Design of a study to determine the impact of insecticide resistance on malaria vector control: a multi-country investigation.

BACKGROUND: Progress in reducing the malaria disease burden through the substantial scale up of insecticide-based vector control in recent years could be reversed by the widespread emergence of insecticide resistance. The impact of insecticide resistance on the protective effectiveness of insecticide-treated nets (ITN) and indoor residual spraying (IRS) is not known. A multi-country study was undertaken in Sudan, Kenya, India, Cameroon and Benin to quantify the potential loss of epidemiological effectiveness of ITNs and IRS due to decreased susceptibility of malaria vectors to insecticides. The design of the study is described in this paper. METHODS: Malaria disease incidence rates by active case detection in cohorts of children, and indicators of insecticide resistance in local vectors were monitored in each of approximately 300 separate locations (clusters) with high coverage of malaria vector control over multiple malaria seasons. Phenotypic and genotypic resistance was assessed annually. In two countries, Sudan and India, clusters were randomly assigned to receive universal coverage of ITNs only, or universal coverage of ITNs combined with high coverage of IRS. Association between malaria incidence and insecticide resistance, and protective effectiveness of vector control methods and insecticide resistance were estimated, respectively. RESULTS: Cohorts have been set up in all five countries, and phenotypic resistance data have been collected in all clusters. In Sudan, Kenya, Cameroon and Benin data collection is due to be completed in 2015. In India data collection will be completed in 2016. DISCUSSION: The paper discusses challenges faced in the design and execution of the study, the analysis plan, the strengths and weaknesses, and the possible alternatives to the chosen study design

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Marital conflict typology and children's appraisals: the moderating role of family cohesion

Intense and frequent marital conflict is associated with greater appraisals of threat and self-blame in children, but little else is known about contextual factors that might affect appraisals. Systemic family theories propose that to understand child adaptation, it is necessary to understand the interconnected nature of family subsystem relationships. In a sample of 257 families with 8- to 12-year-old children, this study examined whether a four-level typology of marital conflict management was related to children's perceptions of marital conflict and their appraisals of perceived threat and self-blame. In addition, family cohesion was tested as a moderator of the relationship between marital conflict style and children's appraisals. Observational coding was used to group couples into Harmonious, Disengaged, Conflictual-Expressive, and Conflictual-Hostile groups. Children's report of the intensity, frequency, and degree of resolution of interparental discord corresponded well with observers' ratings. The relationship between marital conflict style and appraisals of threat and self-blame was moderated by family cohesiveness. At high levels of family cohesiveness, no group differences were found for either perceived threat or self-blame, whereas when family cohesiveness was low, threat was higher for the Harmonious and Conflictual-Hostile groups, as compared to the Conflictual-Expressive group, and self-blame was higher for both conflict groups (expressive and hostile), as compared to the Disengaged group. The results provide further evidence of interconnected nature of family subsystem relationships and the importance of distinguishing among different approaches to marital conflict management for understanding the complex and perhaps subtle but meaningful effects different family system factors have on child adaptation

Aggression and Dominance: The Roles of Power and Culture in Domestic Violence

In the past few decades, it has become increasingly clear to social scientists and policy makers alike that violence within the family is all too common and carries enormous costs to individuals, families, and society as a whole. Numerous controversies exist in the field, particularly with regard to what factors are significant in the etiology and development of violence between intimate partners. This article focuses on relationship power as a critical construct to consider in domestic violence, as it encompasses aspects of social, dyadic, and individual functioning. The literature on the construct of power and its relationship to domestic violence is reviewed and then placed in cultural context, followed by a discussion of future directions for research on and treatment issues in power and violence