study assessing the impact of menstrual cups on BV, VMB, and STIs, included 6 schools from the control (3) and menstrual cup only (3) groups, both receiving BV and STI testing and treatment at each visit. Self-collected vaginal swabs were used to measure VMB (16S rRNA gene amplicon sequencing), BV (Nugent score), and STIs. STIs were a composite of Chlamydia trachomatis and Neisseria gonorrhoeae (nucleic acid amplification test)¸ and Trichomonas vaginalis (rapid immunochromatographic assay). Participants were not masked and were followed for 30 months. The primary outcome was diagnosis of BV; secondary outcomes were VMB and STIs. Intention to treat blinded analyses used mixed effects generalized linear regressions, with random effects term for school. The study was conducted between May 2, 2018, and Feb 7, 2021. 436 participants were included: 213 cup, 223 control. There were 289 BV diagnoses: 162 among control participants and 127 among intervention participants (odds ratio 0.76 [95% CI 0.59–0.98]; p=0.038). The occurrence of Lactobacillus crispatus dominated VMB was higher among cup group participants (odds ratio 1.37 [95% CI 1.06–1.75]), as was the mean relative abundance of Lactobacillus crispatus (3.95% [95% CI 1.92–5.99]). There was no effect of intervention on STIs (relative risk 0.82 [95% CI 0.50–1.35]). The primary limitations of this study were insufficient power for sub-group analyses, and generalizability of findings to non-school and other global settings. Conclusions: Menstrual cups with BV and STI testing and treatment benefitted adolescent schoolgirls through lower occurrence of BV and higher L. crispatus compared with only BV and STI testing and treatment during the 30 months of a cluster-randomized menstrual cup intervention. ClinicalTrials.gov, NCT03051789

Increased reproductive tract infections among secondary school girls during the COVID-19 pandemic: associations with pandemic-related stress, mental health, and domestic safety

Background: Kenya, like many countries, shuttered schools during COVID-19, with subsequent increases in poor mental health, sexual activity, and pregnancy. Aim: We sought to understand how the COVID-19 pandemic may mediate the risk of reproductive tract infections. Methods: We analyzed data from a cohort of 436 secondary schoolgirls in western Kenya. Baseline and 6-, 12-, and 18-month study visits occurred from April 2018 to December 2019 (pre–COVID-19), and 30-, 36-, and 48-month study visits occurred from September 2020 to July 2022 (COVID-19 period). Participants self-completed a survey for sociodemographics and sexual activity and provided self-collected vaginal swabs for bacterial vaginosis (BV) testing, with sexually transmitted infection (STI) testing at annual visits. We hypothesized that greater COVID-19–related stress would mediate risk via mental health, feeling safe inside the home, and sexual exposure, given the pandemic mitigation–related impacts of school closures on these factors. COVID-19–related stress was measured with a standardized scale and dichotomized at the highest quartile. Mixed effects modeling quantified how BV and STI changed over time. Longitudinal mediation analysis quantified how the relationship between COVID-19 stress and increased BV was mediated. Outcomes: Analysis outcomes were BV and STI. Results: BV and STI prevalence increased from 12.1% and 10.7% pre–COVID-19 to 24.5% and 18.1% during COVID-19, respectively. This equated to 26% (95% CI, 1.00–1.59) and 36% (95% CI, 0.98–1.88) higher relative prevalence of BV and STIs in the COVID-19 vs pre–COVID-19 periods, adjusted for numerous sociodemographic and behavioral factors. Higher COVID-19–related stress was associated with elevated depressive symptoms and feeling less safe inside the home, which were each associated with a greater likelihood of having a boyfriend. In mediation analyses, the direct effect of COVID-19–related stress on BV was small and nonsignificant, indicating that the increased BV was due to the constellation of factors that were affected during the COVID-19 pandemic. Clinical Translation: These results highlight factors to help maintain reproductive health for adolescent girls in future crises, such as anticipating and mitigating mental health impacts, domestic safety concerns, and maintaining sexual health services. Strengths and Limitations: Impacts of the COVID-19 pandemic on drivers of reproductive tract health among those who did not attend school or who live in different settings may differ. Conclusions: In this cohort of adolescent girls, BV and STIs increased following COVID-19–related school closures, and risk was mediated by depressive symptoms and feeling less safe in the home, which led to a higher likelihood of sexual exposures

Developmental changes in resting‐state functional networks among individuals with and without internalizing psychopathologies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147755/1/da22864.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147755/2/da22864_am.pd

High Prevalence of Lactobacillus crispatus Dominated Vaginal Microbiome Among Kenyan Secondary School Girls: Negative Effects of Poor Quality Menstrual Hygiene Management and Sexual Activity

The vaginal microbiome (VMB) impacts numerous health outcomes, but evaluation among adolescents is limited. We characterized the VMB via 16S rRNA gene amplicon sequencing, and its association with Bacterial vaginosis (BV) and sexually transmitted infections (STIs; chlamydia, gonorrhea, trichomoniasis) among 436 schoolgirls in Kenya, median age 16.9 years. BV and STI prevalence was 11.2% and 9.9%, respectively, with 17.6% of girls having any reproductive tract infection. Three community state types (CST) accounted for 95% of observations: CST-I L.crispatus-dominant (N=178, BV 0%, STI 2.8%, sexually active 21%); CST-III L.iners-dominant (N=152, BV 3.3%, STI 9.7%, sexually active 35%); CST-IV G.vaginalis-dominant (N=83, BV 51.8%, STI 25.3%, sexually active 43%). In multivariable adjusted analyses, sexually active girls had increased odds of CST-III and CST-IV, and use of cloth to manage menses had 1.72-fold increased odds of CST-IV vs. CST-I. The predominance of L.crispatus-dominated VMB, substantially higher than observed in prior studies of young adult and adult women in sub-Saharan Africa, indicates that non-optimal VMB can be an acquired state. Interventions to maintain or re-constitute L.crispatus dominance should be considered even in adolescents

Vaginal Microbial Network Analysis Reveals Novel Taxa Relationships among Adolescent and Young Women with Incident Sexually Transmitted Infection Compared with Those Remaining Persistently Negative Over a 30-Month Period

A non-optimal vaginal microbiome (VMB) is typically diverse with a paucity of Lactobacillus cris-patus, and is often associated with Bacterial vaginosis (BV) and sexually transmitted infections (STIs). Although compositional characterization of the VMB is well-characterized, especially for BV, knowledge remains limited on how different groups of bacteria relate to incident STIs, espe-cially among adolescents. In this study, we compared the VMB (measured via 16S ribosomal RNA gene amplicon sequencing) of Kenyan secondary school girls with incident STIs (composite of chlamydia, gonorrhea, trichomoniasis) to those who remained persistently negative for STIs and BV over 30 months of follow-up. We applied microbial network analysis to identify key taxa (i.e., those with greatest connectedness in terms of linkages to other taxa), as measured by betweenness and eigenvector centralities, and sub-groups of clustered taxa. VMB networks of those who re-mained persistently negative reflected greater connectedness compared to the VMB from partic-ipants with STI. Taxa with highest centralities were not correlated with relative abundance and differed between those with and without STI. Subject level analyses indicated that sociodemo-graphic (e.g., age, socioeconomic status) and behavioral (e.g., sexual activity) factors contribute to microbial network structure, and may be of relevance when designing interventions to improve VMB health

Utilizing Random Effects Machine Learning Algorithms for Identifying Vulnerability to Depression

No description supplie

B.: A framework for the analysis of attacks against social tagging systems. In

Social tagging systems provide an open platform for users to share and annotate their resources such as photos and URLs. Due to their open nature, however, these systems present a security problem. Malicious users may try to distort the system’s behavior by inserting erroneous or misleading annotations, thus altering the way in which information is presented to legitimate users. This paper addresses the problem of modeling attacks against social tagging systems and evaluating their impact on the systems ’ behavior. Gaining a fundamental understanding of the nature and impact of such attacks will hopefully lead to more secure and robust social Web applications. We present the dimensions that characterize an attack and outline a framework to model the attacks based on various navigation channels and target elements. Using our framework we classify and identify different types of potential attack strategies against a social tagging system. We implement two of our attack models and evaluate their impact on retrieval algorithms commonly used by tagging systems