Herpes simplex virus type 2 seropositivity and relationship status among U.S. adults age 20 to 49: a population-based analysis.

BACKGROUND: U.S. population studies show herpes simplex virus type 2 (HSV-2) seroprevalence levelling by approximately age 30, suggesting few new infections after that age. It is unclear whether this pattern is driven by greater percentages in stable relationships, and to what extent adults who initiate new relationships may be at risk of incident HSV-2 infection. METHODS: Survey and laboratory data from the 1999-2008 waves of the U.S. National Health and Nutrition Examination Survey (NHANES) were combined for 12,862 adults age 20-49. Weighted population estimates of self-reported genital herpes, HSV-2 seroprevalence, and past-year sexual history were calculated, stratified by age, sex, race, and relationship status. Multivariable logistic regression was used to assess whether relationship status provided additional information in predicting HSV-2 over age, race and sex, and whether any such associations could be accounted for through differences in lifetime number of sex partners. RESULTS: Those who were unpartnered had higher HSV-2 prevalence than those who were married/cohabitating. Among unpartnered 45-49 year olds, seroprevalence was 55.3% in women and 25.7% in men. Those who were married/cohabitating were more likely to have had a past-year sex partner, and less likely to have had two or more partners. The effect of age in increasing the odds of HSV-2 was modified by race, with higher HSV-2 prevalence among Black Americans established by age 20-24 years, and the effect of race decreasing from age 30 to 49. Relationship status remained an independent predictor of HSV-2 when controlling for age, race, and sex among those age 30 to 49; married/cohabitating status was protective for HSV-2 in this group (OR = 0.69) CONCLUSIONS: Whereas sexually transmitted infections are often perceived as issues for young adults and specific high-risk groups, the chronic nature of HSV-2 results in accumulation of prevalence with age, especially among those not in married/cohabitating relationships. Increased odds of HSV-2 with age did not correspond with increases in self-reported genital herpes, which remained low. Adults who initiate new relationships should be aware of HSV-2 in order to better recognize its symptoms and prevent transmission.

Lessons learned from undertaking community-based participatory research dissertations: the trials and triumphs of two junior health scholars.

BACKGROUND: For graduate students addressing health issues pertinent to marginalized communities, community-based participatory research (CBPR) methods may be an appropriate mode of inquiry. Although there are a number of useful guides on conducting traditional doctoral dissertations (TDD), there is a paucity of similar resources for students engaged in CBPR. OBJECTIVES: Drawing on our own experiences, we aimed to describe the key lessons learned from doing participatory doctoral research. Furthermore, this paper outlines 6 suggestions for those who may be considering or already conducting a CBPR dissertation. Suggestions are derived from elements of the CBPR process that were employed in our own projects. LESSONS LEARNED: Upon reflection on our experiences conducting CBPR dissertations, we identified 4 lessons learned: (1) to understand the differences between TDDs and the CBPR approach; (2) to be aware of and able to clearly articulate the advantages of CBPR doctoral dissertations; (3) to acknowledge and plan for the possible challenges of CBPR doctoral research; and (4) to recognize aspects of the CBPR process that contribute to the successful completion of doctoral projects. CONCLUSION: This paper provides an additional resource for doctoral students, based on our own experiences working on CBPR projects. Despite many of the obstacles and challenges, we found the process of engaging in CBPR dissertations deeply rewarding, and hope that our experiences are useful to others.

Vitamin A supplementation and neonatal mortality in the developing world: a meta-regression of cluster-randomized trials.

OBJECTIVE: To assess the relationship between the prevalence of vitamin A deficiency among pregnant women and the effect of neonatal vitamin A supplementation on infant mortality. METHODS: Studies of neonatal supplementation with vitamin A have yielded contradictory findings with regard to its effect on the risk of infant death, possibly owing to heterogeneity between studies. One source of that heterogeneity is the prevalence of vitamin A deficiency among pregnant women, which we examined using meta-regression techniques on eligible individual and cluster-randomized trials. Adapting standard techniques to control for the inclusion of a cluster-randomized trial, we modelled the logarithm of the relative risk of infant death comparing vitamin A supplementation at birth to a standard treatment, as a linear function of the prevalence of vitamin A deficiency in pregnant women. FINDINGS: Meta-regression analysis revealed a statistically significant linear relationship between the prevalence of vitamin A deficiency in pregnant women and the observed effectiveness of vitamin A supplementation at birth. In regions where at least 22% of pregnant women have vitamin A deficiency, giving neonates vitamin A supplements will have a protective effect against infant death. CONCLUSION: A meta-regression analysis is observational in nature and may suffer from confounding bias. Nevertheless, our study suggests that vitamin A supplementation can reduce infant mortality in regions where this micronutrient deficiency is common. Thus, neonatal supplementation programmes may prove most beneficial in regions where the prevalence of vitamin A deficiency among pregnant women is high.