Background Prior studies have implicated baseline positive and negative symptoms as predictors of psychosis onset among individuals at clinical high risk (CHR), but none have evaluated latent trajectories of symptoms over time. This study evaluated the dynamic evolution of symptoms leading to psychosis onset in a CHR cohort. Method 100 CHR participants were assessed quarterly for up to 2.5 years. Latent trajectory analysis was used to identify patterns of symptom change. Logistic and proportional hazards models were employed to evaluate the predictive value for psychosis onset of baseline symptoms and symptom trajectories. Results Transition rate to psychosis was 26%. Disorganized communication (i.e., subthreshold thought disorder) presented an increased hazard for psychosis onset, both at baseline (Hazard Ratio (95% CI) = 1.4 (1.1–1.9)) and as a trajectory of high persistent disorganized communication (Hazard Ratio (95% CI) = 2.2 (1.0–4.9)). Interval clinical data did not improve the predictive value of baseline symptoms for psychosis onset. Conclusions High baseline disorganized communication evident at ascertainment tended to persist and lead to psychosis onset, consistent with prior behavioral and speech analysis studies in similar cohorts. Remediation of language dysfunction therefore may be a candidate strategy for preventive intervention.

We study the effect of an exogenous increase in food grain subsidy from a program targeting the poor in rural India and find that the increase in income resulting from the subsidy increased consumption of the subsidized grains and certain more expensive sources of nutrition, lowered consumption of coarse grains, the cheaper, yet, unsubsidized staple food, and increased expenditures on nonfood items but had no effect on nutrition in poor households. Estimates of the price effect of the subsidy on nutrition are also negligible; the price subsidy increased consumption of wheat and rice and lowered consumption of coarse grains.

For pre-exposure prophylaxis (PrEP) and microbicides to effectively prevent HIV, optimal treatment adherence is required. Adherence to these strategies, however, has not been sufficiently studied. This investigation systematically reviews oral PrEP and microbicide trials across 4 domains of adherence: 1) definition and measures used; 2) risks for non-adherence; 3) promotion strategies; and 4) effects on outcomes. Nineteen (n = 19) trials, with 47157 participants, published between 1987 and 2012 were identified. Reported mean adherence to microbicides was 79% and to oral PrEP 87%. Common risks for microbicide nonadherence were decreased motivation over time, sex with primary (noncommercial/casual) partners, and insufficient supply. Oral PrEP non-adherence risks were older age and medication side effects. Psychoeducation and outreach to participants and communities were frequently utilized promotion strategies. Most trials failed to systematically identify barriers and monitor and promote adherence, although adherence moderated outcomes. Recommendations for attending to adherence in future trials are provided.

This paper examines the impact of Ethiopia’s gendered land certification programs on household consumption of healthcare, food, education, and clothing. Ethiopia embarked on a land tenure reform program in 1998, after years of communism during which all land was nationalized. The reform began in Tigray region where land certificates were issued to household heads, who were primarily male. In a second phase carried out in 2003–2005, three other regions issued land certificates jointly to household heads and spouses, presenting variation in land tenure security by gender. Results using household panel data show that joint land certification to spouses was accompanied by increased household consumption of healthcare and homegrown food and decreased education expenditure, compared to household-head land certification. Joint land certification was also accompanied by increased consumption of women’s and girls’ clothing, and decreased men’s clothing expenditures indicating results may be explained by a shift in the gender balance of power within households. Analysis on the incidence and duration of illness indicates that increased healthcare expenditures after joint land certification may be due to joint certification households seeking more effective treatment than head-only certification households for household members who fell ill or suffered injuries.