Reproductive Failure and the Stress Response in American Kestrels Nesting Along a Human Disturbance Gradient

Human disturbance may be an influential environmental stressor that affects birds across life stages. I examined whether external and endogenous factors including habitat type, habitat quality and individual quality (hereafter quality), or human disturbance affect American Kestrel reproductive success in southwestern Idaho. Specifically, I was interested in how these factors lead to nest failure or abandonment. I also investigated whether elevated corticosterone (CORT) concentrations mediate the relationships among explanatory variables and nest failure. As nestling kestrels may respond to stressors differently from adults, I examined whether conditions experienced during the nestling stage affected nestling American Kestrel (Falco sparverius) hypothalamic pituitary adrenal (HPA) axis activity. I predicted that nestlings in high disturbance areas and those exposed to experimental stress would be sensitized to acute handling stress (i.e. would exhibit high baseline and stress induced CORT levels).To examine these relationships I monitored 89 nest boxes posted along roads with varying amounts of traffic and surrounding development in Southwest Idaho during the 2008 and 2009 breeding seasons. I captured adult birds during the incubation stages and then followed nest fates by checking the boxes at expected hatch dates, and when nestlings were 10 and 25 days old. Nestling kestrels, raised in high and low human disturbance areas were exposed to a chronic stress protocol (CSP). At 25 days of age nestlings were sampled for baseline and stress induced plasma CORT. Twenty six (36%) of 73 nests failed and most (n = 23, 88%) nests failed during incubation. Human disturbance, but not habitat type or quality measures, was negatively associated with kestrel reproductive success. A disturbance score based on traffic patterns and the distance of the nest from the road best predicted kestrel reproductive success (disturbance: β = -1.08, 95% CI: -1.87 - -0.28; distance from road: β = 2.44, 95% CI: 0.54 - 5.42). Adult female kestrels nesting near interstates and busy roads had elevated CORT (χ2 = 6.07, P = 0.01; β = 0.10, 95% CI: 0.02 - 0.19) and nests of females with elevated CORT were less likely to be successful (χ2 = 4.37, P = 0.04; β = -1.09, 95% CI: -2.20 - 0). There was no relationship between adult male CORT and disturbance or success. Nestling CORT did not vary with human disturbance levels (F1, 27 = 1.97, P = 0.17), CSP treatment (F1,27 = 0.00, P = 0.97), or with an interaction between human disturbance and CSP (F1, 27 = 0.00, P = 0.97) suggesting that nestling kestrels do not sense or perceive external conditions related to human disturbance as stressful. Because kestrels are cavity nesters, nestlings may be buffered from external conditions and instead may respond more powerfully to stressors within the nest such as brood size. Brood size at fledging best explained baseline (β = 0.10, 95% CI: -0.03 - 0.28) and stress induced CORT (β = 0.06, 95% CI: -0.06 - 0.19). This study provides evidence that adult but not nestling kestrels respond to human activity with a physiological stress response and this can lead to changes in individual behavior resulting in reproductive failure via abandonment. At a larger scale, this study highlights the adverse affects of human disturbance on seemingly “urban-adapted” organisms such as American Kestrels

A qualitative understanding of the effects of reusable sanitary pads and puberty education: Implications for future research and practice

BACKGROUND: The management of menstruation has come to the fore as a barrier to girls’ education attainment in low income contexts. Interventions have been proposed and piloted, but the emerging nature of the field means limited evidence is available to understand their pathways of effect. // METHODS: This study describes and compares schoolgirls’ experiences of menstruation in rural Uganda at the conclusion of a controlled trial of puberty education and sanitary pad provision to elucidate pathways of effect in the interventions. Semi-structured interviews were undertaken with schoolgirls who participated in the Menstruation and the Cycle of Poverty trial concurrent with the final set of quantitative surveys. A framework approach and cross-case analysis were employed to describe and compare the experiences of 27 menstruating girls across the four intervention conditions; education (n = 8), reusable sanitary pads (n = 8), education with reusable sanitary pads (n = 6), and control (n = 5). // RESULTS: Themes included: menstrual hygiene, soiling, irritation and infection, physical experience, knowledge of menstruation, psychological, social and cultural factors, and support from others. Those receiving reusable pads experienced improvements in comfort and reliability. This translated into reduced fears around garment soiling and related school absenteeism. Other menstrual hygiene challenges of washing, drying and privacy remained prominent. Puberty education improved girls’ confidence to discuss menstruation and prompted additional support from teachers and peers. // CONCLUSIONS: Findings have important implications for the development and evaluation of future interventions. Results suggest the provision of menstrual absorbents addresses one core barrier to menstrual health, but that interventions addressing broader needs such as privacy may improve effectiveness. Puberty education sessions should increase attention to body awareness and include strategies to address a wider range of practical menstrual challenges, including pain management. Interviews revealed possibilities for improving quantitative surveys in future research

Measuring the prevalence and impact of poor menstrual hygiene management: a quantitative survey of schoolgirls in rural Uganda

Objectives The primary objective was to describe Ugandan schoolgirls’ menstrual hygiene management (MHM) practices and estimate the prevalence of inadequate MHM. Second, to assess the relative contribution of aspects of MHM to health, education and psychosocial outcomes. Design Secondary analysis of survey data collected as part of the final follow-up from a controlled trial of reusable sanitary pad and puberty education provision was used to provide a cross-sectional description of girls’ MHM practices and assess relationships with outcomes Setting Rural primary schools in the Kamuli district, Uganda. Participants Participants were 205 menstruating schoolgirls (10–19 years) from the eight study sites. Primary and secondary outcome measures The prevalence of adequate MHM, consistent with the concept definition, was estimated using dimensions of absorbent used, frequency of absorbent change, washing and drying procedures and privacy. Selfreported health, education (school attendance and engagement) and psychosocial (shame, insecurity, embarrassment) outcomes hypothesised to result from poor MHM were assessed as primary outcomes. Outcomes were measured through English surveys loaded on iPads and administered verbally in the local language. Results 90.5% (95% CI 85.6% to 93.9%) of girls failed to meet available criteria for adequate MHM, with no significant difference between those using reusable sanitary pads (88.9%, 95% CI 79.0% to 94.4%) and those using existing methods, predominantly cloth (91.5%, 95% CI 85.1% to 95.3%; χ2 (1)=0.12, p=0.729). Aspects of MHM predicted some consequences including shame, not standing in class to answer questions and concerns about odour. Conclusions This study was the first to assess the prevalence of MHM consistent with the concept definition. Results suggest that when all aspects of menstrual hygiene are considered together, the prevalence is much higher than has previously been reported based on absorbents alone. The work demonstrates an urgent need for improved assessment and reporting of MHM, and for primary research testing the links between menstrual management and health, education and psychosocial consequences

School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys

Reports of school and work absences due to unmet menstrual needs have prompted increased attention to menstruation in policy and practice. However, there appear to be few quantitative studies reported in published literature capturing the prevalence of this hypothesised absenteeism. This study undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020 (PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation. Among women and adolescent girls aged 15–49 years who had worked outside the household in the past month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively, reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing school in the past year due to menstruation. Findings support the assertion that menstruation is a source of absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed. In presenting this data we also reflect critically on the performance of questions regarding menstrual-related absenteeism in national monitoring surveys

Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries

Background There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research. Methods and findings Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts. Conclusions We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest

Schoolgirls’ experience and appraisal of menstrual absorbents in rural Uganda: a cross-sectional evaluation of reusable sanitary pads

BACKGROUND: Governments, multinational organisations, and charities have commenced the distribution of sanitary products to address current deficits in girls’ menstrual management. The few effectiveness studies conducted have focused on health and education outcomes but have failed to provide quantitative assessment of girls’ preferences, experiences of absorbents, and comfort. Objectives of the study were, first, to quantitatively describe girls’ experiences with, and ratings of reliability and acceptability of different menstrual absorbents. Second, to compare ratings of freely-provided reusable pads (AFRIpads) to other existing methods of menstrual management. Finally, to assess differences in self-reported freedom of activity during menses according to menstrual absorbent. // METHODS: Cross-sectional, secondary analysis of data from the final survey of a controlled trial of reusable sanitary padand puberty education provision was undertaken. Participants were 205 menstruating schoolgirls from eight schools in rural Uganda. 72 girls who reported using the intervention-provided reusable pads were compared to those using existing improvised methods (predominately new or old cloth). // RESULTS: Schoolgirls using reusable pads provided significantly higher ratings of perceived absorbent reliability across activities, less difficulties changing absorbents, and less disgust with cleaning absorbents. There were no significant differences in reports of outside garment soiling (OR 1.00 95%CI 0.51–1.99), or odour (0.84 95%CI 0.40–1.74) during the last menstrual period. When girls were asked if menstruation caused them to miss daily activities there were no differences between those using reusable pads and those using other existing methods. However, when asked about activities avoided during menstruation, those using reusable pads participated less in physical sports, working in the field, fetching water, and cooking. // CONCLUSIONS: Reusable pads were rated favourably. This translated into some benefits for self-reported involvement in daily activities, although reports of actual soiling and missing activities due to menstruation did not differ. More research is needed comparing the impact of menstrual absorbents on girls’ daily activities, and validating outcome measures for menstrual management research

Exposure to food cues moderates the indirect effect of reward sensitivity and external eating via implicit eating expectancies

Previous research has suggested that the expectancy "eating is rewarding" is one pathway driving the relationship between trait reward sensitivity and externally-driven eating. The aim of the current study was to extend previous research by examining the conditions under which the indirect effect of reward sensitivity and external eating via this eating expectancy occurs. Using a conditional indirect effects approach we tested the moderating effect of exposure to food cues (e.g., images) relative to non-food cues on the association between reward sensitivity and external eating, via eating expectancies. Participants (N\ua0=\ua0119, M\ua0=\ua018.67 years of age, SD\ua0=\ua02.40) were university women who completed a computerised food expectancies task (E-TASK) in which they were randomly assigned to either an appetitive food cue condition or non-food cue condition and then responded to a series of eating expectancy statements or self-description personality statements. Participants also completed self-report trait measures of reward sensitivity in addition to measures of eating expectancies (i.e., endorsement of the belief that eating is a rewarding experience). Results revealed higher reward sensitivity was associated with faster reaction times to the eating expectancies statement. This was moderated by cue-condition such that the association between reward sensitivity and faster reaction time was only found in the food cue condition. Faster endorsement of this belief (i.e., reaction time) was also associated with greater external eating. These results provide additional support for the proposal that individuals high in reward sensitivity form implicit associations with positive beliefs about eating when exposed to food cues

Essential tremor patients experience significant burden beyond tremor: A systematic literature review

BackgroundEssential tremor (ET) is among the most common movement disorders in adults. While ET is diagnosed and primarily characterized by the presence of tremor, it also can impact cognition, sleep, mood, and motor functioning more broadly. The manifestations of ET can have various consequences, including difficulty with activities of daily living (ADL), embarrassment, and overall decline in health-related quality of life, which have not been fully explored in prior studies.ObjectiveWe performed a systematic literature review to comprehensively characterize the burden experienced by patients with ET from the clinical and humanistic perspectives, focusing on outcomes beyond tremor.MethodsThis systematic literature review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches in PubMed, Embase, and Cochrane Library identified original, observational studies of the clinical and humanistic burden in adult patients with ET published in English between 2010 and 2020. Studies assessing epidemiology, treatment patterns, or disease management were excluded. Search results were screened according to pre-determined eligibility criteria. Data from included studies were collected, independently verified, and qualitatively synthesized.ResultsFollowing the screening of 2,303 records and 145 full-text articles, 39 studies were identified. There was significant heterogeneity in study designs, statistical approaches, and patient cohorts across the included studies. Patients with ET in these studies exhibited more severe disabilities and reduced independence compared to healthy individuals, and they often struggled to perform ADL and relied on caregivers for physical and emotional support. Patients also experienced various issues with movement and balance, increased risk of falls, depression, anxiety, poor sleep quality, and psychosocial consequences including embarrassment, apathy, and enfeeblement.ConclusionA systematic literature review of non-tremor manifestations and/or consequences of ET identified far-reaching negative impacts on patients' ability to function independently and revealed accompanying psychosocial effects, including social fear and embarrassment. The reduced function and psychosocial deficits observed in patients with ET result in significant clinical and humanistic burdens, decreasing quality of life. Future studies should evaluate this condition beyond the tremor itself to provide an improved understanding of the multi-dimensional burden of the disease, thereby highlighting the need to diagnose and appropriately manage patients with ET