Spatial Analyses of Oral Polio Vaccine Transmission in an Community Vaccinated With Inactivated Polio Vaccine.

Background: Understanding the spatial dynamics of oral polio vaccine (OPV) transmission will improve resource targeting. Mexico provides a natural laboratory, as it uses inactivated polio vaccine routinely as well as OPV bi-annually. Methods: Using geospatial maps, we measured the distance and density of OPV vaccinees' shedding in the areas nearest to unvaccinated households in 3 Mexican villages. Comparison of transmission to unvaccinated households utilized a mixed effects logistic regression with random effects for household and time, adjusted for age, gender, area, and running water. Results: The median distance from an unvaccinated household to its nearest OPV-shedding household was 85 meters (interquartile range, 46-145) and the median number of vaccinees shedding OPV within 200 m was 3 (2-6). Transmission to unvaccinated households occurred by day 1. There was no association (odds ratio [OR] 1.04; 95% credible interval [CrI] 0.92-1.16) between the distance from OPV shedding and the odds of transmission. The number of OPV vaccinees shedding within 200 m came close to a significant association with unvaccinated transmission (OR 0.93; CrI 0.84-1.01), but this was not the case for households 100 or 500 m apart. Results were consistent across the 3 villages. Conclusions: Geospatial analysis did not predict community transmission from vaccinated to unvaccinated households, because OPV use resulted in rapid, low transmission levels. This finding supports the global cessation of OPV

Levels of self-reported depression and anxiety among HIV-positive patients in Albania: a cross-sectional study

Aim To gain an initial perspective of mental health issues facing the Human Immunodeficiency Virus (HIV)-positive population at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic. Methods From June-August 2009, we conducted semistructured interviews with 79 patients (93% response rate) at the UHCT HIV/AIDS Ambulatory Clinic. The interviews assessed patient-reported histories of mental health diagnoses, patients’ demographics, and current emotional health status. Results The percentage of patients who reported a history of diagnosis of depression or anxiety was high – 62.3% and 82.3%, respectively. Factors associated with a history of depression included having been diagnosed with anxiety (P < 0.001), having a higher number of barriers to care (P < 0.001), having a higher number of current medical and social needs (P < 0.001), or having not obtained antiretroviral therapy (ART) abroad (P = 0.004). Factors associated with a history of anxiety included having been on firstline ART (P = 0.008), having been diagnosed with HIV for shorter periods of time (P = 0.043), having been diagnosed with depression (P < 0.001), having a higher number of current medical and social needs (P = 0.035), or having not obtained ART abroad (P = 0.003). Conclusions Mental health problems are widespread among the known HIV-positive patient population in Albania. The high prevalences of anxiety and depression and of dual diagnoses of these conditions suggest the need for more mental health care for HIV-positive patients in Albania

Variation in rates of sexual assault crisis counsellor usage during forensic examination in California: an observational study

Objectives A critical asset to post-assault care of survivors is support from sexual assault crisis counsellors (SACCs). We sought to elucidate variation in implementation between California counties in SACC accompaniment during Sexual Assault Forensic Examination (SAFE).Methods SACC attendance data from 2019 was obtained from the California Governor’s Office of Emergency Services (CalOES). To assess SACC attendance rates during SAFEs, we requested SAFE quantity data from sheriffs and public health departments, the State Forensic Bureau, and the California Department of Justice (DOJ), but all requests were unanswered or denied. We also sought SAFE data from District Attorneys (DAs) in each county, and received responses from Marin and Contra Costa Counties. To estimate numbers of SAFEs per county, we gathered crime statistics from the Federal Bureau of Investigation’s (FBI’s) Uniform Crime Reporting Program and OpenJustice, a transparency initiative by the California DOJ. For each data source, we compared SACC attendance to SAFE quantities and incidences of sexual assault statewide.Results At the state level, data on SACC attendance per CalOES and DOJ archival data on sexual assault were used to approximate relative rates of SACC accompaniment at SAFEs; 83% (30 of 36) of counties had values &lt;50%. The joint sexual assault crisis centre for Contra Costa and Marin Counties reported that 140 SACCs were dispatched in 2019, while DAs in Contra Costa and Marin reported completion of 87 SAFEs in 2019, for a calculated SACC accompaniment rate of 161%. Proxy data sourced from FBI and DOJ crime statistics displayed significant inconsistencies, and DOJ data was internally inconsistent.Conclusions SACC accompaniment at SAFEs appears to be low in most California counties, however, limited data accessibility and data discrepancies and inaccuracies (e.g., rates over 100%) prevented reliable determination of SACC accompaniment rates during SAFEs. Substantial improvements in data accuracy and transparency are needed to ensure survivors’ adequate access to resources

The Effectiveness of State and National Policy on the Implementation of Perinatal HIV Prevention Interventions

Objectives. The 1994 and 1995 US Public Health Service Guidelines regarding HIV testing and treatment for pregnant women and the resulting 1995 California law mandating an HIV test and treatment offer to every pregnant woman aim to reduce perinatal HIV transmission. However, the effectiveness of such policies after implementation is often unclear. We analyzed the association between these policies and offers of HIV tests and treatment to HIV-infected women in California

Associations between women's perceptions of gender relations and self-esteem and self-efficacy in a former conflict zone: baseline findings in South Kivu, DR Congo

Background: Eastern DR Congo is recovering from decades of armed conflict in which violence against women (VAW) was widely used as a weapon of war. Even now, rates remain high: 34·5% and 47·5% of women in South Kivu report ever experiencing sexual or physical violence, respectively. However, there are few data on the impact of VAW on the health of women and their children. Methods: In August 2016, we collected baseline data on demographic and health-related variables from mothers of children younger than 5 years in 843 households enrolled as part of a larger impact evaluation. Women's empowerment was measured using the previously validated Rosenberg's self-esteem scale (RSES), the generalised self-efficacy scale (GSES), and a gender relations scale originally developed by the Medical Research Council of South Africa. GSES and RSES scores were generated by averaging individual responses to questions; bivariate analyses of the scores with individual gender relations questions were conducted using χ2 tests. Findings: Of the 845 mothers interviewed, 325 (45·5%) had less than a primary education. The mean number of children younger than 18 years per household was four, with 66 (8%) of households having more than seven such children. Mean self-esteem score was 18·2 (SD 5·3) and mean self-efficacy score was 26·2 (SD 6·3), and internal reliability tests of the RSES and GSES scales yielded alphas of α=0·76 and α=0·89, respectively. Women with higher GSES or RSES scores were less likely to accept physical violence or sexual coercion than women with lower scores (p<0·05); however, perception of male authority and gender roles within the household did not vary by score. Interpretation: This population of women had lower self-esteem than for a generalised population in DR Congo (21·3), probably because of the prolonged conflict in eastern DR Congo. Furthermore, mean GSES was lower than that of another post-conflict setting (Iran, 30·2), as well as several higher-income countries (29–32). Funding: American Refugee Committee

Prevalence and risk factors for sexual assault among class 6 female students in unplanned settlements of Nairobi, Kenya: Baseline analysis from the IMPower & Sources of Strength cluster randomized controlled trial.

BackgroundGender-based violence (GBV) is a crucial global health problem among all age groups, including adolescents. This study describes incidences of GBV, as well as factors associated with sexual assault, among female adolescents in class six living in urban informal settlements in Nairobi, Kenya.MethodsStudy participants were interviewed using a structured survey instrument focusing on experiences of GBV, including emotional, physical, and sexual violence, and corresponding perpetrators, as well as gender attitudes, alcohol use, self-efficacy, and previous sexual experiences. Summary statistics and clustered bootstrap confidence intervals were calculated for social behaviors and violence rates. Stepwise logistic regression identified variables associated with an adolescent's experience of sexual assault.FindingsIn this population 7·2% of adolescent girls reported being raped in the prior twelve months, with 11·1% of these rape victims reporting over five experiences. Among the 21·3% who report having had a boyfriend, 38·1% reported emotional, physical, and/or sexual intimate partner violence (IPV). Boyfriends were identified most often as perpetrators, accounting for 46·3% of reported lifetime rapes. Previous experience of physical (p = InterpretationSexual assault and GBV are major challenges in this highly-disadvantaged population. Novel prevention efforts are needed for this age group, as prevention is often targeted at older adolescents. Prevention efforts should focus on assaults by perpetrators known to adolescents, especially boyfriends, and may need to account for the adolescents' previous experience of, and exposure to, violence

Levels of self-reported depression and anxiety among HIV-positive patients in Albania: a cross-sectional study

Aim To gain an initial perspective of mental health issues facing the Human Immunodeficiency Virus (HIV)-positive population at the University Hospital Center of Tirana (UHCT) HIV/AIDS Ambulatory Clinic. Methods From June-August 2009, we conducted semistructured interviews with 79 patients (93% response rate) at the UHCT HIV/AIDS Ambulatory Clinic. The interviews assessed patient-reported histories of mental health diagnoses, patients’ demographics, and current emotional health status. Results The percentage of patients who reported a history of diagnosis of depression or anxiety was high – 62.3% and 82.3%, respectively. Factors associated with a history of depression included having been diagnosed with anxiety (P < 0.001), having a higher number of barriers to care (P < 0.001), having a higher number of current medical and social needs (P < 0.001), or having not obtained antiretroviral therapy (ART) abroad (P = 0.004). Factors associated with a history of anxiety included having been on firstline ART (P = 0.008), having been diagnosed with HIV for shorter periods of time (P = 0.043), having been diagnosed with depression (P < 0.001), having a higher number of current medical and social needs (P = 0.035), or having not obtained ART abroad (P = 0.003). Conclusions Mental health problems are widespread among the known HIV-positive patient population in Albania. The high prevalences of anxiety and depression and of dual diagnoses of these conditions suggest the need for more mental health care for HIV-positive patients in Albania