Rapid Ethnographic Assessment of HIV/AIDS among Garífuna Communities in Honduras: Informing HIV Surveillance among Garífuna Women

ABSTRACT

Garífuna, an Afro-Caribbean ethnic group in Honduras, have among the highest HIV prevalence rates in Central America; 15- to 49-year-old Garífuna have HIV rates comparable to heterosexual transmission rates in regions of sub-Saharan Africa. The heightened rates in this age range pose a significant risk of vertical transmission from woman to child at birth. In 2006, a Behavioral Surveillance Survey plus Biomarkers (BSS+) reexamined seroprevalence of HIV, sexually transmitted infections, and HIV-related risk behaviors among Garífuna to inform HIV prevention activities and monitor trends in HIV transmission over time. To inform the BSS+ survey protocol, we conducted a rapid ethnographic assessment (REA) in Garífuna communities to specifically examine acceptability among Garífuna to be surveyed, suggest ways to minimize HIV-testing related stigma, and determine female gender-specific concerns among BSS+ respondents. Data were collected in 2 weeks in November, 2004, using a semi-structured interview guide for key informant interviews and focus groups. Seventeen key informant interviews and three focus groups were conducted; participant observation and 11 site visits were also conducted. Major findings included high Garífuna acceptability to participate in the BSS+ with key member involvement and incentives. Maintaining confidentiality at HIV testing sites is required to minimize Garífuna women's risk of intimate partner violence. Recommendations to BSS+ partners from this REA informed the BSS+ study protocol and was expected to increase participation and validity and decrease potential risks associated with women's survey participation.     

Are Baby Boomers Richer Than Their Parents? Intergenerational Patterns of Wealth Ownership in the United States

This study compares wealth ownership and mobility patterns among baby boomers and their parents to explore whether the baby boomers have fared as well during their working years and whether they will be as secure in retirement as their parents. Cohort comparisons using survey data indicate that baby boomers had accumulated more wealth as young adults than their parents had at a similar age. Estimates from a simulation model reveal that baby boomers had more wealth than their actual same‐sex parents at every stage of the life course. The simulation model also reveals that baby boomers were considerably more likely than their actual same‐sex parents to experience upward wealth mobility at each point in the life course. These results suggest that speculations that baby boomers may be the first generation to do worse than their parents are misleading.     

The quest for a general theory of aging and longevity

Extensive studies of phenomena related to aging have produced many diverse findings, which require a general theoretical framework to be organized into a comprehensive body of knowledge. As demonstrated by the success of evolutionary theories of aging, quite general theoretical considerations can be very useful when applied to research on aging. In this theoretical study, we attempt to gain insight into aging by applying a general theory of systems failure known as reliability theory. Considerations of this theory lead to the following conclusions: (i) Redundancy is a concept of crucial importance for understanding aging, particularly the systemic nature of aging. Systems that are redundant in numbers of irreplaceable elements deteriorate (that is, age) over time, even if they are built of elements that do not themselves age. (ii) An apparent aging rate or expression of aging is higher for systems that have higher levels of redundancy. (iii) Redundancy exhaustion over the life course explains a number of observations about mortality, including mortality convergence at later life (when death rates are becoming relatively similar at advanced ages for different populations of the same species) as well as late-life mortality deceleration, leveling off, and mortality plateaus. (iv) Living organisms apparently contain a high load of initial damage from the early stages of development, and therefore their life span and aging patterns may be sensitive to early-life conditions that determine this initial damage load. Thus, the reliability theory provides a parsimonious explanation for many important aging-related phenomena and suggests a number of interesting testable predictions. We therefore suggest adding the reliability theory to the arsenal of methodological approaches applied to research on aging.     

The Uses and Abuses of Co-Therapy

The literature on co-therapy suggests increased interest in this treatment procedure. There is some agreement over advantages and disadvantages, but there is also confusion on indications and counter-indications. This paper summarizes the current use and abuse of co-therapy. The reported clinical experiences of several co-therapist teams, including spouse co-therapists, are also discussed. It appears that co-therapy will remain controversial until outcomes are rigorously measured and compared with the results of other therapeutic modalities in a standardized, acceptable way.     

论中国和东盟经济发展的文化动力

艺术和文化正日益成为区域竞争的重要工具之一。在中国和东盟经济合作发展过程中要注重发挥文化产业的推动力作用。文化产业的合作,可以从国家层面和地区层面争取主动,鼓励商业和文化共同体紧密互动,加强东盟各国和中国的区域合作与交流。     

“We're in this together”: Attachment insecurities,dyadic coping strategies,and relationship satisfaction in couples involved in medically assisted reproduction

Attachment is an important predictor of relationship satisfaction and attachment insecurities are a risk factor for couples under stress. Drawing from the Vulnerability–Stress–Adaptation model, we investigated whether dyadic coping strategies (DCS) would explain the links between attachment insecurities and relationship satisfaction in 97 couples involved in medically assisted reproduction (MAR). Path analyses revealed that for women and men, attachment insecurities (anxiety, avoidance) were associated with their own lower relationship satisfaction through their lower use of positive DCS. Attachment avoidance was also associated with participants' own lower relationship satisfaction through their own lower use of negative DCS. Men's attachment avoidance was also related to their partner's lower relationship satisfaction via their own and their partner's lower use of positive DCS. The findings suggest that promoting the use of positive DCS may be important to preserve relationship satisfaction in couples involved in MAR.     

Defining estimands for efficacy assessment in single arm phase 1b or phase 2 clinical trials in oncology early development

The addendum of the ICH E9 guideline on the statistical principles for clinical trials introduced the estimand framework. The framework is designed to strengthen the dialog between different stakeholders, to introduce greater clarity in the clinical trial objectives and to provide alignment between the estimand and statistical analysis. Estimand framework related publications thus far have mainly focused on randomized clinical trials. The intention of the Early Development Estimand Nexus (EDEN), a task force of the cross-industry Oncology Estimand Working Group ( www.oncoestimand.org ), is to apply it to single arms Phase 1b or Phase 2 trials designed to detect a treatment-related efficacy signal, typically measured by objective response rate. Key recommendations regarding the estimand attributes include that in a single arm early clinical trial, the treatment attribute should start when the first dose is received by the participant. Focusing on the estimation of an absolute effect, the population-level summary measure should reflect only the property used for the estimation. Another major component introduced in the ICH E9 addendum is the definition of intercurrent events and the associated possible ways to handle them. Different strategies reflect different clinical questions of interest that can be answered based on the journeys an individual subject can take during a trial. We provide detailed strategy recommendations for intercurrent events typically seen in early-stage oncology. We highlight where implicit assumptions should be made transparent as whenever follow-up is suspended, a while-on-treatment strategy is implied.