Parenting experiences of couples living with human immunodeficiency virus: A qualitative study from rural Southern Malawi

The advent of antiretroviral therapy (ART) has allowed couples living with human immunodeficiency virus (HIV) to live longer and healthier lives. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV (PLWH) to have children. However, little is known about the parenting experiences of couples living with HIV (CLWH). The aim of this qualitative study was to explore and describe parenting  experiences of seroconcordant couples who have a child while living with HIV in Malawi. Data were collected using in-depth interviews with 14 couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa  communities from July to December 2010. The research findings shows that irrespective of kinship organization, economic hardships, food insecurity, gender-specific role expectations and conflicting information from health institutions and media about sources of support underpin their parenting roles. In addition, male spouses are directly involved in household activities, childcare and child feeding decisions, challenging the existing  stereotyped gender norms. In the absence of widow inheritance, widows from patrilineal communities are not receiving the expected support from the deceased husband relatives. Finally, the study has shown that CLWH are able to find solutions for the challenges they encounter. Contrary to existing belief that such who have children depend solely on public aid. Such claims without proper knowledge of local social cultural contexts, may contribute to stigmatizing CLWH who continue to have children. The study is also relevant to PLWH who, although not parents themselves, are confronted with a situation where they have to accept responsibility for raising children from their kin. We suggest the longer-term vision for ART wide access in Malawi to be broadened beyond provision of ART to incorporate social and economic interventions that support the rebuilding of CLWH social and economic lives. The interventions must be designed using a holistic multi-sector approach.Keywords: Malawi, couples, experiences, HIV and AIDS, parentingL’ave`nement de la the´rapie antire´trovirale a permis couples vivant avec le VIH de vivre plus longtemps et en meilleure sante´. La re´duction de la transmission du VIH de la me`re a` l’enfant a encourage´ certaines personnes vivant avec le VIH ont deux enfants. Cependant, on sait peu sur les expe´riences parentales des  couples vivant avec le VIH. Le but de cette e´tude qualitative e´tait d’explorer et de´crire des expe´riences  parentales des couples se´roconcordants qui ont un enfant tout en vivant avec le VIH au Malawi. Les donne´es  ont e´te´ collecte´es abuser des entrevues en profondeur avec des quatorze couples dessein e´chantillonne´s dans les communaute´s matriline´aires et patriline´aires Chiradzulu, Chikhwawa de Juillet jeu. De´cembre 2010.  Les re´sultats de recherche montrent que, inde´pendamment de l’organisation de la parente´, les difficulte´s  e´conomiques, l’inse´curite´ alimentaire, le roˆle des attentes spe´cifiques de genre et des informations  contradictoires des institutions de sante´ et les me´dias au sujet des sources de soutien angoisse leur roˆle  parental En outre, les conjoints de sexe masculin sont directement implique´s dans les activite´s de me´nage,  garde d’enfants et les de´cisions de l’alimentation des enfants, contestant la norme de genre ste´re´otype´s existant. En l’absence de l’he´ritage des veuves, veuves des communaute´s patriline´aires ne rec¸oivent pas le  soutien attendu de la famille du mari de´funt. Enfin, l’e´tude a montre´ que les couples vivant avec le VIH sont  a` l’aise pour trouver des solutions aux de´fis qu’ils rencontrent. Contrairement deux croyance existante que ce  qui ont des enfants de´pendent uniquement sur l’aide publique. Ces revendications sans la connaissance de  contextes socioculturels locaux, peut contribuer a` stigmatiser les couples vivant avec le VIH qui continuent deux  ont des enfants. L’e´tude est e´galement pertinent pour les personnes vivant avec le VIH qui, bien que non les  parents themelves, sont confronte´s a` une situation ou` ils doivent accepter la responsabilite´ d’e´lever les enfants de leurs parents. Nous sugge´rons la vision a` long terme de la the´rapie antire´trovirale large acce`s au Malawi a` eˆtre e´largi au-dela` de la fourniture d’un traitement antire´troviral deux interventions sociales et e´conomiques Incorporer qui soutiennent la reconstruction des couples vivant avec le VIH vie sociale et  e´conomique. Les interventions doivent eˆtre conc¸ues utilisation excessive d’une approche multi-sectorielle  globale.Mots cle´s: Malawi, les couples, les expe´riences, le VIH et le SIDA, la parentalite

Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies?

Background:  The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV.Methods:  A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly,data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis.Results: Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed nonprescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services.Conclusion: This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi

Intermittent mild negative pressure applied to the lower limb in patients with spinal cord injury and chronic lower limb ulcers: a crossover pilot study

Study design Randomized, assessor-blinded crossover pilot study. Objectives To explore the use of an intermittent negative pressure (INP) device for home use in addition to standard wound care (SWC) for patients with spinal cord injury (SCI) and chronic leg and foot ulcers before conducting a superiority trial. Setting Patient homes and outpatient clinic. Methods A 16-week crossover trial on 9 SCI patients (median age: 57 years, interquartile range [IQR] 52–66), with leg ulcers for 52 of weeks (IQR: 12–82) duration. At baseline, patients were allocated to treatment with INP + SWC or SWC alone. After 8 weeks, the ulcers were evaluated. To assess protocol adherence, the patients were then crossed over to the other group and were evaluated again after another 8 weeks. Lower limb INP treatment consisted of an airtight pressure chamber connected to an INP generator (alternating 10 s −40mmHg/7 s atmospheric pressure) used 2 h/day at home. Ulcer healing was assessed using a photographic wound assessment tool (PWAT) and by measuring changes in wound surface area (WSA). Results Seven of nine recruited patients adhered to a median of 90% (IQR: 80–96) of the prescribed 8-week INP-protocol, and completed the study without side effects. PWAT improvement was observed in 4/4 patients for INP + SWC vs. 2/5 patients for SWC alone (P = 0.13). WSA improved in 3/4 patients allocated to INP + SWC vs. 3/5 patients in SWC alone (P = 0.72). Conclusions INP can be used as a home-based treatment for patients with SCI, and its efficacy should be tested in an adequately sized, preferably multicenter randomized trial.måsjekke

Essential nucleotide- and protein-dependent functions of Actb/β-actin

The highly similar cytoplasmic β- and γ-actins differ by only four functionally similar amino acids, yet previous in vitro and in vivo data suggest that they support unique functions due to striking phenotypic differences between Actb and Actg1 null mouse and cell models. To determine whether the four amino acid variances were responsible for the functional differences between cytoplasmic actins, we gene edited the endogenous mouse Actb locus to translate γ-actin protein. The resulting mice and primary embryonic fibroblasts completely lacked β-actin protein, but were viable and did not present with the most overt and severe cell and organismal phenotypes observed with gene knockout. Nonetheless, the edited mice exhibited progressive high-frequency hearing loss and degeneration of actin-based stereocilia as previously reported for hair cell-specific Actb knockout mice. Thus, β-actin protein is not required for general cellular functions, but is necessary to maintain auditory stereocilia

Adult body growth and reproductive investment vary markedly within and across Atlantic and Pacific herring: a meta-analysis and review of 26 stocks

Life-history traits of Pacific (Clupea pallasii) and Atlantic (Clupea harengus) herring, comprising both local and oceanic stocks subdivided into summer-autumn and spring spawners, were extensively reviewed. The main parameters investigated were body growth, condition, and reproductive investment. Body size of Pacific herring increased with increasing latitude. This pattern was inconsistent for Atlantic herring. Pacific and local Norwegian herring showed comparable body conditions, whereas oceanic Atlantic herring generally appeared stouter. Among Atlantic herring, summer and autumn spawners produced many small eggs compared to spring spawners, which had fewer but larger eggs—findings agreeing with statements given several decades ago. The 26 herring stocks we analysed, when combined across distant waters, showed clear evidence of a trade-off between fecundity and egg size. The size-specific individual variation, often ignored, was substantial. Additional information on biometrics clarified that oceanic stocks were generally larger and had longer life spans than local herring stocks, probably related to their longer feeding migrations. Body condition was only weakly, positively related to assumingly in situ annual temperatures (0–30 m depth). Contrarily, body growth (cm × y−1), taken as an integrator of ambient environmental conditions, closely reflected the extent of investment in reproduction. Overall, Pacific and local Norwegian herring tended to cluster based on morphometric and reproductive features, whereas oceanic Atlantic herring clustered separately. Our work underlines that herring stocks are uniquely adapted to their habitats in terms of trade-offs between fecundity and egg size whereas reproductive investment mimics the productivity of the water in question.publishedVersio

Influence of larval transport and temperature on recruitment dynamics of North Sea cod (Gadus morhua) across spatial scales of observation

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Romagnoni, G., Kvile, K. o., Dagestad, K., Eikeset, A. M., Kristiansen, T., Stenseth, N. C., & Langangen, O. Influence of larval transport and temperature on recruitment dynamics of North Sea cod (Gadus morhua) across spatial scales of observation. Fisheries Oceanography, (2020): 1-16, doi:10.1111/fog.12474.The survival of fish eggs and larvae, and therefore recruitment success, can be critically affected by transport in ocean currents. Combining a model of early‐life stage dispersal with statistical stock–recruitment models, we investigated the role of larval transport for recruitment variability across spatial scales for the population complex of North Sea cod (Gadus morhua ). By using a coupled physical–biological model, we estimated the egg and larval transport over a 44‐year period. The oceanographic component of the model, capable of capturing the interannual variability of temperature and ocean current patterns, was coupled to the biological component, an individual‐based model (IBM) that simulated the cod eggs and larvae development and mortality. This study proposes a novel method to account for larval transport and success in stock–recruitment models: weighting the spawning stock biomass by retention rate and, in the case of multiple populations, their connectivity. Our method provides an estimate of the stock biomass contributing to recruitment and the effect of larval transport on recruitment variability. Our results indicate an effect, albeit small, in some populations at the local level. Including transport anomaly as an environmental covariate in traditional stock–recruitment models in turn captures recruitment variability at larger scales. Our study aims to quantify the role of larval transport for recruitment across spatial scales, and disentangle the roles of temperature and larval transport on effective connectivity between populations, thus informing about the potential impacts of climate change on the cod population structure in the North Sea.G.R. was supported by the Norden Top‐level Research Initiative sub‐programme “Effect Studies and Adaptation to Climate Change” through the Nordic Centre for Research on Marine Ecosystems and Resources under Climate Change (NorMER). K.Ø.K. was supported by the WHOI John H. Steele Post‐doctoral Scholar award and VISTA – a basic research program in collaboration between The Norwegian Academy of Science and Letters, and Equinor. We thank an anonymous referee for valuable comments that substantially improved the article