R.E.S.P.e.c.T and intimate partner violence: a cross-sectional study using DHS data in Kenya

BACKGROUND

Thirty per cent of all women experience intimate partner violence (IPV) in their lifetime. The aim of this study was to examine the association between the WHO's novel R.E.S.P.E.C.T framework and IPV among women in Kenya.

METHODS

We used the 2014 Kenya Demographic and Health Survey (KDHS). Only women selected for the domestic violence module and who were married/living with their partner were eligible for this study (n=3737). We created a summary score for the strategies denoted by R.E.S.P.T based on availability of questions addressing these strategies in the KDHS, and a total score that summed responses across all strategies. Each letter was assessed with Cronbach's alpha. Multiple logistic regression models were used to investigate the relationship between R.E.S.P.T scores and IPV.

RESULTS

All strategies except for E lowered the odds of IPV. Decision-making (R) was negatively associated with experiencing IPV (OR=0.62 (0.53 to 0.72)). Land and property ownership (E) were positively associated with experiencing IPV (OR=1.25 (1.08 to 1.43)). Access to healthcare (S) was negatively associated with experiencing IPV (OR=0.55 (0.48 to 0.63)). Higher levels of wealth (P) were negatively associated with experiencing IPV (OR=0.47 (0.37 to 0.62)). Not justifying wife-beating in any scenario (T) was negatively associated with experiencing IPV (OR=0.39 (0.29 to 0.53)). After adjusting for demographics, a 1-unit increase in total R.E.S.P.T score was negatively associated with experiencing IPV (AOR=0.63 (0.57 to 0.70)) with a similar finding for IPV in the past 12 months (AOR=0.59 (0.53 to 0.66)). Younger women, higher education and Muslim religion were associated with decreased odds of experiencing IPV while living in a rural location and working were associated with increased odds of experiencing IPV.

CONCLUSIONS

Our study provides initial evidence that by using the multistrategy R.E.S.P.E.C.T framework, countries can dramatically lower the odds of women experiencing IPV. IPV prevention strategies must have a wide approach. The DHS can be used as a tool to monitor implementation and efficacy of this novel strategy.

Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries

OBJECTIVE

To determine the magnitude of relationships of early life factors with child development in low/middle-income countries (LMICs).

DESIGN

Meta-analyses of standardised mean differences (SMDs) estimated from published and unpublished data.

DATA SOURCES

We searched Medline, bibliographies of key articles and reviews, and grey literature to identify studies from LMICs that collected data on early life exposures and child development. The most recent search was done on 4 November 2014. We then invited the first authors of the publications and investigators of unpublished studies to participate in the study.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies that assessed at least one domain of child development in at least 100 children under 7 years of age and collected at least one early life factor of interest were included in the study.

ANALYSES

Linear regression models were used to assess SMDs in child development by parental and child factors within each study. We then produced pooled estimates across studies using random effects meta-analyses.

RESULTS

We retrieved data from 21 studies including 20 882 children across 13 LMICs, to assess the associations of exposure to 14 major risk factors with child development. Children of mothers with secondary schooling had 0.14 SD (95% CI 0.05 to 0.25) higher cognitive scores compared with children whose mothers had primary education. Preterm birth was associated with 0.14 SD (-0.24 to -0.05) and 0.23 SD (-0.42 to -0.03) reductions in cognitive and motor scores, respectively. Maternal short stature, anaemia in infancy and lack of access to clean water and sanitation had significant negative associations with cognitive and motor development with effects ranging from -0.18 to -0.10 SDs.

CONCLUSIONS

Differential parental, environmental and nutritional factors contribute to disparities in child development across LMICs. Targeting these factors from prepregnancy through childhood may improve health and development of children.

California's Sterilization Survivors: An Estimate and Call for Redress

From 1919 to 1952, approximately 20 000 individuals were sterilized in California's state institutions on the basis of eugenic laws that sought to control the reproductive capacity of people labeled unfit and defective. Using data from more than 19 000 sterilization recommendations processed by state institutions over this 33-year period, we provide the most accurate estimate of living sterilization survivors. As of 2016, we estimate that as many as 831 individuals, with an average age of 87.9 years, are alive. We suggest that California emulate North Carolina and Virginia, states that maintained similar sterilization programs and recently have approved monetary compensation for victims. We discuss the societal obligation for redress of this historical injustice and recommend that California seriously consider reparations and full accountability.

Women’s Midlife Health reviewer acknowledgement 2015

The editor of Women’s Midlife Health would like to thank all of the reviewers who have contributed to the journal in Volume 1 (2015).

Radiolabeled Sentinel Node Biopsy: Collaborative Trial with the National Cancer Institute

The objective of this study was to maximize the success rate of sentinel node (SN) localization in breast cancer patients with the tracer that demonstrated the highest initial success during a preliminary evaluation. Altogether, 145 patients with operable invasive breast cancer and clinically negative lymph nodes were studied. Technetium 99m (99mTc)-sulfur colloid was injected into the breast parenchyma surrounding the invasive cancer or the biopsy cavity. Variable volumes of tracer, amounts of 99mTc, and duration of time between injection and surgery were evaluated. A hand-held gamma detector was used at surgery to locate and guide resection of all radioactive sentinel nodes (SNs), including those that were extraaxillary. A conventional lymphadenectomy was then performed in all cases. Based on previous studies, unfiltered sulfur colloid provided a higher success rate of SN identification than the other tracer types. Further evaluation with 99mTc-sulfur colloid demonstrated that increased volume increased the success rate of SN identification. An injection volume of 8 ml resulted in a success rate of 98%. SNs were not exclusively located in the axilla: In 8.6% of cases SNs were removed from an internal mammary location. The overall accuracy of patients with SNs resected was 98.4%, and the false-negative rate was 4.4%. It was concluded that (1) unfiltered 99mTc-sulfur colloid at a volume of 8 ml resulted in a high success rate for SN identification; (2) a significant number of the SNs were extraaxillary in location; and (3) the accuracy of the SNs for determining whether regional metastases had occurred was high. The U.S. National Cancer Institute is funding a randomized phase III clinical trial to evaluate SN resection compared to conventional axillary lymphadenectomy in clinical node-negative breast cancer patients. Major endpoints of this trial include long-term regional control and survival.

Prospective associations between inflammatory and hemostatic markers and physical functioning limitations in mid-life women: Longitudinal results of the Study of Women's Health Across the Nation (SWAN)

BACKGROUND

Due to the public health burden of age-related declines in physical functioning, it is important to identify targets for intervention for the prevention of functional decline. We prospectively examined whether higher levels of inflammatory and hemostatic markers (high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA-ag), fibrinogen, and Factor VIIc (FVIIc)) were prospectively associated with reporting greater limitations in perceived physical functioning, and explored potential racial differences in the associations, in a multi-ethnic sample of mid-life women.

METHODS

Women (45-56 years) in the Study of Women's Health Across the Nation who completed the physical functioning scale of the Medical Outcome Short Form (SF-36) at follow-up visits 4, 6, or 8 and had inflammatory/hemostatic measures in the preceding year were included (n=2296). The continuous SF-36 physical function score was categorized as: no limitation (86-100 points), some limitation (51-85 points), and substantial limitation (0-50 points). Physical function category at time t was modeled a function of each biomarker, separately, at time t-1 using ordinal generalized estimating equations.

RESULTS

After adjusting for age, race/ethnicity, body size, sociodemographic, medical and lifestyle factors, higher levels of tPA-ag and hs-CRP were associated with subsequently reporting greater limitations in physical functioning, although the latter was only marginally significant (p=0.13). For each standard deviation (SD) increase in logtPA-ag, the odds of some or substantial limitations was 1.18 (95%CI 1.09,1.27); for each SD increase in loghs-CRP, the odds of some or substantial limitation was (1.08, 95%CI 0.98,1.19). In African American women only, higher fibrinogen levels were associated with subsequently reporting greater limitations (OR=1.30, 95%CI 1.13,1.50, for each one SD increase in fibrinogen).

CONCLUSIONS

Higher levels of inflammatory and hemostatic markers were prospectively associated with greater limitations in perceived physical functioning in mid-life women.

Factors associated with repeated refusal to participate in longitudinal population-based HIV surveillance in rural South Africa: an observational study, regression analyses

BACKGROUND

For many estimation purposes, individuals who repeatedly refuse to participate in longitudinal HIV surveillance pose a bigger threat to valid inferences than individuals who participate at least occasionally. We investigate the determinants of repeated refusal to consent to HIV testing in a population-based longitudinal surveillance in rural South Africa.

METHODS

We used data from two years (2005 & 2006) of the annual HIV surveillance conducted by the Africa Centre for Health and Population Studies, linking the HIV surveillance data to demographic and socioeconomic data. The outcome for the analysis was "repeated refusal". Demographic variables included sex, age, highest educational attainment, and place of residence. We also included a measure of wealth and the variable "ever had sex". To compare the association of each variable with the outcome, unadjusted odds ratios and standard errors were estimated. Multivariable logistic regression was used to estimate adjusted odds ratios and their standard errors. Data were analyzed using STATA 10.0.

RESULTS

Of 15,557 eligible individuals, 46% refused to test for HIV in both rounds. Males were significantly more likely than females to repeatedly refuse testing. Holding all other variables constant, individuals in the middle age groups were more likely to repeatedly refuse testing compared with younger and older age groups. The odds of repeated refusal increased with increasing level of education and relative wealth. People living in urban areas were significantly more likely to repeatedly refuse an HIV test than people living in peri-urban or rural areas. Compared to those who had ever had sex, both males and females who had not yet had sex were significantly more likely to refuse to participate.

CONCLUSIONS

The likelihood of repeated refusal to test for HIV in this longitudinal surveillance increases with education, wealth, urbanization, and primary sexual abstinence. Since the factors determining repeated HIV testing refusal are likely associated with HIV status, it is critical that selection effects are controlled for in the analysis of HIV surveillance data. Interventions to increase consent to HIV testing should consider targeting the relatively well educated and wealthy, people in urban areas, and individuals who have not yet sexually debuted.

Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ

BACKGROUND

Ductal carcinoma in situ (DCIS) often requires some method of localization to achieve breast-conserving therapy. The purpose of this study was to compare the efficacy of intraoperative ultrasound versus mammographic needle localization (MNL) for partial mastectomy in DCIS.

MATERIALS AND METHODS

Data were collected from a Breast Cancer Surgery Database. All DCIS cases undergoing partial mastectomy (PM) were identified. Margin status, re-excision rates, and cost were determined for both groups.

RESULTS

A total of 155 patients undergoing PM for DCIS were identified from the database. In the 96 patients undergoing ultrasound-guided PM (Group 1), the positive margin rate was 10.4%, and close margins (<1 mm) were observed in 22.9% after initial surgery. There were 59 patients who underwent MNL (Group 2); the positive margin rate was 11.9%, and close margins were observed in 27.1%. The difference between positive and close margins in Group 1 versus Group 2 was not statistically significant. The rate of re-excision was 20.8% for Group 1 and 30.5% for Group 2, resulting in 1.23 and 1.37 operations per patient, respectively. The average cost of an intraoperative ultrasound at our institution was $933 and $1858 for MNL (excluding cost of radiologic interpretation), a difference of $925 per case.

CONCLUSION

Our study showed equivalent rates of positive margins and re-excision between intraoperative ultrasound and MNL when performing PM for nonpalpable DCIS. Considering the more invasive nature and increased cost of MNL, we consider surgeon-performed intraoperative ultrasound, when possible, the more cost-effective and practical procedure for patients with DCIS.

Age at natural menopause in a sample of Puerto Rican women

OBJECTIVES

To characterize the distribution of age at menopause in a sample of Puerto Rican women and to evaluate the differences in demographic, health and lifestyle factors associated with menopausal state.

BACKGROUND

Age at natural menopause may be an important marker of a woman's long-term risk of chronic disease. Understanding which factors influence the timing of menopause remains limited and while ethnic differences in age at menopause have been reported, little data are available for Puerto Rican women.

METHODS

In 2000, a self-administered questionnaire was completed by a sample of 300 women aged 30-59 attending health fairs in the cities of Carolina, Aguadilla and Yauco, Puerto Rico (PR). Data from this interview was used to determine age at menopause which was described with probit analysis. Women from different menopausal status groups were compared with respect to demographic, lifestyle and health characteristics by using contingency table analysis and chi-square statistics.

RESULTS

In a sample where 53% of women were menopausal, the median age of natural menopause was 51.4 years (95% confidence intervals 50.3-52.5). Compared to premenopausal women, naturally and surgically postmenopausal women had lower educational attainment, increased parity and were more likely to be obese (p < 0.05).

CONCLUSION

This analysis provides the first estimate of age at natural menopause among women living in PR and the age is similar to that reported in other populations. Determining whether this population tends to have an early or late menopause will facilitate a better understanding of the potential chronic disease profile of Puerto Rican women as they age.

Assessment of physical activity with a single global question in a large, multiethnic sample of midlife women

This study compared responses from 13,621 African-American, Chinese, Hispanic, Japanese, and White women to a single, global physical activity question. Respondents aged 40-55 years were randomly selected from seven geographic locations in the United States for the 1996-1997 cross-sectional survey of the Study of Women's Health Across the Nation, a longitudinal, observational study of the menopause transition. Respondents rated their activity level as much less, less, the same as, more, or much more than other women their age. Physical activity rating varied minimally by race/ethnicity. The proportions of women who rated themselves much less active and much more active ranged from 3.1% for Whites to 4.8% for Japanese and from 13.6% for Japanese to 16.4% for African Americans, respectively. Multiple logistic regression models, stratified by race/ethnicity, showed independent associations between a low level of activity and higher body mass index, poor health, functional impairment, perceived stress, difficulty sleeping, and not being employed. A high level of activity was associated with excellent health, single marital status, higher education, lower body mass index, and older age. These findings suggest that a comparative rating of physical activity may rank women by activity level within a specific racial/ethnic group but may not capture differences across racial/ethnic groups.

[Work conditions, labor fatigue and low birth weight among street vendors]

OBJECTIVE

This study presents the demographic, socioeconomic profile, working conditions and labor fatigue among fertile age street vendors in Mexico City.

MATERIAL AND METHODS

426 female street vendors were interviewed in Mexico City. This population was described and the association between the components labor fatigue and low birth weight (LBW) was analyzed by logistic regression in a subgroup of women who worked as street vendors during their last pregnancy.

RESULTS

Of the interviewed group, 56% works more than 48 h per week, 87% had no social security, and 68% only had primary school level. The risk of LBW increased when workers had to cover selling quotes (OR 6.5, CI95% 1.3-31) when the merchandise were seasonal tools such as accessories or spare parts (OR 6.3, CI95% 1.5-26), when women had to exhibit their merchandise on the floor or carry it (OR 7.7 CI95% 1.8-32) and when financial support to initiate vending activities came from someone other than a close relative or friend (OR 7.4 CI95%, 1.2-44).

CONCLUSIONS

These results contribute to identify the female vendors with higher risk of having child with LBW and suggest preventive actions.

The sentinel node in breast cancer--a multicenter validation study

BACKGROUND

Pilot studies indicate that probe-guided resection of radioactive sentinel nodes (the first nodes that receive drainage from tumors) can identify regional metastases in patients with breast cancer. To confirm this finding, we conducted a multicenter study of the method as used by 11 surgeons in a variety of practice settings.

METHODS

We enrolled 443 patients with breast cancer. The technique involved the injection of 4 ml of technetium-99m sulfur colloid (1 mCi [37 MBq]) into the breast around the tumor or biopsy cavity. "Hot spots" representing underlying sentinel nodes were identified with a gamma probe. Sentinel nodes subjacent to hot spots were removed. All patients underwent a complete axillary lymphadenectomy.

RESULTS

The overall rate of identification of hot spots was 93 percent (in 413 of 443 patients). The pathological status of the sentinel nodes was compared with that of the remaining axillary nodes. The accuracy of the sentinel nodes with respect to the positive or negative status of the axillary nodes was 97 percent (392 of 405); the specificity of the method was 100 percent, the positive predictive value was 100 percent, the negative predictive value was 96 percent (291 of 304), and the sensitivity was 89 percent (101 of 114). The sentinel nodes were outside the axilla in 8 percent of cases and outside of level 1 nodes in 11 percent of cases. Three percent of positive sentinel nodes were in nonaxillary locations.

CONCLUSIONS

Biopsy of sentinel nodes can predict the presence or absence of axillary-node metastases in patients with breast cancer. However, the procedure can be technically challenging, and the success rate varies according to the surgeon and the characteristics of the patient.

Alcohol consumption and changes in blood pressure among African Americans. The Pitt County Study

The Pitt County Study is a longitudinal investigation of anthropometric, psychosocial, and behavioral predictors of hypertension in African Americans who were aged 25-50 years at baseline in 1988. At baseline, a strong dose-response gradient was observed for alcohol consumption and blood pressure for both sexes. The current study investigated whether baseline alcohol consumption or, alternatively, changes in drinking status predicted 5-year changes in blood pressure among the 652 women and 318 men who satisfied all inclusion criteria for the longitudinal analyses. In multivariate regression analyses, baseline alcohol consumption was not significantly associated with changes in blood pressure or hypertension incidence (systolic/diastolic blood pressure > or = 160/95 mmHg) by 1993. Change in drinking status, however, was significantly associated with changes in systolic pressure. The systolic pressure increase among individuals who initiated alcohol consumption was 6.2 mmHg (95% confidence interval (CI) 1.1-6.4) greater than abstainers, while that for individuals who reported drinking at both time points was 3.8 mmHg (95% CI 1.3-11.1) greater. Blood pressure increases for persons who discontinued drinking were comparable to those of abstainers. Results were independent of baseline age, body mass index, blood pressure, and sex. Social and economic disadvantage in 1988 was significantly associated with continuation and initiation of alcohol consumption by 1993.

Reliability of potential clinical measures of muscle tone in the elbows of patients after stroke

OBJECTIVES

This study investigated the reliability of joint resting position (EJP), resistance to passive movement (ERM), and the angle of appearance of the resistance (EAR) as measures of muscle hypertonus of elbow flexors in patients after stroke. Previously, similar measures had been found reliable when applied to measuring shoulder and wrist hypertonus in patients after stroke.

METHOD

Forty-five subjects with stroke were randomly selected from occupational therapy admissions at two rehabilitation centers. Tone of elbow flexors was measured twice at the same sitting by two examiners. EJP and EAR were measured with a goniometer, and ERM was measured with a resistance rating scale. Correlations were calculated between first and second measurements by center and by high tone and poor upper extremity function subgroups (with correction for multiple correlations) to determine reliability.

RESULTS

Each of the three measures was highly reliable as demonstrated by a high correlation in at least one of the subgroups (Center 1: EJP, r = .964 for high tone subgroup; ERM, r = .789, EAR, r = .902, both in poor upper extremity function subgroup; and Center 2: EJP, r = .892, ERM, r = .938, both in poor upper extremity function subgroup; EAR, r = .666 for all subjects; all p values < .05). Correlations were especially high when data for subjects with high upper extremity function were eliminated.

CONCLUSION

Reliability of these three methods of measuring upper extremity muscle tone enhances their usefulness as well as therapists' confidence in their judicial application.

Flow cytometric DNA analysis of normal and pathologic parathyroid glands

Assessment of cellular DNA content and cell cycle analysis by flow cytometry has been useful in predicting patient survival and the malignant potential of many neoplasms. In this study, we analyzed the DNA content and cell cycle distribution of 12 parathyroid adenomas, 15 carcinomas, 5 secondary hyperplasias, and 14 normal parathyroid glands. Appropriate areas demonstrating the pathologic changes were dissociated from paraffin-embedded, formaldehyde-fixed tissue for this purpose. All the cells from normal glands were diploid with mean and median S-phase fractions of 1.2% (range, 0.3-2.7%). Of the 18 glands from five patients with secondary hyperplasia, 4 (22%) had some cells which were aneuploid (from three patients), and 14 (78%) had only cells with a diploid DNA content. Mean and median S-phase fractions were 0.8% (range, 0.3-1.5%). One (8%) of the adenomas was tetraploid, 3 (25%) were aneuploid, and 8 (67%) were diploid. The mean S-phase fraction was 1.5% (range, 0.3-3.8%). Four (27%) of the carcinomas had tetraploid cells, 6 (40%) had aneuploid cells, and 5 (33%) had only diploid cells. Carcinomas had a mean S-phase fraction of 6.0% (median, 5.3%; range, 1.4-14.1%). This study indicates that DNA aneuploidy or tetraploidy may be present in many abnormal parathyroid entities, but not in normal parathyroids. Proliferative activity when considered with the DNA index may be a helpful adjunct in separating carcinomas from adenomas or hyperplasias.