Cross-Generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices

This literature review assesses the extent of sexual relations between adolescent girls and older male partners (cross-generational sex) in sub-Saharan Africa; the extent of transactional sex; and the behavioral dynamics of girls and men involved in these sexual relations. The underlying assumption, supported by emerging empirical study, is that sex with older men increases the girls' risk of becoming infected with HIV. Because there seems to be little programmatic attention to reducing HIV risk by focusing on these partnerships, the intention of this review is to inform the efforts of AIDSMark -- in particular, Population Services International and the International Center for Research on Women -- on how to reduce HIV risk by addressing sexual relationships between adolescent girls and older men. Over 45 quantitative and qualitative studies of crossgenerational and transactional sexual relations were reviewed.The review finds that engaging in sexual relations with older partners is the norm for adolescent girls. Sizeable proportions of girls' partners are more than six or 10 years older, although age differences with most current partners appear to be only a few years older. The data also reveal that select groups of girls, such as those who have become pregnant, have much older partners on average. There is a widespread transactional component to sexual relations for adolescent girls, and in some contexts, large proportions of girls have engaged in this type of relationship. It appears that, as adolescent girls mature, they engage in sexual relations with ever-older partners, and are more likely to have engaged in transactional sex. In addition, we find that men have large proportions of adolescent girls as non-marital sexual partners. However, due to the narrow definition of transactional sex in the survey questions, and the stigma of reporting exchange behaviors, these figures are likely to be underestimates.Several studies reveal significant relationships between unsafe sexual behaviors, HIV risk, and cross-generational sex. Three of these studies find that greater age differences between partners indicate a significant increase in adolescent girls' risk of HIV infection. Two additional studies find that unsafe behaviors -- including non-use of condoms and non-discussion of HIV with a partner -- are significantly linked to greater age differences between sexual partners. One study finds that transactions of greater value also have a significant effect on non-use of condoms.Although the motivations for adolescent girls to engage in sexual relationships with older men are varied and overlapping, gifts and other financial benefits was the major theme found. The motivations for financial rewards tend to be complex, ranging from economic survival to desire for status and possessions. Extreme household poverty as a motivator of sexual activity is described less often. Most studies point to girls' strategies to increase their life chances through education or work opportunities, or to pursue the enjoyment that goes along with adolescence and young adulthood. Gifts such as soap, perfume, dresses, meals out, and jewelry have become symbolic of a girl's worth and a man's interest, and girls who do not receive gifts in exchange for sexual relations are humiliated.Because of the limited negotiating power of adolescent girls with respect to sexuality and reproduction, sexual partnerships between adolescent girls and older men are fundamentally imbalanced, with men having more power. Girls appear to be able to negotiate relationship formation and continuance; for example, they can choose the types and number of partners they have, and can discontinue a relationship if gift-giving ceases. However, once in a sexual partnership, adolescent girls are less able to control sexual practices. Men appear to control the conditions of sexual intercourse, including condom and contraceptive use and the use of violence. Girls are not likely to insist on condom use for many reasons, including social norms and lack of selfperceived risk of HIV. On the whole, suggesting condom use jeopardizes their goals for the relationship, including the receipt of money and gifts

Effects of Maternal Nutritional Status and Maternal Energy Supplementation on Length of Postpartum Amenorrhea Among Guatemalan Women

This issue was undated. The date given is an estimate.28 pages, 1 article*Effects of Maternal Nutritional Status and Maternal Energy Supplementation on Length of Postpartum Amenorrhea Among Guatemalan Women* (Kurz, Kathleen M.; Habicht, Jean-Pierre; Rasmussen, Kathleen M.; Schwager, Steven J.) 28 page

Individuals With Multiple Sclerosis Exhibit More Regular Center of Mass Accelerations After Physical Therapy

Objective: The purpose of this investigation was to explore if a physical therapy program involving strength, flexibility, balance, and walking can improve the uncharacteristic gait variability and overall mobility of persons living with multiple sclerosis (pwMS). Design: Pre-post design to evaluate the mobility improvements after undergoing 6 weeks of a gait and balance physical therapy intervention. Setting: The initial 2 weeks were conducted at a medical center under close supervision of a physical therapist. The remaining 4 weeks were performed by the patient at their home and monitored via teleconferences. Participants: Fifteen pwMS with relapsing-remitting (N=11) or secondary progressive multiple sclerosis (N=4) were enrolled in this study (7 women; mean age: 54.8±9 years; Kurtzke Expanded Disability Status Score range: 3.0-6.5). A group of healthy age-matched controls (N=15) were used for comparisons. Interventions: The 6-week physical therapy intervention included exercises that targeted strength, flexibility, balance, and walking. The initial 2 weeks of the intervention were performed on-site with the remaining 4 weeks home-based. The therapy was performed twice-a-day for 5 consecutive days each week. Each session was 45 minutes in length. Main Outcome Measures: Preferred walking speed, spatiotemporal gait kinematics, and a 6-minute walk test were completed before and after therapy. The standard deviation (SD) and sample entropy were used to evaluate the amount of variability and the regularity of the time-dependent variations in the center of mass (COM) accelerations during the 6-minute walk test. Results: Before the intervention, the SD of the COM was reduced, and the time-dependent variations were less regular in the pwMS than the control group. After therapy, the SD was 12% larger, and the time-dependent variations were more 7% regular in the pwMS. The effect size for these changes were large (0.91 and 0.94, respectively), suggesting these changes were meaningful. The changes in the regularity of the COM were related to the mobility improvements in the preferred walking velocity and 6-minute walk test. Conclusions: The results suggest that pwMS have altered COM variability during gait, which can be improved with a similar physical therapy program. These changes appear to be linked with the extent of the mobility improvements

A Functional riboSNitch in the 3\u27 Untranslated Region of

Previous studies have shown that common variants of the gene coding for FK506-binding protein 51 (FKBP5), a critical regulator of glucocorticoid sensitivity, affect vulnerability to stress-related disorders. In a previous report, FKBP5 rs1360780 was identified as a functional variant because of its effect on gene methylation. Here we report evidence for a novel functional FKBP5 allele, rs3800373. This study assessed the association between rs3800373 and post-traumatic chronic pain in 1607 women and men from two ethnically diverse human cohorts. The molecular mechanism through which rs3800373 affects adverse outcomes was established via in silico, in vivo, and in vitro analyses. The rs3800373 minor allele predicted worse adverse outcomes after trauma exposure, such that individuals with the minor (risk) allele developed more severe post-traumatic chronic musculoskeletal pain. Among these individuals, peritraumatic circulating FKBP5 expression levels increased as cortisol and glucocorticoid receptor (NR3C1) mRNA levels increased, consistent with increased glucocorticoid resistance. Bioinformatic, in vitro, and mutational analyses indicate that the rs3800373 minor allele reduces the binding of a stress- and pain-associated microRNA, miR-320a, to FKBP5 via altering the FKBP5 mRNA 3′UTR secondary structure (i.e., is a riboSNitch). This results in relatively greater FKBP5 translation, unchecked by miR-320a. Overall, these results identify an important gene–miRNA interaction influencing chronic pain risk in vulnerable individuals and suggest that exogenous methods to achieve targeted reduction in poststress FKBP5 mRNA expression may constitute useful therapeutic strategies

Der Faktor Unsicherheit bei ersatzteillogistischen Kooperationen auf dem Drittanbietermarkt

Die zunehmende Ersatzteilvielfalt bedingt durch kürzer werdende Innovationszyklen bei gleichzeitig langanhaltender Lebensdauer komplexer Anlagen und der Trend der Auslagerung von Dienstleistungen bewirken, dass der Drittanbietermarkt in der Ersatzteillogistik an Bedeutung gewinnt. Strategisch ausgerichtete Kooperationen zwischen Herstellern, Drittanbietern und Betreibern sind wichtig, um planungsintensive Prozesse nachhaltig zu optimieren. Unsicherheiten behindern jedoch die Bereitschaft, Allianzen einzugehen und sich gegenüber Innovationen in diesem Bereich zu öffnen. Durch eine qualitativ ausgerichtete Studie mit Akteuren des Drittanbietermarktes wurden die Relevanz aus der Literatur erarbeiteter Kooperationsmöglichkeiten erfasst und bestehende Unsicherheiten bzw. deren Ursache erforscht. Die Unsicherheit bezüglich verlässlicher Informationen erwies sich hier als zentraler Aspekt

Polymorphisms in the PON gene cluster are associated with Alzheimer disease

Paraoxonase is an arylesterase enzyme that is expressed in the liver and found in the circulation in association with apoA1 and the high-density lipoprotein, and prevents the accumulation of oxidized lipids in low-density lipoproteins in vitro. Common polymorphisms in genes encoding paraoxonase are established risk factors in a variety of vascular disorders including coronary artery disease and carotid artery stenosis, but their association with Alzheimer disease (AD) is controversial. We tested the association of 29 SNPs in PON1, PON2 and PON3 with AD in 730 Caucasian and 467 African American participants of the MIRAGE Study, an ongoing multi-center family-based genetic epidemiology study of AD. Eight SNPs were associated with AD in the African American families (0.0001 ≤ P ≤0.04) and two SNPs were associated with AD in Caucasian families (0.01 ≤ P ≤ 0.04). Of note, the pattern of association for the PON1 promoter SNP -161[C/T] was the same in both ethnic groups (P = 0.006). Haplotype analysis using sliding windows revealed 11 contiguous SNP combinations spanning the three PON genes with significant global test scores (0.006 ≤ P ≤ 0.04) in the two ethnic groups combined. The most significantly associated haplotype comprised SNPs in the region spanning the -161[C/T] SNP (P = 0.00009). Our results demonstrate association between AD and variants in the PON gene cluster in Caucasians and African Americans. © The Author 2005. Published by Oxford University Press. All rights reserved