Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

BACKGROUND

Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh.

METHODS AND ANALYSIS

AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

ETHICS AND DISSEMINATION

AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

A review of latrine front-end characteristics associated with microbial infection risk; reveals a lack of pathogen density data

Unsafe sanitation accounts for an estimated 898,000 global deaths annually. The faecal pathogen transmission pathway is complex with several possible routes. Latrine front-end characteristics and usage behaviours are one key transmission pathway for microbial pathogens, however, there has not yet been a synthesis of the available research. This review aims to compare the microbial infection risks with latrine front-end components including any quantified microbial densities within the household latrines. This review was conducted with no restriction on the geographical location of the research. Of 118 studies reviewed, only ten (8%) have quantified the microbial density inside the household latrines compared to 109 (92%) measuring the infection risks. The reported risks were most frequent for specific bacterial (n = 34), and helminths infections (n = 32) compared to diarrhoea (n = 23), combined (n = 15), protozoan (n = 4), and viral (n = 4) infections. The infections risk decreased for using latrines lying at a higher position on the sanitation ladder (for example flush latrines) compared to those lying lower (for example pit latrines). The trend was similar for using floor materials that were easier to clean and less favourable for pathogen survival inside the latrines (for example, concrete as opposed to earth). Faecal coliforms were reported highest on the surface of the squat pan (743 CFU/cm2) of pour-flush latrines and helminths on earth floors of pit latrines (1.5 eggs and larvae per gram of soil). Irrespective of latrine type and its position on the sanitation ladder, a dirty latrine, evidenced by a visible lack of cleanliness, significantly increased the risk for all infections. This study recommends that effective microbial infection risk reduction in latrines can be gained efficiently by ensuring washable surfaces and consistent cleaning practices. Future studies should include more rigorous measurements of microbial densities in various latrine types incorporating the different front-end components and usage behaviours.

Atezolizumab-induced psoriasiform drug eruption successfully treated with ixekizumab: a case report and literature review

Immune-related cutaneous adverse events (ircAE) are commonly seen with immune checkpoint inhibitors such as atezolizumab. Atezolizumab-induced psoriasis has been previously reported as an ircAE, especially in patients with pre-existing psoriasis. The severity of the reaction influences treatment of the cutaneous eruption. Biologics should be considered as a treatment option for severe refractory psoriasiform eruptions even in patients with complex medical conditions like chronic infections and malignancy. This is the first reported case of successful treatment of atezolizumab-induced psoriasiform eruption with ixekizumab, a neutralizing IL17A monoclonal antibody, to the best of our knowledge. Herein, we present a 63-year-old man with a history of human immunodeficiency virus and psoriasis who presented with atezolizumab-induced psoriasiform eruption while being treated for metastatic hepatocellular carcinoma. After initiating ixekizumab, atezolizumab was restarted without cutaneous eruption.

Laser cooling of antihydrogen atoms

The photon-the quantum excitation of the electromagnetic field-is massless but carries momentum. A photon can therefore exert a force on an object upon collision1. Slowing the translational motion of atoms and ions by application of such a force2,3, known as laser cooling, was first demonstrated 40 years ago4,5. It revolutionized atomic physics over the following decades6-8, and it is now a workhorse in many fields, including studies on quantum degenerate gases, quantum information, atomic clocks and tests of fundamental physics. However, this technique has not yet been applied to antimatter. Here we demonstrate laser cooling of antihydrogen9, the antimatter atom consisting of an antiproton and a positron. By exciting the 1S-2P transition in antihydrogen with pulsed, narrow-linewidth, Lyman-α laser radiation10,11, we Doppler-cool a sample of magnetically trapped antihydrogen. Although we apply laser cooling in only one dimension, the trap couples the longitudinal and transverse motions of the anti-atoms, leading to cooling in all three dimensions. We observe a reduction in the median transverse energy by more than an order of magnitude-with a substantial fraction of the anti-atoms attaining submicroelectronvolt transverse kinetic energies. We also report the observation of the laser-driven 1S-2S transition in samples of laser-cooled antihydrogen atoms. The observed spectral line is approximately four times narrower than that obtained without laser cooling. The demonstration of laser cooling and its immediate application has far-reaching implications for antimatter studies. A more localized, denser and colder sample of antihydrogen will drastically improve spectroscopic11-13 and gravitational14 studies of antihydrogen in ongoing experiments. Furthermore, the demonstrated ability to manipulate the motion of antimatter atoms by laser light will potentially provide ground-breaking opportunities for future experiments, such as anti-atomic fountains, anti-atom interferometry and the creation of antimatter molecules.

Toward the identification of a phytocannabinoid-like compound in the flowers of a South African medicinal plant (Leonotis leonurus)

OBJECTIVE

Current global trends on natural therapeutics suggest an increasing market interest toward the use and discovery of new plant-derived therapeutic compounds, often referred to as traditional medicine (TM). The Cannabis industry is currently one such focal area receiving attention, owing to the occurrence of phytocannabinoids (pCBs) which have shown promise in health-promotion and disease prevention. However, the occurrence of pCBs in other plant species are often overlooked and rarely studied. Leonotis leonurus (L.) R. Br. is endemic to South Africa with a rich history of use in TM practices amongst indigenous people and, has been recorded to induce mild psychoactive effects akin to Cannabis. While the leaves have been well-reported to contain therapeutic phytochemicals, little information exists on the flowers. Consequently, as part of a larger research venture, we targeted the flowers of L. leonurus for the identification of potential pCB or pCB-like compounds.

RESULTS

Flower extracts were separated and analyzed using high performance thin layer chromatography (HPTLC). A single pCB candidate was isolated from HPTLC plates and, using liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS), we could successfully group this compound as a fatty amide and tentatively identified as 7,10,13,16-Docosatetraenoylethanolamine (adrenoyl-EA), a known bioactive compound.

OP0254 CHROMATIN CONFORMATION SIGNATURE ANALYSIS IN EARLY VS LATE SCLERODERMA PHENOTYPES

Background:

Systemic sclerosis (scleroderma, SSc) is a heterogeneous disease in which clinical outcomes vary widely. Predicting outcomes on an individual basis remains challenging despite progress made through autoantibody analysis and gene expression profiling. Effective targeted therapies are evolving and accurately predicting outcomes is important to enable patient stratification for therapy.

Chromatin Conformation Signature (CCS) profiling of peripheral blood for systemic epigenetic deregulations could be used for such a purpose. The EpiSwitch platform offering high throughput and resolution chromosome conformation (3C) capture detects significant regulatory changes in 3D genome architecture and maps long range interaction between distant genomic locations. This then reveals the spatial disposition and physical properties of the chromosome, such as chromatin loops and inter-chromosomal connections, which have a role in network organization and genetic epistasis controlling gene expression. EpiSwitch automated platform has been successfully utilised in patient stratification in RA, MS and other indications.

This methodology could be applied to patients with SSc to identify CCS associated with different phenotypes and may ultimately be used to stratify and identify patients into pathogenic subtypes.

Objectives:

We aimed to determine significant CCSs associated with early and late phenotypes of SSc.

Methods:

The EpiSwitch-based chromosome conformation capture (3C) method was applied to blood samples from early phenotype, and late phenotype SSc patients. Intact nuclei were isolated from peripheral blood mononuclear cells and subjected to formaldehyde fixation resulting in crosslinking between physically touching segments of the genome via contacts between their DNA bound proteins. For quantification of cross-linking frequencies, the cross linked DNA was digested and then subjected to ligation. Cross-linking was then reversed and individual ligation products detected and quantified by EpiSwitch custom oligo array annotated across the whole genome to the anchoring sites of 3D genome architecture.

Results:

7 significant CCSs were found over the HLA-C, HLA-B and TNF regions on Chromosome 6 in the early phenotype. The top 8 pathways for genetic locations associated to the CCSs are shown in Table 1.

Table 1.

Top 8 pathways for genetic locations associated to significant CCS for the early phenotype.

GeneSet1Natural Killer cell mediated cytotoxicity2Immunoregulatory interations between a lymphoid cell and a non-lymphoid cell3Antigen Processing & presentation4Phagosome5Graft versus host disease6Type 1 diabetes mellitus7Osteoclast differentiation8Class 1 MHC mediated antigen processing & presentation

2 significant CCSs were found centred around the IFNG region of chromosome 12 in the late phenotype. The top 8 pathways for genetic locations associated to significant CCSs are shown in Table 2.

Table 2.

Top 8 pathways for genetic locations associated to significant CCS for the late phenotype.

GeneSet1Surfactant metabolism2IL12 signalling mediated by STAT43Protein digestion & absorption4Calcineruin regulated NFAT dependent transcription in lymphocytes5Transcriptional misregulation in cancer6Kaposi’s sarcoma associated herpes virus infection7IL2 mediated signalling events8Inflammatory bowel disease

Conclusion:

Significant CCSs, as part of 3D genomic regulatory control, and their associated pathways for the genetic locations, were identified in both late and early phenotypes. There were distinct CCSs in the early phenotype compared to the late suggesting the CCSs change as the disease progresses and varies between phenotypes. If CCSs could be linked to each clinically defined subgroup across a SSc cohort they could be used as a biomarker tool to predict outcome and progression in patients.

Disclosure of Interests:

Megan Galloway: None declared, Ewan Hunter: None declared, Alexandre Akoulitchev: None declared, Shivanee Vigneswaran: None declared, Bahja Abdi: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, Inventiva, CSF Behring, Consultant of: Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Bayer, David Abraham: None declared, Richard Stratton: None declared

Bladder scan accuracy in pediatric patients: Does patient position matter?

INTRODUCTION

Despite its widespread use in pediatric urology clinics, portable bladder scanning is an insufficiently studied tool that lacks standardized protocols. Workflow at the present clinic can be impeded by scanning in the supine position, due to multiple trips to the restroom and back to the exam room.

OBJECTIVE

The current study sought to test accuracy of bladder scanning, and hypothesized that it would be equally accurate in the standing versus traditional supine position in children, given the intra-abdominal location of their bladders.

DESIGN

Sixty children from the bladder/bowel clinic were prospectively recruited. Patients had a formal supine renal/bladder ultrasound and pre-void and/or post-void assessment with scans in both the standing and supine positions. The methods were compared using repeated measures one-way ANOVA.

RESULTS

Mean age was 9.2 years. The majority (85%) were female. All bladder scan estimates except for post-void supine significantly correlated with ultrasound volume. Pre-void standing had the strongest correlation (r = 0.83). There was no difference between ultrasound and standing estimates for pre-void volumes, but supine underestimated volumes by 44.8 ml (P < 0.01) (Summary Figure). Sub-group analysis of children aged <10 years showed that pre-void scans in both positions significantly underestimated volume (12% of estimated bladder capacity for standing, 24% for supine, P < 0.05). For post-void volumes, both standing and supine overestimated measurements by 29.4 ml and 18.3 ml, respectively (both P < 0.001). Sub-group analysis based on age yielded comparable results.

DISCUSSION

It is believed that this is the first study to examine bladder scanning in different positions. Limitations included small sample size, and the study fell short of cost-effectiveness and outcome analysis to assess the real-life impact of the proposed use of standing bladder scanning in the clinic.

CONCLUSION

Standing bladder scanning may be used in place of supine. However, bladder scanning generally appeared to have poor accuracy, especially in younger children, and thus should be used with caution. In practical terms, it may decrease specificity of detecting elevated post-void residuals compared to ultrasound.

Service innovations: a depersonalisation research unit progress report

Depersonalisation was described clinically over 100 years ago, yet there has been little research into this interesting but distressing psychiatric disorder. The symptom of depersonalisation can occur alone or in the context of other psychiatric and neurological illnesses and is characterised by the experience of detachment from one's senses and the outside environment, and may be present for several years without remission. Two years after the establishment of the depersonalisation research unit at the Maudsley Hospital, London, we report on current neurobiological and clinical research findings, including functional magnetic resonance imaging, psychophysiology and neuroendocrinology and progress regarding the development of effective treatments.

Coercive Control and the Stay-Leave Decision: The Role of Latent Tactics Among a Sample of Abused Pregnant Women

Prior research on intimate partner violence (IPV) and a survivor's decision whether to remain in or leave a violent relationship has often been framed by the question "why do they stay?" This study looks reframe the discussion and examine one facet of this stay-leave decision: abusers' use of coercive control tactics. Using a qualitative approach with a sample of pregnant women exposed to IPV, we sought to expand on the current knowledge by looking at coercive control more broadly via an open-ended assessment. Interview responses show that (a) coercive control was experienced by most of the women in this sample and (b) coercion most often took the form of "latent" or hidden control, including such tactics as providing incentives, showing remorse, and making promises. However, such latent coercive tactics are rarely assessed in IPV survivors and represent an important factor deserving of further research and recognition.

Three-dimensional rendering of otolith growth using phase contrast synchrotron tomography

A three-dimensional computer reconstruction of a plaice Pleuronectes platessa otolith is presented from data acquired by the Diamond Light synchrotron, beamline I12, X-ray source, a high energy (53-150 keV) source particularly well suited to the study of dense objects. The data allowed non-destructive rendering of otolith structure, and for the first time allows otolith annuli (internal ring structures) to be analysed in X-ray tomographic images.

Host genetics and immune control of HIV-1 infection: fine mapping for the extended human MHC region in an African cohort

Multiple MHC loci encoding human leukocyte antigens (HLA) have allelic variants unequivocally associated with differential immune control of HIV-1 infection. Fine mapping based on single nucleotide polymorphisms (SNPs) in the extended MHC (xMHC) region is expected to reveal causal or novel factors and to justify a search for functional mechanisms. We have tested the utility of a custom fine-mapping platform (the ImmunoChip) for 172 HIV-1 seroconverters (SCs) and 449 seroprevalent individuals (SPs) from Lusaka, Zambia, with a focus on more than 6,400 informative xMHC SNPs. When conditioned on HLA and non-genetic factors previously associated with HIV-1 viral load (VL) in the study cohort, penalized approaches (HyperLasso models) identified an intergenic SNP (rs3094626 between RPP21 and HLA-E) and an intronic SNP (rs3134931 in NOTCH4) as novel correlates of early set-point VL in SCs. The minor allele of rs2857114 (downstream from HLA-DOB) was an unfavorable factor in SPs. Joint models based on demographic features, HLA alleles and the newly identified SNP variants could explain 29% and 15% of VL variance in SCs and SPs, respectively. These findings and bioinformatics strongly suggest that both classic and non-classic MHC genes deserve further investigation, especially in Africans with relatively short haplotype blocks.

Parental emotion socialization in clinically depressed adolescents: enhancing and dampening positive affect

This study compared parental socialization of adolescent positive affect in families of depressed and healthy adolescents. Participants were 107 adolescents (42 boys) aged 14 - 18 years and their parents. Half of the participants met criteria for major depressive disorder and the others were demographically matched adolescents without emotional or behavioral disorders. Results based on multi-source questionnaire and interview data indicated that mothers and fathers of depressed adolescents were less accepting of adolescents' positive affect and more likely to use strategies that dampen adolescents' positive affect than were parents of healthy adolescents. Additionally, fathers of depressed adolescents exhibited fewer responses likely to enhance the adolescents' positive affect than were fathers of healthy adolescents. These findings build on those of previous work in examining parental responses to adolescent emotions, focusing on positive emotions and including both mothers and fathers.

The effects of peer influence on adolescent pedestrian road-crossing decisions

OBJECTIVE

Adolescence is a high-risk period for pedestrian injury. It is also a time of heightened susceptibility to peer influence. The aim of this research was to examine the effects of peer influence on the pedestrian road-crossing decisions of adolescents.

METHODS

Using 10 videos of road-crossing sites, 80 16- to 18-year-olds were asked to make pedestrian road-crossing decisions. Participants were assigned to one of 4 experimental conditions: negative peer (influencing unsafe decisions), positive peer (influencing cautious decisions), silent peer (who observed but did not comment), and no peer (the participant completed the task alone). Peers from the adolescent's own friendship group were recruited to influence either an unsafe or a cautious decision.

RESULTS

Statistically significant differences were found between peer conditions. Participants least often identified safe road-crossing sites when accompanied by a negative peer and more frequently identified dangerous road-crossing sites when accompanied by a positive peer. Both cautious and unsafe comments from a peer influenced adolescent pedestrians' decisions.

CONCLUSIONS

These findings showed that road-crossing decisions of adolescents were influenced by both unsafe and cautious comments from their peers. The discussion highlighted the role that peers can play in both increasing and reducing adolescent risk-taking.

Can otolith elemental chemistry retrospectively track migrations in fully marine fishes?

Otolith microchemistry can provide valuable information about stock structure and mixing patterns when the magnitude of environmental differences among areas is greater than the cumulative influence of any vital effects. Here, the current understanding of the underlying mechanisms governing element incorporation into the otolith is reviewed. Hard and soft acid and base (HSAB) theory is employed to explore the differences in chemical behaviours, distributions and affinities between elements. Hard acid cations (e.g. Mg(2+) , Li(+) and Ba(2+) ) tend to be less physiologically influenced and accepted more readily into the otolith crystal lattice but are relatively homogeneous in seawater. Soft acid cations (e.g. Zn(2+) and Cu(2+) ) on the other hand, exhibit more varied distributions in seawater, but are more likely to be bound to blood proteins and less available for uptake into the otolith. The factors influencing the geographical distribution of elements in the sea, and their incorporation into the otoliths of marine fishes are reviewed. Particular emphasis is placed on examining physiological processes, including gonad development, on the uptake of elements commonly used in population studies, notably Sr. Finally, case studies are presented that either directly or indirectly compare population structuring or movements inferred by otolith elemental fingerprints with the patterns indicated by additional, alternative proxies. The main obstacle currently limiting the application of otolith elemental microchemistry to infer movements of marine fishes appears to lie in the largely homogeneous distribution of those elements most reliably measured in the otolith. Evolving technologies will improve the discriminatory power of otolith chemistry by allowing measurement of spatially explicit, low level elements; however, for the time being, the combination of otolith minor and trace element fingerprints with alternative proxies and stable isotopic ratios can greatly extend the scope of migration studies. Among the otolith elements that routinely occur above instrument detection limits, Ba, Mn and Li were deemed the most likely to prove reliable geographic markers in marine species.

Effectiveness of TaqMan probes for detection of fish eggs and larvae in the stomach contents of a teleost predator

Experiments were conducted on the ability of TaqMan molecular probes to detect plaice Pleuronectes platessa DNA from eggs, and cod Gadus morhua DNA from eggs and larvae following ingestion by a teleost predator, whiting Merlangius merlangus. Estimated half-life detection rate (T50) for eggs was 31 h, and 26 h for larvae, with some positive detections occurring even after visual inspection indicated complete gut clearance. Because TaqMan probes are taxon specific, the results presented demonstrate that this technique can provide a means of rapid and unambiguous detection of predation by teleosts on fish eggs and larvae.

Behavioural comorbidity in Tanzanian children with epilepsy: a community-based case-control study

AIM

The aim of this study was to define the prevalence of and risk factors for behavioural disorders in children with epilepsy from a rural district of Tanzania by conducting a community-based case-control study.

METHOD

One hundred and twelve children aged 6 to 14 years (55 males, 57 females; median age 12 y) with active epilepsy (at least two unprovoked seizures in the last 5 y) were identified in a cross-sectional survey and included in this study. Children who were younger than 6 years were excluded in order to eliminate febrile seizures. Behaviour was assessed using the Rutter scale; children who scored 13 or more were considered to have disordered behaviour. A comparison group was made up of age- and sex-matched children without epilepsy (n = 113; 57 males, 56 females; median age 12 y).

RESULTS

Behavioural disorders were diagnosed in 68 of 103 (66%) children with epilepsy and in 19 of 99 (19%) controls. Disordered behaviour was significantly more common in children with epilepsy than in the comparison group (univariate odds ratio 8.2; 95% confidence interval [CI] 4.3-15.6; p < 0.001) and frequent seizures and poor scholastic attainment were associated in children with epilepsy. Behavioural disorders were not associated with antiepileptic drug usage. Attention problems were present in 48 of 91 (53%) children with epilepsy and 16 of 97 (17%) controls (univariate odds ratio 5.7; 95% CI 2.9-11.1; p < 0.001). In children with epilepsy, attention problems were significantly more common in males and were associated with frequent seizures.

INTERPRETATION

Children with epilepsy in a rural area of sub-Saharan Africa have a high prevalence of behavioural disorders and attention problems, both of which are associated with frequent seizures. Providing behaviour assessment and appropriate intervention programmes for children with epilepsy may reduce the burden of behaviour disorders in this setting.

Genetic variations and heterosexual HIV-1 infection: analysis of clustered genes encoding CC-motif chemokine ligands

Several CC-motif chemokine ligands (CCLs) can block HIV-1-binding sites on CC-motif chemokine receptor 5 (CCR5) and inhibit viral entry. We studied single-nucleotide polymorphisms (SNPs) in genes encoding three CCR5 ligands (CCL3 (MIP-1a), CCL4 (MIP-1b)and CCL5 (RANTES)) along with an adjacent gene encoding a CCR2ligand (CCL2 (MCP-1)) to identify candidate markers for HIV-1 infection and pathogenesis. Analyses of 567 HIV-1 serodiscordant Zambian couples revealed that rs5029410C (in CCL3 intron 2) was associated with lower viral load (VL) in seroconverters, adjusted for gender and age (regression β=-0.57 log(10), P=4x10(-6)). Inaddition, rs34171309A in CCL3 exon 3 was associated with increased risk of HIV-1 acquisition in exposed seronegatives(hazard ratio=1.52, P=0.006 when adjusted for VL of the initially seropositive partner and genital ulcer/inflammation). SNPrs34171309 encodes a conservative Glu-to-Asp substitution. Fiven eighboring SNPs in tight linkage disequilibrium with rs34171309all showed similar associations with HIV-1 acquisition. How these multiple CCL3 SNPs may alter the occurrence or course of HIV-1 infection remains to be determined [corrected].

Social-cultural aspects of epilepsy in Kilimanjaro Region, Tanzania: knowledge and experience among patients and carers

OBJECTIVE

Understanding the social-cultural aspects of epilepsy in sub-Saharan Africa will help to improve the situation of people with epilepsy (PWE) in this region.

METHODS

This qualitative study comprised interviews with 41 PWE and their carers. Participants were identified from a large community-based epidemiological study of epilepsy conducted in 2009.

RESULTS

Epilepsy was commonly ascribed to witchcraft and curses. Nearly all PWE demonstrated pluralistic care-seeking behavior, including the use of prayers and traditional healers alongside modern care. PWE reported discrimination as a result of their condition. The majority of PWE had suffered burns during seizures.

CONCLUSIONS

Poor knowledge and strong cultural and religious beliefs characterize the experience of PWE in this population. Epilepsy-related stigma contributes to overall disease burden, and PWE face exclusion across major life domains. There is a need to educate communities and inculcate perceptions and attitudes that promote early detection of epilepsy and early care-seeking behavior.

Australian Aborigines and alcohol: a review

Following a summary of the relevant historical and legislative background, this article reviews the literature on: (i) rates of alcohol usage and problem drinking in Aboriginal populations; (ii) adverse effects of drinking; (iii) suggested causes of problem drinking among Aborigines; and (iv) treatment and preventive initiatives. The need to examine Aboriginal alcohol use in the wider context of socio-economic deprivation and rapid social change is emphasized. Key issues warranting further research attention are identified and, while recognizing the difficulties inherent in doing so, suggestions are made as to how the quality of research in the area might be raised. It is concluded that, without long-term planning and commitment of the necessary resources by government, little progress will be made in reducing the problems associated with Aboriginal use of alcohol.

U.N. guidance note on HIV and sex work "reworked" by activists

In 2007, UNAIDS issued a guidance note on HIV and sex work, the tone and contents of which angered sex workers, activists and public health workers worldwide. In this article, based on presentations at the conference, M. Seshu et al describe the problems with the guidance note, discuss the reaction to its publication, and explain how a group of activists got together to develop a reworked version of the guidance note.

Intimate partner violence and children's reaction to peer provocation: the moderating role of emotion coaching

The current study examined the relation between intimate partner violence (IPV) and children's reactions to a stressful peer interaction in a community-based sample. The moderating role of parental emotion coaching in buffering children from negative reactions to a peer was also examined. Children participated in a peer provocation paradigm and mothers completed the Parent Meta-Emotion Interview. Both adaptive (i.e., laughing, ignoring) and maladaptive (i.e., hostile/challenging, odd behaviors) reactions to the provocative peer were examined. IPV was positively related to children's laughing and odd behaviors but was unrelated to ignoring and hostile/challenging behaviors. Additionally, emotion coaching was found to moderate relations between IPV and children's laughing and odd behaviors. The importance of understanding protective factors in families experiencing IPV and of developing emotion coaching parenting programs is discussed.

Hospital admissions and length of stay for coronary disease in an Aboriginal cohort

BACKGROUND AND AIMS

Coronary disease (CHD)-related hospital admission is more common among indigenous than non-indigenous Australians. We aimed to identify predictors of hospital admission potentially useful in planning prevention programs.

METHODS AND RESULTS

Length of stay (LOS), interval between, and number of recurrent admissions were modelled with proportional hazards or negative binomial models using lifestyle data recorded in 1988-1989 among Aborigines (256 women, 258 men, aged 15-88years) linked to hospital records to 2002. Among 106 Aborigines with CHD, hypertension (hazard ratio (HR) 1.69, 95% CI 1.05-2.73); smoking (HR 1.90, 95% CI 1.02-3.53); consuming processed meat >4 times/month (HR 1.81, 95% CI 1.01-3.24); >6 eggs/week (HR 1.73, 95% CI 1.03-2.94); and lower intake of alcohol (HR 0.54, 95% CI 0.35-0.83) predicted LOS. Eating eggs (HR 1.05, 95% CI 1.01-1.09) and bush meats > or =7 times/month (HR 0.46, 95% CI 0.23-0.92) predicted interval between recurrent admissions. Hypertension (IRR 4.07; 95% CI 1.32-12.52), being an ex-drinker (IRR 6.60, 95% CI 2.30-19.00), eating red meat >6 times/week (IRR 0.98, 95% CI 0.97-0.99), bush meats >7 times/month (IRR 0.26, 95% CI 0.10-0.67), and adding salt to meals (IRR 3.16, 95% CI 1.12-8.92) predicted number of admissions.

CONCLUSION

Hypertension, alcohol drinking, smoking, and diet influence hospital admissions for CHD in Aboriginal Australians.

Health-related behaviours as predictors of mortality and morbidity in Australian Aborigines

OBJECTIVE

To examine predictors of coronary heart disease (CHD) and all-cause mortality in Aboriginal Australians.

METHOD

In 1988-89, a survey of Western Australian Aborigines (256 women, 258 men) aged 15-88 years documented diet, alcohol and smoking habits. Linkage to mortality and hospital admissions to the end of 2002 provided longitudinal data for modelling of coronary heart disease endpoints and all-cause mortality using Cox regression.

RESULTS

Coronary heart disease risk increased with smoking (HR 2.62, 95% CI: 1.19, 5.75), consumption of processed meats >once/week (HR 2.21, 95% CI: 1.05, 4.63), eggs >twice/week (HR 2.59, 95% CI: 1.11, 6.04) and using spreads on bread (HR 3.14. 95% CI: 1.03, 9.61). All-cause mortality risk was lower with exercise >once/week (HR 0.51, 95% CI 0.26, 1.05), increased in ex-drinkers (HR 3.66, 95% CI: 1.08, 12.47), heavy drinkers (HR 5.26, 95% CI: 1.46, 7.52) and with consumption of take away foods >nine times/month (HR 1.78, 95% CI 0.96, 3.29). Greater alcohol intake, smoking and adverse dietary choices clustered in 53% of men and 56% of women and increased risk of coronary heart disease (HR 2.1, 95% CI: 1.1, 4.0) and all-cause mortality (HR 2.3, 95% CI: 1.2, 4.2).

CONCLUSION

Lifestyle in Aboriginal Australians predicts coronary heart disease and all-cause mortality. Clustering of adverse behaviours is common and increases risk of coronary heart disease and death.

Alcohol intake and incidence of coronary disease in Australian aborigines

AIMS

To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines.

METHODS

In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men, 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002.

RESULTS

In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR) 2.29, 95% CL 1.23, 4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80, 95% CL 1.04, 7.53), and those drinking >150 g/day for men or >100 g/day for women (HR 2.25, 95% CL 1.03, 4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more, and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28, 95% CL 0.10, 0.95). With CVD, only ex-drinkers showed significantly increased risk (HR 1.87, 95% CL 1.20, 2.91).

CONCLUSIONS

More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Alcohol intake and incidence of coronary disease in Australian aborigines

AIMS

To examine risk for coronary heart disease (CHD) and cardiovascular disease (CVD) in relation to alcohol in a cohort of Australian Aborigines.

METHODS

In 1988-1989, alcohol intake, drinking pattern, and beverage preference were elicited by interviewer-administered questionnaire in Western Australian Aborigines (258 men and 256 women) and cardiovascular outcomes ascertained through linkage to mortality and hospital admission records to 2002.

RESULTS

In proportional hazards models, risk for CHD, relative to lifetime abstainers, was significantly increased in ex-drinkers [Hazard ratio (HR), 2.29; 95% confidence intervals (CI), 1.23-4.27], those drinking 41-60 g/day in men or 21-40 g/day in women (HR 2.80; 95% CI, 1.04-7.53) and those drinking >150 g/day for men or >100 g/day for women (HR, 2.25; 95% CI, 1.03-4.90) with a J-shaped relationship. Low-to-moderate drinkers had lower waist girth, exercised more and had a lower prevalence of overweight and smoking than at-risk drinkers. A preference for wine was associated with lower HR (0.28; 95% CI, 0.10-0.95). With CVD, only ex-drinkers showed significantly increased risk (HR, 1.87; 95% CI, 1.20-2.91).

CONCLUSIONS

More favourable health-related behaviours in low-to-moderate drinkers suggest that lower risk could be mediated by lifestyle, as proposed in other populations.

Evaluation of the high specificity Screening Program (C-20-1) of the Frequency Doubling Technology (FDT) perimeter in clinical practice

AIMS

To compare the efficacy of the high specificity Frequency Doubling Technology (FDT) Perimeter Screening Program (C-20-1) to standard threshold automated perimetry in the diagnosis of open-angle glaucoma.

METHODS

A total of 100 consecutively presenting patients attending a glaucoma clinic who volunteered for the study (approximately 30% of whom were attending for an initial visit) were examined with the FDT C-20-1 Screening Program and with the Humphrey Field Analyzer (HFA) SITA Fast algorithm and Program 24-2.

RESULTS

Of the patients, 17 were excluded due to unreliable visual field results or non-glaucomatous ocular abnormalities. In all, 10 patients were diagnosed as normal, 54 with open-angle glaucoma, eight with ocular hypertension, and 11 as glaucoma suspects. Of the 54 glaucomatous patients, 45 exhibited high-tension glaucoma and nine normal tension glaucoma. Perimetry with the HFA gave a sensitivity of 81.5% for the combined category of glaucoma and glaucoma suspect and a specificity of 83.3% for the combined category of normal and ocular hypertension. Perimetry with the FDT gave a sensitivity of 74.5% and a specificity of 85.2% compared to that of the HFA.

CONCLUSION

In the detection of glaucoma, Program C-20-1 of the FDT perimeter exhibits high specificity. It exhibits low sensitivity for the detection of mild loss but high sensitivity for advanced field loss relative to Program 24-2 and the SITA Fast algorithm of the HFA.