Vulnerability assessment and protective effects of coastal vegetation during the 2004 tsunami in Sri Lanka

The tsunami of December 2004 caused extensive human and economic losses along many parts of the Sri Lankan coastline. Thanks to extensive national and international solidarity and support in the aftermath of the event, most people managed to restore their livelihoods completely but some households did not manage to recover completely from the impacts of the event. The differential in recovery highlighted the various vulnerabilities and coping capacities of communities exposed to the tsunami. Understanding the elements causing different vulnerabilities is crucial to reducing the impact of future events, yet capturing them comprehensively at the local level is a complex task. This research was conducted in a tsunami-affected area in southwestern Sri Lanka to evaluate firstly the role of coastal vegetation in buffering communities against the tsunami and secondly to capture the elements of vulnerability of affected communities. The area was chosen because of its complex landscape, including the presence of an inlet connecting the Maduganga estuary with the sea, and because of the presence of remaining patches of coastal vegetation. The vulnerability assessment was based on a comprehensive vulnerability framework and on the Sustainable Livelihoods Framework in order to detect inherent vulnerabilities of different livelihood groups. Our study resulted in the identification of fishery and labour-led households as the most vulnerable groups. Unsurprisingly, analyses showed that damages to houses and assets decreased quickly with increasing distance from the sea. It could also be shown that the Maduganga inlet channelled the energy of the waves, so that severe damages were observed at relatively large distances from the sea. Some reports after the tsunami stated that mangroves and other coastal vegetation protected the people living behind them. Detailed mapping of the coastal vegetation in the study area and subsequent linear regression revealed significant differences between three vegetation classes present in the area with regard to water level and damages to houses. As our region showed homogeneity in some important factors such as coastal topography, our results should only be generalised to comparable regions

Influenza vaccines: the effect of vaccine dose on antibody response in primed populations during the ongoing interpandemic period. A review of the literature.

Health authorities tend to favour an increase of the antigen dose in inactivated influenza vaccines from or = 75%) for a 10 micrograms HA dose of influenza A vaccine components. For both response and protection rates, an increase of the antigenic load from 10 to 15 micrograms HA was not associated with a meaningful increase of seroresponse: in 38 out of 39 stratification groups, the increase of response and/or protection rate varied between -9% and +8%, with a median of 1.5%. These results do not justify the expectation that a vaccine dose of 15 micrograms HA per strain would be clinically superior to a dose of 10 micrograms HA. Only in a group of immune-compromised patients on chronic intermittent haemodialysis were results in favour of a higher dose found, which may justify further evaluation in this special population

Cancer risk in HIV-infected individuals on HAART is largely attributed to oncogenic infections and state of immunocompetence

<p>Abstract</p> <p>Objectives</p> <p>To estimate the cancer risk of HIV-infected patients in the HAART era with respect to a general reference population and to determine risk factors for malignancy.</p> <p>Methods</p> <p>Long term (1996-2009) cancer incidence of the Bonn single centre HIV cohort was compared to the incidence of the reference population of Saarland using standardized incidence ratios (SIR). Poisson regression analysis was used to identify predictors of cancer risk.</p> <p>Results</p> <p>1,476 patients entered the cohort, enabling 8,772 person years of observation. 121 tumours in 114 patients, 7 in-situ and 114 invasive cancers, were identified. Malignancies associated with infectious agents such as Kaposi sarcoma (SIRs: male: 5,683; female: 277), non-Hodgkin lymphoma (SIRs male: 35; female: 18), anal cancer (SIRs male: 88; female: 115) as well a cervical carcinoma (SIR female: 4) and Hodgkin's disease (SIR male: 39) and liver cancer (SIR male: 18) were substantially more frequent in HIV-infected patients than in the general population (p < 0.001, each), whereas all other types of cancer were not increased. Poisson regression identified HAART (incidence rate ratio IRR (95% CI): 0.28 (0.19-0.41), p < 0.001), CD4 count (IRR per 100 cells/μl increase: 0.66 (0.57-0.76), p < 0.001), hepatitis B (IRR: 2.15 (1.10-4.20), p = 0.046) and age (IRR per 10 year increase: 1.23 (1.03 - 1.46), p = 0.023) as independent predictors for the occurrence of any type of cancer.</p> <p>Conclusions</p> <p>HAART and preserved CD4 cells preferentially reduce the risk of malignancies associated with oncogenic infections.</p

Automated quantitative evaluation of brain MRI may be more accurate for discriminating preterm born adults

Objective To investigate the structural brain abnormalities and their diagnostic accuracy through qualitative and quantitative analysis in term born and very preterm birth or with very low birth weight (VP/VLBW) adults. Methods We analyzed 3-T MRIs acquired in 2011–2013 from 67 adults (27 term born controls, mean age 26.4 years, 8 females; 40 VP/VLBWs, mean age 26.6 years, 16 females). We compared automatic segmentations of the white matter, deep gray matter and cortical gray matter, manual corpus callosum measurements and visual ratings of the ventricles and white matter with t tests, logistic regression, and receiver operator characteristic (ROC) curves. Results Automatic segmentation correctly classified 84% of cases; visual ratings correctly classified 63%. Quantitative volumetry based on automatic segmentation revealed higher ventricular volume, lower posterior corpus callosum, and deep gray matter volumes in VP/VLBW subjects compared to controls (p < 0.01). Visual rating and manual measurement revealed a thinner corpus callosum in VP/VLBW adults (p = 0.04) and deformed lateral ventricles (p = 0.03) and tendency towards more “dirty” white matter (p = 0.06). Automatic/manual measures combined with visual ratings correctly classified 87% of cases. Stepwise logistic regression identified three independent features that correctly classify 81% of cases: ventricular volume, deep gray matter volume, and white matter aspect. Conclusion Enlarged and deformed lateral ventricles, thinner corpus callosum, and “dirty” white matter are prevalent in preterm born adults. Their visual evaluation has low diagnostic accuracy. Automatic volume quantification is more accurate but time consuming. It may be useful to ask for prematurity before initiating further diagnostics in subjects with these alterations

Caregiver experience and perceived acceptability of a novel near point-of-care early infant HIV diagnostic test among caregivers enrolled in the PMTCT program, Myanmar : a qualitative study

Background The majority of HIV infection among children occurs through mother-to-child transmission. HIV exposed infants are recommended to have virological testing at birth or 4–6 weeks of age but challenges with centralized laboratory-based testing in Myanmar result in low testing rates and delays in result communication and treatment initiation. Decentralized point-of-care (POC) testing when integrated in prevention of mother-to-child transmission of HIV (PMTCT) services, can be an alternative to increase coverage of early infant diagnosis (EID) and timely engagement in HIV treatment and care. Aim This paper aims to explore experiences of caregivers of HIV-exposed infants enrolled in the PMTCT program in Myanmar and the perceived acceptability of point-of-care EID testing compared to conventional centralised laboratory-based testing. Methods This is a sub-study of the cluster randomised controlled stepped-wedge trial (Trial registration number: ACTRN12616000734460) that assessed the impact of near POC EID testing using Xpert HIV-1 Qual assay in four public hospitals in Myanmar. Caregivers of infants who were enrolled in the intervention phase of the main study, had been tested with both Xpert and standard of care tests and had received the results were eligible for this qualitative study. Semi-structured interviews were conducted with 23 caregivers. Interviews were audio recorded, transcribed verbatim and translated into English. Thematic data analysis was undertaken using NVivo 12 Software (QSR International). Results The majority of caregivers were satisfied with the quality of care provided by PMTCT services. However, they encountered social and financial access barriers to attend the PMTCT clinic regularly. Mothers had concerns about community stigma from the disclosure of their HIV status and the potential consequences for their infants. While medical care at the PMTCT clinics was free, caregivers sometimes experienced financial difficulties associated with out-of-pocket expenses for childbirth and transportation. Some caregivers had to choose not to attend work (impacting their income) or the adult antiretroviral clinic in order to attend the paediatric PMTCT clinic appointment. The acceptability of the Xpert testing process was high among the caregiver participants and more than half received the Xpert result on the same day as testing. Short turnaround time of the near POC EID testing enabled the caregivers to find out their infants’ HIV status quicker, thereby shortening the stressful waiting time for results. Conclusion Our study identified important access challenges facing caregivers of HIV exposed infants and high acceptability of near POC EID testing. Improving the retention rate in the PMTCT and EID programs necessitates careful attention of program managers and policy makers to these challenges, and POC EID represents a potential solution

Risk factors and knowledge associated with high unintended pregnancy rates and low family planning use among pregnant women in Papua New Guinea

Unintended pregnancy is a major driver of poor maternal and child health in resource-limited settings. Data on pregnancy intention and use of family planning (FP) is scarce in Papua New Guinea (PNG), but are needed to inform public health strategies to improve FP accessibility and uptake. Data from a facility-based cross-sectional sample of 699 pregnant women assessed prevalence and predictors of unintended pregnancy and modern FP use among pregnant women in East New Britain Province, PNG. More than half (55%) the women reported their pregnancy as unintended. Few (18%) reported ever having used a modern FP method, and knowledge of different methods was low. Being single, separated or divorced (AOR 9.66; 95% CI 3.27-28.54), educated to a tertiary or vocational level (AOR 1.78 CI 1.15-2.73), and gravidity>1 (AOR 1.43 for each additional pregnancy CI 1.29-1.59) were associated with unintended pregnancy; being accompanied by a male partner to ANC was associated with a reduced unintended pregnancy (0.46 CI 0.30-0.73). Factors associated with modern FP use included male partner involvement (AOR 2.26 CI 1.39-3.67) and gravidity>1 (AOR 1.54 for each additional pregnancy CI 1.36-1.74). FP use also varied by the facility women attended. Findings highlight an urgent need for targeted interventions to improve FP knowledge, uptake and access, and male partner involvement, to reduce unintended pregnancies and their complications

Are sex workers propagating one or two HIV epidemics in Kenya? Findings from a behavioral monitoring survey in Coast Province

Background: Kenya's Coast Province has high prevalence for commercial sex and substance abuse. While many studies have confirmed the association between HIV and alcohol and injection drug use among female sex workers (FCSWs), little known of HIV risk from other substances such as miraa (Catha edulis alias 'khat') and bhang (cannabis) among FCSWs. Despite numerous adverse consequences of miraa, Kenyan law silent on miraa sale and use. To estimate the burden of khat and bhang use and contribution toward risky sexual behaviour, we conducted a behavioural survey targeting FCSWs in Mombasa. Method: Cross-sectional survey recruited 297 FCSWs using time location sampling. Structured questionnaires administered using Personal Digital Assistants (PDA). Outcome measures: prevalence of substance abuse, sexual violence and perceived HIV risk. Results: 46% FCSWs aged 15-24 years, 68% attained primary level education, 66% full time sex workers. 96% percent used at least one substance: Alcohol most popular (91%) (P 5 years more likely to smoke cigarettes than those in the trade shorter duration (p< 0.05; df=1; OR=1.65). 47.5% (141/297 reported sexual violence. Although 40.8% of FCSWs perceived risk of HIV acquisition as medium to high, majority (75%) due to multiple partners, rather than rape (1%). Conclusions: Study confirmed high miraa and bhang use among FCSWs, in addition to alcohol and cigarettes. Combined use of alcohol and miraa associated with more sexual partners, increased risk of sexual violence and moderate-high perception of HIV infection. Further research needed on substance careers, networks and causes to determine how to control miraa and bhang use among FCSWs

Sex, sexuality, and intimate relationships among Afghan women and men of refugee background living in Melbourne, Australia : experiences, opportunities, and transcultural tensions

Over the last two decades, Afghanistan has been a leading country of origin for asylum seekers and refugees arriving in Australia. It is widely recognized that humanitarian migrants experience poorer sexual and reproductive health than the broader population. In turn, a body of research has emerged exploring the sexual and reproductive health of the local Afghan community. However, this has predominantly focused on youth or perinatal experiences, and less attention has been given to the broader relational and social dimensions of sexuality. Accordingly, this research aimed to explore the perspectives and experiences of married Afghan women and men as they navigate and negotiate sex, sexuality, and intimate relationships following settlement in Melbourne, Australia. A total of 57 Afghan women and men participated in six focus group discussions and 20 semi-structured interviews. Male participants described the ways that having increased access to sex and sexually explicit materials in Australia is creating opportunities for them to establish more fulfilling sex lives. Many women also described a growing awareness of sexuality, although often expressed difficulty prioritizing and claiming more pleasurable sexual encounters for themselves. However, concerns about sexual freedom are also creating new challenges for the Afghan community living in Australia in relation to sex and relationships. For example, men expressed fears about women exercising sexual liberties outside of the home, and this appeared to place women's everyday behavior under increased scrutiny. Women also voiced concerns about how easily men can access sex outside of marriage within Australia, and described how this amplified their sense of obligation to be sexually compliant and meet their husband's desires. This study provides new insights into the ways that Afghan community members are moving between societies, and how their understandings of sexual participation, pleasure, desire, health, consent, and capacity for self-determination are being challenged, reshaped, and reconstructed throughout this process