Global Health at the Local Level: Innovative Approaches for Preventing HIV/AIDS Among Adolescent Girls in Botswana with Evidence from an Evaluation Study on Perceptions of Cross Generational Sex and Edu-tainment Strategies

In Botswana, cross-generational sex (CGS) accounts for a disparity in incidence and prevalence rates of HIV infection between young men and women in the country. Ministry of Health quantitative data and ethnographic research indicate that almost one third of college-aged girls in urban cities had high-risk sex with a partner over ten years older in the past year. Described as “Mma 14s” (in the past this was often translated as “mothers at age 14” or “women at 14”) these girls are caught between cultural imperatives that emphasize the “traditional” and global consumption and goals of being a “modern” person. Rates of incidence and prevalence of HIV infection for young women of that age are considerably higher for women despite active education and awareness programs targeted toward the reduction of CGS. Increasingly, global health initiatives have placed emphasis on gender issues in the construction of efficacious, culturally competent prevention strategies but have yet to truly examine how local initiatives (and interpretations) of health messages can facilitate these goals in the twenty-first century. This chapter describes how a local initiative, Makgabaneng, a very popular, long-running radio serial drama, has helped to raise awareness and increase education across the country about CGS. The show, a product of grassroots development and culturally competent strategies, has helped empower young girls as well as community members in their efforts to ameliorate some of the disparities in HIV infection. This approach has had positive outcomes for girls living in urban contexts and from both low and high socio-economic back- grounds, indicating a shift in awareness that transcends assumptions about socioeconomic status (SES) and empowerment. In this chapter, I demonstrate how ethnographically-driven research at the local level helped to inform better strategies for intervention in what has come to be seen as an increasingly problematic aspect of the global epidemic. I suggest that a reconsideration of and reinvestment in more grassroots and culturally logical messages can help move this phase of HIV and AIDS prevention forward and have a positive impact beyond urban to more rural parts of Botswana

Perceptions of Infertility as a Barrier to Cervical Cancer Screening in Rural Botswana: A Qualitative Study

Background: Cervical cancer screening in Botswana and in particular the use of visual screening in rural areas has been on the rise in the past several years. Despite increased awareness and the introduction of less invasive methods of screening, qualitative data indicate that socio-cultural factors such as infertility related stigma, and beliefs about impaired fecundity affect overall efficacy of screening campaigns. Objective: This study sought to explore barriers to the utilization of cervical cancer screening in rural communities in northern Botswana. Methods: In-depth interviews were conducted in this qualitative research study. All interviews were transcribed and coded both manually as well as with the use of MAXQDA software to elicit themes. Results: The respondents all had high awareness of the current visual screening with acetic acid (VIA) and the Pap smear tests but reported non-utilization of these tests when available due to concerns over potential fertility impairment. While awareness of cervical cancer was high, a relatively high lack of understanding and education about cervical cancer and its relation (or not) to fertility outcomes was reported. The major factors identified by women in this qualitative study included lack of desire to screen prior to childbearing, beliefs and fears about inevitability of cervical cancer and lack of treatment options, financial burdens, lack of familial support, geographic burdens and stigma/emotional barriers to results of screening. Conclusion: This study provides new data on the myriad reasons for women’s lack of participation in cervical cancer screening programs. These data suggest potential cultural barriers and fears of fertility related stigma that may impact the efficacy of ongoing cancer prevention strategies. Interventions that take social and gendered beliefs about fertility into account are needed to better implement future strategies for success

Stress and Resilience: The Social Context of Reproduction in Central Harlem

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136374/1/ae.2003.30.3.471.pd

A Qualitative Study of the Experience of Miscarriage from Patients and Providers in the Rural U.S.

This qualitative study examines how female patients in rural communities in the Midwest, who experienced at least one miscarriage, perceived their experience of pregnancy loss. Qualitative data were collected from 10 women who did experience at least one loss in addition to 10 participants who were providers or partners of the women were interviewed. The Socio-Ecological model informed the methodology and thematic analysis. Open-ended qualitative interviews provided the basis for the analysis. Transcribed narrative data were analyzed using standard coding procedures and MAXQDA software. Women who experienced miscarriage discussed how they made meaning of the experience within the context of care and their perceptions of risk given certain socio-environmental factors. Providers, public health professionals and family studies professionals can use the study results to better inform best practices in maternity care particularly in under-served, resource-poor locations

Epigenomic profiling of neuroblastoma cell lines.

Understanding the aberrant transcriptional landscape of neuroblastoma is necessary to provide insight to the underlying influences of the initiation, progression and persistence of this developmental cancer. Here, we present chromatin immunoprecipitation sequencing (ChIP-Seq) data for the oncogenic transcription factors, MYCN and MYC, as well as regulatory histone marks H3K4me1, H3K4me3, H3K27Ac, and H3K27me3 in ten commonly used human neuroblastoma-derived cell line models. In addition, for all of the profiled cell lines we provide ATAC-Seq as a measure of open chromatin. We validate specificity of global MYCN occupancy in MYCN amplified cell lines and functional redundancy of MYC occupancy in MYCN non-amplified cell lines. Finally, we show with H3K27Ac ChIP-Seq that these cell lines retain expression of key neuroblastoma super-enhancers (SE). We anticipate this dataset, coupled with available transcriptomic profiling on the same cell lines, will enable the discovery of novel gene regulatory mechanisms in neuroblastoma

Deconstructing compassionate conservation

Compassionate conservation focuses on 4 tenets: first, do no harm; individuals matter; inclusivity of individual animals; and peaceful coexistence between humans and animals. Recently, compassionate conservation has been promoted as an alternative to conventional conservation philosophy. We believe examples presented by compassionate conservationists are deliberately or arbitrarily chosen to focus on mammals; inherently not compassionate; and offer ineffective conservation solutions. Compassionate conservation arbitrarily focuses on charismatic species, notably large predators and megaherbivores. The philosophy is not compassionate when it leaves invasive predators in the environment to cause harm to vastly more individuals of native species or uses the fear of harm by apex predators to terrorize mesopredators. Hindering the control of exotic species (megafauna, predators) in situ will not improve the conservation condition of the majority of biodiversity. The positions taken by so-called compassionate conservationists on particular species and on conservation actions could be extended to hinder other forms of conservation, including translocations, conservation fencing, and fertility control. Animal welfare is incredibly important to conservation, but ironically compassionate conservation does not offer the best welfare outcomes to animals and is often ineffective in achieving conservation goals. Consequently, compassionate conservation may threaten public and governmental support for conservation because of the limited understanding of conservation problems by the general public

Core Outcome Set for IgE ‐mediated food allergy clinical trials and observational studies of interventions: International Delphi consensus study ‘ COMFA ’

Background: IgE‐mediated food allergy (FA) is a global health concern with substantial individual and societal implications. While diverse intervention strategies have been researched, inconsistencies in reported outcomes limit evaluations of FA treatments. To streamline evaluations and promote consistent reporting, the Core Outcome Measures for Food Allergy (COMFA) initiative aimed to establish a Core Outcome Set (COS) for FA clinical trials and observational studies of interventions. Methods: The project involved a review of published clinical trials, trial protocols and qualitative literature. Outcomes found as a result of review were categorized and classified, informing a two‐round online‐modified Delphi process followed by hybrid consensus meeting to finalize the COS. Results: The literature review, taxonomy mapping and iterative discussions with diverse COMFA group yielded an initial list of 39 outcomes. The iterative online and in‐person meetings reduced the list to 13 outcomes for voting in the formal Delphi process. One more outcome was added based on participant suggestions after the first Delphi round. A total of 778 participants from 52 countries participated, with 442 participating in both Delphi rounds. No outcome met a priori criteria for inclusion, and one was excluded as a result of the Delphi. Thirteen outcomes were brought to the hybrid consensus meeting as a result of Delphi and two outcomes, ‘allergic symptoms’ and ‘quality of life’ achieved consensus for inclusion as ‘core’ outcomes. Conclusion: In addition to the mandatory reporting of adverse events for FA clinical trials or observational studies of interventions, allergic symptoms and quality of life should be measured as core outcomes. Future work by COMFA will define how best to measure these core outcomes

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Perceptions of and Attitudes towards Male Infertility in Northern Botswana: Some Implications for Family Planning and AIDS Prevention Policies

This paper discusses the perceptions of male infertility in northern Botswana and their implications for efficacious family planning and AIDS prevention programmes in the country. HIV rates are rapidly increasing in northern Botswana and it is estimated that nearly 30% of the population are infected. A significant factor in these increases is the perception that infertility is caused by the use of contraceptives. Male infertility in particular is understood as a result of female contraceptive use and is highly stigmatised. In an area with such high HIV rates, these perceptions directly contribute to the lack of efficacious family planning and HIV prevention programmes in the country. (Afr J Reprod Health 2002; 6[3]: 103-111) Résumé Perceptions et attitudes envers la stérilité masculine au nord du Botswana: quelques implications pour la planification familiale et pour les politiques de la prévention du SIDA. Cet article étudie les perceptions de la stérilité masculine au nord du Botswana et leurs implications pour une planification familiale efficace et pour les programmes de la prévention du SIDA dans le pays. Les taux du VIH augument rapidement au nord du Botswana et on estime que près de 30% de la population sont infectées. A l\'égard de ces augmentations, un facteur très important demeure la perception qui consiste à croire que la stérilité est causée par l\'emploi des contraceptifs. La stérilité masculine en particutier est perçue comme une conséquence de l\'emploi des contraceptifs par les femmes et ceci est bien stigmatisé. Dans une région où il y a des taux élevés du VIH, ces perceptions contribuent directement au manque d\'une planification familiale efficace et des programmes de la prévention du VIH dans le pays. (Rev Afr Santé Reprod 2002; 6[3]: 103-111) KEY WORDS: Gender, infertility, Southern Afric