Female health-care providers' advocacy of self-sampling after participating in a workplace program for cervical cancer screening in Ghana: a mixed-methods study

Background: Cervical cancer is the second most common cancer among Ghanaian women and screening coverage is low. ACCESSING is a cross-sectional study investigating human papillomavirus (HPV) prevalence via self-sampling in rural communities of the North Tongu district in Ghana. Female health-care providers (HCPs) were invited to self-collect a cervicovaginal sample with a commercial sampler in order to acquaint themselves with the sampling method. Objective: This study set out to explore female HCPs' perceptions, advocacy for, and implications of self-sampling with the aim of enhancing self-sampling acceptability in the targeted screening population. Methods: A mixed-methods approach was used, consisting of (a) a survey among 52 female HCPs working in a district hospital and (b) 10 one-to-one semi-structured interviews with purposefully sampled HCPs. Results: The quantitative analysis of the survey (n = 52) showed that, among HCPs who took the sample themselves (50/52), all found it 'Easy' or 'Very Easy' and felt 'Very Comfortable' or 'Comfortable'. 82.7% indicated that they would undertake screening more often, and 98.1% indicated they would prefer self-sampling, if cervical cancer risk is as reliably determined as by clinician-directed cytobrush sampling. All interview participants (n = 10) indicated that they appreciated the program and would recommend the screening to their patients and/or family members and neighbours. Common reasons for preferring self-sampling were less (anticipated) pain compared to speculum examination and more privacy. Conclusions: Self-sampling for cervical cancer screening is highly acceptable to female HCPs. Setting up a workplace screening program that entails the option of self-sampling could create greater awareness and positive attitudes among HCPs to educating their patients, families, and neighbours on cervical cancer risks and motivate HCPs to advocate for women's participation in screening

Unraveling site fidelity and residency patterns of sperm whales in the insular oceanic waters of Macaronesia

Knowledge of the distribution and residency of pelagic marine megafauna, particularly deep-diving species, is scarce due to their high mobility over difficult-to-access oceanic areas and long periods underwater. However, the threatened status of many of these species, such as the sperm whale Physeter macrocephalus, increases the need to obtain quantitative data to support conservation measures. In the warm temperate waters of Macaronesia (Eastern North Atlantic), sperm whales occur year-round in a set of island systems (the Azores, Madeira, and the Canaries), mainly in social groups of females and juveniles with the occasional visits of mature males. Although it is known that they perform inter-archipelago movements, information on site fidelity and residency times is still scarce. Here, based on photographic-identification data, site fidelity and residency times of sperm whales were estimated for subareas of the Azores and the Madeira archipelagos, with a preliminary assessment for a subarea of the Canaries. The Azores and Madeira subareas presented similar proportions of individuals with recaptures (~25%), mainly inter-annual, while in the subarea of the Canaries, only <10% of the individuals were recaptured. Standardized Site Fidelity Indexes showed very low values (<0.01) for both the Azores and Madeira subareas. Lagged identification rates based on models including emigration and reimmigration estimated that an average of 44.8 individuals (SE=4.9) spent 12.9 days (SE=1.5) in the Azores before leaving for 99.1 days (SE=12.5), while 8.4 individuals (SE=16.1) spent 0.8 day (SE=6.6) in Madeira before leaving for 8.6 days (SE=6.9), with a very low mortality rate. This study i) indicates a degree of residency of about ¼ of the identified individuals for the Azores and Madeira subareas and ii) supports that these oceanic archipelagos constitute an important habitat for a Vulnerable species in the Atlantic. Moreover, it also highlights the importance of combining data from opportunistic and dedicated surveys and joint national and international efforts toward the conservation of marine megafauna.This study had the support of FCT through the strategic project UIDB/04292/2020 awarded to MARE and through the project LA/P/0069/2020 granted to the Associate Laboratory ARNET. It was also supported through the strategic project M1420-01-0142-FEDER-000001 for the Oceanic Observatory of Madeira and from Oceanário de Lisboa and Oceano Azul Foundation through Whale Tales Project (ODL/2019/003). RF was supported by the FCT grant SFRH/BD/147225/2019, MF by the MAC2/1.1a/385 in the framework of INTERTAGUA (MAC INTERREG 2014-2020), AD by ARDITI throughout the project M1420-09-5369-FSE-000002 and FA by the FCT project UIDP/04292/2020 granted to MARE.info:eu-repo/semantics/publishedVersio

Diverse types of knowledge on a plate: a multi-perspective and multi-method approach for the transformation of urban food systems towards sustainable diets

Urbanization processes are accompanied by growing global challenges for food systems. Urban actors are increasingly striving to address these challenges through a focus on sustainable diets. However, transforming food systems towards more sustainable diets is challenging and it is unclear what the local scope of action might be. Co-production of knowledge between science and non-science is particularly useful for analysing context-specific solutions and promise to result in more robust socio-economic, political and technical solutions. Thus, this paper aims to integrate different types and sources of knowledge to understand urban food systems transformation towards a more sustainable diet in Vienna; and, second, to analyse and reflect on the difficulties and ways forward to integrate diverse actors’ perspectives, multiple methods and epistemologies. We created different future scenarios that illustrate the synergies and trade-offs of various bundles of measures and the interactions among single dimensions of sustainable diets. These scenarios show that there is plenty of scope for local action, but co-ordination across diverse groups, interests, and types of knowledge is necessary to overcome lock-ins

Middle-Class Mass Housing in Germany

The article presents a study on the conceptual and contextual framework of the middle class mass housing (MCMH) neighbourhoods in Germany, contributing to the cross-geographical debate at a broader European level. It complements the case studies presented in this publication, providing a wider framework for their better understanding. The aim of the study is twofold: (1) to contribute to a broader awareness of the specificities of MCMH in Germany, compiling historical description that details background on its emergence and changes to MCMH over time, in particular in the second half of the 20th century; and (2) to provide basic information about the typologies and characteristics thereof, and to give an insight into the specific problems inherent to the conservation and renewal of the MCMH in Germany

Contrast-Enhanced Magnetic Resonance Angiography Using a Novel Elastin-Specific Molecular Probe in an Experimental Animal Model

Objectives. The aim of this study was to test the potential of a new elastin-specific molecular agent for the performance of contrast-enhanced first-pass and 3D magnetic resonance angiography (MRA), compared to a clinically used extravascular contrast agent (gadobutrol) and based on clinical MR sequences. Materials and Methods. Eight C57BL/6J mice (BL6, male, aged 10 weeks) underwent a contrast-enhanced first-pass and 3D MR angiography (MRA) of the aorta and its main branches. All examinations were on a clinical 3 Tesla MR system (Siemens Healthcare, Erlangen, Germany). The clinical dose of 0.1 mmol/kg was administered in both probes. First, a time-resolved MRA (TWIST) was acquired during the first-pass to assess the arrival and washout of the contrast agent bolus. Subsequently, a high-resolution 3D MRA sequence (3D T1 FLASH) was acquired. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were calculated for all sequences. Results. The elastin-specific MR probe and the extravascular imaging agent (gadobutrol) enable high-quality MR angiograms in all animals. During the first-pass, the probes demonstrated a comparable peak enhancement (300.6 +/- 32.9 vs. 288.5 +/- 33.1, p > 0.05). Following the bolus phase, both agents showed a comparable intravascular enhancement (SNR: 106.7 +/- 11 vs. 102.3 +/- 5.3; CNR 64.5 +/- 7.4 vs. 61.1 +/- 7.2, p > 0.05). Both agents resulted in a high image quality with no statistical difference (p > 0.05). Conclusion. The novel elastin-specific molecular probe enables the performance of first-pass and late 3D MR angiography with an intravascular contrast enhancement and image quality comparable to a clinically used extravascular contrast agent

Dual-probe molecular MRI for the in vivo characterization of atherosclerosis in a mouse model: Simultaneous assessment of plaque inflammation and extracellularmatrix remodeling

Molecular MRI is a promising in-vivo modality to detect and quantify morphological and molecular vessel-wall changes in atherosclerosis. The combination of different molecular biomarkers may improve the risk stratification of patients. This study aimed to investigate the feasibility of simultaneous visualization and quantification of plaque-burden and inflammatory activity by dual-probe molecular MRI in a mouse-model of progressive atherosclerosis and in response-to-therapy. Homozygous apolipoprotein E knockout mice (ApoE-/-) were fed a high-fat-diet (HFD) for up to four-months prior to MRI of the brachiocephalic-artery. To assess response-to-therapy, a statin was administered for the same duration. MR imaging was performed before and after administration of an elastin-specific gadolinium-based and a macrophage-specific iron-oxide-based probe. Following in-vivo MRI, samples were analyzed using histology, immunohistochemistry, inductively-coupled-mass-spectrometry and laser-inductively-coupled-mass-spectrometry. In atherosclerotic-plaques, intraplaque expression of elastic-fibers and inflammatory activity were not directly linked. While the elastin-specific probe demonstrated the highest accumulation in advanced atherosclerotic-plaques after four-months of HFD, the iron-oxide-based probe showed highest accumulation in early atherosclerotic-plaques after two-months of HFD. In-vivo measurements for the elastin and iron-oxide-probe were in good agreement with ex-vivo histopathology (Elastica-van-Giesson stain: y = 298.2 + 5.8, R2 = 0.83, p < 0.05; Perls' Prussian-blue-stain: y = 834.1 + 0.67, R2 = 0.88, p < 0.05). Contrast-to-noise-ratio (CNR) measurements of the elastin probe were in good agreement with ICP-MS (y = 0.11x-11.3, R² = 0.73, p < 0.05). Late stage atherosclerotic-plaques displayed the strongest increase in both CNR and gadolinium concentration (p < 0.05). The gadolinium probe did not affect the visualization of the iron-oxide-probe and vice versa. This study demonstrates the feasibility of simultaneous assessment of plaque-burden and inflammatory activity by dual-probe molecular MRI of progressive atherosclerosis. The in-vivo detection and quantification of different MR biomarkers in a single scan could be useful to improve characterization of atherosclerotic-lesions

Molecular MR Imaging of Prostate Cancer

This review summarizes recent developments regarding molecular imaging markers for magnetic resonance imaging (MRI) of prostate cancer (PCa). Currently, the clinical standard includes MR imaging using unspecific gadolinium-based contrast agents. Specific molecular probes for the diagnosis of PCa could improve the molecular characterization of the tumor in a non-invasive examination. Furthermore, molecular probes could enable targeted therapies to suppress tumor growth or reduce the tumor size

Characterization of Human Papillomavirus prevalence and risk factors to guide cervical cancer screening in the North Tongu District, Ghana

Introduction: This population-based study aimed to fill the knowledge gap on Human Papillomavirus (HPV) prevalence and associated sociodemographic risk factors of the general population in the North Tongu District, Ghana. These results are needed to guide cervical cancer prevention efforts, as the leading type of female cancers. Methods: A cross-sectional study including 2002 women in the North Tongu District, Ghana investigated HPV prevalence and associated sociodemographic risk factors. Women were recruited by geographical distribution through the local community-based health system and samples collected using a self-sampling device. For HPV genotyping BSGP5+/6+-PCR with Luminex-MPG readout was used. Multivariate logistic regression analyzed sociodemographic risk factors for HPV positivity. Results: Of 2002 self-collected samples, 1943 were eligible, contained sufficient DNA and provided valid HPV genotyping results. Prevalence of single high risk HPV types was 32.3% and of multiple high risk types 9.7%. The five most common detected HPV types were HPV16 (7.4%; 95%CI: 6.3–8.7), HPV52 (7.2%; 95%CI: 6.1–8.5), HPV35 (4.8%; 95%CI: 3.9–5.8), HPV59 (4.7%; 95%CI: 3.8–5.8), HPV56 (3.9%; 95%CI: 3.1–4.8). Highest prevalence was observed among women aged 18–24 years, while age 25–54 years was inversely associated with high risk HPV positivity in multivariate analysis. Sociodemographic risk factors identified were i) having any sexual partner, ii) more partners increased the odds for high risk HPV positivity, iii) independently from this marital status, in particular not being married. Discussion & conclusion: Most importantly, the high risk HPV prevalence detected from this study is higher than estimates reported for Western Africa. This needs be considered, when deciding on the cervical cancer screening algorithms introduced on a wider scale. Follow-up and triage, depending on the methods chosen, can easily overburden the health system. Self-sampling worked well and provided adequate samples for HPV-based screening. Women with increasing number of sexual partners and not being married were found to have higher odds of being high risk HPV positive, therefore could be a higher prioritized screening target group

Re-structuring of marine communities exposed to environmental change

Species richness is the most commonly used but controversial biodiversity metric in studies on aspects of community stability such as structural composition or productivity. The apparent ambiguity of theoretical and experimental findings may in part be due to experimental shortcomings and/or heterogeneity of scales and methods in earlier studies. This has led to an urgent call for improved and more realistic experiments. In a series of experiments replicated at a global scale we translocated several hundred marine hard bottom communities to new environments simulating a rapid but moderate environmental change. Subsequently, we measured their rate of compositional change (re-structuring) which in the great majority of cases represented a compositional convergence towards local communities. Re-structuring is driven by mortality of community components (original species) and establishment of new species in the changed environmental context. The rate of this re-structuring was then related to various system properties. We show that availability of free substratum relates negatively while taxon richness relates positively to structural persistence (i.e., no or slow re-structuring). Thus, when faced with environmental change, taxon-rich communities retain their original composition longer than taxon-poor communities. The effect of taxon richness, however, interacts with another aspect of diversity, functional richness. Indeed, taxon richness relates positively to persistence in functionally depauperate communities, but not in functionally diverse communities. The interaction between taxonomic and functional diversity with regard to the behaviour of communities exposed to environmental stress may help understand some of the seemingly contrasting findings of past research