Effects of a Novel Erectogenic Condom on Men and Women's Sexual Pleasure: Randomized Controlled Trial.

We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (SD = 0.24; range 21-46). QSE scores were higher among women (B, 0.12; 95% CI, 0.03-0.21) and men (B, 0.21; 95% CI, 0.08-0.35) in the CSD500 relative to the control arm. SEX-Q scores were higher among men in the CSD500 compared to the control arm (B, 3.22; 95% CI, 1.53-4.91). Higher proportions of men in the CSD500 relative to the control arm reported the condom felt "natural" during sex (68.6% vs. 32.3%; p < .01) and that sex with the condom felt "a lot better" than condomless sex (15.5% vs. 5.3%; p < .01). Compared with standard condoms, CSD500 use was associated with higher reports of sexual pleasure and condom acceptability.

Obstacles to contraceptive use in Pakistan: a study in Punjab.

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Survey data are analyzed that were collected in Punjab province in 1996 and that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband's preferences and attitudes, health concerns, and perceived access to services. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future, in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman's perception that such behavior would conflict with her husband's fertility preferences and his attitudes toward family planning and her perception of the social or cultural unacceptability of contraception. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning.

Lack of hemoglobin response to iron supplementation in anemic mexican preschoolers with multiple micronutrient deficiencies.

BACKGROUND: In developing countries, incomplete resolution of anemia with iron supplementation is often attributed to poor compliance or inadequate duration of supplementation, but it could result from deficiencies of other micronutrients. OBJECTIVE: Our objective was to assess children's hematologic response to supervised, long-term iron supplementation and the relation of this response to other micronutrient deficiencies, anthropometry, morbidity, and usual dietary intake. DESIGN: Rural Mexican children aged 18-36 mo (n = 219) were supplemented for 12 mo with either 20 mg Fe, 20 mg Zn, both iron and zinc, or placebo. Children were categorized as iron-unsupplemented (IUS; n = 109) or iron supplemented (IS; n = 108). Hemoglobin, hematocrit, mean corpuscular volume, mean cell hemoglobin, plasma concentrations of micronutrients that can affect hematopoiesis, anthropometry, and diet were assessed at 0, 6, and 12 mo; morbidity was assessed biweekly. RESULTS: At baseline, 70% of children had low hemoglobin (

Measurement of sugars and starches in foods by a modification of the AOAC total dietary fiber method.

A separation scheme for the determination of sugars and starch in processed food was developed. It is based on AOAC Method 985.29 for total dietary fiber with these modifications: carbohydrate starches are separated into soluble and insoluble fractions before they are hydrolyzed; acetonitrile is used instead of ethanol to separate sugars from enzyme-resistant carbohydrates, proteins, and other macromolecules; and a solid-phase extraction filter is included to remove substances that interfere with high-performance liquid chromatography (HPLC). Recovery studies indicate a > 97% sugar recovery. Twenty foods were analyzed. After enzymatic hydrolysis, fructose, glucose, sucrose, maltose, and lactose were extracted and determined by HPLC using a refractive index detector. Starch content was calculated from the increase in the amount of glucose. The results were compared with values listed on the "Nutrition Facts" panel for that food. The analyzed amounts of sugars and starches were 73-96% of declared values.

Vitamin B-12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum.

Vitamin B-12 status was evaluated in 113 Guatemalan women and their infants at 3 mo of lactation. Plasma vitamin B-12 was deficient or low in 46.7% of the mothers, and holotranscobalamin II (holo TC II) concentrations were low in 32.3%, which may indicate vitamin B-12 malabsorption. Only 9% had deficient or low plasma folate. Breast milk vitamin B-12 was low in 31%, and negatively correlated with infant urinary methylmalonic acid (UMMA, r = -0.22, P < 0.05, n = 88); UMMA was elevated in 12.2% of the infants, indicating vitamin B-12 deficiency. Mothers of the infants with elevated UMMA had significantly lower concentrations of vitamin B-12 in their breast milk compared with mothers of infants with normal UMMA concentrations (410.7 +/- 247.7 vs. 705.3 +/- 487.5 pmol/L, P = 0.05, n = 87). Mean maternal dietary intake of vitamin B-12 was significantly correlated with plasma vitamin B-12 (r = 0.20, P = 0. 05, n = 94) and was the main determinant of plasma vitamin B-12 in a linear regression model. Determinants of maternal holo TC II concentrations included dietary intake of vitamin B-12 and Giardia lamblia infection. There were no statistically significant determinants of infant UMMA concentrations. We conclude that vitamin B-12 deficiency is highly prevalent in these lactating women and is associated with depletion of the vitamin in their infants. The cause of the maternal deficiency is unknown, but malabsorption exacerbated by low dietary intake of the vitamin is a possibility.

PIP: This study evaluated vitamin B-12 status in 113 Guatemalan women and their infants at 3 months of lactation. Findings revealed that plasma vitamin B-12 was deficient or low in 46.7% of the mothers and that holotranscobalamin II (holo TC II) concentrations were low in 32.3%, which may indicate vitamin B-12 malabsorption. Only 9% had deficient or low plasma folate. Breast milk vitamin B-12 was low in 31% and negatively correlated with infant urinary methylmalonic acid (UMMA). UMMA was elevated in 12.2% of the infants, indicating vitamin B-12 deficiency. Mothers of the infants with elevated UMMA had significantly lower concentrations of vitamin B-12 in their breast milk compared with mothers of infants with normal UMMA concentrations. Mean maternal dietary intake of vitamin B-12 was significantly correlated with plasma vitamin B-12 and was the main determinant of plasma vitamin B-12 in a linear regression model. Determinants of maternal holo TC II concentrations included dietary intake of vitamin B-12 and Giardia lamblia infection. There were no statistically significant determinants of infant UMMA concentrations. This study concludes that vitamin B-12 deficiency is highly prevalent in these lactating women and is associated with the depletion of the vitamin in their infants. The cause of the maternal deficiency is unknown, but malabsorption, exacerbated by low dietary intake of the vitamin, is a possibility.

Factors underlying unmet need for family planning in the Philippines.

The prevalence of unmet need for family planning is a primary justification for family planning programs, but the causes of unmet need have not been much explored. This article investigates four explanations for unmet need: (1) as an artifact of inaccurate measurement of fertility preferences and contraceptive practice; (2) as a reflection of weakly held fertility preferences; (3) as a result of women's perceiving themselves to be at low risk of conceiving; (4) as due to excessive costs of contraception. The explanations are examined using quantitative and qualitative data collected in 1993 from currently married women and their husbands in two provinces in the Philippines. The results indicate that the preference-behavior discrepancy commonly termed "unmet need" is not an artifact of survey measurement. The most important factors accounting for this discrepancy are the strength of women's reproductive preferences, husbands' fertility preferences, and the perceived detrimental side effects of contraception. Inaccessible family planning services appear to carry little weight in this setting. Modification of services to make them more attentive to other obstacles to contraceptive use would improve their effectiveness in reducing unmet need.

Vitamin B-12 deficiency and malabsorption are highly prevalent in rural Mexican communities.

Vitamin B-12 status of rural Mexicans was evaluated in two studies, 6 y apart. In the first, a single blood sample was collected from children and adults, including pregnant and lactating women. Prevalence of deficient plasma vitamin B-12 values ranged from 19% to 41% among groups, but plasma folate status was normal in all individuals. Breast milk vitamin B-12 concentration was low in 62% of samples. The second study was conducted in 219 children aged 18-36 mo in five communities, whose prevalence of deficient and low plasma vitamin B-12 concentrations, respectively, was 8% and 33% on entry, 3% and 22% 6 mo later, and 7% and 29% 12 mo later. Prevalence of low holotranscobalamin II concentrations, indicating malabsorption of the vitamin, averaged 18-40% across the three same periods. Both vitamin B-12 status indicators differed significantly between communities. The widespread vitamin B-12 deficiency was probably caused by malabsorption, perhaps exacerbated by low dietary intake and, for young children, maternal depletion of the vitamin.

[Diffusion through social interaction and fertility transition: quantitative and qualitative evidence from Costa Rica]. / Difusion por interaccion social y transicion de la fecundidad: evidencia cuantitativa y cualitativa de Costa Rica.

PIP: Explanations of the fertility transition in Costa Rica, as elsewhere in developing societies, have stressed the impacts of socioeconomic changes on the demand for children and of increased supply of family planning services. This paper goes beyond this demand-supply paradigm and examines the additional causal contribution of the "contagion" of birth control practices by social interaction. Aiming at conceptual precision, a simple dynamic model is used to simulate a fertility transition process with interaction diffusion effects. An inspection of the data about the Costa Rican transition shows several characteristics suggesting interaction diffusion effects, notably its pervasiveness toward all socioeconomic strata and the lack of evidence of a downward shift in fertility preferences. Maps of the timing of fertility transition indicate an ordered spatial pattern suggestive of contagion between neighboring areas. An areal regression analysis reveals inter- and within-area contagion effects on birth control adoption. Focus group discussions show real-life situations of interaction diffusion for birth control adoption. These discussions also give qualitative hints of the circumstances surrounding diffusion of birth control, as well as give hints of major value changes that paralleled fertility transition in Costa Rica. (author's)^ieng

Toward classification of dysphagic patients using biomechanical measurements.

Identification of a patient at risk of aspiration is a major problem in the rehabilitation of the dysphagic patient. The present methods of diagnosis are based on clinical evaluation or videofluorography or fiberoptic endoscopic examination of swallowing (FEES). Recently, we developed biomechanical techniques for noninvasive quantitative assessment of the dysphagic patient. The purpose of the present investigation was to assess the clinical validity of the technique. In a double-blind study, both biomechanical test results and videofluorography (including bedside evaluation) results were used to independently classify the patients into four categories of risk for aspiration. Of the 36 patients studied, there was complete agreement between the biomechanical and clinical classifications in 21 patients. In 11 patients, the biomechanical technique overestimated the risk by one category, and underestimated the risk by one category in four patients. The biomechanical technique presents a useful tool for continued patient assessment; however, further studies are needed.

Living arrangements of the Filipino elderly.

The authors describe the living arrangements of the elderly in the Philippines. They find that "only a small fraction of the Filipino elderly are isolated from close kin; however, it is not certain that their living arrangements are favourable for their overall well-being. In many cases of co-residence, the flow of support is from the elderly parents to their children. The article raises several questions concerning social change in the Philippines that need to be answered in future research."

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

PIP: Maternity history and household economic data were analyzed for 2783 ever married women from rural areas collected during the February-June 1980 Egyptian Fertility Survey (part of the World Fertility Survey) to examine economic and health service determinants of infant and child mortality. The neonatal, early infant, and early child mortality rates were 78,63, and 128 respectively. Children who lived in Upper Egypt were more likely to die than those in Lower Egypt. Neither household sanitation, maternal risk factors, socioeconomic factors, nor medical facilities or personnel accounted for this difference. It was thought that differences in culture were responsible for the discrepancy. The major determinants of child survival during the 1st month included maternal risk status (maternal age, parity, and months passed since prior birth) and region (p.01). In addition, neonatal mortality was highest in villages with only a traditional birth attendant (daya) and those with no combination health unit (p.05). Combination units provided health services as well as social, educational, and rural economic services. During the early infancy period (1-7 months), just region and maternal risk status considerably influenced child survival (p.01). By the time children reached the early childhood stage (8-59 months), the effect of region tapered off, but maternal risk status remained a significant determinant (p.01). It was only during this period that higher household income, especially if it were mostly employment income, significantly improved child survival (p.05). Children from households making up to top 1/3 of income distribution were 35% less likely to die than those from the remaining households. Maternal and paternal education did not greatly affect child survival. It is concluded that economic position and economic well being considerably influenced child survival.

Noninvasive acceleration measurements to characterize the pharyngeal phase of swallowing.

Swallowing disorder (dysphagia) presents a major problem in the rehabilitation of stroke and head injured patients. In the present investigation, a new technique is developed for noninvasive assessment of the pharyngeal phase of the swallowing mechanism. Acceleration was measured with two ultra-miniature accelerometers placed on the skin over the throat. Simultaneously, the swallow suction pressure was monitored. Swallowing in normal individuals gave rise to a characteristic acceleration pattern which was quite reproducible, and was in phase with the swallow pressure. In dysphagic patients, the acceleration response was either absent or significantly delayed. The accelerometry technique provides a tool for continuing patient assessment and demonstrating the clinical improvements.

Collecting data on pregnancy loss: a review of evidence from the World Fertility Survey.

Estimates of levels and differentials of pregnancy loss are presented for 40 developing countries participating in the World Fertility Survey (WFS) program. Judged against agreed-upon levels of spontaneous loss in human populations, WFS surveys measured from 50 to 80 percent of recognizable losses. The coverage of induced abortions appears to be much worse. Consistent with data from other sources and settings, the probability of loss is strongly correlated with maternal demographic characteristics: age, pregnancy order, pregnancy spacing, and pregnancy loss history. Despite incomplete coverage, the WFS data on pregnancy loss provide considerable, and largely unexploited, insight on the dynamics of the reproductive career.

PIP: In spite of an assumption that information on pregnancy loss obtained retrospectively would be deficient, World Fertility Survey (WFS) studies carried out in developing countries have collected data on this variable, principally as a means of improving data on live births. Data on pregnancy loss were deemed of importance only in those few countries (Korea and Tunisia) where levels of abortion were high and legal sanctions mild enough that reasonable validity could be assumed. When judged against agreed-upon levels of spontaneous pregnancy loss in human populations (60%, but a maximum recognizable level of 25%), it appears that WFS studies in 40 developing countries measured 50-80% of recognizable such losses. The coverage was most complete for the 5-year period immediately preceding the survey. Overall, spontaneous pregnancy loss appears to be a commonly reported phenomenon,however. In only 8 of the 40 countries analyzed did fewer than 20% of the women report having experienced at least 1 spontaneous loss (Ghana, Lesotho, Mauritania, Nigeria, Nepal, Fiji, Indonesia, and Korea), while in 3 countries over 40% reported at least 1 such loss (Jordan, Dominican Republic, and Guyana). Further analysis of WFS data on spontaneous pregnancy loss suggest several demographic correlates, including maternal age (markedly higher rates of loss over age 30 years than at ages 20-29 years), parity (the probability of loss rises after the 6th pregnancy in all countries), and interbirth interval (with rates of loss most extreme when the interval from previous termination to next conception is less than 6 months). WFS coverage of induced abortions is far less accurate. WFS data show less than 2% of pregnancies terminated by an induced abortion in all 40 countries except Korea, Tunisia, Trinidad and Tobago, and Jordan. There is evidence that many induced abortions are reported as spontaneous pregnancy losses, confounding data analysis. Despite methodological problems, refined attention to the collection of data on pregnancy losses is advised to enhance understanding of variations in fertility over the reproductive cycle.

Household income and child survival in Egypt.

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.

Maternal age, gravidity, and pregnancy spacing effects on spontaneous fetal mortality.

Differentials in the probability of pregnancy loss are examined using pregnancy history data from eight WFS surveys in developing countries. Multiple logistic regression equations are estimated. The probability of loss varies substantially over the reproductive career. Both higher-order pregnancies and those conceived at older ages are more likely to terminate in loss. maternal age differentials are more pronounced for lower-order pregnancies. First and second pregnancies conceived over age thirty suffer especially high levels of loss. Pregnancies conceived relatively soon after the termination of the previous pregnancy are more likely to be lost, as are pregnancies conceived after long intervals. Risk of loss is higher for women previously experiencing loss, and the effect persists beyond the pregnancy following the loss.

PIP: Differentials in the probability of pregnancy loss are examined using pregnancy history data from 8 World Fertility Surveys (WFS) in developing countries. For this analysis we select 8 countries where the coverage appears relatively complete: Ivory Coast, Tunisia, Syria, Korea, the Philippines, Costa Rica, Mexico, and Guyana. Multiple logistic regression equations are estimated. The probability of loss varies substantially over the reproductive career. Both higher-order pregnancies and those conceived at older ages are more likely to terminate in loss. Maternal age differentials are more pronounced for lower-order pregnancies. 1st and 2nd pregnancies conceived over age 30 suffer especially high levels of loss. Pregnancies conceived relatively soon after the termination of the previous pregnancy are more likely to be lost, as are pregnancies conceived after long intervals. Risk of loss is higher for women previously experiencing loss, and the effect persists beyond the pregnancy following the loss. The differentials by maternal education are rather small in the Ivory Coast, Tunisia, the Philippines, and Costa Rica. In Syria, Korea, and Mexico, better- educated women report a higher percentage loss, where in Guyana an inverse pattern emerges. The majority of the Guyanese sample, however, falls into the highest educational category. Excepting Syria, Korea, and Mexico, there is no evidence of markedly better reporting, or of higher proportions of disguised induced losses, among the better educated. Differentials by type of place of residence are somewhat sharper and more uniform, with rural women in all 8 countries reporting the lowest rates of loss. As completeness of reporting would seem more likely to be associated with maternal education than place of residence, we interpret the latter differentials as reflective of a higher incidence of induced loss (reported as spontaneous) in urban areas, where abortion services are likely to be more available.

Biomechanical quantification for assessment and diagnosis of dysphagia.

The swallowing process is divided into three distinct phases: (1) an oral phase involving the coordinated action of the muscles of the lips, tongue, and cheeks; (2) a pharyngeal phase involving pharynx and larynx; and (3) an esophageal phase involving transit of the bolus from the pharynx into the stomach. A description is given of quantitative measurement techniques for assessment of the oral phase and reliable, noninvasive techniques for assessing the pharyngeal phase that are being developed. The goal is to identify the patient at risk of aspiration and choking.

Uptake, translocation, and transformation of pentachlorophenol in soybean and spinach plants.

Soybean plants were grown for 90 days and spinach plants for 64 days in a mixture of sterilized greenhouse soil and sand containing 10 ppm pentachlorophenol. All plant parts and soil samples were extracted and separated into nonpolar and polar fractions. Major nonpolar and polar metabolites were identified by gas-liquid chromatography and mass spectrometry. Nonpolar fractions from both soybean and spinach plants were found to contain pentachlorophenol and its metabolites, 2,3,4,6-tetrachlorophenol, methoxytetrachlorophenol, 2,3,4,6-tetrachloroanisole, and pentachloroanisole. Cleavage of polar metabolites from the soybean plants by acid hydrolysis yielded organic solvent-extractable products. These products were identified as pentachlorophenol, 2,3,4,6-tetrachlorophenol, and methoxytetrachlorophenol. Cleavage of polar materials from spinach plants yielded only pentachlorophenol. The polar metabolites from the soybean plants were also subjected to enzymatic cleavage by beta-glucosidase. The conjugates consisted mostly of O-glucosides of the same metabolites released by acid hydrolysis. Failure of hydrolysis by aryl sulfatase indicated that very little or no sulfates were present. The metabolites found in the plants were not detected in soil samples obtained from pots immediately after the plants were harvested.