In the current context of health care in South Africa, STIs and HIV/AIDS, as well as maternal mortality, partnered deliveries, and involving men in reproductive health, including PMTCT are important issues and priorities. Very little can be achieved for either mothers or infants unless reproductive health providers realize the need and take active steps toward involving men in reproductive health services. The Reproductive Health Research Unit (RHRU) University of the Witwatersrand, in partnership with the FRONTIERS Program of the Population Council, and the KwaZulu Natal Department of Health conducted a three-year operations research study titled "Men in Maternity" (MIM) in the Ethekwini district. The study was completed in July 2003. A randomized cluster matched paired design was used with six clinics implementing the intervention and another six control clinics continuing to provide services following the current practices and guidelines of the Department of Health. Both rural and urban clinics were included.

The Medicare claims-based algorithm showed good discrimination of phenotypic frailty and high predictive ability with adverse health outcomes. This algorithm can be used in future Medicare claims analyses to reduce confounding by frailty and improve study validity.

Although many countries allow over-the-counter distribution of oral contraceptives, doubt remains about whether such provision is safe for the user. The greatest concern is whether women with contraindications for use are given access to the pill. Clearly, women without such contraindications should be given access to it and be offered adequate information about its correct use. In 15 pharmacies in Jamaica, mystery clients approached pharmacists to determine their willingness to sell oral contraceptives and to solicit information from them about correct use of the method. In addition to data from mystery-client observations, interviews were conducted with 78 pharmacists and with 524 pharmacy customers who bought oral contraceptives, providing complementary information about knowledge of, attitudes toward, and experiences with the method. Analysis of the combined findings suggests that over-the-counter provision of oral contraceptives is a safe, practical, and effective method of distribution in Jamaica.

Purpose: This prospective cohort study examined the association between specific leisure-time activity and mortality risk.

Increases in physical activity can reduce joint pain among people with osteoarthritis (PWOA) who are insufficiently physically active. Because evidence suggests that social support from intimate partners may help PWOA become more active, researchers have been interested in recruiting couples to studies of physical activity interventions; however, little guidance exists describing efficient and effective strategies for engaging couples in research. We describe methods used to recruit couples and contrast methods in terms of the proportion of individuals enrolled, sample demographic composition, retention, and resources. We used four recruitment methods to enroll couples in a longitudinal study of PWOA: (1) visiting community sites, (2) sending university-wide emails, (3) contacting patients identified through electronic medical records (EMR), and (4) partnering with a county-based osteoarthritis (OA) research cohort. We found that these methods differed in their challenges and contribution to enrollment goals but demonstrated similar levels of retention. We contacted 747 PWOA; 56% were screened for eligibility and 23% enrolled in the study. The largest proportion of participants recruited were from the email method (35.1%), followed by the community (26%), EMR (22.0%), and OA cohort (19.6%). Couples enrolled through the different methods differed by age, employment, education, and household income. Across the methods for both PWOA and partners, over 80% of participants were non-Hispanic white, about 11% were non-Hispanic black, and 6–8% identified as another race. Over 12 months of follow-up, 31 (17.9%) PWOA and 36 (20.8%) partners were lost to follow-up. Using four distinct recruitment methods allowed us to meet recruitment goals and provided a broader, more diverse population compared to using one method. We recommend that researchers consider several recruitment methods to meet enrollment goals, to ensure a diverse sample, and to match available resources. The lessons learned from this research fill a critical gap in the understanding of how to overcome barriers to recruiting and retaining couples in behavioral research.

Background Higher levels of moderate-to-vigorous physical activity have been associated with a lower risk of diabetes, but less is known about how daily step counts (steps/day) are associated with diabetes risk. Therefore, we examined the association of steps/day and step intensity with incident diabetes. Methods We included 6634 adults from the population-based prospective cohort Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (2008–2017). Cox proportional hazard models that accounted for complex survey design and sampling weights were used to estimate the association of baseline accelerometer-assessed steps/day and step intensity with 6-year risk of incident diabetes as hazard ratios (HR) and 95% confidence intervals (CI). We further examined whether the percent of intense steps at a given accumulation of steps/day was associated with diabetes risk, and if associations were modified by specific cohort characteristics. Results The average age of cohort members was 39 years and 52% were female. Adults had an average of 8164 steps/day and spent 12 min/day in brisk ambulation (> 100 steps/min). Over 6 years of follow-up, there were 1115 cases of diabetes. There was a suggestive lower risk of diabetes with more steps/day– adults had a 2% lower risk per 1000 steps/day (HR = 0.98 (95% CI 0.95, 1.00)). Inverse associations between average steps/day and diabetes incidence were observed across many cohort characteristics, but most importantly among adults at high risk for diabetes – those who were older, or had obesity or prediabetes. Adults who accumulated 17 min/day in brisk ambulation compared to < 2 min/day had a 31% lower risk of diabetes (HR = 0.69 (95% CI 0.53, 0.89)). A greater percent of intense steps for a given accumulation of steps/day was associated with further risk reduction. Conclusion Adults who accumulate more daily steps may have a lower risk of diabetes. Accumulating more steps/day and greater step intensity appear to be important targets for preventing diabetes.

Purpose To quantify the influence of the length of the look-back period on misclassification of heart failure (HF) incidence in Medicare claims available for participants of a population-based cohort. Methods Atherosclerosis Risk in Communities (ARIC) participants with ≥3 years of continuous fee-for-service Medicare enrollment from 2000–2012 was assigned an index date 36 months after enrollment separating the time-in-observation into the look-back and the incidence periods. Incident HF events were identified using ICD-9-CM code algorithms as the first observed hospitalization claim or the second of two HF outpatient claims occurring within 12 months. Using 36 months as a referent, the look-back period was reduced by 6-months increments. For each look-back period, we calculated the incidence rate, percent of prevalent HF events misclassified as incident, and loss in sample size. Results We identified 9,568 ARIC participants at risk for HF. For hospitalized and outpatient HF, the number of events misclassified as incident increased and the total number of incident events decreased with increased length of the look-back period. The incident rate (per 1,000 person years) decreased with increased length of the look-back period from 6 to 36 months and had a greater impact on outpatient HF; for example, from 11.2 to 10.6 for ICD-9-CM 428.xx hospitalization in the primary position and 10.5 to 7.9 for outpatient HF. Conclusion Our estimates can be used to optimize trade-offs between the degree of misclassification and number of events in the estimation of incident HF from administrative claims data, as pertinent to different study questions.

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