Masking for COVID-19 and other respiratory viral infections: implications of the available evidence.

The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.

The Limits of Professional Identity: A Lesson From My Grandfather.

My grandfather was a prominent Jewish physician in Nazi Germany who escaped the Holocaust with his family but nevertheless came to a tragic end. As I, an American family physician, learned more about him, I was surprised by how much I identified with him. I was struck by how his success in his career had not been matched in other areas of his life, leaving him little to fall back on when his professional status was taken away. My grandfather's story has given me insights about him, my family, and myself and has taught me important lessons about the balance between professional and personal life.

Risk factors for delayed intrauterine device removal among menopausal women in rural China.

OBJECTIVE: More women in China have received intrauterine devices (IUDs) than in the rest of the world combined. Recent reports have recognized a growing problem of delayed removal of these IUDs after menopause, especially in rural China, but few studies have examined women's knowledge and other risk factors for delayed removal. METHODS: A total of 1,014 perimenopausal and postmenopausal women aged 45 to 64 years participating in a pilot program providing free IUD removal in rural China completed a questionnaire. We examined their knowledge about when IUDs should be removed and other demographic and reproductive health characteristics and the association of these factors with whether their IUD removal was on time or delayed using bivariate contingency analysis and multivariate logistic regression. RESULTS: A total of 40.2% of women were having their IUDs removed more than 2 years after menopause, and 67.9% did not know the correct time for IUD removal. Women who were older, less educated, had one child, had their IUD placed in a rural facility, and with no gynecological examination in the past 2 years were less likely to know when an IUD should be removed. In multivariate analysis, knowledge, the facility where the IUD was placed, and a recent gynecological examination were independent predictors of on-time removal. At least 170 women had received a gynecological examination after menopause without the IUD being removed at that time. CONCLUSIONS: Lack of knowledge about timing for IUD removal and structural barriers in health service organization must be addressed to improve care for millions of women with IUDs in rural China.

Revisiting COVID-19 policies: 10 evidence-based recommendations for where to go from here.

BACKGROUND: Strategies to control coronavirus 2019 disease (COVID-19) have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Yet knowledge about COVID-19 has grown exponentially, and the expanding rollout of vaccines presents further opportunity to reassess the response to the pandemic more broadly. MAIN TEXT: We review the latest evidence concerning 10 key COVID-19 policy and strategic areas, specifically addressing: 1) the expansion of equitable vaccine distribution, 2) the need to ease restrictions as hospitalization and mortality rates eventually fall, 3) the advantages of emphasizing educational and harm reduction approaches over coercive and punitive measures, 4) the need to encourage outdoor activities, 5) the imperative to reopen schools, 6) the far-reaching and long-term economic and psychosocial consequences of sustained lockdowns, 7) the excessive focus on surface disinfection and other ineffective measures, 8) the importance of reassessing testing policies and practices, 9) the need for increasing access to outpatient therapies and prophylactics, and 10) the necessity to better prepare for future pandemics. CONCLUSIONS: While remarkably effective vaccines have engendered great hope, some widely held assumptions underlying current policy approaches call for an evidence-based reassessment. COVID-19 will require ongoing mitigation for the foreseeable future as it transforms from a pandemic into an endemic infection, but maintaining a constant state of emergency is not viable. A more realistic public health approach is to adjust current mitigation goals to be more data-driven and to minimize unintended harms associated with unfocused or ineffective control efforts. Based on the latest evidence, we therefore present recommendations for refining 10 key policy areas, and for applying lessons learned from COVID-19 to prevent and prepare for future pandemics.

Contraception and abortion among migrant women in Changzhou, China.

OBJECTIVES: Migrant women in China's industrial cities face particular contraceptive challenges, which have changed in recent years as family planning policy has shifted. Little is known about recent trends in contraception and abortion among China's large internal migrant population. We conducted a survey to examine these issues among factory workers in a large Chinese city. METHODS: Married migrant women (N = 801) aged 20-39 years and working in Changzhou, China, completed an anonymous self-administered questionnaire giving details about their sociodemographic background, work and migration situations, and reproductive health. RESULTS: Current contraceptive use was reported by 86.6% of women. Condoms, which have largely replaced longer acting contraceptive methods in this population in recent years, were being used by 54.9% of contraceptive users. Only 41.2% used a longer acting method, mostly an intrauterine device (IUD). A lifetime history of abortion was reported by 40.4%. In the past year, 5.5% had had an unintended pregnancy and 5.2% had had an induced abortion. Older age, lower level of education, lower income, area of origin and husband's residency were associated with IUD use. Lower income, husband's residency and stronger fertility desire were associated with recent unintended pregnancy. CONCLUSION: The results of the study provide evidence that migrant women in China are relying more than ever on less effective methods of contraception. Unintended pregnancy and abortion are common. China's current informed choice model needs to be improved with the provision of better health education before and after migration and easy access to health and reproductive health care services.

Assessment of an HIV-prevention intervention for couples in peri-urban Uganda: pervasive challenges to relationship quality also challenge intervention effectiveness.

Reducing multiple and concurrent partnerships has been identified as a priority in generalised HIV epidemics, yet developing successful interventions to bring about such behaviour change has proven challenging. We offered a three-session intervention aimed to improve couple relationship quality and address HIV risk factors, particularly concurrent sexual partnerships (CSP), in a peri-urban community of Kampala, Uganda. Before launching the intervention, a different group of community members participated in eight single-gender focus group discussions (FGDs) which explored issues of couple relationship quality and satisfaction. Findings from the FGDs guided the intervention. All 162 couples invited to the intervention completed a survey pre- and post-intervention. In FGDs, women and men discussed challenges faced in their relationships, including pervasive dissatisfaction, financial constraints, deception and lack of trust, poor communication, lack of sexual satisfaction, and concurrent sexual partnerships. A difference-in-difference analysis showed no measurable impact of the intervention on relationship quality or sexual risk behaviours over a six-month follow-up among 183 individuals who participated in the intervention, although many stated in response to open-ended questions that they had experienced positive relationship changes. Qualitative findings suggest high demand for couple-focused interventions but also reveal many individual-, couple-, community- and structural-level factors which contribute to women and men seeking concurrent sexual partnerships. More intensive interventions may be needed to overcome these barriers to behaviour change and reduce HIV risk. These findings also raise questions about how to interpret divergent qualitative and quantitative data, a topic which has received little attention in the literature.

Prenatal care among rural to urban migrant women in China.

BACKGROUND: There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants. METHODS: 5372 married rural to urban migrant women aged 20-34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits. RESULTS: 12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care. CONCLUSIONS: Many internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.

Risk Behaviors and Perceptions Among Self-identified Men Who Have Sex with Men (MSM), Bisexuals, Transvestites, and Transgender Women in Western Guatemala.

Guatemala has a concentrated HIV epidemic disproportionately affecting men who have sex with men (MSM) and transgender women. We recruited 205 self-identified MSM, bisexuals, transvestites, and transgender women in western Guatemala using long-chain peer referral, wherein "seed" participants were asked to invite as many as three acquaintances to participate in the study. Self-reported sexual or gender identity was MSM, 46%; bisexual, 28%; transvestite, 21%, and transgender woman, 5%. Median age of the participants was 23 years, and 36% self-identified as being indigenous. Indigenous persons were more likely to self-identity as transvestite (32.9% vs 13.8%, P = 0.04), strongly perceive themselves at risk for HIV (87.7% vs 51.5%, P = 0.001), have had an HIV test in the last 12 months and know the result (97.3% vs 85.4%, P = 0.008), and experience barriers to testing and treatment (86.3% vs 67.7%, P = 0.004). HIV prevention services for indigenous MSM should especially target transvestites and how to overcome stigmatization and barriers to care.

Validation, reliability and operational equivalency of the nutritional screening method "Determine The Nutritional Health Of The Elderly" / Validação, confiabilidade e equivalência operacional do método de triagem nutricional "Verifique a condição nutricional do idoso"

Objective: To analyze the reliability, validity and operational equivalence of the nutritional screening method "Assessing The Nutritional Condition Of The Elderly". Method: This study was conducted with a subsample of 174 elderly persons from the Health, Welfare and Aging (SABE) study. The "Assessing The Nutritional Condition Of The Elderly" method consists of ten questions which classify individuals according to nutritional risk. Anthropometric and nutritional indicators were adopted as gold standard measures for comparison with the values of the method. Reliability was verified using the McNemar and Bland Altman tests, the validity of the discriminant type was assessed by the Mann-Whitney test and operational equivalence was identified through data relating to the time required to apply the method and the degree of understanding of the same using the Likert scale (1 to 5). Results: Of the 174 elderly persons interviewed, 63.8% were women and 52.3% were in the 60-74 years age group. It was found that 43.1% and 33.3% of the subjects had moderate to high nutritional risk, respectively, with a higher prevalence of high nutritional risk among women (33.3%) and those aged 60-74 years (43.4%). The method analyzed showed satisfactory results for reliability and discriminant validity. The average time required to apply this method was approximately seven minutes and the overall mean grade of understanding was 4.8. Conclusion: The method studied can be used by health professionals in epidemiological and clinical studies to identify the presence of nutritional risk in elderly persons living at home.

Objetivo: Analisar a confiablidade, a validade e a equivalência operacional do método de triagem nutricional "Verifique a condição nutricional do idoso". Método: Este estudo foi realizado com subamostra de 174 idosos do Estudo Saúde, Bem-estar e Envelhecimento (SABE). O método "Verifique a condição nutricional do idoso", consiste de 10 perguntas, que classifica os indivíduos, segundo risco nutricional. Adotou-se a antropometria e indicadores nutricionais, como medidas padrão-ouro para comparação com os valores desse método. A confiabilidade foi verificada pelo teste de McNemar e gráficos de Bland Altman, a validade do tipo discriminante foi avaliada por meio do teste Mann-Whitney e a equivalência operacional do método foi identificada pelos dados referentes à duração de realização do método e pelo grau de entendimento do mesmo pela escala Likert (entre 1 e 5). Resultados: Dos 174 idosos entrevistados, 63,8% eram mulheres e 52,3% eram do grupo etário de 60 a 74 anos. Constatou-se que 43,1% e 33,3% dos indivíduos apresentavam risco nutricional moderado e alto, respectivamente, sendo maior a prevalência de risco nutricional alto nas mulheres (33,3%) e naqueles do grupo de 60 a 74 anos (43,4%). O método analisado apresentou resultados satisfatórios para confiabilidade e validade discriminante. A duração média de realização do método foi de aproximadamente sete minutos e nota média geral de entendimento foi de 4,8. Conclusão: O método estudado pode ser utilizado em estudos epidemiológicos e clínicos, por profissionais de saúde, para identificar a presença de risco nutricional em idosos domiciliados.

Couple Relationship Functioning as a Source or Mitigator of HIV Risk: Associations Between Relationship Quality and Sexual Risk Behavior in Peri-urban Uganda.

Despite evidence that a greater focus on couples could strengthen HIV prevention efforts, little health-related research has explored relationship functioning and relationship quality among couples in Africa. Using data from 162 couples (324 individuals) resident in a peri-urban Ugandan community, we assessed actor and partner effects of sexual risk behaviors on relationship quality, using psychometric measures of dyadic adjustment, sexual satisfaction, commitment, intimacy, and communication. For women and men, poor relationship quality was associated with having concurrent sexual partners and suspecting that one's partner had concurrent sexual partners (actor effects). Women's poor relationship quality was also associated with men's sexual risk behaviors (partner effects), although the inverse partner effect was not observed. These findings suggest that relationship quality is linked to HIV risk, particularly through the pathway of concurrent sexual partnerships, and that positive relationship attributes such as sexual satisfaction, intimacy, and constructive communication can help couples to avoid risk.

Migration Experiences and Reported Sexual Behavior Among Young, Unmarried Female Migrants in Changzhou, China.

BACKGROUND: China has a large migrant population, including many young unmarried women. Little is known about their sexual behavior, contraceptive use, and risk of unintended pregnancy. METHODS: 475 unmarried female migrants aged 15-24, working in 1 of 6 factories in 2 districts of Changzhou city, completed an anonymous self-administered questionnaire in May 2012 on demographic characteristics, work and living situation, and health. We examined demographic and migration experience predictors of sexual and contraceptive behavior using bivariate and multivariate regressions. RESULTS: 30.1% of the respondents were sexually experienced, with the average age at first sex of 19 years (standard deviation=3). 37.8% reported using contraception at first sex, 58.0% reported using consistent contraception during the past year, and 28.0% reported having at least 1 unintended pregnancy with all unintended pregnancies resulting in abortion. Those who had had at least 1 abortion reported having on average 1.6 abortions [SD=1] in total. Migrating with a boyfriend and changing jobs fewer times were associated with being sexually experienced. Younger age, less education, and changing jobs more times were associated with inconsistent contraceptive use. CONCLUSION: These findings demonstrate there is an unmet need for reproductive health education and services where these women work as well as in their hometown communities. This education must begin early to reach young women before they migrate.

Adaptação transcultural para o idioma português do método de triagem nutricional Determine your nutritional health®para idosos domiciliados / Cross-cultural adaptation to the Portuguese language of the Determine Your Nutritional Health® screening method for the elderly in assisted living accommodation

Resumo O objetivo deste artigo é descrever o processo de adaptação transcultural do método de triagem nutricional, Determine Your Nutritional Health® (DNH), para utilização na população idosa brasileira. O DNH consiste de 10 questões com enunciados afirmativos, às quais são atribuídas pontuações específicas e cuja soma corresponde ao escore final, que classifica os indivíduos de acordo com a presença ou a ausência de risco nutricional. O processo de adaptação transcultural do método DNH envolveu as seguintes etapas: tradução; retrotradução; equivalência semântica; avaliação dos especialistas; pré-teste e versão final do método. Foram realizadas adaptações de palavras e expressões do método DNH, para a realidade brasileira. A versão final do método foi definida para o Brasil como "Verifique a condição nutricional do idoso", apresentando as mesmas questões da versão original do DNH, contudo, em formato mais claro, por meio de perguntas, consideradas acessíveis e de fácil entendimento, segundo a avaliação de profissionais de saúde e de idosos. A versão brasileira do método de triagem nutricional, "Verifique a condição nutricional do idoso", encontra-se traduzida e adaptada para uso em idosos brasileiros domiciliados.

Abstract This article aims to describe the process of cross-cultural adaptation of the Determine Your Nutritional Health® (DNH) screening method for the elderly Brazilian population. The DNH consists of 10 questions with affirmative statements, to which specific scores are assigned and when added up correspond to the final score, which classifies individuals according to the presence or absence of nutritional risk. The process of cross-cultural adaptation of the DNH method involved the following stages: translation; back translation; semantic equivalence; evaluation by the experts; pre-test and final version of the method. Adjustments were made in words and expressions of the DNH method for the Brazilian reality. The final version of the method has been defined for Brazil as "Verify the nutritional conditions of the elderly," presenting the same questions as in the original version of the DNH. It was in a clearer format, through questions, considered accessible and easy to understand, according to the assessment of health professionals and the elderly. The Brazilian version of the nutritional screening method, "Verify nutritional conditions of the elderly," was translated and adapted, for use in Brazilian elderly in assisted living accommodation.

Sexual and reproductive healthcare utilization among women aged 40 to 49 in rural China.

OBJECTIVE: China's national family planning system is mainly directed toward women of early reproductive ages. Most studies of service provision focused on younger women, who almost all receive regular examinations. Little is known about service-seeking behavior among women of late reproductive ages. METHODS: This cross-sectional household survey interviewed 1,811 rural women aged 40 to 49 in seven provinces. We examined sexual and reproductive health, utilization of sexual and reproductive health services, and predictors of receiving a free gynecological examination in the past 2 years. RESULTS: Educational levels were not high, and most women were rural farmers or housewives. More than one-fourth had migrated for work to big cities when they were younger. The mean frequency of sex in the last month was 3.6 times. Approximately 22.7% of women had not received a gynecological examination and 31.2% had not received any health education during the past 2 years. The first choice for where to seek services was township medical facilities (58.4%). On multivariate regression, age, education, migrant working experience, awareness of the need for intrauterine device removal after menopause, health education received, and attitude toward health examinations were significantly associated with receiving a gynecological examination in the past 2 years. CONCLUSIONS: Women of late reproductive age in rural China are not receiving as regular care as younger women. This study identifies sociodemographic and health service correlates for service-seeking behavior, many of which are modifiable. Health services should pay greater attention to this group, including community-based efforts to encourage routine examinations and appropriate use of health services.

Health-related quality of life of among elders in rural China: the effect of widowhood.

PURPOSE: China has an enormous and rapidly growing population of widowed elders. Little is known about how losing a spouse affects elders' health-related quality of life (QOL), especially in the rural areas where most Chinese elders live. This article analyzes QOL data collected in 2014 among rural Chinese elders to address this question. METHODS: SF12 questionnaires and information about individual and household characteristics were collected from 3053 elders aged 60 and above in rural China. We compared the physical component summary (PCS) and mental component summary (MCS) scores between 1925 married elders and 1060 widowed elders in a bivariate model stratifying by gender and age group and in a general factorial ANOVA multivariate analysis that examined and controlled for other predictors of PCS and MCS scores including education, chronic disease, and family and household factors. RESULTS: Widowed male and female elders' physical health and mental health were in decline with age. Widowed men had lower PCS and MCS scores than married men. Widowed women also had lower PCS scores, but differences in MCS scores did not reach statistical significance. In multivariate analysis, widowhood was associated with lower PCS and MCS scores overall. Support from children was associated with better QOL and, based on interaction analysis, appeared to mitigate negative effects of widowhood. CONCLUSIONS: Widowed rural elders in China have lower physical and mental quality of life than their married counterparts. These elders rely on their children for care, and a supportive family is associated with better QOL.

Treating kleptomania: cross-cultural adaptation of the Kleptomania Symptom Assessment Scale and assessment of an outpatient program.

BACKGROUND: Kleptomania is characterized by repetitive stealing and has severe consequences for patients. Stigma, a lack of standardized therapy and a limited number of assessment tools hinder advances in treatment. This study provides preliminary data on the Portuguese-language version of the Kleptomania Symptom Assessment Scale (P-K-SAS) and preliminary data on an outpatient program. METHODS: Experts in the field analyzed an initial P-K-SAS version, produced through translation/back-translation, in order to arrive at a final version. Eight patients currently on cognitive-behavioral therapy (CBT) and 10 patients under maintenance CBT were initially assessed, then re-assessed 6months later. RESULTS: The mean P-K-SAS score was higher among patients initiating CBT than among those under maintenance CBT (21.1±8.0 vs. 11.3±7.5; Mann-Whitney U=15.0, P=.024). The final version of the P-K-SAS presented excellent reliability (Cronbach's alpha=0.980; inter-item correlation, 0.638-0.907). CONCLUSIONS: The P-K-SAS presented solid psychometrics and seems ready for use in assessing the effectiveness of treatments for kleptomania. The findings suggest that kleptomania patients need follow-up treatment that goes beyond the traditional 12-session structure.

Unmet sexual and reproductive health needs of women aged 50 to 64 years in rural China.

OBJECTIVE: China's family planning program focuses on younger women. Women older than 50 years, especially those in rural areas, are ineligible for free services and often have few other care options. Few studies have examined the sexual and reproductive health demands and unmet needs of these women. METHODS: This cross-sectional, interviewer-administered survey included 1,652 rural women aged 50 to 64 years from seven provinces in China. We examined women's sexual and reproductive health status, knowledge, and service demands, and whether they still had an intrauterine device (IUD). RESULTS: Educational levels were low, and most were rural farmers or housewives. The mean age at menopause was 48.9 years, and 52.4% reported climacteric symptoms. The mean frequency of sex in the last month was 1.8 times. About 47.4% of women had undergone a gynecological examination during the past 2 years. The first choice for care was family planning clinics (31.2%) followed by township hospitals (28.4%). Identified service needs included women's health check-ups (56.5%), sexual health knowledge (54.4%), women's health knowledge (35.4%), menopause counseling (34.8%), and IUD removal after menopause (17.0%). Among 519 postmenopausal women who used an IUD, 19.1% had not had it removed. On multivariate regression, awareness of correct time for IUD removal, beliefs about sex after menopause, receiving formal health education, and undergoing gynecological examination were significantly associated with having had IUD removal. CONCLUSIONS: A large proportion of middle-aged women in rural China lack sexual and reproductive health services, including IUD removal after menopause. A comprehensive program of sexual and reproductive health services is needed for middle-aged women in rural China.

Individual and household-level predictors of health related quality of life among middle-aged people in rural Mid-east China: a cross-sectional study.

BACKGROUND: China has an enormous and growing middle-aged population. Little is known about health-related quality of life (HRQOL) for this group, especially in rural areas. We examined HRQOL and its individual and household predictors among middle-aged people in rural Mid-east China. METHODS: HRQOL questionnaires and information about individual and household characteristics were collected from 428 subjects aged 45 to 65 in 12 villages in Mid-east China. We examined the eight dimensions of the SF-36 instrument, along with the Physical Component Summary (PCS) and Mental Component Summary (MCS) using a reference sample in Hong Kong for standardization. Individual and household predictors of PCS and MCS were examined by one-way ANOVA and binary logistic regression analysis. RESULTS: Self-reported HRQOL was similar to that seen in middle-aged populations elsewhere. Based on univariate analyses, PCS differed by age, education, occupation, household per capita income, drinking water supply, and frequency of household members caring about each other; MCS differed by education, household per capita income, drinking water supply, and frequency of caring about each other. Individual and household-level factors accounted for 12.5% and 8.2% of the variance in PCS, respectively, and for 3.1% and 10.7% of the variance in MCS. CONCLUSIONS: HRQOL among middle-aged people in rural China appears similar to that observed elsewhere, and varies by income, education, and other factors. Household factors, particularly the extent to which household members care about each other, are significant predictors of physical and mental health. In addition to improving general socioeconomic conditions, efforts to improve HRQOL for middle-aged people in rural China need to focus on the family environment.

Impact of integrating HIV and TB care and treatment in a regional tuberculosis hospital in rural Guatemala.

Resource-limited settings have made slow progress in integrating TB and HIV care for co-infected patients. We examined the impact of integrated TB/HIV care on clinical and survival outcomes in rural western Guatemala. Prospective data from 254 newly diagnosed TB/HIV patients (99 enrolled in the pre-integrated program from August 2005 to July 2006, and 155 enrolled in the integrated program from February 2008 to January 2009) showed no significant baseline differences between clients in the two periods. They were principally male (65.5 %), Mayan (71 %), median age 33 years, and CD4 count averaged 111 cells/mm³. TB/HIV co-infected patients were more likely to receive antiretroviral therapy in the integrated program than in the pre-integrated program (72 vs. 22 %, respectively) and had lower mortality (HR 0.22, 95 % CI 0.14­0.33). This study shows how using a TB setting as the entry point for integrated TB/HIV care can improve health outcomes for HIV-positive patients in rural Guatemala.

Risk of sexually transmitted infections among Mayan women in rural Guatemala whose partners are migrant workers.

HIV and sexually transmitted infection (STI) are of concern in Mayan districts of Guatemala in which labor migration is common. This study assessed whether the migration status of men is associated with reported STI symptoms among their female primary partners. In a multivariate analysis of survey data taken from a larger Mayan sexual health study, the odds of reporting STI symptoms were twofold higher among women who reported that their partner migrated (OR 2.08, 95 % CI, 1.16-3.71), compared to women whose partners did not. Women from the Mam and Kaqchikel ethnolinguistic groups reported higher rates of STI symptoms after adjustment for their partners' migration status.

Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies.

This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.