This multi-national study hypothesized that higher levels of country-level gender equality would predict smaller differences in the frequency of women’s compared to men’s drinking in public (like bars and restaurants) settings and possibly private (home or party) settings. GENACIS project survey data with drinking contexts included 22 countries in Europe (8); the Americas (7); Asia (3); Australasia (2), and Africa (2), analyzed using hierarchical linear models . Age, gender and marital status were individual predictors; country-level gender equality as well as equality in economic participation, education, and political participation, and reproductive autonomy and context of violence against women measures were country-level variables. In separate models, more reproductive autonomy, economic participation, and educational attainment and less violence against women predicted smaller differences in drinking in public settings. Once controlling for country-level economic status, only equality in economic participation predicted the size of the gender difference. Most country-level variables did not explain the gender difference in frequency of drinking in private settings. Where gender equality predicted this difference, the direction of the findings was opposite from the direction in public settings, with more equality predicting a larger gender difference, although this relationship was no longer significant after controlling for country-level economic status. Findings suggest that country-level gender equality may influence gender differences in drinking. However, the effects of gender equality on drinking may depend on the specific alcohol measure, in this case drinking context, as well as on the aspect of gender equality considered. Similar studies that use only global measures of gender equality may miss key relationships. We consider potential implications for alcohol related consequences, policy and public health. A nuDespite a lack of research, some scholars attribute convergence in alcohol consumption to increased gender equality  a mostly male activity has been seen as a marker of gender deviance –38. WomeThe growing literature on effects of macro-level gender equality on health –10 offerIn addition to using composite indicators to measure overall gender equality, the literature on gender equality and health generally measures and explores the following domains: gender equality in economic participation and opportunity, gender equality in education, gender equality in political participation, control of reproduction, and context of violence against women . GendereThis study takes the first step in building a research program based in the area of gender differences in drinking in different settings, gender equality, and, to be studied later, alcohol related-harms. This study first characterizes twenty-two countries from the developed and developing world by the size of gender differences in frequency of drinking in public and in private settings. It then explores whether country-level gender equality modifies the size of gender differences in frequency of drinking in two major settings- on premise (bars and restaurants) and off premise , controlling for country-level economic status and individual-level factors. Because indicators of country-level gender equality mostly measure equality in the public sphere, we hypothesize that indicators of macro-level gender equality will be more likely to predict the size of gender differences in drinking in public than in private settings. While plausibly connected to alcohol related harms, exploring the connections between gender differences in drinking in public and private settings and harms is, as noted, beyond the scope of this initial analysis.2.2.1.Survey samples come from the multi-country GENACIS project . Twenty-ns of male and, especially female, current drinkers vary greatly and are small in some cases. Although women’s full samples were adequate  was randomly or systematically selected per enumerated or selected household. The average sample size per country was 1,270 men and 1,054 women. Per the GENACIS study objectives, nearly all datasets, with the exception of Brazil and Isle of Man, include a minimum sample size of 1,000. The datasets from the United States and Canada were substantially larger. Because of gender differences in abstention, actual adequate , there a2.2.2.2.1.last 12 months, about how often did you drink in the following circumstances? Think of all the times that apply in each situation”. Two situations, or contexts, were chosen to represent Public drinking: “in a bar/pub/disco” and “in a restaurant” and two were chosen to represent Private drinking: “at a party or celebration” and “in your own home”. The eight response categories ranged from “every day or nearly every day” through “once or twice a year” to “never in the last 12 months”. Categories were converted to the metric of days per year using category midpoints. The values for each of the two constituent contexts were summed to indicate the frequency of drinking in each (public and private) setting. Because it is possible to drink in two settings on a given day, the summed frequencies could exceed 365 days. However, exceeding 365 days was extremely rare, so results were not truncated.This study examines two separate dependent variables: frequency of drinking in public settings and in private settings over the past 12 months. Frequency, rather than usual quantity or volume, was used because only frequency and not quantity in different settings was collected in the surveys. These variables are based on the GENACIS Expanded Core questions. The surveys assessed frequency of drinking in various contexts by asking: “Thinking back over the i.e., in (a) a bar, pub, or disco and (b) restaurant. However, Denmark, Iceland, and Sri Lanka surveys asked about frequency of drinking in a bar, pub, disco, or restaurant/café in a single combined question. Asking multiple questions tends to give higher values than use of a single, combined question. To make responses from surveys more comparable and reduce the methodological ‘penalty’ in the three surveys with the single public setting question, gender specific ratios of frequency of drinking in bars, pubs, and discos versus in restaurants from similar countries were applied to the gender-specific combined public venue data. For Denmark and Iceland, Swedish ratios were applied. For Sri Lanka, Indian ratios were applied. Restaurant drinking was minimal in India and in Sweden, so this adjustment made very little practical difference.Identical or similar questions were asked in each participating country. Sweden only asked these questions in a random third of the full sample; however, the one-third sample was similar in size to those of other countries . Most co2.2.2.Country-level variables: Country-level variables to measure gender equality and economic status include both existing indices and indices created specifically for this study.Gender equality We included four existing indices and two newly created indices to measure composite gender equality; gender equality in economic participation and opportunity, education, and political participation; reproductive autonomy; and context of violence against women. The existing indices were: the 2008 Gender Empowerment Measure (GEM) and the 2007 Global Gender Gap Index (GGI) Economic Participation and Opportunity, GGI Education, and GGI Political Participation sub-indices [-indices –54. Indi-indices ,15,55.The GEM is a composite index that measures gender equality in political participation and decision-making, economic participation and decision-making, and power over economic resources. Higher scores indicate greater gender equality. Sweden has the highest GEM score (0.925), with Denmark and Iceland also highly ranked (0.887 and 0.881 respectively). India, Sri Lanka, and Nigeria have low GEM scores ; while Costa Rica, Argentina, and the United States have moderate scores . GGI sub-indices estimate relative to men, women’s economic participation and opportunity, educational attainment, and political participation. Higher GGI scores indicate greater gender equality The GGI also has a composite index of country-level gender equality. However, the GGI composite index includes gender differences in life expectancy. Therefore, the GEM was preferred as the composite gender equality indicator.To our knowledge, there are no existing indices that measure women’s reproductive autonomy across countries. However data about reproductive autonomy and women’s actual control over reproduction are consistently collected and reported in multiple sources. We created a reproductive autonomy index based on the following variables: restrictiveness of abortion laws , contracTo our knowledge, there are also no existing indices that measure the context of violence against women across countries. Recently, many countries have started to collect data on both actual violence against women and countries’ responses to this violence. However, data on actual rates of violence against women are collected inconsistently and are often not comparable across countries. Recent attempts to standardize data collection have moved in a positive direction . HoweveCountry-specific indices were created through factor analysis. Variables included in the factor analysis were chosen based on completeness of data and findings from pairwise correlations with a wider range of measures that included varying time frames for sexual assault and partner physical violence as well as gender-disaggregated homicide rates. Only total homicide rate was included because there were more missing data for gender disaggregated rates and male and female homicide rates were highly correlated (0.75). The seven variables included: percent of women reporting ever being sexually assaulted, percent of women reporting physical violence against them by a partner in the past year, percent of the population feeling unsafe on the street after dark, rate per 100,000 of mortality caused by homicide, percent of men reporting that violence towards one’s wife was justifiable, quality of legislation within the country punishing violence against women , and the number of different domains of activity to address violence against women that a country engages in, as reported to the UN Secretary General . The percent of the population feeling unsafe on the street after dark was initially included in the factor analysis, but produced a very small factor loading and was therefore excluded. Similar to the results for the reproductive autonomy factor, a strong single dimension emerged from the analysis .Economic status Gross Domestic Product per capita 2006 (GDP) and the Human Development Index (HDI) were both considered as indicators of country-level economic status. The two measures were highly correlated (0.82) and multilevel findings from the HDI were similar to GDP. Therefore, only results for GDP are reported here as it was less correlated with the other country level variables than the HDI  were missing. The missing values were for sexual assault (eight countries), physical violence from partner (seven countries), and quality of legislation punishing violence against women (one country). Data were imputed in the NORM program . This prIndividual Level Variables: Age, gender, and marital status were taken from responses to the GENACIS surveys in each country. Across countries, age was asked as a continuous variable. Marital status, although asked with slightly different possible categories across country, was coded as 1 if the respondent was married or living with a partner and 0 otherwise. Gender was coded as 0 if female and 1 if male.2.3.Hierarchical Linear Modeling (HLM) , using HMarital status and age were each centered around their overall means in order to obtain interpretable intercept and gender coefficients from the HLM model. Each country level variable was centered and scaled to have a mean 0 and a variance 1, for ease of comparison. Sampling weights, accounting for survey design, were used for all analyses.i,cy is the frequency of drinking in public settings for the thi respondent in the thc country, i,cA their age, i,cM is their marital status, and i,cG is an indicator for whether the respondent was male. The variable Zc is the country-level predictor . This two-level model contains two random effects: a random intercept and a random gender coefficient. Individual-level marital status and age were assumed to be fixed effects. The random effects u0,c and u1,c were assumed to be distributed normally with variance-covariance matrix T and were assumed to be independent of the normally distributed country level variance term ɛi,c which was assumed to be independent across individuals. Therefore, the interpretation of the intercept αc is that of the country-specific frequency of drinking in public settings for women at the average age and for the average proportion married. The interpretation of the random gender coefficient βc is the country-specific difference in frequency of drinking in public settings between men and women at the average age and for the average proportion married. A significant positive coefficient for 0,1γ would suggest that, as women in a country gain more reproductive autonomy, women’s frequency of drinking in public places increases. Similarly, a significant positive coefficient for 1,1γ would suggest that increased rights would be associated with a smaller difference in the frequency of drinking in public settings between men and women.Separate models were estimated for drinking in public and in private settings and for each country-level gender equality and economic status predictor. The model for drinking in public settings using the reproductive rights measure is presented here for illustrative purposes. The model estimated was:In addition to separate models for each country-level predictor for both public and private settings (models 2), a final model (model 3) was estimated to examine which, if any, of the country-level equality indicators were still significant after controlling for GDP. This model used a forward stepwise procedure where all country-level variables that were significant in the separate models were entered simultaneously, starting first by forcing the entry of GDP into the model. The condition number for the correlation matrix  of the c3.3.1.The samples sizes, proportion of the population drinking within the past 12 months, and frequency of drinking in public and, in private settings, are shown in The relative frequency of drinking in each setting across countries varies less for women than for men. For women, the order of countries from least to greatest mean frequencies is roughly similar across public and private settings. For men, the order of countries is more heterogenous across the two settings. This difference can be seen by ranking each of the public and private frequencies separately and then summing the corresponding paired differences of these ranks as well as by Pearson correlations between mean frequency of drinking in each setting. For women, the summed difference is 52 and the correlation is 0.92. For men, the summed difference is 154 and the correlation is 0.04.The size of the gender difference in drinking appears influenced by both men’s and women’s drinking, but does not appear to be due to overall frequency of drinking in the country. Specifically, higher mean frequencies of drinking for women and lower mean frequencies of drinking for men were associated with smaller expected gender differences in each setting, although these associations were stronger for women’s than men’s frequency. For women, correlations between the intercept and gender slope coefficients for Model 1  were mod3.2.Values for each country-level variable are available from the first author. Estimates for the multilevel models can be seen in 3.2.1.Married people report significantly lower frequency of drinking in public settings than unmarried people See , Model 1i.e., the gender difference) and not for the gender intercept. All country-level gender equality and economic status indicators, with the exception of gender equality in political participation, predicted the gender slope coefficient. For each significant association, increased gender equality and economic status predicted a smaller gender difference in frequency of drinking in public settings. Context of violence was reverse coded, which is the reason the sign of the coefficient is positive. Because country level variables were standardized, the magnitude of the coefficients can be compared. Most coefficients were near 0.15. The coefficient for economic participation and opportunity was somewhat larger (0.21) and that for gender equality in educational attainment was somewhat smaller (0.11).The within country gender differences in mean frequencies are indicated by the slopes of the lines connecting the paired estimates in Analyses in Model 2 were also conducted for current drinkers only (results not shown). While gender slope coefficients were slightly larger in magnitude on average (ranging from 0.2 to 0.3), each country-level indicator that was significant in the whole sample was again significant at similar levels of significance as for the entire sample. Political participation was again not significant. There was also very little change in individual-level coefficients once country-level variables were entered in Model 2.The stepwise forward entry model results where GDP was forced in and essentially controlled for (Model 3) are shown in 3.2.2.p < 0.05) between men’s and women’s frequency of drinking in private settings. However, after entering both GDP and equality of educational attainment (Model 3), educational attainment was no longer significant (p = 0.16).Unlike results for public settings, married people reported significantly higher frequency of drinking in private settings than unmarried people and age was not associated with frequency of drinking , less violence against women and more state response to the violence (p = 0.02) and higher values of the HDI (p < 0.001) were each associated with larger gender differences in frequency of drinking in private settings. Multivariate models were not estimated.For the sample of current drinkers only (results not shown), more gender equality in educational attainment , the direction of the findings was opposite from the direction in public settings, with more equality predicting a larger gender difference. However, this relationship was no longer significant after controlling for country-level economic status.That smaller gender differences in frequency of drinking in public settings are associated with both higher frequency by women and lower frequency by men suggest two competing plausible implications that need to be researched further. Hypothetically, smaller gender differences could imply that increased equality in economic participation will lead women to face increased alcohol-related consequences, including but not limited to sexual assault. Conversely, an alternative possibility is that smaller gender differences in public drinking might lead these contexts to be less “masculine,” and so could reduce the well-documented harms –26,28–334.1.i.e., homicide rates). Despite these limitations, most of the variables loaded on one factor, suggesting that it was meaningful to include this theoretically important factor in our analysis. Still, coefficients for the context of violence against women index should be interpreted with some caution. Fourth, regarding the measures of drinking in public and in private settings, the private measure may be imperfect, as private includes drinking at parties, which could be considered to be either a public or a private setting. However, we considered primarily the on- versus off-premise  notion, important from a policy perspective, since parties are often ‘closed’ and thus formally private, and generally cannot be regulated as can bars and restaurants which are, in many cases, licensed venues. Fifth, for this secondary analysis, only frequency of drinking in each setting, and not volume or usual quantity consumed in that setting, was available due to limitations in most of the GENACIS surveys. If alcohol-related problems are, as seems likely, more a function of volume or quantity consumed, then only to the extent that frequency is correlated with these will the results be relevant to alcohol-related harms. Previous research has found that frequency of drinking in bars, and not just intoxication in bars, has been linked to increased risk for victimization for women [This study should be interpreted in light of its limitations. First, as this is a cross-sectional study, it is not possible to determine if increases in gender equality caused smaller gender differences. It is possible that in countries where both men and women drink frequently in public settings, barriers to women’s economic participation will be smaller. Longitudinal data is needed to determine the direction of this relationship. Second, country-level variables are derived from multiple data sources. Although attempts were made to match years of country-level variables and survey years, country-level data do not correspond exactly to survey year in each instance. Third, the indicator of context of violence against women was assembled from multiple sources and data availability required the use of different time frames and definitions for prevalence of sexual and physical violence. It includes both violence against women and overarching violence  macro-level gender equality may influence public more than private behavior; (2) the relationship between macro-level factors and alcohol consumption may differ for drinking in different settings; in turn suggesting that future research should account for drinking context; and (3) identification of indicators of macro-level gender equality, mainly gender equality in economic participation and opportunity, may be important for alcohol research and investigation of alcohol-related outcomes in cross-national studies. Second, the sample (22 countries) included countries with comparable drinking context questions based on a core questionnaire developed by an international group of scholars and generally comparable methods , thus ma5.Macro-level gender equality may influence alcohol consumption patterns . Consumption patterns, including the preferred environments in which one drinks, in turn are known to influence alcohol-related harms . The eff5.1.From a public health perspective, the findings from this study offer some suggestions for strategies to prevent alcohol related harms and also raise important questions for future research to inform such strategies. First, the characterization of countries in this study by frequency of drinking for both women and men provides information for locating interventions. For example, in countries where women drink frequently in public settings, it is appropriate to locate alcohol interventions, such as responsible beverage service programs, in public settings. Second, this characterization provides information for the content of alcohol-related interventions. Countries where the majority of drinking by men takes place in public settings may benefit from increased regulation of on-premise drinking while countries where the majority of drinking by men takes place in private settings may require a focus on regulating off-premise liquor sales. Research is needed to understand the different types of harms for both men and women associated with drinking in settings with large and small gender differences and whether there is a tipping point at which the level or type of harms begins to change. Both qualitative and quantitative studies will be needed. Such research will inform the content of future interventions. Finally, it is also not yet clear how changes in frequency of drinking in public settings relates to health and to negative alcohol-related consequences. However, the possibility that increased gender equality may influence alcohol consumption patterns should be accounted for in studies of gender equality and health behaviors of considerable relevance to setting public health priorities in this arena.


The application of Information and Communication Technologies (ICTs) in the field of university education can play an important role in order to fulfil the objectives of the European Space for Higher Education (ESHE). In the absence of an infrastructure that allows virtual preparations, the high definition video may become an alternative for many PC users and telepathology enthusiasts.We have begun a video biopsy discontinuous recording pilot programme, also known as interval cinematography, in order to give our students pathological images to gather documentary evidence to follow their clinical cases. We have a working post available with a ZEISS Axioshop 2 microscope connected to a JVC digital camera with a double output for video, a PVM_14N1MDE Sony Triniton colour monitor and a LG RH199 HDD-DVD recorder.Pathologists can easily produce videos lasting between 45" and 5' according to the case. Later those videos are assessed all together and given to the student and/or the doctor who requested the case study.Better follow-up studies of the cases can be achieved using Discontinuous video recording of biopsies. This approach has also clinical benefits since it contributes to the enrichment of integral patient care. The application of Information and Communication Technologies (ICTs) in the field of university education can play an important role in order to fulfil the objectives of the European Space for Higher Education (ESHE). ICTs can be a valid tool when considering lifelong learning as part of higher education. At the Berlin conference (2003:4), the term lifelong learning was defined as the "continuous learning process that allows individuals, from childhood to old age, to acquire and update knowledge, skills and competences in the different periods of their life and in a variety of learning contexts, formal as well as non-formal, therefore maximizing their personal development, job opportunities and fostering their active participation in a democratic society".The Rey Juan Carlos University, the youngest of the six public universities in Madrid, was founded in 1996. The faculty of Health Sciences is located in the district of Alcorcón, in the south of Madrid, with a population of 160,000 inhabitants. It began its teaching activity in April 1997 starting with a three-year degree in Physiotherapy and Occupational Therapy. One year later, a three-year degree in Nursing began and, in the academic year 2003–2004, a five-year degree in Odontology. A five-year degree in Medicine is expected to commence in the academic year 2008–2009.The five-year degree in Odontology aims to train odontologists to act in different areas of dental clinics, as well as in health prevention and promotion. Studies leading to a five-year degree in Odontology are structured in two cycles: a two and a three-year cycle respectively, with a total of 329.5 credits. In the first cycle, the basic subjects are concentrated, while the second cycle includes more specific subjects. An important part of the credits are practical lessons in laboratories and clinics with attention to patients. The availability of a great number of laboratories with experimental facilities, as well as care clinics, allows students, supervised by university teachers, to carry out practical lessons and treat patients.Fifth-year Odontology students teach the subjects Integrated Odontological Clinic for Adults, Integrated Odontological Clinic for Children and Integrated Odontological Clinic for Special Patients. In addition, in a third cycle, students have the option of developing their skills doing a Master in Implant and Oral Surgery. It is in those three above-mentioned subjects in their degree and in the Master where the Histology and Pathology Areas have developed an information flow system with the objective of collaborating with the rest of the teachers, in order to inform as to the diagnostic means of the infectious, traumatological, tumoral and dysembrioplastic or dysmorphic processes of the oral-facial area, so that the student can carry out a diagnosis, prognosis and a proposal for treatment.In the absence of an infrastructure that allows virtual preparations, the high definition video may become an alternative for many PC users and telepathology enthusiasts. No matter if we watch high definition TV at home or a DVD while travelling, we always prefer high quality images. The new video formats that are being launched into the market  meet that demand and allow us to watch high definition films on our computers. The high definition video (HDV) offers a practical functioning scheme easily accepted by both consumers and manufacturers. All things considered, this might be a good solution since it is not as costly as the professional HD production systems (Sony HDCam and Panasonic DVCPro HD) and it offers a reasonable quality and fidelity similar to the DV video .In this context, we have begun a video biopsy discontinuous recording pilot programme, also known as interval cinematography, in order to give our students pathological images to gather documentary evidence to follow their clinical cases. We have a working post available with a ZEISS Axioshop 2 microscope connected to a JVC digital camera with a double output for video, a PVM_14N1MDE Sony Triniton colour monitor and a LG RH199 HDD-DVD recorder.Our work flow is as follows: once the anatomopathological study request of a biopsy coming from the Odontology University Clinic has been registered, the material is processed according to the usual routine and assessed in the microscope by the pathologist. Together with microscopic assessment, the pathologist carries out a discontinuous video recording on the fields he considers to be the most interesting for the final diagnosis. Those videos last between 45" and 5' according to the case. Later those videos are assessed all together and given to the student and/or the doctor who requested the case study.Through this procedure we have been able to carry out better follow-up studies of the cases and we have found the point of view of the clinic beneficial as it contributes to the enrichment of integral patient care.


This loss was corticosteroid-independent and not affected byCyclosporin A. The disappearance of CD4+CD8+ thymocytes was strictly correlated withthe induction of apoptosis inside the thymus as shown by morphological studies and bythe induction of intracellular transglutaminase expression. Considering that PGE2 hasbeen found to be produced by different cell populations inside the thymus, these resultsindicate that PGE2 may act as endogenous signals for apoptosis during T-celldifferentiation.In vivo administration in mice of a synthetic analog of prostaglandin E


P = 0.0005), advanced FIGO stage (P = 0.001) and primary residual tumour (P = 0.0001). Low p21/WAF1 expression was a marker of poor overall survival (P = 0.012). Similarly, p53-positivity and high cell proliferative activity were significant predictors of poor survival in univariate analyses. Moreover, the patients with p21–/p53+ tumours had a poorer overall (P < 0.00005) and recurrence-free (P = 0.0005) survival in univariate analyses, and the p21/p53 expression independently predicted tumour recurrence in Cox's multivariate analysis. Our results suggest that p21/WAF1 expression is mostly p53-dependent in epithelial ovarian cancer. High p21/WAF1 expression seems to function as a negative cell cycle regulator and as a marker of favourable disease outcome in epithelial ovarian cancer. In addition, the patients with their tumour expressing no or low p21/WAF1 protein but positive for p53 had a notably higher risk of recurrent disease, implicating that these patients might be more prone to treatment failures. © 1999 Cancer Research CampaignThe role and prognostic value of the tumour suppressor p21/WAF1 expression in epithelial ovarian cancer has not yet been defined. Therefore, the expression of p21/WAF1 was assessed immunohistochemically (IHC) in 316 epithelial ovarian malignancies in relation to p53, cell proliferation and patient survival. p21/WAF1 expression was inversely correlated with p53 and cell proliferation. Low p21/WAF1 expression was significantly associated with high grade of the tumour (


During this time, the stromal component reflected that of thenormal embryo with cortical and medullary epithelial areas readily identifiable by bothmorphology and surface-antigen expression. An abundance of subcapsular and corticalepithelial antigens was detected in the cultured thymus, particularly those normallyexpressed by the epithelium lining the capsule, trabeculae, and vascular regions (typeepithelium) in the adult and embryonic thymus. Medullary epithelial antigensdeveloped in organ culture, although were present in lower frequency than observed inthe age-matched embryonic thymus. MHC class II expression by both epithelial andnonepithelial cells was maintained at high levels throughout the culture period. Withincreasing time in culture, the ratio of epithelial to nonepithelial cells decreased,concurrent with a decrease in thymocyte frequency and suggestive of a bidirectionalinteraction between these two cell types. Thus, a functionally intact thymicmicroenvironment appears to be maintained in embryonic thymus organ culture, amodel that is currently being exploited to assess the role of stromal antigens, as definedby our mAb, in the process of thymopoiesis.The chicken thymic microenvironment, as it developed in an embryonic thymus organculture system, was phenotypically mapped using a panel of mAb defining bothepithelial and nonepithelial stromal cell antigens. We have previously reported thatthymocyte proliferation and differentiation will proceed for up to 6–8 days in thymusorgan culture, hence demonstrating the functional integrity of the thymicmicroenvironment


Falling numbers of maternal deaths have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The purpose of this study was to document the frequency and causes of near miss and maternal deaths in four hospitals in West Java, Indonesia.Cross sectional study in four hospitals in two districts in Banten province, Indonesia. We reviewed registers and case notes to identify the numbers and causes of near miss and death between November 2003 and October 2004. Near miss cases were defined based on organ dysfunction, clinical and management criteria. Near miss were categorized by whether or not the woman was at a critical state at admission by reviewing the final signs at admission.The prevalence of near miss was much greater in public than in private hospitals . Hemorrhage and hypertensive diseases were the most common diagnoses associated with near miss, and vascular dysfunction was the most common criterion of organ dysfunction. The occurrence of maternal deaths was 1.6%, with non-obstetric complications as the leading cause. The majority (70.7%) of near miss in public hospitals were in a critical state at admission but this proportion was much lower in private hospitals (31.9%).This is the first study to document near miss in public and private hospitals in Indonesia. Close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals. Even though the private sector takes an increasingly larger share of facility-based births in Indonesia, managing obstetric emergencies remains the domain of the public sector. Falling numbers of maternal deaths in developed countries have stimulated an interest in investigating cases of life threatening obstetric morbidity or near miss. The advantages of near miss over death are that near miss are more common than maternal deaths, their review is likely to yield useful information on the pathways that lead to severe morbidity and death, investigating the care received may be less threatening to providers because the woman survived, and one can learn from the women themselves since they can be interviewed about the care they received ,2.This growing interest is reflected in an increasing number of systematic reviews on the prevalence of near miss -5. The rAt the hospital level, an investigation into the pattern causes and timing of near miss can inform the needs for preventive programs and health care resources . HospitaThe study was conducted in four hospitals in Pandeglang and Serang districts in Banten province. Two hospitals were public hospitals  and two were private . All hospitals perform obstetric surgery, but only the public hospital in Serang has an intensive care unit and very severe cases may be referred there. The four hospitals cover almost all hospital admissions related to pregnancy and childbirth in the two districts. In these two districts approximately only 8% of births occur in a hospital, and the findings reported here apply to hospital births only.Near miss cases were defined as cases of life-threatening complications in women admitted during pregnancy, labor or postpartum who survived, adapting the criteria proposed by Mantel et al 1998) . The lat998 . Thest 2003 and October 31st 2004. Data on complications, mode of delivery, age, parity and birth outcome were extracted from registers in the delivery ward, surgical ward, obstetric ward, and intensive care unit, linking women by hospital admission number. All women reported to have any complication, surgery or a perinatal death in any of the registers were selected for detailed case note review. For maternal deaths, further efforts were made to screen all registers from other female wards in the hospital. The data collection was done by eight medical doctors using structured extraction forms. They scrutinized the case notes and reported the diagnoses listed by the providers, the presence of specific near miss criteria, and the timing of the occurrence of complications. They also differentiated cases admitted in a critical state from those whose life-threatening complication developed during hospitalization, relying on the information on vital signs and conditions at admission, as well as on the data collectors'  judgment in the case of missing information.Data were collected retrospectively between October 2004 and October 2005, covering all admissions between November 1The statistical analysis was descriptive; proportions were compared using the Chi Square.Ethical approval by an ethic committee of the University of Indonesia was obtained prior to field work. In addition, written consent for collecting and sharing the data was obtained from the head of each hospital, and the obstetricians gave verbal approval. The data were stored electronically as part of the Immpact data-base in Indonesia and UK offices.There were 5,669 pregnancy-related admissions in one year in the four hospitals: 2,803 in Serang hospital, 1,212 in Pandeglang hospital, 873 in Budi Asih and 781 in Kencana. Information from the registers identified 4,571 (80.6%) women as having had a complication, and case notes were found in 4,270 (93.4%) of those.Figure There were 763 cases of near miss in all four hospitals. The near miss criteria and their frequency are shown in Table Vascular dysfunction was by far the most common organ dysfunction (77.7%) followed by cardiac (5.1%) and renal dysfunction (4.5%) Table . Septic Table Among all life-threatening complications (i.e. near miss and death), mortality was highest for non-obstetric admissions (50%), followed by hypertensive diseases (17.8%) and dystocia 14.5%) (Table .5% (TablSevere anemia was extremely common among near-miss Table . More thThe majority 67.2%) of near miss were in a critical state at admission and this proportion was higher in public than in private hospitals  , but some case notes were clearly incomplete. The extremely low rates of immunological and respiratory dysfunction, for example, may reflect the poor recording of such complications, and the incidence of these complications in the hospitals may have been underestimated. The assessment of whether the woman was in a critical state at or after admission may also have been erroneous in some cases, and these results have to be interpreted with cautionThe main causes of near miss identified here, such as hemorrhage and hypertensive diseases, are similar to those found elsewhere ,6,11. SeWomen with obstetric complications, near miss and maternal deaths were all less common in the private than in the public sector. The two private hospitals accounted for about a third of all admissions, yet they only represented 9.0% and 1.6% of near miss and maternal deaths respectively. It is clear that healthier, and most likely wealthier, women selectively opt for obstetric care in the private sector and the differences in morbidity and mortality between public and private hospitals are most certainly due to case-mix differences. Private hospitals are also likely to refer women with severe complications to public hospitals, thereby keeping the incidence of near miss lower. These differences do not imply that care is less good in one sector than another.Quantifying the magnitude, causes and timing of near miss in hospitals is only a first step in the investigation of near miss. The large number of near miss upon arrival begs the question as to why women get to hospital so late. Births in hospital are very infrequent in Indonesia, and caesarean section rates are extremely low among large sections of the population . InterviThis is the first study to document near miss in public and private hospitals in Indonesia. Close to a fifth of admissions in public hospitals were associated with near miss; and the critical state in which the women arrived suggest important delays in reaching the hospitals. Even though the private sector takes an increasingly larger share of facility-based births in Indonesia, managing obstetric emergencies remains the domain of the public sector.The author(s) declare that they have no competing interests.CR has made substantial contributions to conception and design of the study, interpretation of data, drafted the manuscript and revising it critically for important intellectual content. CS has been involved in drafting the manuscript and revising it critically for important intellectual content. FN participated in data acquisition and interpretation. PD participated in data acquisition, statistical analysis and versions of the manuscript. AA has been involved in the design of the study, acquisition of data and interpretation of data, and in drafting the manuscript. The manuscript has been read and approved by all authors.The pre-publication history for this paper can be accessed here:


P < 0.001). There was a significant positive association between p21 and AP-2 expression levels (P = 0.01). p21 intensity and percentage were higher in Dukes' A and B stages (P < 0.001). The cancer-related survival and recurrence-free survival (RFS) rates were significantly lower among patients with a low signal for p21 (P < 0.001) and low p21 percentage in tumour epithelium (P < 0.001). High p53 staining intensity in tumour epithelium predicted poor survival (P = 0.01) and RFS (P = 0.003). In the multivariate analysis, p21 percentage distribution independently predicted cancer-related survival in all cases, and p21 expression intensity in T1–4/N0–3/M0 and T1–3/N0/M0 cases. p21 percentage distribution was an independent predictor of RFS in all and T1–3/ N0/M0 cases. AP-2 staining did not reach any prognostic significance. These results suggest that the immunohistochemical detection of cyclin-dependent kinase inhibitor p21 could be used to predict more precisely the outcome of colorectal cancer patients. © 1999 Cancer Research Campaignp21/WAF1 expression was studied in a series of 162 colorectal carcinoma patients and its relation to p53- and activator protein (AP)-2 expressions and to stage as well as survival was assessed. p21 expression was moderate or intense in 33% of the tumours, and 53% of the tumours had moderate or strong p53 staining intensity. Eighty-nine percent of the tumours showed a weak cytoplasmic AP-2 signal. As expected, p21 and p53 stainings were inversely related to each other (


India's life expectancy has more than doubled, and infant mortality, halved in the last fifty years. The exteMicronutrients are required in small quantities and responsible for vital functions of the human body. Logically, they should be addressed easily and on a priority basis. The facts are, however, contrary. As a result, micronutrient malnutrition has been a persistent problem in India, and as the recent data suggest, some forms of micronutrient malnutrition are reaching their peak in the present century. We are broadly looking at the magnitude of this problem, and the initiatives taken by the government to tackle it and the results obtained with those efforts. Then, an effort is made to consider newer options and commitments required that are available for tackling the problem of micronutrient malnutrition.The intake of micronutrients in daily diet is far from satisfactory and largely less than 50% RDA is consumed by over 70% of Indian population. The lossEvery day, more than 6,000 children below the age of five die in India. More than half of these deaths are caused by malnutrition-mainly the lack of Vitamin A, iron, iodine, zinc and folic acid. About 57% of preschoolers and their mothers have subclinical Vitamin A deficiency. Anemia pThe consequences of micronutrient malnutrition are unacceptably high morbidity and mortality. Vitamin Micronutrient malnutrition needs effective control on a priority basis. For effective control program for any disease, there are three essential components: a well defined goal, enabling policy and effective strategy. These thth Five Year Plan (2002-2007),(In the 1002-2007), the goveEliminate Vitamin A deficiency as a public health problem.Reduce the prevalence of anemia by 25%, and moderate and severe anemia by 50% in children, adolescents, pregnant and lactating women.Achieve universal access to iodized salt.Reduce the prevalence of IDD in the country to less than 10% by 2010.th five year plan, anemia prevalence increased instead of reduction as envisaged in the goals set by the five year plan.These targets indicate a well-defined goal and policy planning by the government. However, the effective strategy to successfully achieve what is to be done was lacking. A program that did not have sound plan for implementation and that has a poor monitoring potential is likely to fail. Thus, a program that perhaps did not do well before 2002 as there were no clear goals set and program guidelines not worked out, continued to fail despite clear goals as the strategy did not specify who would do what and did not involve contingency planning. A strong monitoring component backed up by corrective action is required for positive results. Among the competing priorities of communicable diseases and eradication targeted programs such as that of poliomyelitis, one program that always got pushed back was that of micronutrient malnutrition. Thus during the 10It is with this reason largely that despite India being one of the first countries to start anemia control program along with initiating vitamin A supplementation, both as early as in 1970, the current scenario is not satisfactory. For almost two years now all the states are depleted of iron and folic acid tablet stock for pregnant women acknowledging that anemia contributes to 20% of maternal deaths every year in India. How can the Ministry of Health in the state department endorse this on one side and fail to utilize even 50% of funds made available to them under the National Rural Health Mission on the other?The government is now committed to prioritize and work toward resolving micronutrient malnutrition. Indian Micronutrient Investment Plan for 2007In summary, the additional cost for control of micronutrient malnutrition works out to be Rs. 5.40 per capita per year, and Rs. 28.50 per high risk beneficiary. This additional cost constitutes 1% of the estimated per capital GDP loss incurred due to micronutrient malnutrition and 0.1% of the government expenditure. The total cost is thus about Rs. 77.6 crore. This is small amount as compared to budget of Rs. 3315 crore for ICDS expenses.The challenges are high, but the promises are far reaching. We as public health specialists should refuse to accept these levels of micronutrient malnutrition and discourage set-ups where for two years at a primary health care level, iron and folic acid tablets are not made available to a severely anemic pregnant mother!


Smoking, drinking, and psychiatric distress are inter-related and may also be associated with socioeconomic position (SEP). This paper investigates the role of SEP in adolescent development across all three of these outcomes.Data were self-reported by adolescents in the Twenty-07 Study  at ages 15, 17, and 18 years. Latent class analysis was used to identify homogeneous subgroups of adolescents with distinct developmental patterns. Associations between developmental patterns and a range of socioeconomic indicators were then tested.Low Risk class had low levels for all outcomes. A High Distress class had persistently high levels of distress, but was otherwise similar to the Low Risk group. A High Drinking class drank alcohol earlier and more heavily but also had higher levels of distress than the Low Risk group. Smokers were grouped in two classes, Early Smokers and Late Smokers, and both also had raised levels of drinking and distress. Early Smokers tended to begin earlier and smoke more heavily than Late Smokers. Relative to the Low Risk class, adolescents in a disadvantaged SEP were more likely to be Early Smokers and somewhat less likely to be in the High Drinking class. SEP was not consistently associated with membership in the High Distress or Late Smokers classes.Five classes were identified. A Associations with SEP are evident in opposing directions or absent depending on the combination and timing of outcomes, suggesting that a disadvantaged SEP is not a simple common cause for all three outcomes. A disadvantaged socioeconomic position is specifically associated with a developmental pattern where smoking begins early and higher levels of drinking and distress follow. Outside of this pattern, drinking and distress appear somewhat more common among more affluent adolescents. Such opposing processes are only apparent when examining these outcomes in combination.Smoking and excessive alcohol consumption (hereafter referred to as drinking) are related to psychiatric distress (or symptoms of anxiety and depression) in both adolescent and adult populations. These behaviors and symptoms usually begin in adolescence and continue into adulthood One potentially important etiological factor is a person's socioeconomic position (SEP), which could influence each outcome via the stratification of social and economic resources or stressors. If SEP is a common cause then this may explain the associations among these outcomes, though an etiological role of SEP does not exclude further pathways linking the outcomes to each other such as those suggested above. Although adolescents in a disadvantaged SEP are more likely to smoke This paper aims to identify the most common patterns of adolescent development in smoking, drinking, and psychiatric distress and see whether a disadvantaged SEP is associated with all patterns of increased health risk, or only with specific developmental patterns. Latent class analysis Data are from the Twenty-07 Study based in and around Glasgow in the West of Scotland Respondents self-reported each outcome at each measurement point. Regarding smoking and drinking, respondents were asked about their current status and then for further detail on quantity/frequency if they were current smokers/drinkers. For smokers the number of cigarettes smoked daily was obtained (dividing by 7 where respondents had reported weekly amounts). At baseline drinkers reported the frequency of their drinking, while in the two follow-up surveys they reported their drinking in detail over the past 7 days. Psychiatric distress was assessed using the 12-item General Health Questionnaire (GHQ-12) A four-category measure was constructed for each outcome to cover the range from no use or no symptoms to heavy use or severe symptom levels. Smoking was categorized at each survey into: not currently smoking, smoking fewer than 1-a-day, smoking regularly (1-a-day or more), and smoking heavily (10-a-day or more). At baseline, drinking was categorized according to the available information into: not currently drinking, drinking less than monthly, monthly drinking, and weekly drinking. At the two later surveys, drinking was categorized into: not currently drinking, drinking less than weekly, weekly drinking within UK recommended limits in the past week  Gender was coded 1 for females, 0 for males. All SEP indicators came from the parental interview at baseline, and were based on parental or household characteristics. They are viewed as representing the SEP of the households in which the adolescents were being raised and are thus considered conceptually as antecedent to the outcomes. Household social class was coded according to the UK Registrar General's 1980 classification Analyses were performed using Mplus version 7 p = .12). The analysis was also performed using modal class assignments with similar findings ; High Drinking (20.9%); Early Smokers (21.8%); Late Smokers (8.6%); and High Distress (8.9%).A model with five latent classes was selected as the optimal description of the developmental profiles within the smoking, drinking, and psychiatric distress data see  online. Low Risk class, for gender and SEP. Females were more likely to be in the High Distress and Late Smokers classes and less likely to be in the High Drinking class than males. Four of the seven indicators of a disadvantaged SEP were associated with lower odds of membership in the High Drinking class . Associations between most of the other indicators of a disadvantaged SEP and being in the High Drinking class showed trends in the same direction, but did not reach statistical significance. There was also a gender interaction (not shown) such that females with unemployed parents were less likely to be in this group (p < .05). All indicators of a disadvantaged SEP (except those for area deprivation) were associated with increased odds of being Early Smokers. In contrast, all SEP indicators showed a trend toward lower odds of being Late Smokers for those in a disadvantaged SEP, but this only reached statistical significance for area deprivation. For the High Distress class, there were significant associations with SEP in opposite directions for different measures: adolescents from lone parent families were more likely to be in this group and those from more deprived areas were less likely to be in this group. Those whose parents had less education were also somewhat less likely to be in this group (p < .1). However, most of the SEP indicators did not show significant associations with membership in this class. No other interactions between gender and SEP were observed (p < .05).Low Risk class had low levels of smoking and drinking, and low but increasing levels of psychiatric symptoms. Compared with this group, smokers had raised risks for drinking and psychiatric distress, and the majority of smokers were in the Early Smokers class where drinking and distress tended to develop after smoking initiation. This supports previous research showing prospective relationships between adolescent smoking and later problematic alcohol use and mental health problems Distinct patterns of adolescent development in smoking, drinking, and psychiatric distress were identified and support previous evidence of inter-relationships between smoking, drinking and psychiatric distress Early Smokers were the only class for which a disadvantaged SEP was associated with a higher likelihood of membership. In the High Drinking and Late Smokers classes, which both included increased risks for drinking and distress, there was either no association with SEP or an association in the opposite direction. For the High Distress class associations with SEP were inconsistent, most showed no effect but some measures showed associations in opposite directions, and thus this probably represents the more specific characteristics of each SEP measure more than SEP in general, suggesting a weak relationship with SEP. Adolescents in more deprived areas stood out as unlikely to be in the Late Smokers and High Distress classes. Both of these classes had high levels of distress, suggesting there may be something particular about more deprived areas  that is protective in terms of distress. On the other hand, this may represent a cultural bias against reporting such symptoms within more deprived areas.The findings were contrary to what would be expected if SEP were a simple, common cause of these outcomes; the Early Smokers class tended to precede problems with drinking and distress, it may be that a disadvantaged SEP promotes early uptake of smoking only, and this then acts as a causal factor leading to later problems with drinking and psychiatric distress Early Smoking developmental pattern described, while vulnerability in a more advantaged SEP leads into the High Drinking pattern.As smoking in the Early Smokers class, may be a marker for stress-related processes within a disadvantaged SEP, which may then also promote coping-motivated drinking. If drinking in the High Drinking class represented more pleasure-motivated drinking then this might explain why this pattern was somewhat more likely for those in a more affluent SEP. Alternatively, there may be other processes of socioeconomic disadvantage that promote both early smoking and drinking, such as fewer alternative activities or lower quality parental monitoring Inconsistent associations between drinking and SEP have previously led some to suggest that two opposing processes link SEP and drinking; that is, a lower SEP is generally associated with poorer health including heavier drinking, while a higher SEP indicates more resources for obtaining alcohol Opposing processes might also explain why previous research from the Twenty-07 Study has indicated late adolescence as a period of relative equality in psychiatric distress Early Smokers class, many of whom would have been identifiable from the baseline data due to their early smoking. Thus the small differences in drop-out by SEP are unlikely to have greatly influenced the results. Also, the data refer to the specific geographic and temporal context of the West of Scotland in the late 1980s and early 1990s. Different developmental patterns and associations with SEP might be evident in other contexts where outcomes are more or less prevalent. For example, more recent female cohorts from this region have higher prevalence rates for all outcomes These findings are presented with some caveats. The drinking measurements combined quantity and frequency, which might not have adequately reflected the consumption of those who drank heavily but infrequently, though previous research suggests that only a minority of adolescents drink this way Examining adolescent development across all three outcomes—smoking, drinking, and psychiatric distress—suggests opposing processes linking drinking and distress to SEP contingent upon early smoking. Such opposing processes could be missed in research that focuses on only one outcome at a time, as the opposition would result in weak or null associations. A key area for further research seems to be in determining whether early smoking makes a causal contribution to later drinking and distress, or is merely a marker for other causal processes related to a disadvantaged SEP. If early smoking is causal, then intervening to prevent smoking in early adolescence may be especially important, whereas if it is a marker for other processes it is important to understand what those processes are so that appropriate interventions can be devised.


Pea has lagged behind other model legumes in the molecular study of nodulation and mycorrhizae-formation because of the difficulty to transform its roots and its poor growth on agar plates. Here we describe for pea 1) a transformation technique which permits the complementation of two known non-nodulating pea mutants, 2) a rhizobial inoculation method which allows the study of early cellular events giving rise to nodule primordia, and 3) a targeted fungal inoculation method which allows us to study short segments of mycorrhizal roots assured to be infected. These tools are certain to advance our knowledge of pea root symbioses. Pisum sativum (pea) has been a model organism in plant research for more than a century; however, it has lagged behind other plants in becoming the model organism to study root symbioses, i.e., those resulting in nodulation and mycorrhiza-formation. Reasons for this stem from the fact that pea is a large plant which requires a large area for growth and has a relatively long life-cycle (~ 90 days). It has a large genome (about 4 × 109 base pairs . Thes. ThesLoty e.g., ,6]. Comp. CompLoty . Pea, ls e.g., -13] may  may Agro [et al.  reported12A gene . The sucobtained . When stobtained . To addrobtained . These cobtained ]. Likelyobtained , and gen clover)  or barre clover) .Lotus and Medicago whereby plants are grown on agar plates with varying nutrients . This ts e.g., ,22]. A s. A sLotus , were surface-sterilized, imbibed, and planted in sterile vermiculite to germinate (see below for specifics). Unless otherwise mentioned, P. sativum plants were grown under incandescent  and cool white fluorescent lights  in a growth-room with a 23°C/18°C, 16 h/8 h light/dark regime. The total light intensity received by the plants was 280 μmol·m-2·s-1.Seeds of Agrobacterium rhizogenes AR12 and AR1193 Agrobacte .NOTE: The dark treatment promotes etiolation and thus facilitates the shoot excision at a later step.3| Set plants into a controlled growth-room for 3 days to provide time for the leaves to develop Figure .® cubes  into smaller cubes (~ 2.5 cm3). Use a dissecting probe to make a small starter hole, a quarter to half way through the cube, into which the stem of the plant will be inserted (step 7). Sterilize the cubes (pre-vacuum cycle for 20 min) in autoclave. 4| Cut FibrgroNOTE: Without this hole the stems of the plants broke easily when inserted.A. rhizogenes 9 DAP as described above.5| Prepare the culture of ® cubes, with the holes facing up, in 12 cm sterile Petri plates. Inoculate the cubes with the diluted A. rhizogenes culture until complete saturation; 4 to 7 mL of inoculum is usually sufficient per cube . Remove the lid on the following day and leave the plants on the bench for an additional 24 hours to promote wilting of the shoots . Leave tray on lab bench for 24 hours .9| Add sterile water to the Petri plates when the stems are wilted, and replace the dome for an additional 24 hours Figure . Place tNOTE: Keep the plastic dome snug to the plastic tray and the ventilation holes closed to enhance humidity, which increases transgenic yield .® cube away from the roots when the roots are visible (~10DAI)  Figure . Excise NOTE: At this stage most of the roots are adventitious and their removal promotes root growth from the callus.11| Transfer the callus-forming shoot with its epicotyl to a pot filled with sterile vermiculite; tightly pack the vermiculite around the rootless callus so that the shoot is kept upright Figure .R. leguminosarum as explained above. Inoculate the plants with 5 mL of a 5% bacterial solution 3 days after moving them to vermiculite.12| Two days before inoculation, grow a culture of 13| Inspect plants 21 DAI and check for nodules.Figure 1| As 1| above.2| Plant seeds in 7.5 cm pots filled with sterile vermiculite and let grow for 3 days Figure .NOTE: Growing seeds in vermiculite is crucial to obtain plants with straight roots for easy transfer to pouches. It is important to allow the pea seedlings to develop for 3 days as the length of the radicle is optimal at this time.3| Three days later, prepare to transfer one seedling per germination pouch . Make a hole with a clean razor blade in the top centre of the pouch filter paper, so that the root enters the pouch but the cotyledons do not fall through the hole.4| Wet the pouch with sterile low-nitrogen nutrient solution [as in ] until tNOTE: Micro-nutrients such as boron are required for nodules to develop . It is e5| Remove gently the seedlings from the pots, and the seed-coat from the seedling, and place the primary root through the hole previously made Figure . The roo6| Tape the top of the pouch closed, leaving a hole for the shoot to emerge Figure . Taping 7| Cut a piece of the growth pouch 2.5 cm from its bottom with a pair of scissors Figure . The fil8| Place the growth pouches with the seedlings in 15 cm diameter pots Figure  and fillNOTE: Covering the pouch with vermiculite prevents light from reaching the roots; this is important as exposure to light inhibits pea nodulation .9| Moisten the vermiculite with water and place the pots in trays in a controlled growth-room. Water the plants by adding water to the tray. The vermiculite maintains a humid environment for the pouch and filter paper.10| Two days before inoculation, grow a rhizobial culture as above.NOTE: Do not water the plants during this time to reduce the amount of residual water in the pouch. If the pouches are too wet, the inoculum drop will not remain on the root. It is of prime importance to time the earlier watering so that at this stage the pouches are only damp.11| After 5 days of growth in the pouches, lateral roots will be of an optimal length for spot-inoculation Figure . Remove NOTE: Condensation on the inside of the plastic pouch can impede the viewing of roots. Gently lift the top layer of the pouch from the bottom and use a sterile filter paper to remove the water droplets.12| Mark the zone of the most susceptibility on the outside of the pouch with a water-proof marker Figure . Do not 4 CFUs/mL.13| Lift the top plastic sheet at the bottom end of the pouch and apply with a micro-pipette onto the root a 0.5 μL drop of rhizobial suspension adjusted to the viable cell density of 6.4 × 10NOTE: Do not place the top of the pouch back onto the root right away; let the drop sink in the root and paper before closing the pouch.14| Return the pouches to the pots and cover with vermiculite Figure . Water t15| In our experiments carried out under the described conditions, we observed nodulation events, such as divisions of pericycle cells, as early as 24 hours after spot-inoculation; pink nodules are seen at 10 DAI.The protocol used in the fungal spot inoculation of pea begins with steps 1-9 of the rhizobial spot-inoculation protocol as stated above, except for step 4 where a low-phosphate nutrient solution [as in ] is used10| After 5 days of growth in pouches, prepare enough freshly autoclaved Phytagel™ (Sigma P8961) medium  so tNOTE: The medium should be kept warm (60°C) to maintain its liquid form until the time of inoculation.11| Remove each pouch from the pots; under axenic conditions, choose a location along one or more lateral roots for inoculation to occur. Mark this location on the top of the plastic sheet with a waterproof marker.12| Lift the top plastic sheet at the bottom end and gently lift the lateral root chosen using tweezers. Apply 1 mL of liquid Phytagel™ to the filter paper of the growth pouch in the desired location below the selected lateral root. Using another set of tweezers, place a media plug containing the fungal inoculum onto the Phytagel™ and lower the root into place over the top of the plug, gently pushing the root into the medium of the plug.13| Allow a minute or so for the plug to set in place and for the Phytagel-™ to solidify before lowering the plastic sheet. Return the pouches to the pots and cover them with fresh vermiculite. Water the plants when needed; however, be mindful of overwatering which can encourage fungal contamination of the pouches. Harvest plants at the desired time.14| When harvesting the plants, remove the pouch from pots with special care so that none of the roots within the pouch are disturbed. Note the location of the plug and make cuts in the plastic to expose the root system. Remove the fragment of lateral root that was placed on top of the plug using a scalpel blade. Clear the root fragment and stain it with ink-vinegar  in orderCFU: colony forming unit; DAI: day after inoculation; DAP: day after planting; IAA: indole-3-acetic acid; LB: Luria Bertoni; rpm: rotations per minute.The authors declare that they have no competing interests.SYM10 construct and discussed experimental approaches with SRC. SRC wrote the first draft of the manuscript. FCG directed the experiments and wrote the final draft of this manuscript. All authors have read and approved the final manuscript.SRC conceived, designed, and carried out the experiments of transformation and rhizobial spot-inoculation. LC conceived and performed the experiments of fungal inoculation. LHM made the


One young adult in two has entered university education in Western countries. Many of these young students will be exposed, during this transitional period, to substantial changes in living arrangements, socialisation groups, and social activities. This kind of transition is often associated with risky behaviour such as excessive alcohol consumption. So far, however, there is little evidence about the social determinants of alcohol consumption among college students. We set out to explore how college environmental factors shape college students' drinking behaviour.In May 2010 a web questionnaire was sent to all bachelor and master students registered with an important Belgian university; 7,015 students participated (participation = 39%). The survey looked at drinking behaviour, social involvement, college environmental factors, drinking norms, and positive drinking consequences.On average each student had 1.7 drinks a day and 2.8 episodes of abusive drinking a month. We found that the more a student was exposed to college environmental factors, the greater the risk of heavy, frequent, and abusive drinking. Alcohol consumption increased for students living on campus, living in a dormitory with a higher number of room-mates, and having been in the University for a long spell. Most such environmental factors were explained by social involvement, such as participation to the student folklore, pre-partying, and normative expectations.Educational and college authorities need to acknowledge universities’ responsibility in relation to their students’ drinking behaviour and to commit themselves to support an environment of responsible drinking. In 2007 one young adult in two has entered university education in Western countries and this proportion is likely to increase in the future. Many ofIndeed, it is reckoned that college students are particularly exposed to alcohol during their college years. An international study of alcohol consumption among students found wide geographical variation in the prevalence of risky drinking behaviour, with more than 40% of students aged 17-30 having drunk heavily in the U.S.A. and in several European countries[Risky alcohol consumption among young people is becoming a key public health priority because of its important health and educational consequences. Among those aged 15-29, alcohol accounts for more than 10% of the overall burden of disease and injury,7. The cRisky alcohol consumption has first been approached from an individual perspective, with a strong emphasis on individual risk factors, such as gender, age, and psychological factors, and on drinking motives,9,10. AdInternational comparison, however, shows there is wide cross-country variation in the prevalence of risky drinking among college students. Within The study analyses alcohol consumption among college students from a community health perspective. We aim to understand how the college-related environment shapes students’ drinking behaviour. In particular, we assess the role of living arrangements, college social activities, and social norms in drinking patterns. We explore two questions: (1) does the college-related environment influence alcohol use? (2) How do social and normative factors contribute to these college influences on alcohol use?This study is part of an important multi-method investigation into alcohol drinking among college students. It was carried out in a Belgian university with two main campuses, one in Louvain-La-Neuve, a town of 20,000 inhabitants, half of whom are students living in dormitories. The other campus, mainly devoted to health sciences, is located in Brussels, 30 km away from the main campus.th March 2010.A web survey was carried out in May 2010. An e-mail invitation was sent to all bachelor and master students registered with the university , with a link to a web-survey questionnaire. No financial or material incentive was provided. The students could request a copy of the final report, and 62% of the respondents made such request. The form included 31 questions related to socio-demographics, living arrangements, study programmes, involvement in student activities, alcohol use, injunctive and descriptive norms, and positive and negative consequences of alcohol use. On average, filling in the questionnaire took 12 minutes and very few break-offs were recorded. The study was approved for ethical issues by the Social and Student Affairs review board of the university on the 26After up to two reminders, 7,015 students (39%) participated, a rate well above the average web survey participation rate. CompareAlcohol consumption measures came from the Eurostat European Health Interview Survey schedule and from the European School Survey Project on Alcohol and Other Drugs (ESPAD) questionnaire. We modeCollege environmental factors included curricular and extra-curricular features. The former consisted of the number of years the student had been studying and the study programme (a student class within a curriculum). The study programme factor was expected to capture the peer effect linked to the culture of alcohol consumption specific to faculties. The extra-curricular features were: living arrangements (living in a dormitory or with parents), living on the campus (yes or no), and the number of room-mates (0 for staying with parents).Social involvement was measured by involvement in traditional student folklore, pre-partying, and being a student representative. Student folklore shares some similar features with the sororities and fraternities in the U.S.A. It has long played a traditional role in European university social life: traditional students’ organisations contribute to welcoming freshmen and to rites of passage; they organise parties and other recreational activities that may or may not involve drinking. Some student associations also manage student accommodation and sit on consultative bodies related to student social affairs. Involvement in this kind of traditional student folklore was measured by a score ranging from a low of 0 to a high of 3 according to rites of passage or positions of responsibility in student folklore. One point was given for each of the following: participation in hazing activities at the beginning of the academic year, after which one is labelled “baptisé”; participation in another traditional activity that upgrades the student’s prestige and allows him/her to wear a ritual cap called a “calotte”; and participation in the folklore organisation. The score was categorised in three groups . Finally, the university provides students with many curricular or extra-curricular social organisations. We asked the students whether they were members of any organisation of that kind.Pre-partying was defined as the consumption of alcohol with friends while preparing to go out for the night. Pre-partying helps to improve sociability and conviviality, easing the discomfort associated with meeting new people at a party,24-26. SThe normative factors included descriptive and injunctive norms. Alcohol injunctive norms were covered by a four-item questionnaire measuring approval by friends of four kinds of drinking behaviour: drinking every weekend, daily, after driving, and enough to be drunk. Each itIn order to also include experiential reporting, students’ positive drinking consequences were registered via the Positive Drinking Consequences Questionnaire, a 14-item scale. This scThe analysis was in two stages, according to our two research questions. First, we investigated the role of socio-demographics and college environmental factors. Second, we added to the analysis social-involvement, normative, and experiential factors that might contribute to the influence of college environmental factors. However, cross-sectional analysis of drinking behaviour is vulnerable to selection bias: unobserved heterogeneity across individuals may explain why some vulnerable individuals self-select into an at-risk college environment, as predicted by the theory of increased heterogeneity. We assevs 21.8, F = 21.5, p < 0.01) but there was no significant association between gender and study year . On average students have been attending the University for about 2.8 years (std = 1.7) and were pursuing bachelor degrees. A majority of students were staying on the campus (66.9%) and in a dormitory (64%), with an average of 4.4 room-mates (std = 4.2). A minority of the students (12.3%) was highly involved in traditional student folklore with a score of 2 to 3. Most students pre-party (67%), with an average of 2.3 pre-parties per month (std = 3.3).On average, students were aged 21.5 (std = 3.3), and mainly female , was younger (21.5 y vs 21.9 y), and had a higher proportion of undergraduates (62% vs 59%). Overall, these differences were small and do not indicate a systematic tendency towards more or less frequent drinking: women generally drink less than men and undergraduates generally drink more than postgraduates.On average, students had their first drink at the age of 15.7 (std = 1.8), while only a small percentage had never drink alcohol (6%). In Belgium, the legal drinking age is 16. On average, a student drank seven times a month (std = 6.6), had 1.7 drinks a day (std = 21), and 2.8 episodes of abusive drinking per month (std = 4.4). Over the last year, the students acknowledged on average 5 positive consequences (std = 3.1). The three most frequent consequences were to “approach a person that I probably wouldn’t have spoken to otherwise” (68%), to “find it easy to engage in a conversation in a situation in which I would usually have stayed quiet” (65%), and to feel “like I had enough energy to stay out all night partying or dancing” (64%).College students overestimated what a typical student drinks; this overestimation decreased for closer-reference students: 4.2 (std = 4.7) daily drinks for students in general, 3.9 (std = 4.9) for same-sex students, 3.5 (std = 4.4) for friends (to be compared with a self-declared 1.7). College students overestimated their friends’ drinking by 2 drinks a day.Overall socio-demographic variables played a more important role for abusive drinking and number of drinks than for the frequency of drinking Table , Model 1Higher exposure to college environmental factors meant, in most cases, more frequent, and more abusive drinking Table , Model 1p < 0.001; Social Sciences Mean = 2.1, p < 0.001), with a lower number in the faculties of medicine  and psychology (mean = 1.17 NS).There was a small intra-class correlation linked to the study programme and this was more important for abusive drinking (0.23) than for frequency of drinking (0.03), suggesting a slight programme effect on abusive drinking but not on drinking frequency. We found the Faculty of Engineering and the Faculty of Social Sciences to have a higher number of drinks per day . Likewise, the more a student thought his friends were permissive regarding drinking, the higher the risk of all drinking behaviour, particularly for drinking frequency (OR = 1.08). Drinking frequency or quantity increased by at least 10% for each additional positive consequence a college student experienced.In most cases, controlling for social engagement, normative, and experiential factors led to a reduction in the risk associated with the college environment. The effect of the number of years attending the University on abusive drinking decreased from OR = 1.11 to OR = 1.05, while the effect of the number of room-mates decreased from 1.06 to 1.02. The effect of living arrangements became insignificant or very small.The model’s robustness was checked by including age at first drink, a factor likely to capture individual vulnerability. In most cases, the ORs were only slightly affected: the effect of time attending the university on abusive drinking decreased from 1.11  to 1.109 ; the effect of living on the campus on abusive drinking frequency decreased from 1.56 to 1.52; the effect of traditional student folklore from 2.11 to 2.09. Pre-partying frequency was not affected by this kind of sensitivity analysis.This study confirmed that excessive alcohol consumption is common among college students, with an average of 3 episodes of abusive drinking per month. Greater exposure to college environmental factors, such as living on the campus, a longer spell at university meant more frequent drinking. These community risk factors were more pronounced for excessive drinking patterns than for the quantity or frequency of drinking. Time had a double and mixed effect: older students drink less and less excessively than younger students; however, the longer the period a student has spent in the university, the higher his/her risk of drinking. These effects of college environmental factors were partly explained by social-involvement, experiential, and normative expectations: college students drank for the positive consequences, because they over-estimate the drinking of their friends, or because of other normative expectations.The role of living arrangements has been shown in previous American, EuropeaYet, our study shows that the college environment influences drinking behaviour in a much more complex way that involves not only where students live but also the kind of living arrangements, participation in traditional student folklore, the duration of college training, and the type of faculty in which the student is studying. In particular, living in a dormitory with a high number of room-mates and being highly involved in traditional student folklore also play a role in the frequency of abusive drinking. There is thus not one college environmental risk factor but several that relate to different aspects of student life. This may explain why living away from home had a slightly greater effect on heavy drinking in the American (OR = 1.72) or in the international comparison study (OR = 1.61) than in ours (OR = 1.57). The role of dormitory size needs, in particular, to be emphasized and could be explained by innovation diffusion. As adolescent social network studies have shown, teenagers who have a denser social network are more likely to drink than those with less dense social networks. The finOur study shows that abusive drinking increased with the period attending the college, whereas it decreased with age. These two opposite effects were of similar magnitude: this may explain why previous studies have found no clear relationship between age and drinking behaviour: it all p < 0.001), which compares quite well a Z fisher value of 0.29 from a previous meta-analytic integration of 23 studies[We found that students overestimate other students’ average number of daily drinks. To compare our results with previous studies of self-other comparison in drinking, we computed the Z Fisher transformation correlation between self-reported daily number of drinks and friends’ numbers of drinks. Our Z Fisher correlation was 0.36 ( studies, may res studies. We foun studies.Our cross-sectional study is vulnerable to reversed causality, so the results need to be interpreted with caution. It could be that involvement in student life and drinking behaviour are confounded by unobserved vulnerability. Extraverted individuals are sensitive to positive social rewards and, thus, more likely to engage in socially-motivated drinking, so the relationship between traditional student folklore and drinking behaviour may be biased upwards. Moreover, the dose-response relationship with involvement in traditional student folklore or with the number of room-mates may downplay this risk of confounding without totally removing it. To assess the risk of confounding we replicated the analysis controlling for the age at which the student reported that he or she started drinking, a factor known to predict a heavy alcohol consumption trajectory. Our resThe second limitation has to do with the setting, which unlike other campuses in Belgium or abroad, is much less socially mixed, giving the college environmental factors more clout while mitigating other social control effects. Our results, nevertheless, are in line with a cross-comparative study such as the College Alcohol study in the U.S.A. or the EIt is foreseen that in the future most young adults will attend university where, our study shows, they will be exposed to frequent and intensive drinking behaviour. That experience will have subsequent and important consequences lasting into adulthood. CollegeThe authors declare that they have no conflicts of interest relevant to the manuscript submitted to BMC Public Health.VL conceived the study, carried out the survey, performed the data analysis, and drafted the manuscript. PN participated in the design of the study, carried out the survey, contributed to analysis and helped draft the manuscript. VES contributed to analysis and helped draft the manuscript. WD contributed to analysis and helped draft the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/13/615/prepub


Recent evidence has confirmed that circumcision can be performed as a preventive strategy for HIV and early infant male circumcision (EIMC) is regarded to be safer than circumcision in adulthood; however, limited data are available in the literature about EIMC in China. Therefore, the present study was designed to determine the willingness and attitudes of Chinese parents on newborn male circumcision so as to provide data for exploring the feasibility of implementing EIMC as an HIV prevention strategy in China.Simple random sampling was used to draw participants from parents who had a newborn son delivered at Nanjing Maternity and Child Health Care Hospital, which is affiliated to Nanjing Medical University, between March and December 2010. A questionnaire was used to determine general medical knowledge or information about circumcision, attitudes about EIMC, and level of decision-making on circumcision for the newborn son.Data derived from 558 responses were analyzed and the ratio of respondents was 56.3% for fathers and 43.6% for mothers. Of the respondents, 34.4% agreed to circumcise their newborn son, and the level of agreement was 3.25 ± 1.17 . The major reason for EIMC was for health (44.8%), followed by doctor’s advice (31.2%). The major reason not to agree to EIMC was concern about pain (50.5%), followed by the risk of the procedure (23.5%).The willingness and acceptability of EIMC in China is low and the parents of newborn sons are usually not very affirmative when making a decision on such a procedure, suggesting that significant effort will be needed if EIMC is to be implemented as an HIV prevention strategy for China. The results from three randomized controlled clinical trials conducted in Africa confirmed that male circumcision (MC) lowers the risk of HIV acquisition by 55%-76% in heterosexual men -3. BasedAlthough the prevalence of HIV/AIDS in China is currently low, the annual morbidity and mortality rates have exhibited upward tendencies since 2003, and the HIV/AIDS epidemic is spreading from high-risk groups to the general population as a result of sexual transmission ,12. In rThis study was conducted at the Nanjing Maternity and Child Health Care Hospital, which is affiliated to the Nanjing Medical University, between March and December in 2010 and approved by the Ethics Committee of Nanjing Maternity and Child Health Care Hospital (FYLL1012). The study participants were parents who had a newborn son delivered at the hospital. The inclusion criteria were Chinese ethnicity and basic Chinese literacy. The participants who were foreigners, or Chinese who declined to participate in the study, or Chinese who could not complete the questionnaire were excluded. A simple random sampling method was used to draw participants, i.e., by drawing a lot from an opaque bag to decide whether or not the participant was to be interviewed. Informed written consent was obtained from the participants after explaining that the investigation involved circumcision and health. The survey was anonymous and self-administered. The questionnaire items were developed from general medical knowledge or information about circumcision, attitudes regarding EIMC, and the level of decision-making on circumcision for the newborn son. Questions were presented in a multiple choice or yes/no format. Other variables included age, level of education, socio-economic status, religion, and the relationship with the newborn son (mother or father), as shown in Table Preliminary pre-testing was carried out on a group of 30 parents to ensure that the questionnaire items were valid and could be understood. Some of the question items were modified by the feedback obtained. The layout of the print and the arrangement of the questionnaire were designed to be easily read and answered by the participants. Statistical analysis was performed using SPSS . Descriptive ratings were used for individual questionnaire items, except for the level of agreement regarding circumcision, which was presented as the mean + standard deviation. The chi-square test and Pearson’s correlation coefficient were used to evaluate the relationship among variables. A P value < 0.05 was considered statistically significant.A total of 2865 subjects were asked to participate in the current study; 435 declined and 2430 agreed to participate. A sample size of 810 was drawn from the population of 2430, based on a 1:3 sampling ratio, which accounts for about 5% of male neonates in Nanjing city per year. All incomplete (201) and unacceptable responses (51) were excluded. Of the participants, 52.1% were fathers and 47.9% were mothers, with average ages of 29.3 ± 4.1 and 27.8 ± 3.9 years, respectively. The majority of participants (94.2%) had no religious preference. Finally, the data derived from 558 responses were analyzed, with a response rate of 68.9% (558/810). The ratio of the respondents in the final analysis was 56.3% for fathers and 43.6% for mothers, with average ages of 30.6 ± 3.6 and 29.4 ± 3.4 years, respectively. For all the respondents in the final analysis, 90.2% had no religious preference, and most of the participants had a college or higher education. The characteristics of the respondents are shown in Table χ2 = 12.853, P = 0.008). For those who agreed to EIMC, most (66.7%) regarded the father to have the final say. Health, doctor’s advice, and religion were regarded as the major reasons for EIMC in 54.8%, 31.2%, and 1.1% of the parents, respectively. For those who did not agree to EIMC, the major reason was concern about pain (50.5%), followed by the risk of the procedure (23.5%). Most parents (60.6%) were in agreement regarding circumcision of their newborn son. The family income and the level of education of the parents were not associated with agreement regarding EIMC . We also observed that only 35.8% of the parents considered circumcision for their sons in the future; 7% of the parents thought the best time for circumcision was during the neonatal period, and most of the parents (74.0%) believed that the best age for the procedure was after 1 year of age.Only 34.4% of the respondents agreed to EIMC, and the level of agreement was 3.25 ± 1.17 . A significantly higher proportion of fathers compared to mothers agreed to circumcise their newborn sons  desired to know the effects of circumcision on health. Unfortunately, 68.1% of the subjects considered that the medical workers did not provide them with enough information regarding circumcision. All of the results are summarized in Table % desiredCurrent scientific evidence has convincingly shown that MC is associated with enormous public health benefits, including protection from sexually transmitted HIV, HPV, syphilis, and chancroid, and the penile and prostate cancer rate . StudiesThe culture of circumcision in China is not well understood. The present study is the first to survey parents’ opinions about EIMC in China. In this study, approximately one-third of parents reported that they would agree to circumcise their newborn son; however, the parents were generally not very affirmative and some were not in agreement when making such a decision, suggesting great difficulties in the implementation of EIMC in China. In Chinese traditional culture, it is believed that the body, hair, and skin should not be self-mutilated because they were borne by parents and it is the first step of filial piety. Such traditional beliefs might make people more reluctant to excise a part of the body unless necessary. Although it is difficult to gauge how these traditional perceptions would affect decisions regarding circumcision, such perceptions have probably contributed to the lack of tradition and motivation for circumcision in China. Nonetheless, retention of the prepuce is not regarded as crucial to one’s ethnic identity amongst Chinese; thus, it is likely that traditional beliefs can be changed by promoting education on the health benefits of MC. Modern propaganda, including the internet and television, provides a convenient medium for such education. Furthermore, among those respondents in the current study who considered circumcision for their sons in the future (35.8%), most 74.0%) regarded > 1 year of age to be the best age to undergo circumcision and only 7% thought the neonatal period to be the best time; this confirms the difficulties in implementing EIMC. In a survey from South Korea , another4.0% regaEven so, the fear of pain and the risk of the procedure were reported to be the major barriers to EIMC ,10,23. TBased on this evidence and the fact that most parents (84.2%) would like to know the health benefits of circumcision, as suggested in the present investigation, we speculate that the willingness and acceptance of EIMC would increase in China if the parents of newborns were provided with sufficient information about EIMC , which is consistent with the findings in reports from other countries ,19,24. I One limitation of this study was that we did not investigate the effect of educational interventions on decision-making about EIMC. In addition, the sample of the present study was obtained from Nanjing city, but not from China as a whole, so one should be careful when these findings are generalized to the entire country as regional variations cannot be excluded. Further studies are warranted to evaluate the impact of educational interventions in a more representative sample within China.Generally, the willingness and acceptance of EIMC in China is low and the parents of newborns are usually not very affirmative when making a decision regarding EIMC. The major reason for EIMC unwillingness is concern about pain and risk of the procedure. Sufficient education about the benefits of circumcision and HIV prevention is needed if EIMC is to be implemented as an HIV prevention strategy in China.The authors declare that they have no competing interests.Pan Lianjun and Wang Zhong designed the study. Zhang Aixia and Shen Rong conducted the study and collected the data. Pan Lianjun analyzed the data, performed the statistical analysis, drafted the article, and revised the manuscript critically. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/738/prepub