Determinants of communication between partners about STD symptoms: implications for partner referral in South Africa

BackgroundSTDs as preventable diseases are a major public health problem in South Africa, both in terms of their effect on quality of life, their economic costs and the fact that STDs as co-factors drive the HIV epidemic. Their widespread occurrence and high prevalence rates are cause for concern. It is argued that the duration of infection increases the probability of harmful sequelae and STD transmission, including HIV, to others. The promotion of seeking health care for STD symptoms at an early stage and partner referral for STD treatment are important strategies in preventing STD transmission to others and re-infection of partners. The cost implications of contact tracing by healthcare workers has resulted in patients being encouraged to refer their partners for STD treatment. This has not always been effective, despite efforts to improve partner referral rates by improved “contact cards” (i.e. a card with a code representing the STD that the patient has been treated for to be given to sexual partners as a way to speed up treatment) and more accessible healthcare services. Other studies have found that the proportion of clients who present with contact cards at STD services ranged from about 2% to 39%, while the proportion of partners who were referred for treatment range from 16% to 30%. Mathews et al. argue that returning contact cards might not be a sensitive enough proxy indicator for partner referral rates.Partner referrals have been found to be seriously compromised by patients' causal explanations for STDs, as well as by the unequal power of the genders in sexual relationships, which impacts on the patients' ability to communicate about sexual matters. Patients often lack an understanding of the importance of referring their asymptomatic partners for treatment. Women's inability to discuss sexual issues due to their unequal status in sexual relationships might impact on partner referral behaviour. Men have been found to blame the STD on the “outside women” (sexual partners outside the primary relationship) and are therefore less likely to refer these partners. The conflict that could arise from informing a partner about an STD was viewed by men as a reason not to communicate about having a STD.While the ability to communicate about STDs with sexual partners is an essential prerequisite for referring them for medical treatment, little attention has been paid to understanding this process. This study is aimed at gaining some understanding of the determinants of communication between partners about STD symptoms. In this study, “talking with a partner about STD symptoms” before seeking medical treatment was viewed as an indication of the likelihood of future partner referral behaviour.Methods A randomly selected sample of 1 477 patients with STD symptoms was interviewed using a structured questionnaire. Logistic regression analysis was used to identify the determinants of talking to a partner about the present STD.ResultsIt was found that patients who had talked with their partner about their current STD symptoms were more likely to be female, be employed, have a tertiary level of education, have had only one sexual partner in the preceding six months, have used condoms, albeit inconsistently during the last six months, and to have thought about abstaining from sex while infected. Those who talked were also more likely to have good knowledge about the effects of STDs and the transmission of STDs in the absence of symptoms, had positive attitudes towards condoms and perceived social support for partner referral.ConclusionImproved partner referral through health education interventions needs to focus specifically on a subgroup of patients, e.g. men and the unemployed, and on the improvement of knowledge regarding the consequences of STDs and asymptomatic transmission. Social and partner support for partner referral and perceived self-efficacy in this regard should be encouraged and maintained. In the absence of skills and counselling services to manage the consequences of STD partner referral, this prevention strategy will remain vulnerable.For full text, click here:SA Fam Pract 2006;48(7):17-17

The value of radiographic markers in the diagnostic work-up of rotator cuff tears, an arthroscopic correlated study

Objective To evaluate the value of radiographs during the diagnostic work-up of rotator cuff tears, using arthroscopy as reference standard. Materials and methods This retrospective study included 236 shoulders of 236 patients. All radiographs were evaluated for inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, greater tubercle cysts, and subacromial space calcifications. Predictive value of these radiographic signs in predicting rotator cuff tears was determined with arthroscopy as reference standard. Results According to arthroscopy, 131 shoulders were diagnosed with rotator cuff tears. Seventy-two out of 131 shoulders (55%) had inferior cortical acromial sclerosis, 37 (28%) lateral acromial spur, 21 (16%) superior migration of the humeral head, 7 (5%) greater tubercle cysts and 15 subacromial space calcifications (11%). Inferior cortical acromial sclerosis (P = 0.001), lateral spur (P = 0.001), superior migration (P = 0.002), and cysts (P = 0.03) were significantly and independently associated with rotator cuff tears, whereas subacromial calcifications (p = 0.21) was not. Inferior cortical acromial sclerosis, superior migration, lateral acromial spur, and cysts combined have a positive predictive value of 78%. Conclusions The combination of inferior cortical acromial sclerosis, lateral acromial spur, superior migration of the humeral head, and greater tubercle cysts has a high positive predictive value for the presence of full-thickness rotator cuff tears. In patients with a high suspicion for having a rotator cuff tear based on radiographic findings, MRI can be performed directly without the delay and costs caused by an additional ultrasound exam

Forward Amortized Inference for Likelihood-Free Variational Marginalization

In this paper, we introduce a new form of amortized variational inference by using the forward KL divergence in a joint-contrastive variational loss. The resulting forward amortized variational inference is a likelihood-free method as its gradient can be sampled without bias and without requiring any evaluation of either the model joint distribution or its derivatives. We prove that our new variational loss is optimized by the exact posterior marginals in the fully factorized mean-field approximation, a property that is not shared with the more conventional reverse KL inference. Furthermore, we show that forward amortized inference can be easily marginalized over large families of latent variables in order to obtain a marginalized variational posterior. We consider two examples of variational marginalization. In our first example we train a Bayesian forecaster for predicting a simplified chaotic model of atmospheric convection. In the second example we train an amortized variational approximation of a Bayesian optimal classifier by marginalizing over the model space. The result is a powerful meta-classification network that can solve arbitrary classification problems without further training.Comment: 9 pages, 3 figure

SISTA South Africa: The adaptation of an efficacious HIV prevention trial conducted with African-American women for isiXhosa-speaking South African women

Although new HIV treatments continue to offer hope for individuals living with HIV, behavioural interventions shown to reduce HIV risk behaviour remain one of the most powerful tools in curbing the HIV epidemic. Unfortunately, the development of evidencebased HIV interventions is a resource-intensive process that has not progressed as quickly as the epidemiology of the disease. As the epidemic continues to evolve, there is a need to expedite the development of evidence-based HIV interventions for populations that are often disproportionately impacted by HIV/AIDS. One mechanism of accelerating the development process is to adapt evidence-based HIV interventions for vulnerable populations. The aim of this paper was to describe the adaptation process of a HIV intervention for African-American women for black South African Xhosa women. For African-American women the intervention was effective in increasing consistent condom use, sexual self-control, sexual communication, sexual assertiveness and partner adoption of norms supporting consistent condom use. Keywords: Intervention, women, cultural adaptation, HIV transmission risk behaviours.SAHARA-J Vol. 5 (4) 2008: pp. 186-19

Evaluation of factors associated with bulk milk somatic cell count and total plate count in Indonesian smallholder dairy farms

Increasing milk quality in smallholder dairy farms will result in a greater quantity of milk being delivered to milk collection centers, an increased milk price for farmers and consequently an improved farmers’ livelihood. However, little research on milk quality has been performed on smallholder farms in Southeast Asia. The objective of this study was to identify risk factors associated with somatic cell count (SCC) and total plate count (TPC) in Indonesian smallholder dairy farms. One dairy cooperative in West Java, Indonesia was selected based on its willingness to participate. All 119 member farmers in the cooperative, clustered in six groups, were interviewed and a bulk milk sample from all farms was collected in April 2022. Risk factors associated with dairy farms’ SCC and TPC were investigated using multivariable population-averaged generalized estimating equations (GEE) models. The mean geometric SCC and TPC from these farms were 529,665 cells/mL of milk and 474,492 cfu/mL of milk, respectively. Five risk factors including manure removal frequency, receiving mastitis treatment training, washing the udder using soap, number of workers, and ownership of the pasture area were associated with SCC. Two risk factors, manure removal frequency and dairy income contribution, were associated with TPC. These findings can therefore be used as a starting point to improve udder health and milk quality in Indonesia and other countries where smallholder farmers play a significant role in milk production

Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in

Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35,

Spatiotemporal dynamics of cortical representations during and after stimulus presentation

Visual perception is a spatiotemporally complex process. In this study, we investigated cortical dynamics during and after stimulus presentation. We observed that visual category information related to the difference between faces and objects became apparent in the occipital lobe after 63 ms. Within the next 110 ms, activation spread out to include the temporal lobe before returning to residing mainly in the occipital lobe again. After stimulus offset, a peak in information was observed, comparable to the peak after stimulus onset. Moreover, similar processes, albeit not identical, seemed to underlie both peaks. Information about the categorical identity of the stimulus remained present until 677 ms after stimulus offset, during which period the stimulus had to be retained in working memory. Activation patterns initially resembled those observed during stimulus presentation. After about 200 ms, however, this representation changed and class-specific activity became more equally distributed over the four lobes. These results show that, although there are common processes underlying stimulus representation both during and after stimulus presentation, these representations change depending on the specific stage of perception and maintenance. </p

Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: Design of a prospective cohort study

Background: Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. Methods. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. Discussion. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis