Assessing the clinical validity and cost-effectiveness of human papillomavirus testing using self-collected specimens for cervical cancer screening in Kenya

Invasive cervical cancer (ICC) is the leading cause of cancer-related deaths among women in sub-Saharan Africa (SSA). Through the implementation of organized cytology-based screening programs, high-income countries have reduced ICC incidence and mortality by 80%. However, challenges remain in screening program implementation and coverage in SSA due to relatively weak healthcare infrastructure, poorly equipped health facilities, and limited skilled healthcare providers. In Kenya, the estimated screening coverage is only 3.5% among women aged 25 - 64years, compared to the global coverage of 40%. To improve access and effectiveness of cervical cancer prevention programs in low-resource settings, screening methods that are cost-effective, simple to implement, and incorporate effective linkage to treatment are needed. From 2013 to 2018, a total of 399 female sex workers participated in this cross-sectional study. Participants provided two self-collected specimens: one stored dry(sc-DRY) using a Viba brush (Rovers), and one stored wet (sc-WET) with Aptima media (Hologic) using an Evalyn brush (Rovers). Two physician-collected specimens for HPV mRNA testing (APTIMA) and conventional cytology were collected. We estimated test characteristics for each hr-HPV screening method using conventional cytology as the gold standard. We also examined participant preference for sc-DRY and sc-WET. HR-HPV mRNA positivity was higher in sc-WET (36.8%) than sc-DRY samples (31.8%). Prevalence of ≥HSIL was 6.9% (n = 27). Sensitivity of hr-HPV mRNA testing for detecting ≥HSIL was similar in sc-WET (85%, 95% CI: 66-96), and sc-DRY specimens (78%, 95% CI: 58-91). Specificity was 65% (95% CI: 61-71) in sc-WET and 70%, (95% CI: 65-75) in sc-DRY specimens. Women preferred sc-DRY specimen collection (46%) compared to sc-WET (31%). However, more women preferred physician-collection (64%) than self-collection (36%), which should be further evaluated. Sc-DRY specimens appeared to perform similarly to sc-WET for the detection of ≥HSIL. To evaluate cost-effectiveness of cervical cancer screening delivery using self-collection, we assessed the outcomes, costs, and cost-effectiveness of four cervical cancer screening scenarios in Kenya, each using community health campaign (CHC) based HPV self-screening: (1) followed by VIA to assess appropriateness of cryotherapy (“HPV & Treat”), with standard linkage to treatment and (2) “HPV & Treat” with enhanced linkage to treatment; and (3) followed by VIA screening for triage to treatment (“HPV+VIA & Treat”), with standard linkage to treatment and (4) “HPV+VIA & Treat” with enhanced linkage to treatment. Compared to “HPV+VIA & treat,” we found that “HPV & Treat” led to better health outcomes, as measured in DALYs and was more cost-effective due to fewer missed cases of CIN2+ eligible for treatment. More specifically, we found that compared to no screening, HPV& Treat with enhanced linkage to treatment was the most cost-effective option at $5492.62 I$/DALY averted. Deterministic sensitivity analyses showed that the proportion of women successfully linked to treatment significantly impacted the cost-effectiveness of “HPV& treat” options. Future studies to assess programmatic costs from the perspective of the Kenyan Ministry of Health to inform national scale-up of CHCs are needed.Doctor of Philosoph

Getting Psyched About Memes in the Psychology Classroom

Introduction: Internet memes are a ubiquitous part of internet culture and a common communication tool among students. Because they are a good medium for expressing ideas and concepts in a concise and fun manner, memes are a potentially valuable tool for teaching and engaging students. Statement of the Problem: Instructors may not know how to use memes in classroom assignments or activities to support learning objectives. Literature Review: Students finding or creating their own class-related content is an empirically-supported way to enhance learning. Instructors can enhance learning by using multimedia approaches (pictures/videos in addition to words), which is a good fit for the use of memes. We include examples of ways that memes have already been used in psychology classrooms. Teaching Implications: Incorporating meme assignments or activities in the classroom could be beneficial. Conclusion: We describe how students can explain or generate memes that illustrate concepts related to course material. Instructions and supporting information and resources, as well as calls for research into the effectiveness of the use of memes in the classroom, are included

Skilled Labor Shortages May Lead to Wage Inflation

In Boise there has been a growing demand for high skilled labor that is not being met, leading to rising wages for jobs that require those skills. Our objective is to research which high skill position jobs in the City of Boise are seeing higher than average annual wage growth. This information will give us more insight as to why, despite the rising wages, not enough high skilled labor is being supplied in order to meet the demand for certain jobs. We hope the City of Boise will be able to use our research to attract high skilled workers in local industries where they are lacking. Through the direction of a Boise Job Recruiter we will focus our research on several specific skilled position jobs that are seeing higher wage increases than average. Basic information will be gathered through various websites such as clustermapping.us, bls.gov, and others. More detailed information will be obtained via email, phone calls, and in-person meetings with various companies who are seeing this lack of skilled work being filled. We will be contacting several large companies in the City of Boise that employ skilled workers in order to learn more about their current wages compared to typical wage growth. We are also expecting to learn which skilled jobs in Boise are seeing higher wage increases and the economic reasoning behind these increases compared to typical wage growth

Minor gynecologic surgery: A review of the training experience and skill building opportunities for providers in low and middle income countries

Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results: Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models

Tamoxifen Initiation After Ductal Carcinoma In Situ

Endocrine therapy initiation after ductal carcinoma in situ (DCIS) is highly variable and largely unexplained. National guidelines recommend considering tamoxifen for women with estrogen receptor-positive (ER+) DCIS or who undergo excision alone. We evaluated endocrine therapy use after DCIS over a 15-year period in an integrated health care setting to identify factors related to initiation

"Like Birds in Cages" Community Definitions and Concepts of Home, Rights, Justice, and Citizenship in Rohingya Camps

A participatory action research project was undertaken from November 2020 to February 2021 in which three Rohingya researchers asked 33 of their fellow Rohingya refugees living in Cox’s Bazar, Bangladesh camps to share their own definitions and concepts regarding four terms: home, justice, rights, and citizenship. Out of the 33 respondents, 21 of the project respondents were youth aged 18-29; one third (11) were female and two were elders. This report is the third in a three-part series that uses ‘participatory action research’ to uncover how displaced communities in Cox’s Bazar camps have experienced the Covid-19 pandemic and the ensuing lockdown. As with the past reports, the emphasis is on Rohingya youth perspectives, targeting the viewpoints of those aged 18-29 years old. The overall aim of this round of research was to better understand Rohingya conceptualisations of terms that are often used in programming delivered by the international community that is intended to benefit Rohingya. An appreciation for different interpretations amongst Rohingya community members--and between Rohingya and those engaged in international humanitarian response efforts--is crucial for ensuring that service delivery is appropriate and is informed by what displaced people living in Cox’s Bazar want for themselves and their families now and in the future. The project explored questions such as ‘What is home’ at a time where ideas of home were fluctuating for Rohingya. Not only have fires devastated parts of the Cox’s Bazar camps and caused many to lose their houses, but as the research project was coming to a close the February 2021 coup in Myanmar cast hopes of returning ‘home’ in a new light

Meta-evaluation of a whole systems programme, ActEarly: a study protocol

INTRODUCTION: Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme's impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making. METHODS: The ActEarly meta-evaluation will follow and adapt the five iterative stages of the 'Evaluation of Programmes in Complex Adaptive Systems' (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model ("LifeSim") will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly's dynamic programme outputs at different system levels and measure the programme's system changes on early life health and well-being. DISCUSSION: This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose

Meta-evaluation of a whole systems programme, ActEarly: A study protocol

Introduction: Living in an area with high levels of child poverty predisposes children to poorer mental and physical health. ActEarly is a 5-year research programme that comprises a large number of interventions (>20) with citizen science and co-production embedded. It aims to improve the health and well-being of children and families living in two areas of the UK with high levels of deprivation; Bradford in West Yorkshire, and the London Borough of Tower Hamlets. This protocol outlines the meta-evaluation (an evaluation of evaluations) of the ActEarly programme from a systems perspective, where individual interventions are viewed as events in the wider policy system across the two geographical areas. It includes investigating the programme’s impact on early life health and well-being outcomes, interdisciplinary prevention research collaboration and capacity building, and local and national decision making./ Methods: The ActEarly meta-evaluation will follow and adapt the five iterative stages of the ‘Evaluation of Programmes in Complex Adaptive Systems’ (ENCOMPASS) framework for evaluation of public health programmes in complex adaptive systems. Theory-based and mixed-methods approaches will be used to investigate the fidelity of the ActEarly research programme, and whether, why and how ActEarly contributes to changes in the policy system, and whether alternative explanations can be ruled out. Ripple effects and systems mapping will be used to explore the relationships between interventions and their outcomes, and the degree to which the ActEarly programme encouraged interdisciplinary and prevention research collaboration as intended. A computer simulation model (“LifeSim”) will also be used to evaluate the scale of the potential long-term benefits of cross-sectoral action to tackle the financial, educational and health disadvantages faced by children in Bradford and Tower Hamlets. Together, these approaches will be used to evaluate ActEarly’s dynamic programme outputs at different system levels and measure the programme’s system changes on early life health and well-being./ Discussion: This meta-evaluation protocol presents our plans for using and adapting the ENCOMPASS framework to evaluate the system-wide impact of the early life health and well-being programme, ActEarly. Due to the collaborative and non-linear nature of the work, we reserve the option to change and query some of our evaluation choices based on the feedback we receive from stakeholders to ensure that our evaluation remains relevant and fit for purpose

Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: a population based, cross-sectional study

Abstract Background The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine. Methods A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine. Results The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35–44 years (aOR: 2.92 (1.34–6.33) and rural women aged 25–34 years (aOR: 2.90 (1.24–6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67–7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61–5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28–3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high. Conclusions Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on cervical cancer must include information on symptoms, risk factors, and preventive methods. Despite poor knowledge, the study population was willing to receive the HPV vaccine

Training the next generation of physician researchers – Vanderbilt Medical Scholars Program

Abstract Background As highlighted in recent reports published by the Physician-Scientist Workforce Working Group at the National Institutes of Health, the percentage of physicians conducting research has declined over the past decade. Various programs have been put in place to support and develop current medical student interest in research to alleviate this shortage, including The Vanderbilt University School of Medicine Medical Scholars Program (MSP). This report outlines the long-term program goals and short-term outcomes on career development of MSP alumni, to shed light on the effectiveness of research training programs during undergraduate medical training to inform similar programs in the United States. Methods MSP alumni were asked to complete an extensive survey assessing demographics, accomplishments, career progress, future career plans, and MSP program evaluation. Results Fifty-five (81%) MSP alumni responded, among whom 12 had completed all clinical training. The demographics of MSP alumni survey respondents are similar to those of all Vanderbilt medical students and medical students at all other Association of American Medical College (AAMC) medical schools. MSP alumni published a mean of 1.9 peer-reviewed manuscripts (95% CI:1.2, 2.5), and 51% presented at national meetings. Fifty-eight percent of respondents reported that MSP participation either changed their career goals or helped to confirm or refine their career goals. Conclusions Results suggest that the MSP program both prepares students for careers in academic medicine and influences their career choices at an early juncture in their training. A longer follow-up period is needed to fully evaluate the long-term outcomes of some participants