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Human immunodeficiency virus infection in urban Rwanda. Demographic and behavioral correlates in a representative sample of childbearing women.

OBJECTIVE: --To determine behavioral and demographic risk factors for human immunodeficiency virus (HIV) infection in central Africa. DESIGN: --Cross-sectional survey. SETTING: --Kigali, Rwanda. PARTICIPANTS: --A representative sample of 1458 childbearing women aged 19 to 37 years who were recruited from outpatient prenatal and pediatric clinics at the only community hospital in the city. MAIN OUTCOME MEASURE: --Antibodies to HIV assessed by enzyme immunoassay and confirmed by Western blot or indirect immunofluorescence. RESULTS: --The HIV seroprevalence was 32% overall. Infection rates were higher in women who were single, in those in steady relationships that began after 1981, and in the 33% of women reporting more than one lifetime sexual partner. Women in legal marriages or monogamous partnerships had lower rates of infection, but even low-risk women had prevalences on the order of 20%. History of venereal disease in the past 5 years, although the strongest risk factor in a multiple logistic analysis (odds ratio, 2.7; 95% confidence interval, 2.0 to 3.7), was reported by only 30% of those infected. Having a male sexual partner who drank alcohol or who had higher income were significant risk factors for HIV infection in the multivariate analysis, but use of oral contraceptives and having an uncircumcised partner were not. CONCLUSIONS: --The epidemic of the acquired immunodeficiency syndrome in Rwanda has spread beyond high-risk groups to the general population of women without known risk factors. For most of these women, a steady male partner is the source of their HIV risk and therefore a vital target for intervention efforts.

Adult↗

Hepatitis C virus infection in spouses: sexual transmission or common exposure to the same risk factors?

OBJECTIVES: The aim of this study was to evaluate whether the transmission of hepatitis C virus (HCV) between spouses occurs through sexual contact or through other types of exposure. METHODS: We consecutively enrolled 311 chronic HCV carriers and their spouses. The spouses underwent HCV blood testing. Exposure to parenteral risk factors was compared between couples of which both partners were HCV positive and couples with one positive partner. In couples with both partners positive, qualitative detection of serum HCV RNA and genotyping were performed. RESULTS: The prevalence among spouses was 10.3% (32/311). The mean age was higher for HCV-positive spouses (57.7 vs 49.6 yr for HCV-negative spouses; p < 0.01). The prevalence among spouses increased with the duration of marriage, whereas no difference was found in relation to the clinical status of the index case. The 32 HCV-positive spouses reported parenteral exposure (blood transfusion, drug use, and use of multiple-use glass syringes inside or outside the family) more often than the 279 HCV-negative spouses (84.4% vs 26.2%; odds ratio [OR], adjusted for age by multiple logistic regression analysis, 12.4; 95% CI = 4.5-34.0). The percentage of couples sharing glass syringes was significantly higher among those with both partners infected (65.6% vs 12.9%; OR = 12.9; 95% CI = 5.4-31.4). Qualitative serum HCV RNA was determined in 22 couples with both partners infected; in 13 of them, both partners were HCV RNA positive, whereas in the remaining nine, only one partner was positive. In eight of the 13 couples with both partners HCV RNA positive, the same genotype was found for both partners. CONCLUSIONS: The findings that the same genotype was detected for both partners in relatively few couples, and that a history of parenteral exposure was an independent predictor of HCV positivity, suggest that the risk of sexual transmission is low. The sharing of glass syringes may have played an important role in transmission between spouses.

Adult↗

Predictive indicators of successful varicocele repair in men with infertility.

OBJECTIVE: We sought predictive indicators of functionally successful repair in 168 infertile Japanese males who underwent high ligation of a varicocele via a retroperitoneal approach. METHODS: Possible indicators evaluated included age at marriage, duration of infertility, testicular volume, varicocele grade, seminal analysis findings, and serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone. All patients had palpable or visible unilateral left varicoceles. Success in conception was evaluated in all subjects 1 year after varicocele repair. RESULTS: No associations were observed between outcome and mean age at marriage, infertility duration, varicocele grade, seminal volume, or serum PRL and testosterone concentrations, but testicular volume, sperm count, percentage of motile sperm, and serum FSH and LH concentrations were significantly associated with outcome. Multiple regression analysis of dependence of outcome revealed testicular volume and serum FSH concentrations to be independent predictors. CONCLUSIONS: Varicocele repair is likely to accomplish fertility in patients with a combined testicular volume of at least 30 mL or serum FSH concentrations lower than 11.7 mIU/mL.

Adult↗

Are bi-directionally violent couples mutually victimized? A gender-sensitive comparison.

Mutual victimization in marriage was studied in a sample of clinic couples (N = 57) where both spouses reported partner aggression on an adapted version of the Conflict Tactics Scale (Straus, 1979). As predicted, wives sustained more injuries and were more negatively affected by their partner's physical aggression than did husbands. Multiple dimensions of aggression were used to identify subgroups of mutually victimized couples (e.g., frequency, severity of aggressive act[s], psychological impact, and severity of injury). The largest subgroup consisted of spouses who reported low levels of victimization on all dimensions. Subgroup 2 included couples in which wives reported higher overall levels of victimization than did their husbands. A third small subgroup was also identified where husbands reported higher levels of victimization than did their wives. Contrary to prediction, both highly victimized wives and highly victimized husbands in the asymmetrical victimization subgroups reported greater levels of relationship and individual distress than did spouses in the mutual/low victimization and nonaggression control groups. However, the marriages of the two highly victimized subgroups did differ in important ways. The findings were interpreted to suggest an integration of feminist and dyadic theories of marital aggression.

Adult↗

Infant-feeding practices among middle-class Anglos and Hispanics.

Feeding practices have been analyzed prospectively in a sample of 1,112 healthy infants selected from families using an HMO. Data were collected at well-child visits during the first year of life regarding breast-feeding, formula feeding, and use of solid foods and cow's milk. Seventy percent of all infants were breast-fed, with the mean duration of breast-feeding being almost 7 months. Factors positively associated with breast-feeding included education and marriage, whereas maternal employment outside the home and ethnicity (being Hispanic rather than Anglo-American) were related to bottle feeding. Solid foods were introduced earlier by Hispanics and, also, among less well educated and single women; maternal employment was unrelated to the introduction of solid foods. Multiple regression analysis indicated different patterns for the two ethnic groups: education and employment were related to almost all feeding practices for Anglo-Americans, whereas education and employment predicted few feeding practices for the Hispanics. These findings suggest that the effects of ethnicity are independent of those of education.

Adult↗

Race differences in the effects of multiple roles on health: longitudinal evidence from a national sample of older men.

This paper examines race differences in the effects of social roles on physical health. Using data from the older men cohort of the National Longitudinal Surveys of Labor Market Experience, we examine the impact of employment, marriage, and being a supporter on health limitations and mortality. Employment has the most consistent health-protective effect, and the benefits of employment are more pronounced for Blacks than for Whites. Marriage affects health in conjunction with employment. These findings lend further support to the growing literature on the effects of roles on health. The results further illustrate the importance of ascribed statuses as structural determinants of the relationship between roles and health, highlighting the very real differences in the meanings and expectations of social roles for Blacks and Whites.

Black or African American↗

Inbreeding coefficients and degree of consanguineous marriages in Spain: a review.

The contribution of consanguineous marriages corresponding to uncle-niece or aunt-nephew (C12), first cousin (C22), first cousin once removed (C23), and second cousin (C33) to the inbreeding coefficient (alpha) was analyzed from a sample of Spanish areas and periods. Multiple regressions were performed taking as independent variables the different degrees of consanguinity previously selected (C12, C22, C23, and C33) and as dependent variable the inbreeding coefficient (alpha). According to the results obtained for any degree and period, rural frequencies always surpass urban. However, the pattern is similar in both areas. In the period where consanguinity was more elevated (1890-1929) the C22/C33 ratio increased. Its variation is not due to C22 and C33 changes in the same way. In rural areas, this ratio surpasses the expected value by a factor of 2-3, but in urban areas it was 7-10 times larger, in some cases due to migration. While in rural Spain the C33 frequency was approximately 1.5 times C22, in cities C22 was 1.5 times C33. The best fit among the various types of consanguineous matings and alpha involves a lineal relationship. Regardless of the number of variables contributing significantly to alpha, C22 matings are always present. Moreover, their standardized (beta) coefficients are the highest. The above indicates that this consanguineous relationship conditions the inbreeding coefficient the most. In the period of greater consanguinity, close relationships, uncle-niece C12, and first cousin once removed (C23) make a significant contribution to alpha. In rural Spain second cousins (C33) always significantly determined alpha; however, in cities the inbreeding variation was mainly due to C12 and C23.

Consanguinity↗

Schwartz-Jampel syndrome. Clinical, electrophysiological and histopathological study of a severe variant.

This report describes a child, offspring of a first cousin marriage, with a severe and progressive disorder of bone and cartilage growth associated with a myotonia-like syndrome. Clinical manifestations of this disease began at birth with marked generalized muscle hypertrophy, stiffness, myotonia and multiple skeletal deformities. Successively severe dwarfism and mental retardation were observed. Neurophysiological studies showed continuous high frequently low voltage activity at rest and myotonic discharges which did not wax and wane. These abnormalities persisted after complete curarization. Muscle biopsy showed mild dystrophic changes. Polymeric glycosaminoglycans and degradation product excretion was normal. These findings are similar to those described in Schwartz-Jampel syndrome, but since the clinical picture was fully expressed at birth and was unusually severe, it is suggested that the patient's condition may have represented a severe variant of this syndrome.

Abnormalities, Multiple↗

[Xeroderma pigmentosum and its ocular manifestations. The first case in Cameroon].

We report a case of xeroderma pigmentosum in a 9-year-old back Cameroonian boy. The diagnosis was based on typical clinical presentation of the disease: cutaneous atrophy, hypepigmented macules, and areas of depigmentation on sun exposed regions of the skin. Multiple tumoral lesions were localized on the head. Ocular findings were also present: conjunctival hyperemia, peripheral corneal opacification. Excision of the tumors and potoprotection was proposed for this patient. The role of tribal black African marriage traditions in disease transmission is discussed.

Atrophy↗

Molecular analysis of Berardinelli-Seip congenital lipodystrophy in Oman: evidence for multiple loci.

Congenital generalized lipodystrophy (CGL) is a rare disorder characterized by the absence of body fat and insulin resistance and accompanied by other features, including acanthosis nigricans, organomegaly, hyperandrogenism, and diabetes. We have examined case subjects from 11 families in Oman with CGL. All subjects were the progeny of consanguineous marriages; therefore, a homozygosity mapping strategy was used to investigate the reported loci, 11q13 and 9q34. Three subjects could be linked to 11q13, and mutations were found within the seipin gene. An additional eight subjects were linked to 9q34, but the locus was in a 9-cM interval with no known microsatellites, so further fine mapping was not possible. However, two sibships (four subjects) did not map to either locus, raising the possibility of more than two lipodystrophy loci within the Oman population.

Chromosome Mapping↗

Simultaneous equations for hazards: marriage duration and fertility timing.

"This paper develops an approach to simultaneity among hazard equations which is similar in spirit to simultaneous Tobit models. It introduces a class of continuous time models which incorporates two forms of simultaneity across related processes--when the hazard rate of one process depends (1) on the hazard rate of another process or (2) on the actual current state of or prior outcomes of a related multi-episode process. This paper also develops an approach to modeling the notion of 'multiple clocks' in which one process may depend on the duration of a related process, in addition to its own. Maximum likelihood estimation is proposed based on specific parametric assumptions. The model is developed in the context of and empirically applied to the joint determination of marital duration and timing of marital conceptions."

Demography↗

Women in academic psychiatry in Canada.

A comparison of numbers of women psychiatrists with faculty appointments and women residents in Departments of Psychiatry in Canada in 1975 and 1985 showed that the average percentage of women faculty has increased from 11.4% to 14.3% and of women residents from 23.5% to 43.4%. Some departments appeared to be oblivious to the special educational role of women faculty and had not discussed the discrepancy between the numbers of faculty and residents. Only two departments were actively recruiting women faculty. The study also demonstrated a continued concentration of women in the lower ranks. Barriers to recruiting women faculty include lack of academic role models, job advertising not specifically designed to attract women candidates, rigid requirements for appointments, women's lack of access to male corridors of power, pervasive underlying doubts about women's abilities and competence based on cultural stereotypes, female socialization which does not lend itself readily to roles of authority, assertiveness and leadership, and the role strain that ensues when women psychiatrists try to combine career, marriage and motherhood. If women psychiatrists are to fill some of the positions in Departments of Psychiatry, which will fall vacant over the next decade, much more attention must be paid to eliminating or diminishing the multiple obstacles for women who chose a career in academic psychiatry.

Canada↗