BackgroundOverwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data.Methods and FindingsDuring Lesotho Defence Force applicant screening in 2009, 241 (77%) of 312 men, aged 18–25 y, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC) to 4 (complete MC). MC was self-reported by 27% (n = 64/239) of participants. Of the 64 men self-reporting being circumcised, physical exam showed that 23% had no evidence of circumcision, 27% had partial circumcision, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were seven times higher among those reportedly circumcised by initiation school personnel (odds ratio = 7.22; 95% CI = 2.29–22.75).ConclusionsApproximately 27% of participants self-reported being circumcised. However, only 50% of these men had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up voluntary medical MC (VMMC) should obtain physical-exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting VMMC should provide comprehensive education regarding the definition of VMMC.

Novelty statement (100 words max): The study identifies the extent of low alcohol health literacy in young adults with Type 1 diabetes, with less than 10% of participants able to identify the alcohol and carbohydrate content accurately in more than half of commonly consumed drinks.  Alcohol consumption amongst participants was common with almost a third of women (32.9%) and over a fifth of men (22.6%) engaged in increased risk drinking.  Strategies to minimise alcohol-associated risk were inconsistent and so young adults are at increased risk for diabetes mis-management when consuming alcohol. Abstract:Aims: Alcohol-specific health literacy is poor in the general population and this is also likely to apply to young adults with type 1 diabetes (T1DM). Alcohol directly affects glycaemic control and accurate estimation of alcohol intake can support effective diabetes management. Little is known about alcohol knowledge accuracy and management strategies of young adults with T1DM when consuming alcohol. The study investigated knowledge of alcohol and carbohydrate content of commonly consumed beverages among young adults with T1DM and explored alcohol consumption while identifying diabetes self-management strategies for minimising alcohol-associated risk.Method: An open-access, multiple-choice web-survey investigating knowledge of alcohol and carbohydrate content of typical alcoholic drinks using images. Participants also recorded current alcohol consumption and diabetes selfmanagement strategies when drinking.Results: 547 participants aged 18-30 years participated (341 women; 192 men; mean age 24.5 SD 3.7 years), of whom 365 (66.7%) drank alcohol. 84 (32.9%) women and 31 (22.6%) men scored above the cut-off for increased risk drinking. Knowledge accuracy of alcohol units was poor: only 7.3% (n=40) correctly identified the alcohol content of ≥6 of ten drinks. Carbohydrate content was also poor: no participant correctly identified the carbohydrate content of ≥6 of ten drinks. Various and inconsistent strategies to minimise alcohol-associated risk were reported. Conclusions:Alcohol consumption was common, however, knowledge of alcohol and carbohydrate content were poor. Greater alcohol related health literacy is required to minimize alcohol-associated risk. Further research should develop effective strategies to improve health literacy and support safe drinking for young adults with T1DM.

BackgroundIodine deficiency is a global problem representing the most common preventable cause of mental retardation. Recently, the impact of subtle deficiencies in iodine intake on children and pregnant women has been questioned. This study was designed to compare hypothyroidism among infants born to US military families in countries of varied iodine nutrition status.MethodsA cohort design was used to analyze data from the Department of Defense Birth and Infant Health Registry for infants born in 2000-04 (n = 447,691). Hypothyroidism was defined using ICD-9-CM codes from the first year of life (n = 698). The impact of birth location on hypothyroidism was assessed by comparing rates in Germany, Japan, and US territories with the United States, while controlling for infant gender, plurality, gestational age, maternal age, maternal military status, and military parent's race/ethnicity.ResultsHypothyroidism did not vary by birth location with adjusted odds ratios (OR) as follows: Germany (OR 0.82, [95% CI 0.50, 1.35]), Japan (OR 0.67, [95% CI 0.37, 1.22]), and US territories (OR 1.29, [95% CI 0.57, 2.89]). Hypothyroidism was strongly associated with preterm birth (OR 5.44, [95% CI 4.60, 6.42]). Hypothyroidism was also increased among infants with civilian mothers (OR 1.24, [95% CI 1.00, 1.54]), and older mothers, especially ages 40 years and older (OR 2.09, [95% CI 1.33, 3.30]).ConclusionsIn this study, hypothyroidism in military-dependent infants did not vary by birth location, but was associated with other risk factors, including preterm birth, civilian maternal status, and advanced maternal age.

Background: Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data.

This finding suggests the protective health effects of fitness standards may be reduced shortly after retirement. This is true despite activities such as screening before and during military service and exposure to USAF health promotion efforts and fitness standards throughout a period of active duty service lasting at least 20 years. In general, military members should be counseled that on retirement, efforts to maintain a healthy weight have continued benefit and should not be forgotten. The risk of MetS after retirement is particularly increased for those identified as being overweight during their active duty careers. Interventions that prevent and reduce unhealthy weight gain may be an appropriate investment of resources and should be studied further.