Labile assembly of a tardigrade protein induces biostasis.

Tardigrades are microscopic animals that survive desiccation by inducing biostasis. To survive drying tardigrades rely on intrinsically disordered CAHS proteins, which also function to prevent perturbations induced by drying in vitro and in heterologous systems. CAHS proteins have been shown to form gels both in vitro and in vivo, which has been speculated to be linked to their protective capacity. However, the sequence features and mechanisms underlying gel formation and the necessity of gelation for protection have not been demonstrated. Here we report a mechanism of fibrillization and gelation for CAHS D similar to that of intermediate filament assembly. We show that in vitro, gelation restricts molecular motion, immobilizing and protecting labile material from the harmful effects of drying. In vivo, we observe that CAHS D forms fibrillar networks during osmotic stress. Fibrillar networking of CAHS D improves survival of osmotically shocked cells. We observe two emergent properties associated with fibrillization; (i) prevention of cell volume change and (ii) reduction of metabolic activity during osmotic shock. We find that there is no significant correlation between maintenance of cell volume and survival, while there is a significant correlation between reduced metabolism and survival. Importantly, CAHS D's fibrillar network formation is reversible and metabolic rates return to control levels after CAHS fibers are resolved. This work provides insights into how tardigrades induce reversible biostasis through the self-assembly of labile CAHS gels.

An Exploratory Study of Acculturation and Reproductive Health Among Haitian and Haitian-American Women in Little Haiti, South Florida.

There is unmet contraceptive need among Haitian immigrants and Haitian-American women (Haitian women). The study explored associations of three measures of acculturation with contraceptive/reproductive health history among Haitian women residing in the Little Haiti community of Miami. This was a cross-sectional, exploratory study among 57 Haitian women. We conducted descriptive univariate analyses, then bivariate analyses to investigate the association of acculturation with reproductive health risk behavior including contraceptive use, tampon use, and parity, as well as interest in a female-initiated barrier contraceptive method. The most commonly ever-used contraceptive methods were male condoms (78.9 %) and oral contraceptives (OC 19.3 %). Women who primarily spoke Créole at home were less likely than those who did not to use OC (11.9 vs. 42.9 %, p = .01). Among women who resided in the U.S. ≥10 years, tampon use was 51.9 % compared to 16.7 % among those who were in the U.S. for less time (p = .005). Among U.S. born women, 60 % were tampon users compared to 22.7 % among those born in Haiti (p = .05). Women not speaking primarily Créole at home (p = .06) and those born in U.S. (p = .008) had fewer children. Contraceptive use was low among Haitian women but influenced by acculturation, where greater acculturation was associated with protective reproductive health behavior. Despite traditional norms discouraging contraceptive use, and little experience with female barriers, Haitian women indicated an interest in learning about and using a female-initiated barrier contraceptive. Increasing contraceptive uptake of potential multipurpose technologies is a potential point of intervention for decreasing HIV/STI transmission in this at-risk population.

Post-immigration Changes in Social Capital and Substance Use Among Recent Latino Immigrants in South Florida: Differences by Documentation Status.

Changing social capital among recent Latino immigrants (RLIs) influences substance use post-immigration. This was a longitudinal study of 476 South/Central American RLIs examining social capital and substance use changes pre to post-immigration. Self-reported measures of social capital and substance use were compared between surveys administered within 1 year of immigration and 2 years post-immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased. Women were less likely to engage in hazardous drinking [adjusted odds ratio (AOR) .32, p < .001], and less likely to use illicit drugs (AOR .67, p = .01). Documented individuals with higher levels of 'business' social capital had increased odds of illicit drug use (AOR 2.20, p < .05). Undocumented individuals with higher levels of 'friend and others' social capital had decreased risk for hazardous drinking and illicit drug use (AOR .55, p < .01; AOR .56, p < .05). Documentation status moderated the relationship between social capital and substance use. RLIs can be targeted for primary prevention of substance abuse.

A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce the risk of sexually transmitted diseases in women.

INTRODUCTION: Effective public health interventions to reduce the incidence of sexually transmitted disease (STD), including HIV, among women are urgently needed. METHODS: A randomized trial among STD clinic patients of two types of counseling regarding methods to reduce disease transmission: a 'hierarchical' message (HP), with counseling on male condoms, female condoms, diaphragms, cervical caps, and spermicides (three formulations) and a single method message (SM) covering male condoms only or female condoms only. For this analysis, 1591 subjects received one of three educational messages at the central public STD clinic in Philadelphia. Disease incidence data for up to 6 months following the index visit were extracted from the clinic's electronic database. The primary outcome was STD reinfection: laboratory-confirmed trichomonas infection and/or clinical diagnoses of at least one of four STD. Rates were based on the full sample of randomized women (full sample) and on the subset who spontaneously returned between 22 days and 183 days following their initial visit (returners). RESULTS: Rates of trichomonas infection (SM 2.5% full sample and 12.9% returners versus HP 2.4% full sample and 11.5% returners) and clinical diagnoses (SM 6.3% full sample and 39.7% returners versus HP 6.9% full sample and 41.2% returners) did not differ across the two arms of the randomized trial, both as a straight percentage and in survival analysis (P = .81). CONCLUSION: At least in this single-session intervention trial, increasing choices in protection for women did not produce a change in disease risk compared with single-method approaches.

CA 125 levels in menopausal women.

To assess the use of CA 125 as a potential screening test for ovarian cancer, it is necessary to understand how the test performs among cancer-free women, who would constitute the overwhelming majority of those being tested at any time. Two hundred fifty-eight menopausal volunteers who were not seeking gynecologic care had CA 125 measured on two occasions and also underwent transvaginal ultrasonography to measure ovarian volumes. Only one subject had a CA 125 level greater than 35 U/mL. The mean value for CA 125 was 5.6 +/- 3.5 U/mL. Within women, the correlation between two tests was very high (r = 0.82). Among women with apparently normal ovaries, CA 125 values were low, tightly distributed, and reproducible; these findings indicate that the test may prove to be useful and cost-effective in a screening program. The correlation between CA 125 values and ovarian volume determined by sonogram was low (r = 0.11). The independence of these two tests would also be desirable in any screening program. Other studies have found normal women to have higher levels of CA 125 with wider distributions than found here; further evaluation of test performance at these low levels is needed.

The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia.

STUDY OBJECTIVE: Administrative databases from the City of Philadelphia that track public shelter utilisation (n=44 337) and AIDS case reporting (n=7749) were merged to identify rates and risk factors for co-occurring homelessness and AIDS. DESIGN: Multiple decrement life tables analyses were conducted, and logistic regression analyses used to identify risk factors associated with AIDS among the homeless, and homelessness among people with AIDS. SETTING: City of Philadelphia, Pennsylvania, USA. MAIN RESULTS: People admitted to public shelters had a three year rate of subsequent AIDS diagnosis of 1.8 per 100 person years; nine times the rate for the general population of Philadelphia. Logistic regression results show that substance abuse history (OR = 3.14), male gender (OR = 2.05), and a history of serious mental disorder (OR = 1.62) were significantly related to the risk for AIDS diagnosis among shelter users. Among people with AIDS, results show a three year rate of subsequent shelter admission of 6.9 per 100 person years, and a three year rate of prior shelter admission of 9%, three times the three year rate of shelter admission for the general population. Logistic regression results show that intravenous drug user history (OR = 3.14); no private insurance (OR = 2.93); black race (OR = 2.82); pulmonary or extra-pulmonary TB (OR = 1.43); and pneumocystis pneumonia (OR = 0.56) were all related to the risk for shelter admission. CONCLUSIONS: Homelessness prevention programmes should target people with HIV risk factors, and HIV prevention programmes should be targeted to homeless persons, as these populations have significant intersection. Reasons and implications for this intersection are discussed.

Acceptability of a new intravaginal barrier contraceptive device (Femcap).

A comprehensive questionnaire to assess acceptability was sent to 106 participants (and their partners) in a study on the safety and effectiveness of the Femcap. Participants were asked to rate their satisfaction with various aspects of the method, and were also asked about complaints such as vaginal infections, urinary tract infections, or other irritation. Eighty-one percent of the study sample either returned the mailed questionnaires or completed telephone interviews. Results were encouraging in that none of the study subjects or their partners reported any discomfort, trauma, or interference in sexual spontaneity with the cap. Vaginal irritation and infections were infrequently reported. The feature best liked by most participants was the absence of hormones associated with the method; the feature least liked was removal of the device. The Femcap may be an acceptable alternative to currently available barrier contraceptive devices.

PIP: 86 (81%) of 106 women participating in a study of the barrier contraceptive Femcap answered a mailed questionnaire or completed a telephone interview about acceptability of the device. The Femcap is a silicone rubber rim and brim that covers both the cervix and a portion of the vagina, which is used with spermicide, self-inserted, and worn for a minimum of 8 hours after intercourse, or a maximum of 48 hours. The study of subjects were 18-40 years old, and were self-selected in that they entered the study because they either had intolerable side effects from or were dissatisfied with other contraceptive methods, or could not be fitted with a Prentif cervical cap. For the study the women demonstrated proficiency in inserting the device, and were followed every 3 months. 57% of the women used the Femcap for 12 cycles or more. 74% continued using it after 1 year. Reasons for discontinuing this method included desire to conceive, loss of sexual partner, and dislike of insertion and removal. Total women-months accumulated were 1300. Only 3 complained of side effects such as urinary tract infections or vaginal problems. The most liked features of the Femcap were absence of hormones (80%), lack of side effects, perceived contraceptive effectiveness, and control by the woman. The most disliked features were difficulty in removing the Femcap, irritation from spermicide, and the mechanics of insertion and removal. The Femcap is an attractive alternative barrier method because of its ready fit, lack of urinary tract infection side effects, and user-friendly teaching booklet and videotape.

The Prentif cervical cap and Pap smear results: a critical appraisal.

An analysis from a randomized study has suggested that a larger percentage of Class III Pap smears appears among Prentif cervical cap users three months after initiation of use of the method than among diaphragm users. This suggestion has been the basis of a U.S. Food and Drug Administration (FDA) requirement that women seeking to use the cap have Pap smears taken before initiating use and again after three months of use. The data from the pivotal randomized study are reanalyzed here. No significant differences exist in the distributions of smears between cap and diaphragm users at three months or throughout the first year. The majority of cap users with "Class III" smears at three months did not have even mild dysplasia when subsequently evaluated by biopsy or colposcopy. This was also the case for diaphragm users classified as having grade III smears at three months. Other studies of the Prentif cap have not found conversions to Class III smears at one year. The requirement of a 3-month Pap smear is not only economically burdensome to potential users of the cap but appears to be without firm foundation in the original data or in our current views of cervical carcinogenesis.

High-risk adolescents and female condoms: knowledge, attitudes, and use patterns.

PURPOSE: To explore data on high-risk male and female adolescents' attitudes towards female condoms, compared with male condoms. METHODS: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms' construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized. RESULTS: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half 'good' and 24% 'bad' things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents' female condom use were not having female condoms available and/or females feeling uncomfortable inserting them. CONCLUSIONS: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.

PIP: The aim of this study was to explore data on high-risk male and female adolescents' attitudes towards the female condom as compared with the male condom. Exploratory survey research was utilized with convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre- and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small-group sessions, discussing the female condom's construction; purpose of the rings; its efficacy in preventing pregnancy and sexually transmitted infections; and how to lubricate, insert, and use it. Content and Chi-square analyses were utilized. 63% used the male condom as their primary contraceptive method; almost half (48%) said they always used a male condom, but 44% reported having sex without using one at least once in the 2 weeks prior to the pre-test. 95% had heard of the female condom (half had heard "good" things and 24% had heard "bad" things), but only 15% had ever used one. At post-test all respondents gave reasons they might use a female condom in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male condom to the female condom. The major potential barriers to adolescents' female condom use were not having a female condom available and/or females feeling uncomfortable inserting them. The female condom should be offered to adolescents as an additional choice rather than as a replacement for the male condom. Further research is needed to assure access to, availability of, and comfort with the female condom and male participation in its use.

Connections between AIDS and homelessness.

Although the links between health and environment are well known, interventions that target these associations in order to improve health are rare. Health and social service agencies often function independently of one another, maintaining separate, unlinked databases. For example, relationships among homelessness, AIDS, and tuberculosis have been noted, but services have not focused on the intersecting populations these conditions affect. This Issue Brief summarizes efforts to merge databases and provide policymakers with information to guide housing, social service, and health care resources. The investigators identify risk factors associated with AIDS among the homeless, and homelessness among people with AIDS.

The female condom: tool for women's empowerment.

International and US experience with the female condom has shown that the device empowers diverse populations of women, helping them negotiate protection with their partners, promoting healthy behaviors, and increasing self-efficacy and sexual confidence and autonomy. This commentary reflects on some approaches that have been taken to study empowerment and makes several observations on the political and scientific initiatives needed to capitalize on this empowerment potential. Women's interest in the female condom indicates a need for more women's barrier methods to be made available. For some women, cultural proscriptions against touching the genitals may create initial hesitancy in trying these methods. But the disposition of regulatory agencies and the attitudes of health care providers has unfortunately exaggerated this reticence, thereby effectively reducing access to these methods. Also, lack of important detail in clinical studies restricts our capacity to introduce the female condom, or similar methods, under optimal conditions. Future trials should prioritize community-based designs and address a range of other critical health and social issues for women. Women's need for HIV/AIDS prevention technologies remains an urgent priority. Both political and scientific efforts are needed to realize the public health potential embodied in the female condom.

The female condom: STD protection in the hands of women.

PIP: In 1993, the US Food and Drug Administration (FDA) approved the female condom Reality. It provides better protection against sexually transmitted diseases (STDs) than does the male condom. The polyurethane sheath is more resistant to tears and covers the vagina, cervix, and vulva. Since it does not depend on erection of the penis, the female condom protects women from STDs/HIV that can be transmitted through the pre-ejaculate. In light of the AIDS epidemic, FDA approved the female condom based on its contraceptive effectiveness rather than on its ability to protect against STDs. Annual contraceptive failure rates for Reality range 5-21%, which match those of other barrier methods for women and men. Incorrect or inconsistent use affects its contraceptive effectiveness. The female condom prevents passage of virus particles as small as the hepatitis B virus which is smaller than HIV. In a study, all women who correctly and consistently used Reality were protected from Trichomonas vaginalis, while sporadic users were not protected. Currently, less than 20% of US couples use male condoms, indicating a need for women to have options to protect their reproductive and genital health. The female condom provides women such an option since women are in total control of its use. Women with partners who do not want to use a male condom maintain that Reality will revolutionize sexual dynamics. Its visibility does not help women with violent partners, however. Educational efforts about all methods that can be used without men's knowledge need to reach these women. Family planning providers need to shed the old concept of women as incompetent users and set up counseling programs that promote women's methods. They should accept and provide the female condom. Basic sexual education and constant provider support and encouragement are crucial.^ieng

Human rights is a US problem, too: the case of women and HIV.

Overall, US AIDS incidence and mortality have shown significant declines since 1996, probably because of new antiviral therapies. For women, however, these benefits have been much less pronounced than for men. At the heart of women's HIV risk is gender-based discrimination, which keeps women, and especially women of color, poor and dependent. Although human rights issues are often linked with AIDS issues abroad, in the US they receive insufficient attention in our response to women's HIV risk. Advocacy from public health professionals is needed to overcome the longstanding paternalistic attitudes of federal agencies toward women and to change the paradigm of women's HIV/AIDS prevention and care. Examples of unjust and punitive social policies that may affect women's HIV risk include the 1996 welfare policy legislation, drug treatment policies for women, and women's access to medical research and technology. The overriding public health response to AIDS consists of behavioral interventions aimed at the individual. But this approach will not successfully address the issues of women with AIDS until efforts are made to eliminate society's unjust and unhealthy laws, policies, and practicles.

Women need HIV prevention approaches that maximize choice.

PIP: The Philadelphia Women's Health Sister Studies examined protective options against HIV and sexually transmitted diseases with women. A total of 292 women participating in the study were subdivided into a male condom arm, a female condom arm, and a hierarchy arm. Findings showed that the percentage of women retained in the study was poorest for the single message arm; about 51% for the female condom arm, 58% for the male condom arm, and 75% for the hierarchy arm. Moreover, most women were satisfied using the female condom. Well-liked aspects were high level of protection, natural feel, and female control; dislikes were related to insertion, appearance, and the inner ring. This study has important implications for women's prevention interventions.^ieng

Commentary: methods women can use that may prevent sexually transmitted disease, including HIV.

Although sexually transmitted diseases, including human immunodeficiency virus (HIV), are a major concern for women, few prevention messages are targeted specifically to women. Those that are generally stress abstaining, altering the number or selection of partners, and urging partners to use condoms. But these behaviors may be unrealistic for many women, particularly women who are at highest risk for sexually transmitted diseases, because they require significant changes in life-style or depend on male-controlled condom use. Recommendation of contraceptives for prevention of sexually transmitted diseases depends largely on how well specific methods perform under controlled conditions, either in the laboratory or in clinical trials. Observational studies, which better reflect day-to-day use, indicate that condoms, barriers, and spermicides, used properly and consistently, can provide substantial protection against various sexually transmitted diseases. Condoms can similarly help protect against HIV, but studies of barriers and spermicides are scant and currently inconclusive. Finally, those methods that are controlled by women are consistently more effective in preventing sexually transmitted diseases. Thus, although condoms used well are still the best choice, the imperative for female-controlled methods indicates that diaphragms and spermicides should receive greater emphasis in prevention messages.

Regulation by heme of the synthesis of cytochrome C oxidase subunits V and VII in yeast.

The effects of heme on the synthesis of subunits V and VII of cytochrome c oxidase were examined in the heme-deficient yeast mutant, GL1. In vitro translation and immunodetection with subunit-specific antisera indicated a 50% decrease in both proteins, with RNA obtained from hemeless cells. Unsupplemented, pulse-labeled cells contained both V and VII polypeptides, but at extremely low levels as compared with those found in delta-aminolevulinic acid-supplemented cells. The data suggest that heme controls the formation of mRNAs for the two subunits, and may also have a regulatory role in translation and in the stability of the polypeptides.

Commentary: the new female condom--item 1 on a women's AIDS prevention agenda.

A US Food and Drug Administration (FDA) advisory panel has recommended that the female condom Reality be approved for contraception and acquired immunodeficiency syndrome (AIDS) prevention. Final FDA approval will mark the first official recognition of a woman-controlled method for protection against sexually transmitted disease. A female condom allows women to use just one method to respond to the twin anxieties of AIDS and unwanted pregnancy. In those couples in which the man refuses to wear a male condom, the availability of a female condom makes protection possible for the first time. Although the female condom has some advantages over the male condom--greater comfort for some women and men and nonreliance on male arousal--general population experience with the device is needed to achieve regular widespread use and hence effectiveness at population levels. The FDA still lags behind in responding to women's needs for information on AIDS and sexually transmitted disease.

Regulation of mucin gene expression in secretory epithelial cells.

To gain insight into the regulation of mucin biosynthesis and secretion at a molecular level, we studied the expression of four mucin genes in several secretory cell types. Oligonucleotide probes for MUC1, MUC2, MUC3, and MUC4 were used in Northern blot analysis of total RNA from the cells. It was shown that MUC4 was constitutively expressed in the endometrial cell line (Ishikawa), which we use as a model system for studying airway mucin. Expression was enhanced by secretagogues. Cultured bronchial epithelial cells gave identical results. MUC1, MUC2, and MUC3 were not detected in either cell system. Secretory phase endometrial tissues also expressed only MUC4, but proliferative tissues expressed both MUC4 and MUC1. The data indicate that the mucin genes are differentially expressed in various cells and suggest a possible regulatory role for steroid hormones.

Short-term acceptability of the female condom among staff and patients at a New York City Hospital.

An acceptability study of the female condom undertaken at New York's Harlem Hospital between August 1993 and February 1994 enrolled 52 women aged 18-57, 41 of whom (79%) used the female condom at least once. Of these, one-half used the female condom at least three times and 40% used it once; on average, women used it 2.4 times. Two-thirds of users liked the female condom either very much or somewhat, 20% were neutral and 15% stated that they did not like it. One-half of the women reported that their partner liked the device, while 17% said he felt neutral about it and approximately one-quarter said he disliked it. Seventy-three percent of respondents and 44% of their partners preferred the female condom to the male condom.

PIP: To facilitate integration of the female condom into family planning programs, a survey focused on the acceptability of this method was conducted among staff and patients at New York City's Harlem Hospital in 1993-94. The 52 study participants ranged in age from 18-57 years (mean age, 35 years); 87% were Black and 63% were single. At study entry, 39% of subjects reported that their partner always used a condom; 73% had previous experience with a female barrier method, primarily foam (35%) and the diaphragm (31%). Only 41 women actually used the female condom; the remaining 11 women were not sexually active during the six-month study period or were lost to follow-up. The number of times the female condom was used ranged from 1 to 8, with a mean of 2.4 times. Mean scores on a Likert-type scale that ranged from 0 (most positive) to 5 (most negative) were 1.1 for general reaction to the method, 1.2 for ease of insertion, 0.3 for ease of removal, and 0.7 for partner's opinion. Women who used the female condom more than once rated the device more positively than those who used it only once. When asked to identify positive attributes of the female condom, 50% cited its protectiveness, 31% approved of the soft and nondrying texture, and 19% appreciated having control over their own protection without a need for partner negotiation. On the other hand, several women experienced technical problems, including penile misrouting (15%), inadvertent removal when the penis was withdrawn (17%), and pushing of the outer ring into the vagina during intercourse (22%). 73% of female respondents and 44% of their partners preferred the female to the male condom. Overall, these findings indicate that the female condom--the only device to enable women to protect themselves from sexually transmitted diseases--is highly acceptable and increases women's confidence.