1,720,982 research outputs found
Putting the C back into the ABCs: a multi-year, multi-region investigation of condom use by Ugandan youths 2003-2010.
Get PDFA major strategy for preventing transmission of HIV and other STIs is the consistent use of condoms during sexual intercourse. Condom use among youths is particularly important to reduce the number of new cases and the national prevalence. Condom use has been often promoted by the Uganda National AIDS Commission. Although a number of studies have established an association between condom use at one's sexual debut and future condom use, few studies have explored this association over time, and whether the results are generalizable across multiple locations. This multi time point, multi district study assesses the relationship between sexual debut and condom use and consistent use of condoms thereafter. Uganda has used Lot Quality Assurance Sampling surveys since 2003 to monitor district level HIV programs and improve access to HIV health services. This study includes 4518 sexually active youths interviewed at five time points (2003-2010) in up to 23 districts located across Uganda. Using logistic regression, we measured the association of condom use at first sexual intercourse on recent condom usage, controlling for several factors including: age, sex, education, marital status, age at first intercourse, geographical location, and survey year. The odds of condom use at last intercourse, using a condom at last intercourse with a non-regular partner, and consistently using a condom are, respectively, 9.63 (95%WaldCI = 8.03-11.56), 3.48 (95%WaldCI = 2.27-5.33), and 11.12 (95%WaldCI = 8.95-13.81) times more likely for those individuals using condoms during their sexual debut. These values did not decrease by more than 20% when controlling for potential confounders. The results suggest that HIV prevention programs should encourage condom use among youth during sexual debut. Success with this outcome may have a lasting influence on preventing HIV and other STIs later in life
HPTN 062: A Pilot Randomized Controlled Trial Exploring the Effect of a Motivational-Interviewing Intervention on Sexual Behavior among Individuals with Acute HIV Infection in Lilongwe, Malawi.
Get PDFObjectiveWe pilot tested a Motivational Interviewing (MI) -based counseling intervention for individuals with Acute HIV Infection (AHI) to reduce risky sexual behavior in Lilongwe, Malawi.MethodsTwenty-eight individuals diagnosed with AHI were randomized to receive either brief education alone, or the brief education plus the MI-based intervention, called Uphungu Wanga. Participants in Uphungu Wanga received four sessions delivered on the day of diagnosis, three days later and at weeks 1 and 2 with a booster session at week 8; participants were followed for 24 weeks from diagnosis. An interviewer administered quantitative questionnaire was conducted at baseline and at weeks 2, 4, 8, 12, 16, 20 and 24. Semi-structured qualitative interviews (SSI) were conducted at weeks 2, 8, 12, and 24.ResultsThe majority of participants in both arms reported rapid and sustained behavior change following diagnosis with AHI. Very few participants reported having sex without a condom after diagnosis. Participants reported a trend towards fewer sex partners and abstaining from sex during study follow-up. Participants in the MI-based arm provided concrete examples of risk reduction strategies in the SSIs while those in the brief education arm primarily described reducing risk behavior, suggesting that the MI-based group may have acquired more risk reduction skills.ConclusionsIndividuals in both study arms reduced risky sexual behaviors after diagnosis with AHI. We found few major differences between study arms during the 6-month follow up period in self-reported sexual behaviors therefore a MI-based intervention may not be needed to trigger behavior change following AHI. However, comparing the MI-based intervention to repeated brief education sessions made it difficult to assess the potential benefit of an MI-based intervention in a setting where standard counseling often consists of one post-test session. Nevertheless, provision of counseling immediately following diagnosis with HIV to support behavior change should remain a priority.Trial registrationClinicalTrials.gov NCT01197027
A cluster randomised controlled effectiveness trial evaluating perinatal home visiting among South African mothers/infants.
Get PDFBACKGROUND:Interventions are needed to reduce poor perinatal health. We trained community health workers (CHWs) as home visitors to address maternal/infant risks. METHODS:In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1) the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women), or 2) a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme), in addition to clinic care (n = 12 neighbourhoods; n = 644 women). Participants were assessed during pregnancy (2% refusal) and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received. RESULTS:Benefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008); nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014), have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045), height-for-age measurements (OR = 1.13, p<0.001), breastfeed exclusively for six months (OR = 3.59; p<0.001), and breastfeed longer (OR = 3.08; p<0.001). Number of visits was positively associated with infant birth weight ≥2500 grams (OR = 1.07; p = 0.012), healthy head-circumference-for-age measurements at 6 months (OR = 1.09, p = 0.017), and improved cognitive development at 18 months (OR = 1.02, p = 0.048). CONCLUSIONS:Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes. However, visits likely must extend over several years for persistent benefits. TRIAL REGISTRATION:ClinicalTrials.gov NCT00996528
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Sexual network structure, diffusion and prevention of HIV within populations: A case study using complete network data in Likoma Island (Malawi)
No full textThe sexual networks connecting members of a population have important consequences for the spread of sexually transmitted diseases including HIV. However, very few datasets currently exist that allow an investigation of the structure of sexual networks, particularly in sub-Saharan Africa where HIV epidemics have become generalized. This dissertation represents an attempt to fill this void. It builds on a unique sociocentric study of sexual partnerships conducted in small island of Lake Malawi, which provides the first map of a large sexual network through which HIV has diffused extensively. The four chapters comprising this dissertation highlight the role of network connectivity in determining the dynamics leading to the generalization of HIV epidemics. The first chapter describes the context and methods of the Likoma Network Study (LNS) and shows that the collection of sociocentric network data is feasible, even in a sub-Saharan context. Based on these data, the second chapter documents the existence of a large and robust sexual network linking a substantial fraction of the island\u27s young adult population. Contrary to claims that sexual networks are too sparse to sustain generalized epidemics through heterosexual contacts in remote areas of sub-Saharan Africa, the sexual network structure observed on Likoma Island appears compatible with a broad diffusion of pathogens to low-risk groups. This chapter also shows that the prevalence of HIV varies significantly across of the network, suggesting that network characteristics are an important determinant of the dynamics of HIV spread within a population. The third chapter investigates the role of migrants in diffusing HIV and other STIs into networks connecting the members of a local population. It shows that some STIs may circulate within rural populations independently of contacts with migrants and other outsiders. Finally, the fourth chapter systematically analyzes the quality of the network data. In particular, it emphasizes the potential impact of errors in link tracing on the estimates of network measures: such errors did not occur at random but were related to several important determinants of the disease diffusion process
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Measuring Child Health Coverage: Validation of Maternal-Reported Care-seeking and New Methods for Estimating Coverage of Appropriate Management of Childhood Illness
Get PDFProblem Statement: Accurate data on coverage of health interventions is required for continued reduction in child mortality. This study assessed the validity of the standard indicator on care-seeking for child illness and methods for linking household and provider data to improve measures of child health coverage.
Methods: The study was conducted in Southern Province, Zambia. Children <5 years were given cards with barcodes. Healthcare providers tracked sick children brought for care by scanning barcodes and distributing tokens. Provider preparedness to manage child illness was assessed using a tool based on the Service Availability and Readiness Assessment. We conducted a household survey on care-seeking for child illness in the preceding two weeks. We compared maternal-reported and provider-documented care-seeking events. We linked household data on source of care with provider preparedness data to estimate coverage using exact source care and measures of geographic proximity, with data on all providers and only health facilities.
Results: Most children sought care from government facilities or community-based agents (CBAs). We found high sensitivity (0.95, 95% CI: 0.88-0.98) and reasonable specificity (0.74, 95% CI: 0.65-0.81) of maternal report of care-seeking for child illness. Coverage of appropriate management of child illness, calculated using a measure based on provider preparedness, was 55% (95% CI: 51%-58%) overall. Exact-match linking was effective at this small scale. Most ecological linking methods produced similar coverage estimates. Use of facility-only data reduced coverage estimates in the rural area because CBAs were a common skilled source of care.
Conclusions: Maternal report is a valid measure of source of care for child illness in settings where utilization of public sector providers is high. With reliable household data on source of care, exact-match linking may be a feasible method for producing more informative estimates of coverage of appropriate management of child illness. Ecological linking with data on a sample of all skilled providers may be as effective as exact-match linking in areas with low variation in preparedness within a provider category or minimal provider bypassing. More studies are needed at larger scale and a more diverse provider landscape to further evaluate and guide linking methodology
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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