Adjusting HIV Prevalence Estimates for Non-participation: an Application to Demographic Surveillance

Introduction: HIV testing is a cornerstone of efforts to combat the HIV epidemic, and testing conducted as part of surveillance provides invaluable data on the spread of infection and the effectiveness of campaigns to reduce the transmission of HIV. However, participation in HIV testing can be low, and if respondents systematically select not to be tested because they know or suspect they are HIV positive (and fear disclosure), standard approaches to deal with missing data will fail to remove selection bias. We implemented Heckman-type selection models, which can be used to adjust for missing data that are not missing at random, and established the extent of selection bias in a population-based HIV survey in an HIV hyperendemic community in rural South Africa.

Methods: We used data from a population-based HIV survey carried out in 2009 in rural KwaZulu-Natal, South Africa. In this survey, 5565 women (35%) and 2567 men (27%) provided blood for an HIV test. We accounted for missing data using interviewer identity as a selection variable which predicted consent to HIV testing but was unlikely to be independently associated with HIV status. Our approach involved using this selection variable to examine the HIV status of residents who would ordinarily refuse to test, except that they were allocated a persuasive interviewer. Our copula model allows for flexibility when modelling the dependence structure between HIV survey participation and HIV status.

Results: For women, our selection model generated an HIV prevalence estimate of 33% (95% CI 27–40) for all people eligible to consent to HIV testing in the survey. This estimate is higher than the estimate of 24% generated when only information from respondents who participated in testing is used in the analysis, and the estimate of 27% when imputation analysis is used to predict missing data on HIV status. For men, we found an HIV prevalence of 25% (95% CI 15–35) using the selection model, compared to 16% among those who participated in testing, and 18% estimated with imputation. We provide new confidence intervals that correct for the fact that the relationship between testing and HIV status is unknown and requires estimation.

Conclusions: We confirm the feasibility and value of adopting selection models to account for missing data in population-based HIV surveys and surveillance systems. Elements of survey design, such as interviewer identity, present the opportunity to adopt this approach in routine applications. Where non-participation is high, true confidence intervals are much wider than those generated by standard approaches to dealing with missing data suggest.

Reasons for non-participation in the Northern Ireland Bowel Cancer Screening Programme: a qualitative study

OBJECTIVES: To identify the reasons why some people do not participate in bowel cancer screening so that steps can be taken to improve informed decision-making.

DESIGN: Qualitative study, using focus groups with thematic analysis of data to identify, analyse and report patterns. Transcripts were repeatedly read and inductively coded using a phenomenological perspective, and organised into key themes.

SETTING: Belfast and Armagh, two areas of Northern Ireland with relatively low uptake of bowel cancer screening.

PARTICIPANTS: Ten women and 18 men in three single-gender focus groups (two male and one female), each with 9-10 participants. Study participants were recruited by convenience sampling from the general public and were eligible for, but had not taken part in, the Northern Ireland Bowel Cancer Screening Programme.

RESULTS: Key themes identified were fear of cancer; the test procedure; social norms; past experience of cancer and screening; lack of knowledge or understanding about bowel cancer screening; and resulting behaviour towards the test. Fear about receiving bad news and reluctance to conduct the test themselves were reactions that participants seemed willing to overcome after taking part in open discussion about the test.

CONCLUSIONS: We identified barriers to participation in bowel cancer screening and used these insights to develop new materials to support delivery of the programme. Some of the issues raised have been identified in other UK settings, suggesting that knowledge about barriers, and strategies to improve uptake, may be generalisable.

The Dublin Lock Hospital: Medicine, Morality, Disease and Sin

Anecdotal evidence has it that when Dublin’s venereal disease hospital closed its doors for the last time in the 1950s, its administrative staff began to burn its records, starting with the most recent. This attempt to conceal the results of sexual profligacy is perhaps understandable in the rarefied climate of mid-century Catholic Ireland. However, the sense of shame attached to this institution has been pervasive. For example, of all Dublin’s major hospitals, the lock hospital remains the only one without a dedicated history. And, throughout its two centuries of existence, the ‘lock’ had often been a site of controversy and approbation.

The institution began in the eighteenth century as the most peripatetic, poor relation of the city’s voluntary hospitals, wandering indiscriminately through a series of temporary premises before finally achieving a permanent home and official recognition as a military-sponsored medical hospital in 1792. It also gained architectural extensions by both Richard and Francis Johnston and in the following decades. This new-found status and a growing re-conceptualisation of venereal disease as a legitimate medical problem rather than a matter of morality was, however, somewhat compromised by the choice of site at Townsend Street. The institution occupied a hidden part of city, appropriating the vacated home of the Hospital for Incurables, another marginalised group whose presence in the city had been viewed through the lens of superstition and fear. For the rest of its existence, the lock hospital would share this experience occupying a nebulous position between medicine and morality; disease and sin.

Using what’s left of the hospital’s records and a series of original architectural drawings, this paper discusses the presence and role of the lock hospital in the city in the eighteenth and early nineteenth century, tracking how changes in its administration and architectural form reflected wider attitudes towards disease, sexuality and gender in Georgian Dublin.

Behavioural reactivity of ewes and lambs during partial and total social isolation

This work investigated the differences in the reactivity of Sarda (primiparous n= 18, multiparous n= 17) and Dorset (multiparous n= 8) breeds of sheep and their singleton lambs to two challenging test situations involving a mother-lamb partial separation test and an isolation test. Non-parametric analysis used single behavioural variables and fear scores to evaluate the effect of parity, sex of lambs, and the association between mother-lamb behaviour. Amongst ewes, Dorset were characterised by a more calm temperament while Sarda (especially primiparous ewes) were more active in their response to challenge (i.e. more attempts to escape). As with their dams, lambs reflected to a certain extent this divergence and overall during isolation lamb fear score was on average significantly higher than dams. Correlations between measures of behavioural reactivity across tests were carried out to search for predictive measures of fear. A very strong correlation emerged linking vocalisation to locomotor activity. Vocalisation could be a good candidate as predictor factor of an active reaction of sheep to a fearful situation.

Validity of model devices used to assess canine temperament in behavioral tests

Temperament tests are widely accepted as instruments for profiling behavioral variability in dogs, and they are applied in numerous areas of investigation (e.g. suitability for adoption or for breeding). During testing, to elicit a dog's reaction toward novel stimuli and predict its behavior in everyday life, model devices such as a child-like doll, or a fake dog, are often employed. However, the reliability of these devices to accurately stimulate dogs' reactions to children or dogs, is unknown and perhaps overestimated. This may be a particular concern in the case of aggressive behavior toward humans, a significant public health issue. The aim of this study was to: (1) evaluate the correlation between dogs' reactions to these devices, and owners' reports of their dog's aggression history (using the C-BARQ ??); (2) compare reactions toward the devices of dogs with and without histories of aggression. Subjects were selected among those visiting for behavioral consultation at the Veterinary Hospital of the University of Pennsylvania, and previously categorized as aggressive toward unfamiliar children, conspecifics, or as non-aggressive dogs (control). The test consisted of different components: an unfamiliar female tester approaching the dog; the presentation of a child-like doll, an ambiguous object, and a fake plastic dog. All tests were videotaped and durations of behaviors were later analyzed on the basis of a specified ethogram. Dogs' reactions were compared to C-BARQ scores, and interesting correlations emerged for 'dog-directed aggression/fear' (R = 0.48, P = 0.004), and 'stranger-directed aggression' (R = 0.58, P <0.001) factors. Dogs differed in their reactions toward the devices: the child-like doll and the fake dog elicited more social behaviors than the ambiguous object used as a control stimulus. Issues concerning the reliability of these tools to assess canine temperament are discussed. ?? 2012 Elsevier B.V. All rights reserved.

Spectacle acceptance among secondary school students in rural China: the Xichang Pediatric Refractive Error Study (X-PRES)--report 5.

PURPOSE: To assess determinants of spectacle acceptance and use among rural Chinese children. METHODS: Children with uncorrected acuity < or = 6/12 in either eye and whose presenting vision could be improved > or = 2 lines with refraction were identified from a school-based sample of 1892 students. Information on obtaining glasses and the benefits of spectacles was provided to children, families, and teachers. Purchase of new spectacles and reasons for nonpurchase were assessed by direct inspection and interview 3 months later. RESULTS: Among 674 (35.6%) children requiring spectacles (mean age, 14.7 +/- 0.8 years), 597 (88.6%) were followed up. Among 339 children with no glasses at baseline, 30.7% purchased spectacles, whereas 43.2% of 258 children with inaccurate glasses replaced them. Most (70%) subjects paid US$13 to $26. Among children with bilateral vision < or = 6/18, 45.6% bought glasses. In multivariate models, presenting vision < 6/12 (P < 0.009), refractive error < -2.0 D (P < 0.001), and amount willing to pay for glasses (P = 0.01) were predictors of purchase. Reasons for nonpurchase included satisfaction with current vision (78% of those with glasses at baseline, 49% of those without), concerns over price or parental refusal (18%), and fear glasses would weaken the eyes (13%). Only 26% of children stated that they usually wore their new glasses. CONCLUSIONS: Many families in rural China will pay for glasses, though spectacle acceptance was < 50%, even among children with poor vision. Acceptance could be improved by price reduction, education showing that glasses will not harm the eyes, and parent-focused interventions.

Change in psychological distress in longer-term oesophageal cancer carers: are clusters of illness perception change a useful determinant?

Objective: This study provides a longitudinal assessment of distress in longer-term oesophageal cancer carers, while examining illness perception schema as a possible determinant of change in distress over time.
Methods: Oesophageal cancer carers (n=171), 48-months post-diagnosis, were assessed at baseline and 12-months later with the Illness Perception Questionnaire-Revised, Cancer Coping Questionnaire, Hospital Anxiety and Depression Scale and Concerns About Recurrence Scale.
Results: Findings report deterioration from normal to probable anxiety in 35.7% of carers and probable depression in 28.7% carers over time. Fear of recurrence remained stable. Changes in control, consequence and cause beliefs were identified as key determinants of a change in psychological morbidity.
Conclusions: Illness beliefs appear to be valuable targets for psychological intervention to improve wellbeing among carers of people with oesophageal cancer.

The neoliberalisation of the Cathedral Quarter and its contestations

Over time Belfast has been well researched as a site of ethnosectarian conflict, segregation and fear see (Boal et al 1976) and (Gaffiken and Morrisey 2011). The study of socio-spatial patterns of ‘ethnocracy’ is useful, but this article will argue how it is equally important to understand local forms of urban restructuring in terms of global processes that are linked to neoliberalism. To better understand the neoliberal urbanisation of Belfast this article is organised into two parts. The first part will demonstrate how the Northern Ireland State has sought legitimacy in the free market as ‘therapy’ for the production of neutral socio-spatial formations such as the Cathedral Quarter. Secondly it will examine this performance of neoliberal urbanism, as it ‘actually exists’ and demonstrate how market-led renewal has been extended through the clustering and non-sectarian interests, ‘soft’ arrangements of urban governance, cultural re-branding strategies, economic development incentives, and the development of various flagship projects. Critically this place-based grounding of neoliberalism is useful, as it also allows for the contestations of neoliberal urbanism to become real rather than just theoretical. The second part of the article will draw attention to the responses of local, and sometimes marginal, interests that have looked to challenge, adapt and, at times, divert the extension of market-led renewal. To be clear, this article does not want to overstate the performance of such interests. Nor does it want to claim that they significantly impact or obstruct the wider neoliberal urbanisation of Belfast. Instead it is interested in their behaviours and their different methods of working to explore what may be constituted as ‘alternative’, at least in the locality of the Cathedral Quarter. By studying how and why these interests have responded to the extension of neoliberal urbanism over time, it may just be possible to provide a better platform to articulate what more progressive forms of urban resistance might look like.

A closer look at Carver and White's BIS/BAS scales: Factor analysis and age group differences

The Behavioural Inhibition and Behavioural Activation System (BIS/BAS) scales were developed by Carver and White (1994) and comprise four scales which measure individual differences in personality (Gray 1982, 1991). More recent modifications, namely the five-factor model derived from Gray and McNaughton's (2000) revised Reward Sensitivity Theory (RST) suggests that Anxiety and Fear are separable components of inhibition. This study employed exploratory and confirmatory factor analyses on the scales in order to test whether the four or five-factor model was the better fit in a sample of 994 participants aged 11–30 years. Consistent with RST, superior model fit was shown for the five-factor model with all variables correlated. Significant age effects were observed for BIS Fear and BIS Anxiety, with scores peaking in middle and late adolescence respectively. The BAS subscales showed differential effects of age group. Significantly increasing scores from early to mid and from mid to late adolescence were found for Drive, but the effect of age on Fun Seeking and Reward Responsiveness was not significant.

Sexual Abuse in Malawi: Patterns of Disclosure

Potential human immunodeficiency virus transmission makes prompt disclosure of child sexual abuse in Africa critical. The pattern of disclosure of 133 children presenting to the largest hospital in Malawi were analyzed. Eighty percent presented early enough for effective use of HIV postexposure prophylaxis. Seventy-five percent of children made a disclosure of child sexual abuse; 29% spontaneously and 47% after prompting. Disclosures were most commonly made to a parent, and age did not affect the pattern of disclosure. The number of children reporting child sexual abuse is increasing, possibly because of increasing awareness, availability of services, and fear of HIV. Although prompt disclosure rates were relatively high, facilitating easier disclosure of child sexual abuse by a free telephone help-line and better training of teachers may be helpful. 

Ansiedade social e assertividade na adolescência

O presente trabalho pretende caracterizar a associação entre ansiedade social e assertividade na adolescência, bem como desenvolver um modelo compreensivo e de intervenção teórica e empiricamente fundamentado acerca desta problemática. A ansiedade social é definida por medo intenso em situações sociais, associado a crenças negativas predisponentes e comportamentos de segurança ou evitamento subsequentes de situações sociais. A assertividade consiste numa resposta comportamental de auto-expressão empática, fundamentada em crenças positivas e activação emocional reduzida. Assim, estes dois conceitos parecem estar em dissonância, uma vez que, por definição, a ansiedade social surge associada a défice de comportamentos sociais adequados e a assertividade a diminuída activação ansiosa em eventos sociais. Por outro lado, ansiedade social e défice assertivo poderão fundamentar-se em mecanismos psicológicos semelhantes. Para verificar estas duas premissas, o presente trabalho utilizou uma amostra de 679 adolescentes do ensino secundário público de ambos os sexos. Para avaliar a ansiedade social nas três dimensões do funcionamento psicológico foram utilizadas a Escala de Crenças e Pensamentos Sociais e a Escala de Ansiedade e Evitamento de Situações Sociais para Adolescentes. No caso da assertividade, foram utilizados o Questionário de Esquema Interpessoal Assertivo e Escala de Comportamento Interpessoal. A análise de dados permite verificar a existência de uma associação recíproca negativa entre ansiedade social e assertividade, em todos os níveis considerados. Igualmente, os resultados obtidos indicam que esta associação poderá ser fundamentada na existência de baixas crenças sociais positivas que activam pensamentos sociais negativos e subsequentemente ansiedade e desconforto em situações sociais e reduzida frequência de comportamento assertivo. Esta conclusão fundamentou uma intervenção integrada para a promoção da gestão de ansiedade social e da prática de competências assertivas. Esta intervenção foi construída, implementada e avaliada em dois ensaios clínicos junto a 6 adolescentes. Os resultados de significância clínica indicam que o programa tem eficácia terapêutica, ainda que este estudo preliminar não exclua a necessidade de uma avaliação mais aprofundada do benefício associado a esta intervenção. Estes trabalhos assumem, assim, implicações educativas e terapêuticas, ao permitir explicitar e clarificar a associação entre ansiedade social e assertividade, e ao contribuir para o desenvolvimento e avaliação de formas de intervenção adequadas junto ao adolescente social tímido ou inibido. A compreensão e intervenção preventiva para a promoção do ajustamento psicossocial do adolescente emergem como uma realidade possível, pertinente e acessível a todos os agentes educativos.

Tecnologias de informação e comunicação e o cidadão sénior : estudo sobre o impacto em variáveis psicossociais e a conceptualização de serviços com e para o cidadão sénior

Perante uma sociedade em célere envelhecimento demográfico e permanente avanço tecnológico, justifica-se a aposta em estudos que potenciem a ação comunicativa e a diminuição do isolamento social decorrente das perdas biopsicossociais associadas à idade sénior. Esta tese possui quatro objetivos de estudo: i) pretende-se investigar qual é o impacto da utilização das Tecnologias de Informação e Comunicação (TIC) no autoconceito (AC), no ânimo e na qualidade de vida (QV) de um grupo de seniores; ii) perceber se existe e qual a relação entre as variáveis independentes sexo, idade, estado civil, escolaridade, profissão, IPSS, regime de frequência, tempo na IPSS, orientação para frequentar a IPSS, visita de familiares e visita de amigos e as variáveis dependentes AC, ânimo, QV e respetivos fatores e domínios, nos momentos de pré e pós-teste; iii) perceber se a sua participação no processo de conceptualização de um serviço de comunicação assíncrona, email, influencia a sua usabilidade ao nível das componentes eficácia, eficiência e satisfação; iv) e sugerir a componente política da comunidade online sénior em desenvolvimento no âmbito do Projeto SEDUCE. Para o desenvolvimento do estudo estabeleceram-se parcerias com quatro Instituições Particulares de Segurança Social do concelho de Aveiro, integradas no âmbito do projeto SEDUCE. Os instrumentos utilizados para a avaliação do autoconceito, do ânimo e da qualidade de vida foram o Inventário Clínico de Auto-Conceito, a Escala de Ânimo do Centro Geriátrico de Philadelphia e a Escala de Qualidade de Vida da Organização Mundial de Saúde WHOQOL-Bref, respetivamente. No processo de conceptualização do serviço de email e da componente política da comunidade online utilizou-se a observação participativa e o contextual design. O estudo envolveu a participação de 42 seniores distribuídos por duas condições experimentais: 22 seniores do grupo experimental utilizaram as TIC duas vezes por semana (em sessões de 90 minutos cada, num total de 80 sessões) e 19 seniores do grupo de controlo passivo não experimentaram qualquer intervenção. Para a avaliação das variáveis psicossociais realizaram-se dois momentos de avaliação, antes e depois de 11 meses de intervenção, de Agosto de 2011 a Julho de 2012. Ao longo das sessões de envolvimento com as TIC observou-se que os seniores apresentam, continuamente, dificuldades em: manipular o rato e percecionar a sua ação no monitor; fazer a distinção entre teclas (enter, spacebar, delete, caps lock entre outras); em utilizar duplas teclas para colocar pontuação e acentuação; iniciar atividades no Microsoft Office Word; selecionar a informação disponibilizada em motores de pesquisa; perceber quais as zonas clicáveis; falta de confiança em efetivar ações; receio em iniciar nova atividades, pela falta de conhecimento e pelo medo de errar; memorizar endereços de email e passwords; e dar continuidade às tarefas. Na utilização do serviço de email consideram importante receber resposta quando enviam uma mensagem, assim como responder sempre aos remetentes; raramente colocam assunto nas mensagens; e expressam grande satisfação ao receber mensagens de familiares e/ou amigos. O processo de desenvolvimento de serviços com a participação ativa dos seniores revela-se exequível mas é necessário adaptar as práticas: os processos devem ser iterativos; evitar linguagem formal; clarificar o objetivo; deixar os seniores pensar em voz alta; dar-lhes tempo; mantê-los focados e não conduzi-los nas tarefas. Os resultados sugerem que houve aumento significativo do domínio físico da qualidade de vida do grupo experimental. Os participantes que exprimiram maiores níveis de satisfação ao utilizar as TIC apresentam uma perspetiva mais positiva sobre a maturidade psicológica e menos solidão e insatisfação. No grupo experimental e no grupo de controlo passivo verificam-se relações entre as variáveis independentes e as variáveis dependentes, quer no momento de pré-teste como de pós-teste. Conclui-se que a participação dos seniores no processo de conceptualização do serviço de email permitiu fomentar a componente eficácia da usabilidade mas não a satisfação ao utilizar o mesmo. Os resultados sobre a eficiência são inconclusivos. Sobre a componente política os seniores validam a existência de termos de utilização que orientem o comportamento de todos os utilizadores, assim como de uma política de privacidade. A área de registo proposta é adequada ao utilizador sénior.

Ecology and conservation of felids in the Brazilian pantanal

Habitat conversion and environmental degradation have reached alarming levels in the Pantanal, endangering all its biodiversity. This scenario is complicated by the fact that the biome relies on only a few protected areas, which combined do not exceed 10% of the territory. Felids, as predators, play a vital role in the maintenance of this ecosystem, but require large areas, have low population densities and, typically, are very sensitive to environmental disturbances. Amolar Mountain Ridge is considered an area of extreme importance and high priority for conservation within the biome. There are four species of felids in this region: the jaguar (Panthera onca), the puma (Puma concolor), the ocelot (Leopardus pardalis), and jaguarundi (Puma yagouaroundi). However, little is known about the ecology of these species in this region or the magnitude of interaction between the communities living around the protected areas and the animals. The goal of this study was to increase our knowledge about these felids and understand how people interact with them in order to contribute to their conservation in the network of parks within Amolar. Camera trapping surveys were carried out in two areas of the network, covering approximately 83,000 hectares, in order to identify the species of mammals occurring in the region, those that may be potential prey for the felids, and to obtain basic ecological data about both felids and prey. In addition, we conducted surveys in three riverside schools in order to assess the knowledge, perceptions and attitudes of schoolchildren regarding the four focal felids, and surveys among the adult population to assess their perceptions and attitudes towards the jaguar. We recorded a total of 33 species of mammals from both study areas. The large cats were cathemeral, reflecting the temporal activity of larger prey, whereas the ocelot was nocturnal, mirroring the activity of smaller prey. Jaguar occupancy was influenced by prey abundance, while puma occupancy was influenced by patch density in drier dense forest. Jaguars and pumas may be competitors over temporal and spatial scales, while no resource overlap was found for ocelots. Overall, both adults and children tended to have negative perceptions about the cats, which were related to the fear of being attacked. To increase awareness about the species and to maximize the effectiveness of protective measures in the network of reserves, it is recommended to develop and implement an Environmental Educational Program in the medium- to long-term in order to minimize the fear of these felids and to counsel locals on the role of felids in the maintenance of the Pantanal’s biodiversity.

Various Joyful Encounters with the Dystopias of Affective Capitalism

This article contends that what appear to be the dystopic conditions of affective capitalism are just as likely to be felt in various joyful encounters as they are in atmospheres of fear associated with post 9/11 securitization. Moreover, rather than grasping these joyful encounters with capitalism as an ideological trick working directly on cognitive systems of belief, they are approached here by way of a repressive affective relation a population establishes between politicized sensory environments and what Deleuze and Guattari (1994) call a brain-becoming-subject. This is a radical relationality (Protevi, 2010) understood in this context as a mostly nonconscious brain-somatic process of subjectification occurring in contagious sensory environments populations become politically situated in. The joyful encounter is not therefore merely an ideological manipulation of belief, but following Gabriel Tarde (as developed in Sampson, 2012), belief is always the object of desire. The discussion starts by comparing recent efforts by Facebook to manipulate mass emotional contagion to a Huxleyesque control through appeals to joy. Attention is then turned toward further manifestations of affective capitalism; beginning with the so-called emotional turn in the neurosciences, which has greatly influenced marketing strategies intended to unconsciously influence consumer mood (and choice), and ending with a further comparison between encounters with Nazi joy in the 1930s (Protevi, 2010) and the recent spreading of right wing populism similarly loaded with political affect. Indeed, the dystopian presence of a repressive political affect in all of these examples prompts an initial question concerning what can be done to a brain so that it involuntarily conforms to the joyful encounter. That is to say, what can affect theory say about an apparent brain-somatic vulnerability to affective suggestibility and a tendency toward mass repression? However, the paper goes on to frame a second (and perhaps more significant) question concerning what can a brain do. Through the work of John Protevi (in Hauptmann and Neidich (eds.), 2010: 168-183), Catherine Malabou (2009) and Christian Borch (2005), the article discusses how affect theory can conceive of a brain-somatic relation to sensory environments that might be freed from its coincidence with capitalism. This second question not only leads to a different kind of illusion to that understood as a product of an ideological trick, but also abnegates a model of the brain which limits subjectivity in the making to a phenomenological inner self or Being in the world.

It’s time: Generation and temporality in psychoanalytic feminism

In this paper I examine some key aspects of defining one’s generation: transmitting values to younger generations in a way that makes sense to them; cultivating a psychic flexibility that allows us to welcome the future and be prepared for the unexpected whilst not succumbing to the fear of social, political and economic precarity; thinking of generation as both our collective moment in time and as generative potential; reaffirming the value of communication and sharing experience; and maintaining a dialogue between psychoanalytic feminism and other strands of feminist philosophy.