Clinical health outcomes of Ebola virus disease survivors eight years post recovery: a cross-sectional study in Sierra Leone.

Background: The West African Ebola virus disease (EVD) epidemic that occurred between 2013-2016 resulted in >28,000 confirmed cases and >11,000 fatalities. Thousands of survivors necessitate an understanding of the long-term health effects and future medical needs of these patients. Methods: A cross-sectional study of 595 EVD survivors from Sierra Leone and 403 close contacts (n=998). An in-person survey conducted between November 2021 and March 2022 included demographics, clinical health symptomology assessment of each organ system and a reproductive health assessment including sexual dysfunction question sets. The frequency of each disorder was examined and the association of each disorder with EVD survival was assessed. Results: Of 12 number of symptom types, five were reported by >50% of EVD survivors (Ocular, Neurological, Constitutional, Genitourinary, Dermatological), and all but one were reported by >40% of EVD survivors. Symptom types associated with EVD survival included ENT symptoms (AOR: 8.75, 95% CI: 5.63 - 13.60, p < 0.001), ocular symptoms (AOR: 7.18, 95% CI: 5.02 - 10.25, p < 0.001), dermatological symptoms (AOR: 4.16, 95% CI: 3.06 - 5.65, p < 0.001) and cardiovascular symptoms (AOR: 2.96, 95% CI: 2.12 - 4.13, p < 0.001). Conclusion: The West Africa EVD epidemic resulted in a high prevalence of persistent health issues among disease survivors. Continued support for survivor services in West Africa is crucial, and future outbreak response planning should include dedicated funding to ensure adequate care for survivors, both during the acute phase of infection and throughout the post recovery period.

Adaptation and psychometric assessment of a sexual and reproductive empowerment scale in Arabic among refugee and non-refugee adolescent girls.

BACKGROUND: Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. METHODS: An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. RESULTS: The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. CONCLUSIONS: This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Contraceptive risk events among family planning specialists: a cross sectional study.

BACKGROUND: Proponents of abortion restriction cite advancements in contraceptive technology as a reason against the need for abortion care today, most recently through oral arguments in the Supreme Court of the United States case, Dobbs v. Jackson Women's Health. However, consistent and correct use of contraception requires reproductive health literacy. Our objectives were to quantify contraceptive risk events and assess contraceptive history and preferences among a population well-equipped to evade contraceptive risks, family planning specialists following initiation of their medical training. "Risk events" are defined as reported episodes of contraceptive failure, emergency contraception use and/or unprotected or underprotected intercourse. METHODS: This was a cross-sectional study among current members of a professional organization of family planning specialists. Inclusion criteria included: status as a current or retired clinician, consensual penile-vaginal intercourse and personal or partner capacity to become pregnant since the start of medical training. Descriptive statistics were performed. This study was IRB exempt. RESULTS: Among 229 respondents, 157 (69%) reported experiencing a contraceptive risk event since training. Twenty-nine (13%) respondents reported an occurrence within the last year. By category, 47% (108/229; 3 reported unknown) reported under- or unprotected intercourse, 35% (81/229) reported emergency contraception use, and 52% of participants (117/227; 2 unknown) reported known or suspected contraceptive failure. The mean number of contraceptive methods used was 3.7 (SD 1.7) out of the 13 methods listed. Almost all (97%) participants reported at least one method was not an acceptable option, with a mean of 5.6 (SD 2.7) of the 13 listed methods. CONCLUSIONS: The majority of family planning specialists have experienced contraceptive risk events during times of active pregnancy prevention since their medical training. Contraceptive method change is common and most respondents were limited in the number of methods that were personally acceptable to them. Dialogue idealizing the role of contraception in minimizing or eliminating abortion need is simplistic and inaccurately represents the lived realities of pregnancy-capable individuals and their partners, including among those with exceptional contraceptive literacy and access.

ANTECEDENTES: Los que apoyan la restricción del aborto citan los avances en la tecnología anticonceptiva como una razón en contra de la necesidad de la atención del aborto hoy en día, más recientemente a través de los argumentos orales en el caso de la Corte Suprema de los Estados Unidos, Dobbs v. Jackson Women's Health. Sin embargo, el uso sistemático y indicado de los anticonceptivos requiere unos conocimientos sobre salud reproductive. Nuestros objetivos eran cuantificar los eventos de riesgo anticonceptivo y evaluar los antecedentes y las preferencias entre una población bien equipada para eludir los riesgos anticonceptivos, los especialistas en planificación familiar tras el inicio de su formación médica. Los "eventos de riesgo" se definen como episodios reportados de fallo anticonceptivo, uso de anticoncepción de emergencia y/o relaciones sexuales sin protección o con protección insuficiente. MéTODOS: Este fue un estudio transversal entre miembros actuales de una organización profesional de especialistas en planificación familiar. Los criterios de inclusión incluyeron: condición de clínico/a en activo/a o jubilado/a, relaciones sexuales consentidas pene-vagina desde el inicio de la formación médica y capacidad personal o de la pareja para quedarse embarazada. Se realizaron estadísticas descriptivas. Este estudio estaba exento de IRB. RESULTADOS: De las 229 encuestadas, 157 (69%) declararon haber sufrido un evento de riesgo anticonceptivo desde la formación. Veintinueve (13%) encuestadas declararon haberlo sufrido un incidente en el último año. Por categoría, el 47% (108/229; 3 informaron de forma desconocida) informaron de relaciones sexuales sin protección o con poca protección, el 35% (81/229) informaron del uso de anticonceptivos de emergencia y el 52% de los participantes (117/227; 2 informaron de forma desconocida) informaron de un fallo anticonceptivo conocido o sospechado. El promedio de métodos anticonceptivos utilizados fue 3,7 (DE 1,7) de los 13 métodos enumerados. Casi todas las participantes (97%) informaron de que al menos un método no era una opción aceptable, con un promedio de 5,6 (DE 2,7) de los 13 métodos enumerados. CONCLUSIONES: La mayoría de los especialistas en planificación familiar han experimentado eventos de riesgo anticonceptivo en momentos de prevención activa del embarazo desde su formación médica. El cambio de método anticonceptivo es frecuente y la mayoría de los encuestados tenían un número limitado de métodos que les resultaban personalmente aceptables. El diálogo que idealiza el papel de la planificación familiar a la hora de minimizar o eliminar la necesidad de abortar es simplista y representa de forma inexacta las realidades vividas por las personas con capacidad de embarazo y sus parejas, incluso entre aquellas con conocimientos y acceso excepcionales a la anticoncepción.

Prolonged exposure to rosuvastatin from pre-puberty to adulthood impairs sperm quality in mice and leads to paternally mediated developmental toxicity.

Nowadays, changes in human lifestyle have increased dyslipidemia, reinforcing the necessity of using lipid-lowering drugs, such as statins, to control the lipid profile. Among the statins, rosuvastatin has shown greater efficacy in controlling dyslipidemia. Previous studies have shown adverse effects in adult men and pre-pubertal rodents after exposure to statins, such as reduced testosterone levels and delayed puberty. This study aimed to evaluate the reproductive parameters and fertility of male mice exposed to rosuvastatin from pre-puberty to sexual maturity by simulating human chronic exposure to rosuvastatin from pre-puberty to adulthood. This is the first study to evaluate male reproduction and developmental outcomes after prolonged rosuvastatin exposure since pre-puberty, mimicking the human exposure to relevant doses of the drug. Then, we hypothesize that prolonged exposure to rosuvastatin since pre-puberty may impair reproductive parameters in males and generate paternally mediated developmental toxicity. Male mice were divided into three experimental groups that received a 0.9% saline solution, 1.5 or 5.5mg/kg/day of rosuvastatin, by intragastric oral gavage, from postnatal day (PND) 23 to PND 80. Puberty onset was delayed and sperm quality was reduced in both rosuvastatin-treated groups. Furthermore, testicular interstitial tissue showed increased vascularization in a dose-dependent manner. After mating with non-treated females, the post-implantation loss rate increased in both rosuvastatin-exposed groups. There was an increase in the percentage of fetuses with opened eyelids in the offspring of males exposed to 1.5mg/kg/day of the statin and a decrease in the craniocaudal distance of male offspring from males exposed to the higher dose. In summary, our hypothesis that rosuvastatin exposure would cause male reproductive toxicity and developmental impairment in the offspring of male mice was confirmed. This study raises concerns about the reproductive health of men who take this medication from infancy until adulthood in prolonged treatment.

Exploring the Arsenal of Novel Antifungal Drug Targets for Combating Fungal Infections.

Fungal infections contribute to over 1.5 million fatalities each year, with cutaneous mycoses standing as prominent global infections. The spectrum of these mycoses varies widely, encompassing enduring afflictions like ringworm, localized infections such as tinea capitis, recurrent instances like vaginal candidiasis, and potentially fatal systemic infections impacting multiple organ systems. The escalating recognition of the health and socioeconomic ramifications associated with fungal pathogens underscores their importance in contemporary discourse. On a global scale, projections indicate that over 300 million individuals experience significant fungal infections annually, resulting in a mortality rate exceeding 1.5 million deaths per year. Alarmingly, resistance to commonly used antifungal drugs was on the rise, with some reports suggesting that over 10% of Candida bloodstream isolates worldwide were resistant to fluconazole, a commonly prescribed antifungal medication. Therefore, there is an immediate need to increase the accessibility of new antifungal medications while minimizing their costs and adverse effects. Fungi, as heterotrophic organisms, acquire nutrients through absorption. Their filamentous structure, composed of hyphae, facilitates efficient nutrient uptake by secreting enzymes that break down complex organic matter into simpler compounds. These organisms exhibit remarkable adaptability in responding to environmental cues, adjusting growth rates, and altering morphological features. Fungi regulate their metabolism intricately, undergoing various metabolic pathways for energy production and utilizing diverse substrates for respiration. Additionally, they exhibit distinctive reproductive strategies, employing both sexual and asexual modes of reproduction, contributing to their genetic diversity and resilience in diverse ecosystems. We now have more information than ever on the origins of infection as well as the physiology of fungi cells, giving us the chance to use it to produce new generations of antifungals. This review includes various novel antifungal drug targets showing their possible effects via different mechanisms aiming at vital functions like GPI synthesis, cell wall synthesis, hyphal growth, and other essential pathways responsible for fungal growth.

Health condition and socioeconomic status mediate the causal effect of reproductive traits on nonalcoholic fatty liver disease: evidence from Mendelian randomization study.

Background: Observational data posits a correlation between reproductive traits and nonalcoholic fatty liver disease (NAFLD), but their causal inference is still unclear. This investigation seeks to elucidate the causal influence of reproductive traits on NAFLD and determine the intervening role of health condition and socioeconomic status in these connections. Methods: Utilizing a Mendelian Randomization (MR) approach, this research leveraged a comprehensive dataset from the Genome-wide Association Study (GWAS) database. The study incorporated body mass index, major depression, educational level, household income and Townsend deprivation index as intermediary variables. Initially, a bidirectional two-sample MR study was conducted to explore the genetic associations between reproductive traits and NAFLD. Then, two-step MR analyses were implemented to quantify the extent of mediation by these indicators. The weighted inverse variance method was the primary analytical approach, complemented by several sensitivity analyses to affirm the robustness of the MR assumptions. Finally, these findings were validated in the FinnGen research. Results: The bidirectional MR analysis indicated that earlier reproductive traits (age at menarche, age at first sexual intercourse, and age at first birth) were associated with an elevated risk of NAFLD, absent any evidence of the reverse relationship. Body mass index accounted for 35.64% of the association between premature menarche and NAFLD. Additionally, body mass index, major depression, educational level and household income mediated 41.65%, 14.35%, 37.88%, and 18.59% of the connection between early sexual intercourse and NAFLD, respectively. Similarly, these same variables elucidated 36.36%, 15.58%, 41.56%, and 22.73% of the correlation between younger age at first birth and NAFLD. Conclusion: Our study elucidated the causal relationships between reproductive traits and NAFLD. Potential underlying mechanisms may involve factors such as body mass index, major depression, educational attainment and household income.

Epilepsy and Anti-Seizure Medications: Secret Agents for Endocrine Disruption.

There is a reciprocal relationship between epilepsy and reproductive endocrine disorders. Seizures and anti-seizure medications (ASMs) can contribute to reproductive and endocrine dysfunction and reproductive dysfunction may exacerbate seizures. Epilepsy via neuroendocrine mechanisms affects the hypothalamic-pituitary-ovarian (HPO) axis, disrupting the regulation of gonadotropin secretion, and resulting in dystrophic effects on the ovaries and early menopause. Anti-seizure medications have endocrine-related side effects on sexual function and bone health. Long-term use of ASMs may result in menstrual irregularities, sexual dysfunction, anovulatory cycles, polycystic ovaries, and reduced fertility. Some ASMs also interfere with bone metabolism. Epilepsy patients treated with ASMs are at risk for bone loss and fractures. This article explores the endocrine and hormonal effects of seizures and ASMs.

Sexual Activity, Function, and Satisfaction in Reproductive-Aged Females Living with Chronic Kidney Disease.

Up to 80% of women living with chronic kidney disease (CKD) experience sexual dysfunction, though its link with sexual activity and sexual satisfaction is not well understood. Among older women with CKD treated with hemodialysis, the majority report sexual inactivity, though few describe sexual difficulty and most report high sexual satisfaction. Whether this applies to reproductive-aged females living with CKD is yet unknown. This study aimed to assess the sexual activity, function, and satisfaction of reproductive-aged females living with CKD. Self-identified females aged 18-51 years with CKD were recruited from nephrology clinics in Calgary, Canada. Sexual activity, function, and satisfaction were assessed with a modified version of the Female Sexual Function Index. Fifty-seven participants were recruited (35% CKD without kidney replacement therapy, 44% CKD treated with hemodialysis, 9% CKD treated with peritoneal dialysis, 12% CKD treated with kidney transplant) and nearly half (47%) reported sexual activity. Among sexually active participants, there was a high prevalence of sexual dysfunction (67%) and only 25% of participants reported sexual satisfaction. A strong relationship between sexual function and satisfaction was identified. Reproductive-aged females living with CKD are sexually active, though experience high rates of sexual dysfunction and dissatisfaction. These findings emphasize the importance of recognition and management of sexual dysfunction in this important population.

Sexual and Reproductive Health Rights and Service Use among Undocumented Migrants in the EU: A Systematic Literature Review.

Most EU member states fail to provide essential sexual and reproductive health services to undocumented migrants, a vulnerable population facing limited access, utilization, and worse health-related outcomes. This study systematically reviewed the literature on access to and use of these services, as well as related health, economic, and migratory outcomes for undocumented migrants in the EU-EFTA region. The systematic review is reported based on the PRISMA 2020 checklist and includes 37 studies published between 2017 and 2024. Included studies were based upon original quantitative, qualitative, or mixed-methods data; conducted in one or more European countries; and published in one or more of the following languages: English, Spanish, French, Portuguese, or Romanian. A quality assessment was conducted using the CASP checklist for qualitative studies and the NHLBI Study Quality Assessment Tools for quantitative studies. The findings revealed numerous access barriers, including refusal of care, lack of knowledge about national healthcare schemes, bureaucratic hurdles, and affordability issues. Even when care was available, stigma, fear of deportation, socio-economic precarity, and abuse further hindered utilization. These barriers contributed to generally worse reproductive health outcomes for undocumented migrants in Europe, though the findings may not generalize to all EU-EFTA countries.

Multi-level predictors of young people's attitudes towards gender biases concerning rape, sexual and domestic violence in intimate relationships among young people, Ebonyi State, Southeast Nigeria.

This study assessed multi-level factors that shape young people's attitudes towards gender biases about rape, sexual, and domestic violence in intimate relationships. This cross-sectional study was undertaken in three urban and three rural communities in Ebonyi State, southeast Nigeria. Data were collected from 1,020 young people using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were performed using STATA. Findings revealed that most(64%) young people agree that when a girl doesn't physically fight back, you cannot really say it was rape. Many agreed that a girl who is raped is promiscuous or has a bad reputation (50%) and usually did something careless to put herself in that situation(45%). Young girls were approximately 2 times more likely to have positive attitudes towards sexual violence, rape, and domestic violence in intimate relationships than young boys (OR=1.5;P<0.01). Multi-level strategies to effectively address adverse gender norms and inequalities in intimate relationships are highly recommended.

Cette étude a évalué les facteurs à plusieurs niveaux qui façonnent les attitudes des jeunes à l'égard des préjugés sexistes concernant le viol, la violence sexuelle et domestique dans les relations intimes. Cette étude transversale a été entreprise dans trois communautés urbaines et trois communautés rurales de l'État d'Ebonyi, au sud-est du Nigeria. Les données ont été recueillies auprès de 1 020 jeunes à l'aide d'un questionnaire administré par un intervieweur. Des analyses de régression descriptive et logistique ont été effectuées à l'aide de STATA. Les résultats ont révélé que la plupart (64 %) des jeunes conviennent que lorsqu'une fille ne se défend pas physiquement, on ne peut pas vraiment dire qu'il s'agit d'un viol. Beaucoup conviennent qu'une fille violée est une promiscuité ou a une mauvaise réputation (50%) et a généralement fait quelque chose de négligent pour se mettre dans cette situation (45%). Les jeunes filles étaient environ 2 fois plus susceptibles d'avoir des attitudes positives à l'égard de la violence sexuelle, du viol et de la violence domestique dans les relations intimes que les jeunes garçons (OR=1,5 ; P<0,01). Des stratégies à plusieurs niveaux pour lutter efficacement contre les normes de genre défavorables et les inégalités dans les relations intimes sont fortement recommandées.

Transactional sex in humanitarian settings: A comparative analysis of livelihood and demographic predictors.

Millions of people have been displaced within or outside their countries. Disruptions associated with displacement often lead to transactional sex with dire social, sexual and reproductive health implications. A common driver of transactional sex is food insecurity among refugees and internally displaced persons (IDPs), yet IDP/refugee settings offer an opportunity for females to challenge and renegotiate gender norms and exercise greater control over their lives and sexuality. We compared predictors of transactional sex across humanitarian settings and found them to be significantly different. Among IDPs, the likelihood of transactional sex reduces with having access to food ration and education, but increases with having 'other sources' of income. Among refugees, transactional sex likelihood reduces with having either/both parent(s) alive but increases with working for money. Hence, multiple factors drive transactional sex in different contexts. Protecting women in humanitarian situations from the risks of transactional sex requires an understanding of these differences.

Des millions de personnes ont été déplacées à l'intérieur ou à l'extérieur de leur pays. Les perturbations associées au déplacement conduisent souvent à des relations sexuelles transactionnelles avec des conséquences désastreuses sur la santé sociale, sexuelle et reproductive. L'insécurité alimentaire parmi les réfugiés et les personnes déplacées à l'intérieur de leur propre pays (PDI) est un facteur courant du sexe transactionnel. Pourtant, les contextes de PDI/réfugiés offrent aux femmes la possibilité de remettre en question et de renégocier les normes de genre et d'exercer un plus grand contrôle sur leur vie et leur sexualité. Nous avons comparé les prédicteurs du sexe transactionnel dans différents contextes humanitaires et nous avons constaté qu'ils étaient significativement différents. Parmi les personnes déplacées, la probabilité de relations sexuelles transactionnelles diminue avec l'accès à la ration alimentaire et à l'éducation, mais augmente avec « d'autres sources ¼ de revenus. Parmi les réfugiés, la probabilité de relations sexuelles transactionnelles diminue lorsque l'un ou les deux parents sont en vie, mais augmente lorsque l'on travaille pour de l'argent. Par conséquent, de multiples facteurs déterminent le sexe transactionnel dans différents contextes. Protéger les femmes dans les situations humanitaires contre les risques liés aux relations sexuelles transactionnelles nécessite une compréhension de ces différences..

Gender differences in adolescents' perceptions of condom use in Ebonyi State, Southeast Nigeria.

This paper assessed gender differences and perceptions towards condom use among in-school adolescents in Ebonyi State, Nigeria. This was a cross-sectional study undertaken in six local government areas in Ebonyi State, Nigeria. Data were collected using a structured questionnaire and summarised using frequencies and proportions. Chi-square test and binary logistic regression were used in the analysis. The level of statistical significance was a p-value of <0.05. Findings showed that a significantly higher proportion of male respondents (58.8%) had a good perception of condom use when compared to female respondents (45.8%). Gender, level of schooling, and working for pay had significant associations with good perceptions of condom use, while the significant predictors in the logistic regression model were gender, level of schooling, and working for pay. Interventions that promote the sexual and reproductive health and rights of adolescents and those that empower women with relevant skills by addressing unequal gender power relations in relationships should be prioritized.

Cet article a évalué les différences entre les sexes et les perceptions concernant l'utilisation du préservatif parmi les adolescents scolarisés dans l'État d'Ebonyi, au Nigeria. Il s'agissait d'une étude transversale entreprise dans six zones de gouvernement local de l'État d'Ebonyi, au Nigeria. Les données ont été collectées à l'aide d'un questionnaire structuré et résumées à l'aide de fréquences et de proportions. Le test du chi carré et la régression logistique binaire ont été utilisés dans l'analyse. Le niveau de signification statistique était une valeur p <0,05. Les résultats ont montré qu'une proportion significativement plus élevée d'hommes interrogés (58,8 %) avaient une bonne perception de l'utilisation du préservatif par rapport aux femmes interrogées (45,8 %). Le sexe, le niveau de scolarité et le travail rémunéré étaient associés de manière significative à de bonnes perceptions de l'utilisation du préservatif, tandis que les prédicteurs significatifs dans le modèle de régression logistique étaient le sexe, le niveau de scolarité et le travail rémunéré. Les interventions qui promeuvent la santé et les droits sexuels et reproductifs des adolescents et celles qui donnent aux femmes les compétences nécessaires en s'attaquant aux relations de pouvoir inégales entre les sexes dans les relations devraient être prioritaires.

A revisit of knowledge, attitude and practice of emergency contraception in Hong Kong.

OBJECTIVES: To revisit women's knowledge, attitudes and practices (KAP) regarding emergency contraception (EC) in Hong Kong. The research sought to provide insights for improving the accessibility and quality of EC services. STUDY DESIGN: A cross-sectional study, where self-administered questionnaires were distributed at a major community sexual and reproductive health service in Hong Kong over a 3-month period between July 2023 and October 2023. Descriptive and regression analyses were used. RESULTS: Of 1127 respondents, the majority (n=1057, 93.8%) reported using contraception and 513 (45.6%) had used EC. The main contraceptive methods used were male condoms and oral contraceptive pills. The majority (n=1035, 91.8%) of respondents demonstrated awareness about EC and 938 (83.2%) participants correctly reported the timeframe for oral EC. Around two-thirds reported the internet as being their leading source of EC knowledge. Over 93% of respondents advocated for enhancing public awareness. Acceptance of non-traditional means of obtaining EC, such as over-the-counter provision (51.3%), pharmacy provision (49.8%) and telemedicine consultation (43.1%), were higher than face-to-face EC consultations (32.9%). CONCLUSIONS: Family planning service users' characteristics and KAP regarding EC have significantly changed over the last 20 years. Women now demonstrate greater awareness, knowledge and openness regarding EC, indicating improved readiness for more liberal delivery of EC nowadays. This study highlights the need for restructuring EC service provision in Hong Kong to address women's changing preferences and contraceptive needs, and to minimise barriers to EC access. We recommend reclassifying emergency contraceptive pills as non-prescription drugs in Hong Kong to align with international practice.

Visual supports and informative material not to forget counselling on reproductive health in dialysis: a point of view.

Contraception, pregnancy and fertility are seldom discussed with women receiving dialysis and the medical staff of dialysis centres. Since the majority of women on dialysis are past childbearing age, these themes are not always given proper consideration and this category of patients may be missing important information. Young women of childbearing age who are on dialysis frequently experience sexual dysfunction and hormonal disorders of the hypothalamic-pituitary-gonadal axis. In addition, dialysis often has a relevant psychological impact and affects the person's social role. Physical changes may accompany kidney failure, including the presence of a vascular or peritoneal access. The dialysis ward is not a place that facilitates privacy, and discussing contraception is not always easy, particularly in some cultural contexts, or between a male doctor and a young woman. While pregnancy and contraception are routinely addressed with women waiting for a kidney transplant, they are less frequently discussed with women on dialysis. Numerous studies have found that over half of the pregnancies in women on dialysis are unplanned. How frequently patients are seen (at each dialysis session, or during periodic visits) does not necessarily make things better, as often some issues are taken for granted or discussing them is postponed. In our centre, over 160 patients are on chronic hemodialysis (HD) and 20 are on peritoneal or home HD. Only nine women were of childbearing age in our center, all on HD. We discussed with them on counselling about pregnancy, and to ensure that all women of childbearing age would be offered counselling on contraception and pregnancy, we designed simple leaflets and an infographic, in collaboration with our nursing team and residents, as a guide and a reminder for our staff to discuss these topics with the patients.

Safe Sex and the Debate over Condoms on Campus in the 1980s: Sperm Busters at Harvard and Protection Connection at the University of Texas at Austin.

During the 1980s, college students in the United States helped to destigmatize the distribution and use of condoms. They shifted their aims from preventing unwanted pregnancy to stopping the spread of sexually transmitted infections including the newly identified acquired immunodeficiency syndrome (AIDS). Two student-led initiatives to deliver condoms after hours at Harvard University in Cambridge, Massachusetts and the University of Texas at Austin show regional and temporal differences in sexual mores as awareness of AIDS increased. These male students adopted a non-pharmaceutical intervention to prevent pregnancy and disease in the context of increased marketing of Trojan® brand condoms. Interviews with co-founders reveal how the students grappled with backlash from family members and campus administrators less enthusiastic about their popularization of condoms. Co-founders described how media attention affected their college experiences and how condom companies changed campus culture. Overall, large non-pharmaceutical companies such as Trojan® and small condom-resellers such as those at Harvard and the University of Texas at Austin reshaped cultural norms around safe sex as awareness of AIDS grew between 1985 and 1987.

Exploring comprehensive sexuality education experiences and barriers among students, teachers and principals in Nepal: a qualitative study.

BACKGROUND: Comprehensive sexuality education (CSE) is essential in empowering adolescents with the knowledge and confidence to manage their sexual and reproductive health. Despite its recognized benefits, access to quality CSE remains limited, especially in low-income countries, where societal norms and structural barriers hinder effective delivery. The aim of this study is to investigate the experiences and perceptions among students, teachers, and principals in Nepal about comprehensive sexuality education. METHODS: Qualitative methods were used. 13 Semi-structured interviews and 1 focus group discussion were carried out with 15 teachers and principals working at higher secondary schools and two focus group discussions were conducted with a total of 13 adolescents. Thematic analysis was used to analyze the data. RESULTS: Four themes were developed: Resistance to Teaching and Learning, Preparation and Engagement Strategies, Taboos and Silencing and Structural Barriers. Students, teachers, principals and students reported discomfort and embarrassment when discussing sensitive topics, with gender dynamics playing a significant role. Strategies like warm-up sessions and continuous interaction with students and parents were used to create a supportive learning environment. However, socio-cultural barriers and family attitudes continued to hinder open discussions about sexuality. Structural barriers, including the lack of formal training for teachers and inadequate instructional materials, further impeded effective CSE delivery. CONCLUSION: The experiences of CSE in Nepal among students, teachers and principals highlight significant barriers including cultural taboos, gender dynamics and insufficient resources. Addressing these barriers through comprehensive teacher training, curriculum reform, and societal engagement is critical to ensure access to CSE.

The HIV prevention decision-making cascade: Integrating behavioural insights into HIV prevention efforts.

The syndemic of HIV, sexually transmitted infections (STIs), and early pregnancy remain a key challenge to global public health. Decision-making around sexual and reproductive health (SRH) behaviours is critical to ensuring the uptake of biomedical technologies. Drawing from behavioural science theories, we propose a novel conceptual framework-the Decision Cascade-to describe the decision-making process that a user will go through as they navigate these decisions. Analogous to the HIV prevention and treatment cascade, this model describes key steps individuals go through when deciding to use HIV prevention technologies. Each step (being cued/triggered to act, reacting to the behaviour, evaluating the behaviour, assessing the feasibility of acting and the timing and final execution of the action), is influenced by a myriad of individual and socio-cultural factors, shaping the ultimate decision and behaviour outcome in a continual cycle. This framework has applications beyond HIV prevention, extending to other SRH technologies and treatments. By prioritizing human-centered design and understanding user decision-making intricacies, interventions can enhance effectiveness and address the complexities of SRH service uptake across diverse populations. The Decision Cascade framework offers a comprehensive lens to inform intervention design, emphasizing the need for nuanced approaches that resonate with the realities of decision-makers. Adopting such approaches is essential to achieving meaningful impact in HIV prevention and broader SRH initiatives.

Evaluating the Impact of a Dutch Sexual Health Intervention for Adolescents: Think-Aloud and Semistructured Interview Study.

BACKGROUND: Engagement with and the potential impact of web-based interventions is often studied by tracking user behavior with web analytics. These metrics do provide insights into how users behave, but not why they behave as such. OBJECTIVE: This paper demonstrates how a mixed methods approach consisting of (1) a theoretical analysis of intended use, (2) a subsequent analysis of actual use, and (3) an exploration of user perceptions can provide insights into engagement with and potential impact of web-based interventions. This paper focuses on the exploration of user perceptions, using the chlamydia page of the Dutch sexual health intervention, Sense.info, as a demonstration case. This prevention-focused platform serves as the main source of sexual and reproductive health information (and care if needed) for young people aged 12-25 years in the Netherlands. METHODS: First, acyclic behavior change diagrams were used to theoretically analyze the intended use of the chlamydia page. Acyclic behavior change diagrams display how behavior change principles are applied in an intervention and which subbehaviors and target behaviors are (aimed to be) influenced. This analysis indicated that one of the main aims of the page is to motivate sexually transmitted infection (STI) testing. Second, the actual use of the chlamydia page was analyzed with the web analytics tool Matomo. Despite the page's aim of promoting STI testing, a relatively small percentage (n=4948, 14%) of the 35,347 transfers from this page were to the STI testing page. Based on these two phases, preliminary assumptions about use and impact were formulated. Third, to further explore these assumptions, a study combining the think-aloud method and semistructured interviews was executed with 15 young individuals aged 16-25 (mean 20, SD 2.5) years. Template analysis was used to analyze interview transcripts. RESULTS: Participants found the information on the Sense.info chlamydia page reliable and would visit it mostly for self-diagnosis purposes if they experienced potential STI symptoms. A perceived facilitator for STI testing was the possibility to learn about the symptoms and consequences of chlamydia through the page. Barriers included an easily overlooked link to the STI testing page and the use of language not meeting the needs of participants. Participants offered suggestions for lowering the threshold for STI testing. CONCLUSIONS: The mixed methods approach used provided detailed insights into the engagement with and potential impact of the Sense.info chlamydia page, as well as strategies to further engage end users and increase the potential impact of the page. We conclude that this approach, which triangulates findings from theoretical analysis with web analytics and a think-aloud study combined with semistructured interviews, may also have potential for the evaluation of web-based interventions in general.