Socio-Structural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in the Democratic Republic of the Congo: A Systematic Review.

Introduction The Democratic Republic of the Congo (DRC) had the second-highest mother-to-child HIV transmission rate in Sub-Saharan Africa at 29% in 2013, however the uptake of preventive services for mother-to-child transmission of HIV (PMTCT) remains suboptimal. This systematic review explores socio-cultural and structural factors influencing PMTCT service uptake in the DRC. Methods We conducted a search of electronic databases. The PEN-3 model was used as a framework to synthesize factors influencing PMTCT service uptake into perceptions, enablers, and nurturers. Results Sixteen studies, 14 quantitative and two qualitative, were retained. Maternal, socio-economic, structural, and cultural factors were found to influence PMTCT service uptake in the DRC. Cost, accessibility, and quality of PMTCT services were key barriers to service uptake. Integration, male partner involvement, and evolving PMTCT policies improved PMTCT service delivery and uptake. This review also revealed several socio-cultural challenges in involving male partners in PMTCT programs. Discussion Findings highlight the need to address barriers and reinforce enablers of PMTCT uptake. Creating culturally appropriate, male-friendly, and family-oriented PMTCT programs will improve service uptake in the DRC.

"Going to the Gym Is Not Congolese's Culture": Examining Attitudes Toward Physical Activity and Risk for Type 2 Diabetes Among Congolese Immigrants.

Purpose The purpose of this study was to explore perceptions and attitudes around physical activity among immigrants from the Democratic Republic of Congo and examine the influence of Congolese cultural beliefs on physical activity practice. Methods In-depth interviews were conducted and augmented by photo-elicitation among 20 Congolese immigrants, distributed equally by gender, aged 35 years or older. The PEN-3 model was used as the cultural conceptual framework. Results Using both the Relationships and Expectations dimension (Perceptions, Enablers, and Nurturers) and Cultural Empowerment dimension (Positive, Existential, and Negative) of the PEN-3 model, emergent themes were categorized around knowing the benefits of being physically active (perceptions), doctor encouragement to be more physically active (enablers), and the habit and local tradition of consuming beer after a soccer match (nurturers). Other emergent themes included Congolese loves to dance (positive), going to the gym is not Congolese culture (existential), and the challenge of increased physical activity (negative). Conclusions Congolese have their intrinsic cultural perceptions and attitudes around types of physical activity. The study disclosed a much more pronounced willingness to dance (as a potential source of increased physical activity) than to go to a gym. As such, if one wants to advocate a regimen of increased physical activity to offset the risk for type 2 diabetes, dance is an alternative to consider among some immigrants.

Attitudes Toward Intimate Partner Violence and Associations With Condom Use Among Men in Haiti: An Analysis of the Nationally Representative Demographic Health Survey.

Although men have substantial decision-making power regarding condom use, the majority of HIV knowledge and prevention studies in the general Haitian population have been conducted among youth and women. We investigated attitudes toward intimate partner violence, knowledge of, and use of condoms among 9493 men in Haiti using data from the 2012 nationally representative Demographic and Health Survey. Only 36% of HIV-negative and 44% of HIV-positive men reported using a condom the last time they had had sex. Logistic regression revealed that believing it was justified for a man to hit or beat his wife if she refuses to have sex with him was associated with a lower odds of condom use. The odds of using a condom during last sex was higher among men who reported knowing condoms can prevent HIV and who had been tested for HIV. Given the low rate of condom use among men in Haiti, these findings suggest that interventions promoting HIV knowledge, HIV testing, and gender-violence prevention among men may also increase condom use.

Applying anthropology to eliminate tobacco-related health disparities.

INTRODUCTION: Disparities in tobacco's harm persist. Declines in smoking among the general population have not been experienced to the same extent by vulnerable populations. Innovative strategies are required to diminish disparities in tobacco's harm. As novel tools, anthropological concepts and methods may be applied to improve the design and outcomes of tobacco cessation interventions. METHODS: We reviewed over 60 articles published in peer-reviewed journals since 1995 for content on anthropology and smoking cessation. The specific questions framing the review were: (a) "How can lessons learned from anthropological studies of smoking improve the design and effectiveness of smoking cessation interventions?" (b) How can anthropology be applied to diminish disparities in smoking cessation? and (c) How can qualitative methods be used most effectively in smoking cessation intervention research? RESULTS: Three specific disciplinary tools were identified and examined: (a) culture, (b) reflexivity, and (c) qualitative methods. Examining culture as a dynamic influence and understanding the utilities of smoking in a particular group is a precursor to promoting cessation. Reflexivity enables a deeper understanding of how smokers perceive quitting and smoking beyond addiction and individual health consequences. Qualitative methods may be used to elicit in-depth perspectives on quitting, insights to inform existing community-based strategies for making behavior changes, and detailed preferences for cessation treatment or programs. CONCLUSIONS: Anthropological tools can be used to improve the effectiveness of intervention research studies targeting individuals from vulnerable groups. Synthesized applications of anthropological concepts can be used to facilitate translation of findings into clinical practice for providers addressing tobacco cessation in vulnerable populations.

Disaster triage after the Haitian earthquake.

In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future.

Breastfeeding practices of Cameroonian mothers determined by dietary recall since birth and the dose-to-the-mother deuterium-oxide turnover technique.

Exclusive breastfeeding during the first 6 months of infant's life is a public health recommendation and important factor for the promotion of optimal growth, health and behavioural development of each child. The accuracy of the mothers' self-reported past infant-feeding events was examined and compared with the isotopic dilution technique. Breastfeeding practices were assessed in a sample of 44 Cameroonian mother-infant pairs using dietary recall since birth. Intakes of breast milk and non-breast milk water were measured in the same sample using the dose-to-the-mother deuterium-oxide turnover technique and compared with questionnaire. Results showed that mothers' self-reported behaviour overestimates the exclusive breastfeeding rate. Seventy-five per cent of the mothers who claimed to be exclusively breastfeeding were found to be predominantly or partially breastfeeding by the dose-to-the-mother deuterium-oxide turnover technique. Only 11% of the infants were exclusively breastfed, and the breast milk output was not significantly affected (P ≤ 0.05) by the mother's body composition. Mean intakes of breast milk and non-breast milk water were 701 mL day(-1) and 268 mL day(-1), respectively. Introduction of non-breast milk foods is associated with a reduction in the level of breast milk intake, but the difference in breast milk intake was not significant between exclusively and predominantly breastfed infants. In conclusion, the dose-to-the-mother deuterium-oxide turnover technique can be applied to validate the mother's reports of infant-feeding practices, but non-breast milk water intake by breastfeeding category still needs to be normalized.

Bacteria in the oral mucosa and its effects on the measurement of cortisol, dehydroepiandrosterone, and testosterone in saliva.

Bacteria load in saliva was experimentally manipulated, and the consequences for the measurement of salivary testosterone (T), dehydroepiandrosterone (DHEA), and cortisol (C) were examined. Healthy adults (n = 19) donated the first saliva sample upon rising after which they rinsed their mouths with water, waited 10 min, and donated a second sample. Samples were either left untreated or passed through a 0.22-microm filter and then frozen at -80 degrees C or incubated at room temperature (RT) for 10 days. Aliquots of each sample were cultured on agar to determine baseline and post-incubation (or freezing) bacteria load. Bacteria counts were not significantly influenced by rinsing (with water), were substantially reduced by filtration, and increased by incubation at RT. Average levels of salivary T and C, but not DHEA, were significantly lower in samples stored at RT than samples frozen the day of collection. The change in bacteria count induced by storing samples at RT was associated with a change in testosterone but not cortisol or DHEA. When samples were passed through a 0.22-microm filter bacteria counts were reduced, and the association between bacteria and testosterone was reduced to non-significant. These findings contribute to a growing body of literature revealing that the process of sample collection, storage, and handling can dramatically influence the accuracy of information generated when salivary biomarkers are integrated into research and clinical diagnostics.

Chondroblastoma of the temporal bone involving the temporomandibular joint, mandibular condyle, and middle cranial fossa: case report and review of the literature.

Chondroblastoma is a highly destructive tumor, derived from immature cartilage cells, typically occurring in epiphyses of the long bones of adolescents and young adults. Those occurring in the temporal bone and TMJ area are likely to mimic TMJ symptoms. This report describes a unique case in which a chondroblastoma resulted in extensive destruction of the temporal bone, temporomandibular joint, mandibular condyle, and cranial base, including gross intracranial and extracranial involvement. With appropriate surgical management, the outcome for patients with chondroblastoma of the temporomandibular region is quite favorable. This case brings the total reported chondroblastomas to 59 in the temporal bone and eight in the mandibular condyle as of the date of submission of this article for publication.