Factors Associated With Recent Decline in Anal Health Among Older Gay and Bisexual Men: A Cross-sectional Analysis.

ABSTRACT: We investigated factors associated with "worse than usual" anal health among gay and bisexual men aged ≥35 years recruited to a longitudinal study of anal human papillomavirus infection/lesions from September 2010 to August 2015.Among 616 participants (median age 49 years; 36% HIV-positive), 42 (6.8%) reported worse than usual anal health in the last 4 weeks. Associated factors included spending less time with gay friends (odds ratio [OR] = 2.25, 95% CI = 1.06-4.77), most time "feeling down"(OR = 9.17, 95% CI = 2.94-28.59), reduced libido (OR = 2.90, 95% CI = 1.52-5.52), current anal symptoms (OR = 6.55, 95% CI = 2.54-16.90), recent anal wart diagnosis (OR = 4.33, 95% CI = 1.98-9.49), and fear of developing anal cancer (OR = 9.34, 95% CI = 4.52-19.28).Concerns regarding anal health should be routinely discussed by clinicians, and potentially associated psychosocial, physical, and sexual issues further explored.

A meta-analysis comparing cognitive function across the mood/psychosis diagnostic spectrum.

BACKGROUND: The nature and degree of cognitive impairments in schizoaffective disorder is not well established. The aim of this meta-analysis was to characterise cognitive functioning in schizoaffective disorder and compare it with cognition in schizophrenia and bipolar disorder. Schizoaffective disorder was considered both as a single category and as its two diagnostic subtypes, bipolar and depressive disorder. METHODS: Following a thorough literature search (468 records identified), we included 31 studies with a total of 1685 participants with schizoaffective disorder, 3357 with schizophrenia and 1095 with bipolar disorder. Meta-analyses were conducted for seven cognitive variables comparing performance between participants with schizoaffective disorder and schizophrenia, and between schizoaffective disorder and bipolar disorder. RESULTS: Participants with schizoaffective disorder performed worse than those with bipolar disorder (g = -0.30) and better than those with schizophrenia (g = 0.17). Meta-analyses of the subtypes of schizoaffective disorder showed cognitive impairments in participants with the depressive subtype are closer in severity to those seen in participants with schizophrenia (g = 0.08), whereas those with the bipolar subtype were more impaired than those with bipolar disorder (g = -0.23) and less impaired than those with schizophrenia (g = 0.29). Participants with the depressive subtype had worse performance than those with the bipolar subtype but this was not significant (g = 0.25, p = 0.05). CONCLUSION: Cognitive impairments increase in severity from bipolar disorder to schizoaffective disorder to schizophrenia. Differences between the subtypes of schizoaffective disorder suggest combining the subtypes of schizoaffective disorder may obscure a study's results and hamper efforts to understand the relationship between this disorder and schizophrenia or bipolar disorder.

Reducing socioeconomic disparities in the STEM pipeline through student emotion regulation.

Educational attainment is one lever that can increase opportunity for economically disadvantaged families-especially in Science, Technology, Engineering, and Math (STEM). Unfortunately, students from lower-income backgrounds often perform poorly and fail high school STEM courses, which are a necessary step in pursuing fast-growing and lucrative STEM careers, graduating high school, and matriculating to college. We reasoned that, because high school STEM courses often use high-stakes tests to gauge performance, and such tests can be especially stressful for lower-income students, interventions that help students regulate their negative emotions during tests should reduce the achievement gap between higher- and lower-income students. In a large-scale (n = 1,175) field experiment conducted in ninth grade science classrooms, students were asked to complete a control exercise, or they were given the opportunity to complete an exercise to help them regulate their worries and reinterpret their anxious arousal before their tests. We found significant benefits of emotion regulation activities for lower-income students in terms of their science examination scores, science course passing rate, and students' attitudes toward examination stress, suggesting that students' emotions are one factor that impacts performance. For example, 39% of lower-income students failed the course in the control group compared with only 18% of students failing the course if they participated in the emotion regulation interventions-a reduction in course failure rate by half. Our work underscores the crucial importance of targeting students' emotions during impactful points in their academic trajectories for improving STEM preparedness and enhancing overall academic success.

Elementary school teachers' math anxiety and students' math learning: A large-scale replication.

A solid foundation in math is important for children's long-term academic success. Many factors influence children's math learning-including the math content students are taught in school, the quality of their instruction, and the math attitudes of students' teachers. Using a large and diverse sample of first-grade students (n = 551), we conducted a large-scale replication of a previous study (Proceedings of the National Academy of Sciences of the USA, 2010, 1860; n = 117), which found that girls in classes with highly math anxious teachers learned less math during the school year, as compared to girls whose math teachers were less anxious about math. With a larger sample, we found a negative relation between teachers' math anxiety and students' math achievement for both girls and boys, even after accounting for teachers' math ability and children's beginning of year math knowledge, replicating and extending those previous results. Our findings strengthen the support for the hypothesis that teachers' math anxiety is one factor that undermines children's math learning and could push students off-track during their initial exposure to math in early elementary school.

Assessing the Reliability of the Retrospective Reproductive Calendar: Evidence from Urban Kenya.

The reproductive calendar is a data collection tool that collects month-by-month retrospective histories of contraceptive use. This survey instrument is implemented in large-scale demographic surveys, but its reliability is not well-understood. Our analysis helps to address this research gap, using longitudinal panel data with overlapping calendars from urban Kenya. Our findings indicate calendar data collected in 2014 underestimated 2012 reports of current use by 5 percentage points. And while the overall percentage of women reporting at least one episode of contraceptive use was similar across the two calendars (67 percent vs. 70 percent), there was notable disagreement in contraceptive behavior when comparing the histories of individual women; less than 20 percent of women with any contraceptive use reported the exact same pattern of use in both calendars. Low calendar reliability was especially apparent for younger women and those with complicated contraceptive histories. Individual-level discordance resulted in a small difference in 12-month discontinuation rates for the period of calendar overlap; when surveyed in 2014, women reported a 12-month discontinuation rate of 39 percent, compared to a rate of 34 percent reported in 2012. When using retrospective calendar data, attention must be paid to the potential for individual reporting errors.

Self-reported anal symptoms and their association with anal pathology among gay and bisexual men: a cross-sectional observational analysis.

Background Anal symptoms may indicate serious pathology. Receptive anal intercourse (RAI) and sexually transmissible infections (STIs) may contribute to a higher prevalence of symptoms among gay and bisexual men (GBM). This study investigated associations with anal symptoms among GBM. METHODS: The Study of the Prevention of Anal Cancer was a longitudinal study of anal human papillomavirus and related lesions in Sydney, Australia. GBM aged ≥35 years were recruited from community settings between September 2010 and August 2015. Information about anal symptoms (discharge, itch, pain defecating, lump, bleeding, 'sores', tearing, tenesmus), STIs and sexual behaviours was collected. High-resolution anoscopy (HRA) and STI testing were performed. Logistic regression analyses on baseline data were performed to assess associations with each symptom. RESULTS: Among 616 participants (median age 49 years, 35.9% HIV positive), 35.3% reported at least one anal symptom within the past week and 65.3% were diagnosed with fistula, fissure, ulcer, warts, haemorrhoids and/or perianal dermatoses at HRA. Anal symptoms were not associated with anal chlamydia, gonorrhoea, warts or syphilis. Self-reported 'sores' were associated with previous anal herpes simplex virus (HSV; P < 0.001). 'Sores' (P < 0.001), itch (P = 0.019), discharge (P = 0.032) and lump (P = 0.028) were independently associated with ulceration. Among participants diagnosed with fissure, fistulae, haemorrhoids and perianal dermatoses, 61.9%, 100%, 62.0% and 63.9% respectively were asymptomatic. Only self-reported anal tear was independently associated with recent RAI. CONCLUSIONS: Previous anal HSV was the only STI associated with any symptom. Anal pathology was highly prevalent, but often asymptomatic. Anal symptoms do not appear to be useful markers of most anal pathology in GBM.

"If the Big Fish are Doing It Then Why Not Me Down Here?": Informal Fee Payments and Reproductive Health Care Provider Motivation in Kenya.

Informal fees are payments made by patients to their health care provider that are over and above the official cost of services. Payments may be motivated by a combination of factors such as low supervision, weak sanctions, and inadequate provider salaries. The practice of soliciting informal fees from patients may result in restricted access to medical care and reduced care-seeking behavior among vulnerable populations. The objective of this study is to examine nuanced health care provider perspectives on informal fee payments solicited from reproductive health patients in Kenya. We conducted in-depth semistructured interviews in 2015-2016 among a sample of 20 public and private-sector Kenyan health care workers. Interviews were coded and analyzed using an iterative thematic approach. More than half of participants reported that solicitation of informal fees is common practice in health care facilities. Providers reported low public-sector wages were a primary driver of informal fee solicitation coupled with collusion among senior staff. Additionally, patients may be unaware that they are being asked to pay more than the official cost of services. Strategies for reducing this behavior include more adequate and timely remuneration within the public sector, educating patient populations of free or low-cost services, and evidence-based methods to increase provider motivation.

The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study.

BACKGROUND: In 2006, the Government of India launched the accredited social health activist (ASHA) program, with the goal to connect marginalized communities to the health care system. We assessed the effect of the ASHA program on the utilization of maternity services. METHODS: We used data from Indian Human Development Surveys done in 2004-2005 and in 2011-2012 to assess demographic and socioeconomic factors associated with the receipt of ASHA services, and used difference-in-difference analysis with cluster-level fixed effects to assess the effect of the program on the utilization of at least one antenatal care (ANC) visit, four or more ANC visits, skilled birth attendance (SBA), and giving birth at a health facility. RESULTS: Substantial variations in the receipt of ASHA services were reported with 66% of women in northeastern states, 30% in high-focus states, and 16% of women in other states. In areas where active ASHA activity was reported, the poorest women, and women belonging to scheduled castes and other backward castes, had the highest odds of receiving ASHA services. Exposure to ASHA services was associated with a 17% (95% CI 11.8-22.1) increase in ANC-1, 5% increase in four or more ANC visits (95% CI - 1.6-11.1), 26% increase in SBA (95% CI 20-31.1), and 28% increase (95% CI 22.4-32.8) in facility births. CONCLUSIONS: Our results suggest that the ASHA program is successfully connecting marginalized communities to maternity health services. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize, and retain ASHAs.

Understanding healthcare provider absenteeism in Kenya: a qualitative analysis.

BACKGROUND: Healthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. There is a dearth of qualitative information on the scope, contributing factors, and impact of absenteeism in Kenyan healthcare facilities. METHODS: In-depth semi-structured interviews were conducted between July 2015 and June 2016 with 20 healthcare providers in public and private healthcare facilities in Central and Western Kenya. Interviews were audio-recorded, transcribed, coded, and analyzed using an iterative thematic approach. RESULTS: Half of providers reported that absenteeism occurs in both private and public health facilities. Absenteeism was most commonly characterized by providers arriving late or leaving early during scheduled work hours. The practice was attributed to institutional issues including: infrequent supervision, lack of professional consequences, limited accountability, and low wages. In some cases, healthcare workers were frequently absent because they held multiple positions at different health facilities. Provider absences result in increased patient wait times and may deter patients from seeking healthcare in the future. CONCLUSION: There is a significant need for policies and programs to reduce provider absenteeism in Kenya. Intervention approaches must be cognizant of the contributors to absenteeism which occur at the institutional level.

Characterizing the neural coding of symbolic quantities.

How the brain encodes abstract numerical symbols is a fundamental question in philosophy and cognitive neuroscience alike. Here we probe the nature of symbolic number representation in the brain by characterizing the neural similarity space for symbolic quantities in regions sensitive to their semantic content. In parietal and occipital regions, the similarity space of number symbols was positively predicted by the lexical frequency of numerals in parietal and occipital areas, and was unrelated to numerical ratio. These results are more consistent with a categorical, frequency-based account of symbolic quantity encoding. In contrast, the similarity space of analog quantities was positively predicted by ratio in prefrontal, parietal and occipital regions. We thus provide an explanation for why previous work has indicated that symbolic and analog quantities are distinct: number symbols operate primarily like discrete categories sensitive to input frequency, while analog quantities operate more like approximate perceptual magnitudes. In addition, we find substantial evidence for related patterns of activity across formats in prefrontal, parietal and occipital regions. Crucially however, between-format relations were not specific to individual quantities, indicating common processing as opposed to common representation. Moreover, evidence for between-format processing was strongest for quantities that could be represented as exact, discrete values in both systems (quantities in the 'subitizing' range: 1-4). In sum, converging evidence presented here indicates that symbolic quantities are coded in the brain as discrete categories sensitive to input frequency and largely independent of approximate, analog quantities.

Gender norms and modern contraceptive use in urban Nigeria: a multilevel longitudinal study.

BACKGROUND: Evidence suggests that gender equality positively influences family planning. However, the evidence from urban Africa is sparse. This study aimed to examine the association between changes in gender norms and modern contraceptive use over time among women in urban Nigeria. METHODS: Data were collected in 2010/2011 from 16,118 women aged 15-49 living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and Zaria) and again in 2014 from 10,672 of the same women (34% attrition rate). The analytical sample included 9933 women living in 480 neighborhoods. A four-category outcome variable measured their change in modern contraceptive use within the study period. The exposure variables measured the changes in the level of gender-equitable attitudes towards: a) wife beating; b) household decision-making; c) couples' family planning decisions; and d) family planning self-efficacy. Multilevel multinomial logistic regression models estimated the associations between the exposure variables at the individual and neighborhood levels and modern contraceptive use controlling for the women's age, education, marital status, religion, parity, household wealth, and city of residence. RESULTS: The proportion of women who reported current use of modern contraceptive methods increased from 21 to 32% during the four-year study period. At both surveys, 58% of the women did not report using modern contraceptives while 11% reported using modern contraceptives; 21% did not use in 2010/2011 but started using by 2014 while 10% used in 2010/2011 but discontinued use by 2014. A positive change in the gender-equitable attitudes towards household decision-making, couples' family planning decisions, and family planning self-efficacy at the individual and neighborhood levels were associated with increased relative probability of modern contraceptive use (adoption and continued use) and decreased relative probability of modern contraceptive discontinuation by 2014. No such associations were found between the individual and neighborhood attitudes towards wife beating and modern contraceptive use. Accounting for the individual and neighborhood gender-equitable attitudes and controlling for the women's demographic characteristics accounted for 55-61% of the variation between neighborhoods in the change in modern contraceptive use during the study period. CONCLUSION: Interventions that promote gender equality have the potential to increase modern contraceptive use in Nigerian cities.

Contraceptive Practices, Preferences, and Barriers Among Abortion Clients in North Carolina.

OBJECTIVES: Abortion clinics provide an ideal setting for women to receive contraceptive care because the women served may not have other contacts with the health system and are at risk for unintended pregnancies. The objective of this study was to understand practices, preferences, and barriers to use of contraception for women obtaining abortions at clinics in North Carolina. METHODS: We conducted a cross-sectional survey of abortion clients and facilities at 10 abortion clinics in North Carolina. We collected data on contraceptive availability at each clinic. We collected individual responses on women's experiences obtaining contraception before the current pregnancy and their intentions for future use of contraception. RESULTS: From October 2015 to February 2016, 376 client surveys were completed at 9 clinics, and 10 clinic surveys were completed. Almost one-third of women (29%) reported that they had wanted to use contraception in the last year but were unable. Approximately three-fourths of respondents (76%) stated that they intend to use contraception after this pregnancy. Approximately one-fifth of women stated that would like to use long-acting reversible contraception (LARC) after this abortion. Only the clinics that accepted insurance for abortion and other services provided LARC at the time of the abortion (40%). CONCLUSIONS: This study provides a unique, statewide view into the contraceptive barriers for women seeking abortion in North Carolina. Addressing the relatively high demand for LARC after abortion could help significantly reduce unintended pregnancy and recourse to abortion in North Carolina.

Study of low salt diet in hypertensive patients with chronic kidney disease.

INTRODUCTION: The efficacy of blood pressure (BP) reduction with salt restriction in CKD subjects and its sustainability is not well established. METHODS: We enrolled 75 hypertensive patients with CKD into one-month salt restricting diet. 24-hour urinary sodium and potassium was measured to verify their salt intake followed by 1½ year follow-up. RESULTS: Their creatinine clearance was 43 ± standard deviation 33ml/min/1.73m2. Urinary Na excretion (24HUNa) was 173±129mmol/day, reducing to 148±81 by 31±6 day. Mean, systolic and diastolic BP (MBP, SBP, DBP) were reduced from 102±9 to 97±11 (p<0.001), 148±10 to 139±16 (p<0.001), 78±12 to 75±12 mmHg (p=0.012) respectively. Moderate correlations were shown between reductions in 24-hour urinary Na and MBP, SBP, DBP: r=0.366, 0.260, 0.365; p=0.001, 0.025, 0.001; whereas 24-hour urinary Na-K ratio showed mild correlation. Subjects have some tendency to drift back to previous Na intake profile in follow-up and thus repetitive education is necessary. In subanalysis, 34 subjects with baseline 24HUNa >150 mmol/day, benefited significantly with MBP, SBP, DBP reduction from 102±9 to 95±9 (p=0.001), 146±10 to 135±14 mmHg (p=0.001), 80±11 to 75±11 mmHg (p=0.002) in line with 24HUNa reduction from 253±154 to 163±87mmol/day (p=0.004) and urinary protein-creation ratio reduction from geometric mean of 95 to 65 g/mol. Thirty five subjects with 24HUNa reduction of >20mmol/day have significant reduction in MBP, SBP, DBP: -8 vs -2, -15 vs -4, -5 vs -2 mmHg (p=0.027, 0.006, 0.218) and urinary protein-creatinine ratio: -82 vs 2g/mol (p=0.030) compared to the other forty subjects. CONCLUSION: Quantification of 24-hour urinary Na helps in predicting potential antihypertensive effect with dietary salt reduction of CKD subjects. Salt restriction reduces BP especially in patients with estimated daily sodium intake of >150mmol/day. Reduction in sodium intake beyond 20mmol/day reduced both BP and proteinuria.

Performance during competition and competition outcome in relation to testosterone and cortisol among women.

A contribution to a special issue on Hormones and Human Competition. This study investigated the relation between competition, testosterone (T), and cortisol (C) in women. One hundred and twenty female participants competed against a male confederate in a computerized laboratory task. The task was preprogrammed so that half the women won and half of the women lost the competition. T and C concentrations were measured in saliva samples collected at four time points before and after the competition. Accuracy and reaction time during the competition were recorded. T and C increased directly after the competition, though not significantly for C, and then decreased over time regardless of the competition outcome. Regression analyses demonstrated that baseline T was significantly and positively associated with competition accuracy, though only in individuals who were low in C. Individuals who were high in C showed no relation between T and accuracy. This relation was further qualified by competition outcome. Losers of the competition showed a significant positive relation between baseline T levels and competition accuracy, though only if they were low in C. No relation was found between T and accuracy in losers who were high in C. Winners of the competition showed no relation between T and accuracy, regardless of whether C levels were high or low. These results are in line with the dual-hormone hypothesis, whereby the effects of T on status-seeking behaviors are dependent on C levels for individuals whose status is threatened.

How do generic statements impact performance? Evidence for entity beliefs.

Generic statements about the abilities of children's social groups (e.g. 'Girls/Boys are good at this game') negatively impact children's performance - even if the statements are favorable towards children's own social groups. We explored the mechanism by which generic language impairs children's performance. Across three studies, our findings suggest that generic statements influence children's performance by creating an entity belief (i.e. a belief that a fixed ability determines performance). Children who were exposed to a generic statement about their social group's ability performed worse than children in control conditions. This effect hurt children's performance even when the person who made the generic statement was no longer present and a new person not privy to the statement replaced them. However, when children heard a generic statement paired with an effort explanation (i.e. 'Girls/Boys are good at this game because they try really hard when they draw') they performed better than children who heard the generic statement with no explanation (i.e. just 'Girls/Boys are good at this game') and children who heard the generic statement paired with a trait explanation (i.e. 'Girls/Boys are good at this game because they are smart and really good at drawing'). This work uncovers when and how generic statements that refer to the ability of one's social group hinder performance, informing the development of practices to improve student motivation and learning.

Micellization of alkyltrimethylammonium bromide surfactants in choline chloride:glycerol deep eutectic solvent.

Deep eutectic solvents have shown the ability to promote the self-assembly of surfactants in solution. However, some differences have been found compared with self-assembly in pure water and other polar organic solvents. The behaviour of alkyltrimethylammonium bromides in choline chloride:glycerol deep eutectic solvent has been studied by means of surface tension, X-ray and neutron reflectivity and small-angle neutron scattering. The surfactants were found to remain surface active and showed comparable critical micelle concentrations to the same surfactants in water. Our scattering studies demonstrate that these surfactants form globular micelles with ellipsoidal shape in solution. The size, shape and aggregation number of the aggregates were found to vary with the chain length of the surfactant. Specific solvent-headgroup interactions were not found in this system, unlike those we have previously postulated for anionic surfactants in choline chloride deep eutectic solvents.

On the relationship between math anxiety and math achievement in early elementary school: The role of problem solving strategies.

Even at young ages, children self-report experiencing math anxiety, which negatively relates to their math achievement. Leveraging a large dataset of first and second grade students' math achievement scores, math problem solving strategies, and math attitudes, we explored the possibility that children's math anxiety (i.e., a fear or apprehension about math) negatively relates to their use of more advanced problem solving strategies, which in turn relates to their math achievement. Our results confirm our hypothesis and, moreover, demonstrate that the relation between math anxiety and math problem solving strategies is strongest in children with the highest working memory capacity. Ironically, children who have the highest cognitive capacity avoid using advanced problem solving strategies when they are high in math anxiety and, as a result, underperform in math compared with their lower working memory peers.