Vaginal Microbicide Preferences Among Midwestern Urban Adolescent Women

Purpose The purpose of this study was to assess adolescent women's preferences for specific microbicide characteristics including pregnancy prevention, timing of application, potential for side effects, and whether it targeted human immunodeficiency virus (HIV) or other sexually transmitted infections (STI). Potential differences in microbicide preferences by adolescent age group and behavioral patterns including engaging in sexual intercourse and use of hormonal contraception were examined, as it was hypothesized that as adolescents progress into adulthood and gain sexual experience their preferences in microbicide characteristics may shift. Method Adolescent and young women (N = 405, 56.0% African American; 24.0% Euro-American) between the ages of 14 and 20 (mean = 17.0, SD = 1.8) were recruited from urban community-based clinics. Video-Audio Computer-Assisted Self-Interviews were conducted with the young women, during which they were asked about their preferences regarding the characteristics of hypothetical vaginal microbicides. Conjoint analysis was utilized to determine adolescent women's relative preferences for each microbicide characteristic and intent-to-purchase microbicides based upon a combination of the selected properties. Results Overall, the results suggest adolescent and young women had an ordered preference for a microbicide with (1) no side effects, (2) pregnancy prevention, (3) postcoital application, and (4) protection against HIV. Age and behavioral group conjoint analyses resulted in the same pattern of preferences as those reported for the entire group. However, women having sex and not using hormonal contraception had a stronger preference for postcoital application. Conclusion The findings suggest that young women's ratings of microbicides were sensitive to characteristics such as side effects, pregnancy prevention, and timing of application and should be considered in microbicide development. The conjoint analysis approach is useful in understanding microbicide preferences, and should be utilized with other populations to assess preferences for specific microbicide characteristics

Vaginal microbicide preferences among midwestern urban adolescent women

Abstract: Purpose The purpose of this study was to assess adolescent women's preferences for specific microbicide characteristics including pregnancy prevention, timing of application, potential for side effects, and whether it targeted human immunodeficiency virus (HIV) or other sexually transmitted infections (STI). Potential differences in microbicide preferences by adolescent age group and behavioral patterns including engaging in sexual intercourse and use of hormonal contraception were examined, as it was hypothesized that as adolescents progress into adulthood and gain sexual experience their preferences in microbicide characteristics may shift. Method Adolescent and young women (N = 405, 56.0% African American; 24.0% Euro-American) between the ages of 14 and 20 (mean = 17.0, SD = 1.8) were recruited from urban communitybased clinics. Video-Audio Computer-Assisted Self-Interviews were conducted with the young women, during which they were asked about their preferences regarding the characteristics of hypothetical vaginal microbicides. Conjoint analysis was utilized to determine adolescent women's relative preferences for each microbicide characteristic and intent-to-purchase microbicides based upon a combination of the selected properties. Results Overall, the results suggest adolescent and young women had an ordered preference for a microbicide with (1) no side effects, (2) pregnancy prevention, (3) postcoital application, and (4) protection against HIV. Age and behavioral group conjoint analyses resulted in the same pattern of preferences as those reported for the entire group. However, women having sex and not using hormonal contraception had a stronger preference for postcoital application. Conclusion The findings suggest that young women's ratings of microbicides were sensitive to characteristics such as side effects, pregnancy prevention, and timing of application and should be considered in microbicide development. The conjoint analysis approach is useful in understanding microbicide preferences, and should be utilized with other populations to assess preferences for specific microbicide characteristics. microbicides | adolescent women | sexuality | conjoint analysis | adolescent health | Keywords: sexual health Article: The search for a woman-initiated prevention method has led to focus on topical microbicides for sexually transmitted infection (STI)/ human immunodeficiency virus (HIV) prevention. Microbicides are substances that may substantially reduce transmission of STI when applied in the vagina or rectum [1]. Some microbicides may also prevent pregnancy, although not all microbicides will be contraceptive [2]. Microbicides are not currently commercially available; products are in various phases of clinical trials [1]. Most microbicides under development are coitus dependent, requiring women to recognize and prepare for sexual situations and be willing to use a product that requires some comfort with touching their genitals [3]. The process of inserting a microbicide into the vagina may be challenging, as the dialogue around young women's sexuality and their bodies is often lacking [4]. Acceptability research, therefore, remains crucial to anticipate and prospectively address the kinds of obstacles previously associated with other female-initiated products, such as the female condom [5] and [6]. For instance, although women enjoyed having more control in using the female condom, they often did not like the size and discomfort associated with use or the inability to use it covertly [6]. Extant microbicide acceptability research with young women has suggested that contraceptive and disease prevention properties, timing of use, and associated side effects are important characteristics [7]. The findings suggest that young women generally prefer both pregnancy and disease prevention in a single product and insertion with an applicator up to 8 hours in advance [8]. In addition, there is a preference for lubricating products [9] and [10] with low amounts of messiness [9] and leakage [8]. Previous research also indicated that relevant potential side effects may impact microbicide use, including yeast infections, vaginal itching, and allergic reactions [7] and [11]. Furthermore, access was an important gauge of acceptability in a group of adolescent women. Women indicated that microbicides should be promoted through "adolescentspecific and girl-specific venues," including women's magazines [7]. There was also a reported desire for microbicides that would be small enough to carry in their pocket, bra, or within cell phone or palm pilot cases, and should be distributed through schools and sexuality education classes [7]. Most young women preferred over-the-counter availability of microbicides, yet stated they would be embarrassed if purchasing the product in the presence of others [7] and [8]. Thus far, microbicide acceptability research with adolescents has been conducted primarily with older adolescents, using individual interview and focus group methodologies [7] [16]. These qualitative methodologies allow for an in-depth assessment of individual as well as relational and age-related issues that may influence microbicide use [13] and [17]. However, social desirability is often a concern when studying stigmatized or socially sensitive issues associated with sexuality [18] and [19]. Past research has shown that using a video-audio computer-assisted self-interview (VACASI) format (participants privately responding to questions on a computer) for presenting survey questions alleviates the tendency for individuals to present themselves positively and answer questions in a socially desirable fashion [20]. In addition, women and adolescents report sensitive behaviors more frequently when questions are asked using computer interviewing techniques than when participating in a face-to-face interview [20], [21] and [22]. Existing microbicide acceptability research with adolescents also often lacks detailed attention to the multiple dimensions that must be considered simultaneously in a decision to try a product such as a microbicide. The addition of quantitative biopsychosocial studies addressing these issues thus complements the existing qualitative microbicide acceptability research [8], [23] and [24]. The purpose of this study was to quantitatively assess, using full-profile ratings based conjoint analysis, preferences for specific microbicide characteristics among a young, urban population of women. Building on the existing literature we chose to assess young women's preferences for pregnancy and STI (including HIV) prevention as well as timing of application and side effect potential. It was hypothesized that as women progress through the adolescent years, their relative preferences for specific microbicide characteristics may change as a function of their age and sexual experience. Methods Study participants Participants were 405 adolescent and young women between the ages of 14 and 20 (mean = 17, SD = 1.8) recruited from community-based urban health clinics in the Midwestern United States in an area with relatively low rates of HIV [25]. See Study procedure After informed consent was received, the young women were given a computer and headphones in a private exam room to begin the questionnaire. The VACASI began with participants being asked to choose one of four possible "guides" whose face and voice were used throughout the VACASI. Guides were young women (approximately 18-20 years old) who were professional actors of varied ethnic appearance and voice. The guides were used to increase young women's level of comfort with the interview [27]. Following the choice of a guide, more information was given about the microbicide and a product sample was shown. The participant was then asked multiple demographic and sexual behaviors questions and presented with microbicide vignettes that asked her to rate the likelihood of buying each microbicide. The self-interviews were completed in English and lasted 25-45 minutes. Participants received $20 compensation for the time and effort involved in completing the questionnaire. The protocols for the entire project were approved by the University's institutional review board

Telomere Lengths, Pulmonary Fibrosis and Telomerase (TERT) Mutations

mutations. mutation carriers demonstrate reduced life expectancy, with a mean age of death of 58 and 67 years for males and females, respectively. mutation have shorter telomere lengths than controls, demonstrating epigenetic inheritance of a shortened parental telomere length set-point

Storytelling in den Vereinten Nationen: Mahbub ul Haq und menschliche Entwicklung

Ausgehend von der Beobachtung, dass Mitarbeiter der Vereinten Nationen eine wichtige Rolle in Prozessen des ideellen Wandels auf internationaler Ebene spielen können, beschäftigt sich dieser Beitrag mit einer bestimmten Form individuellem Einflusses – dem storytelling. Mein Verständnis von storytelling als Einflusstaktik kombiniert dabei kollektive Elemente der soziologischen Praxistheorie mit den reflexiven, akteursbezogenen Überlegungen von Michel de Certeau. Ich analysiere storytelling anhand von drei analytischen Elementen: einem (chronologischen) Plot, einer Reihe von Charakteren und einem interpretativen Thema – die jeweils ihre Wirkung im Zusammenspiel mit der Subjektivität ihres storytellers entfalten. Ich illustriere diese theoretischen Überlegungen mit dem Fall von Mahbub ul Haq, dem es als Sonderberater des United Nations Development Programme (UNDP)-Administrators zu Beginn der 1990er Jahre gelungen ist, die Idee der menschlichen Entwicklung im System der Vereinten Nationen und der internationalen Entwicklungspolitik zu etablieren

Developmental assessment of infants with biliary atresia: differences between boys and girls

The aim of the present study was to investigate whether male and female infants with biliary atresia (BA) differ cognitively and to confirm previously documented developmental lags in infants with BA before liver transplantation

Language and motor skills are impaired in infants with biliary atresia before transplantation

OBJECTIVE: To test the hypothesis that in very young patients with biliary atresia, cognitive deficits are apparent before transplantation. STUDY DESIGN: With the Mullen Scales of Early Learning (Mullen), we examined 15 infants (mean age, 7.8 months) with biliary atresia, correlating Mullen scores with standard clinical and biochemical parameters. RESULTS: Overall, participants displayed significant delays in gross motor and language skills, and fine motor and visual reasoning skills were relatively preserved. The international normalized ratio correlated inversely with gross (P < .01) and fine (P < .05) motor skills. Growth parameters correlated positively with expressive language ability, but length of hospitalization and mode of feeding did not. Age at performance of the Kasai procedure was found to correlate with receptive language performance (P < .05). CONCLUSIONS: Very young children with biliary atresia display a characteristic profile of early developmental deficits before transplantation. These findings suggest that early intervention and aggressive nutritional management should be the standard of care to minimize neurocognitive effects

Intracranial Metastatic Neuroblastoma Treated with Gamma Knife Stereotactic Radiosurgery: Report of Two Novel Cases

Intracranial metastasis of neuroblastoma (IMN) is associated with poor survival. No curative therapy for the treatment of IMN currently exists. Unfractionated radiotherapy may be beneficial in the treatment of IMN given the known radiosensitivity of neuroblastoma as well as its proclivity to metastasize as discrete lesions. We present two patients with IMN treated with Gamma Knife stereotactic radiosurgery (SRS). Single-fraction radiotherapy yielded temporary reduction of tumor burden and stability of disease in both patients. SRS may be a useful palliative tool in the treatment of IMN and expands the overall treatment options for this disease