Parental Acceptance of HPV Vaccine in Peru: A Decision Framework

En: Plos ONE, Vol. 7, No. 10, e48017. doi:10.1371/journal.pone.0048017Objective and Method: Cervical cancer is the third most common cancer affecting women worldwide and it is an important cause of death, especially in developing countries. Cervical cancer is caused by human papillomavirus (HPV) and can be prevented by HPV vaccine. The challenge is to expand vaccine availability to countries where it is most needed. In 2008 Peru’s Ministry of Health implemented a demonstration project involving 5th grade girls in primary schools in the Piura region. We designed and conducted a qualitative study of the decision-making process among parents of girls, and developed a conceptual model describing the process of HPV vaccine acceptance. Results: We found a nonlinear HPV decision-making process that evolved over time. Initially, the vaccine’s newness, the requirement of written consent, and provision of information were important. If information was sufficient and provided by credible sources, many parents accepted the vaccine. Later, after obtaining additional information from teachers, health personnel, and other trusted sources, more parents accepted vaccination. An understanding of the issues surrounding the vaccine developed, parents overcome fears and rumors, and engaged in family negotiations–including hearing the girl’s voice in the decision-making process. The concept of prevention (cancer as danger, future health, and trust in vaccines) combined with pragmatic factors (no cost, available at school) and the credibility of the offer (information in the media, recommendation of respected authority figure) were central to motivations that led parents to decide to vaccinate their daughters. A lack of confidence in the health system was the primary inhibitor of vaccine acceptance. Conclusions: Health personnel and teachers are credible sources of information and can provide important support to HPV vaccination campaigns

A hazardous substance exposure prevention rating method for intervention needs assessment and effectiveness evaluation: the Small Business Exposure Index

Aims This paper describes the refinement and adaptation to small business of a previously developed method for systematically prioritizing needs for intervention on hazardous substance exposures in manufacturing worksites, and evaluating intervention effectiveness. Methods We developed a checklist containing six unique sets of yes/no variables organized in a 2 × 3 matrix of exposure potential versus exposure protection at three levels corresponding to a simplified hierarchy of controls: materials, processes, and human interface. Each of the six sets of indicator variables was reduced to a high/moderate/low rating. Ratings from the matrix were then combined to generate an exposure prevention \u27Small Business Exposure Index\u27 (SBEI) Summary score for each area. Reflecting the hierarchy of controls, material factors were weighted highest, followed by process, and then human interface. The checklist administered by an industrial hygienist during walk-through inspection (N = 149 manufacturing processes/areas in 25 small to medium-sized manufacturing worksites). One area or process per manufacturing department was assessed and rated. A second hygienist independently assessed 36 areas to evaluate inter-rater reliability. Results The SBEI Summary scores indicated that exposures were well controlled in the majority of areas assessed (58% with rating of 1 or 2 on a 6-point scale), that there was some room for improvement in roughly one-third of areas (31% of areas rated 3 or 4), and that roughly 10% of the areas assessed were urgently in need of intervention (rated as 5 or 6). Inter-rater reliability of EP ratings was good to excellent (e.g., for SBEI Summary scores, weighted kappa = 0.73, 95% CI 0.52–0.93). Conclusion The SBEI exposure prevention rating method is suitable for use in small/medium enterprises, has good discriminatory power and reliability, offers an inexpensive method for intervention needs assessment and effectiveness evaluation, and complements quantitative exposure assessment with an upstream prevention focus

WHAT CAN WE LEARN FROM IN VIVO BIOMECHANICAL INVESTIGATIONS OF LOWER EXTREMITY?

In vivo biomechanical investigations of human movement are needed to better understand function and injury mechanism of the musculoskeletal system and to validate models or methods that otherwise could not be validated. In this report, we showcase two biomechanical approaches that use in vivo experiments to directly measure skin movement artefacts and the role of hamstring neuromuscular control in protecting the anterior cruciate ligament (ACL). The study on skin movement artefacts revealed that surface markers provided kinematics which can present repeatable patterns within a participant for various movements. However these repeatable patterns must not be misinterpreted as accurately representing skeletal kinematics, at least beyond the sagittal plane of movement. In the second investigation the neuromuscular control of the hamstring and gastrocnemius muscles showed a protective mechanism to prevent excessive ACL elongation, whereas the quadriceps muscles resisted against the collapsing of the knee joint after foot impact with the ground. This paper highlights the value of in vivo experimentation in contributing to our understanding of biomechanical functions or processes

Platelet-derived extracellular vesicles in Huntington's disease.

The production and release of extracellular vesicles (EV) is a property shared by all eukaryotic cells and a phenomenon frequently exacerbated in pathological conditions. The protein cargo of EV, their cell type signature and availability in bodily fluids make them particularly appealing as biomarkers. We recently demonstrated that platelets, among all types of blood cells, contain the highest concentrations of the mutant huntingtin protein (mHtt)-the genetic product of Huntington's disease (HD), a neurodegenerative disorder which manifests in adulthood with a complex combination of motor, cognitive and psychiatric deficits. Herein, we used a cohort of 59 HD patients at all stages of the disease, including individuals in pre-manifest stages, and 54 healthy age- and sex-matched controls, to evaluate the potential of EV derived from platelets as a biomarker. We found that platelets of pre-manifest and manifest HD patients do not release more EV even if they are activated. Importantly, mHtt was not found within EV derived from platelets, despite them containing high levels of this protein. Correlation analyses also failed to reveal an association between the number of platelet-derived EV and the age of the patients, the number of CAG repeats, the Unified Huntington Disease Rating Scale total motor score, the Total Functional Capacity score or the Burden of Disease score. Our data would, therefore, suggest that EV derived from platelets with HD is not a valuable biomarker in HD.The study was funded by an operating grant from the Merck Sharpe & Dohme to F.C. who is also a recipient of a National Researcher career award from the Fonds de Recherche du Québec en santé (FRQS) providing salary support and operating funds. I.S.-A. was supported by a CIHR-Huntington Society of Canada postdoctoral fellowship. R.A.B. and S.L.M. are supported by a National Institute for Health Research (NIHR) award of a Biomedical Research Center to the University of Cambridge and Addenbrooke’s Hospital. E.B. is supported by the Canadian Institutes of Health Research. N.D. MD-MSc. also funded by CIHR and by Canadian Consortium on Neurodegeneration in Aging (CCNA). HLD and JPL hold a Desjardins scholarship from the Fondation du CHU de Québec. HLD hold a bourse d’excellence du Centre Thématique de Recherche en Neurosciences (CTRN) du CHU de Québec. The authors would like to thank all the students and staff who helped with the blood collections in Cambridge, Quebec City and Montreal and importantly, all patients and their families for being so generous with their time in participating to this stud

Evaluation of a workplace suicide prevention program in the Australian manufacturing industry : protocol for a cluster-randomised trial of MATES in manufacturing

Males are at higher risk of death by suicide than females in Australia, and among men, blue-collar males are at higher risk compared to other working males. In response, MATES in Construction developed a workplace suicide prevention program for the construction sector in 2007 that has been widely implemented in Australia. In the current project, this program is being adapted and trialled in the manufacturing sector. The common aims of MATES programs are to improve suicide prevention literacy, help-seeking intentions, and helping behaviours. The program will be evaluated using a cluster randomised-controlled trial design with waitlist controls across up to 12 manufacturing worksites in Australia. We hypothesise that after 8 months of the MATES in Manufacturing program, there will be significantly greater improvements in help-seeking intentions (primary outcome) compared to waitlist controls. The project is led by Deakin University in collaboration with the University of Melbourne, and in partnership with MATES in Construction and a joint labour-management Steering Group. Trial registration: The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry on 25 January 2022 (ACTRN12622000122752)

An Evaluation of the Return to Practice Programme (Nursing) at City University of London (2017-2018)

In response to concerns over a predicted chronic nursing shortage recent focus has been placed on Return to Practice (RTP) programmes, which aim to increase the nursing workforce by enabling former nurses to return to the profession. In order to encourage former nurses to return to practice, it is important to understand the motivations, expectations and experiences of current returnees by evaluating RTP programmes. Aims: To evaluate the RTP programme by exploring the views and experiences of returnees to nursing, and of the nursing staff who support them. Methods: This was a mixed methods study: an electronic survey of all students currently or recently on the RTP programme at City, University of London; and interviews with a range of stakeholders, including returnees, mentors and senior managers, at North East London Foundation Trust (NELFT). Descriptive statistics were used to summarise quantitative responses to the survey and Framework method was employed to analyse qualitative data. Results: Seventy-four responses to the survey were received; eight interviews were carried out with returnees, and five with NELFT staff. Overall, data suggests that the programme has been very successful: most views were positive, many were very positive. Though returnees found the course fairly challenging, they also found it largely fit for purpose. There were many useful suggestions about how to improve and promote the programme. There were also some reservations about the organisation of placements and of mentorship arrangements, the latter largely due to the difficulty of arranging for time for returnees and their mentors to work together. Recommendations: RTP programmes should be continued and if possible expanded. Wider advertising, ideally involving successful RTP returnees, should be used to attract more recruits, and funding for returnees should be maintained or increased. Higher Education Institutions (HEIs) should offer support to enable RTP nurses to return to study and to achieve their academic objectives as smoothly as possible. This may include responding to the individual learning needs of RTP nurses and allowing flexibility for students who need longer for private study. National Health Service (NHS) Trusts/Boards should ensure that Human Resource (HR) departments are willing and able to deal quickly with arrangements for employed RTP students. Processes for arranging placements should include realistic timetables for Disclosure and Barring Service (DBS) checks to be carried out. NHS providers should consider the suggestion that returnees can arrange their own placements if they wish. NHS providers should make even greater efforts to ensure that front-line staff understand the position of RTP nursing students, what they can expect from them and what their responsibilities to them are. Recent RTP graduates should be encouraged and enabled to support future RTP students. As champions of the programme, they should support the Trust in clarifying to existing staff what RTP students need and can be permitted to do

Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock

Importance Vasopressin is an alternative to catecholamine vasopressors for patients with distributive shock—a condition due to excessive vasodilation, most frequently from severe infection. Blood pressure support with a noncatecholamine vasopressor may reduce stimulation of adrenergic receptors and decrease myocardial oxygen demand. Atrial fibrillation is common with catecholamines and is associated with adverse events, including mortality and increased length of stay (LOS). Objectives To determine whether treatment with vasopressin + catecholamine vasopressors compared with catecholamine vasopressors alone was associated with reductions in the risk of adverse events. Data Sources MEDLINE, EMBASE, and CENTRAL were searched from inception to February 2018. Experts were asked and meta-registries searched to identify ongoing trials. Study Selection Pairs of reviewers identified randomized clinical trials comparing vasopressin in combination with catecholamine vasopressors to catecholamines alone for patients with distributive shock. Data Extraction and Synthesis Two reviewers abstracted data independently. A random-effects model was used to combine data. Main Outcomes and Measures The primary outcome was atrial fibrillation. Other outcomes included mortality, requirement for renal replacement therapy (RRT), myocardial injury, ventricular arrhythmia, stroke, and LOS in the intensive care unit and hospital. Measures of association are reported as risk ratios (RRs) for clinical outcomes and mean differences for LOS. Results Twenty-three randomized clinical trials were identified (3088 patients; mean age, 61.1 years [14.2]; women, 45.3%). High-quality evidence supported a lower risk of atrial fibrillation associated with vasopressin treatment (RR, 0.77 [95% CI, 0.67 to 0.88]; risk difference [RD], −0.06 [95% CI, −0.13 to 0.01]). For mortality, the overall RR estimate was 0.89 (95% CI, 0.82 to 0.97; RD, −0.04 [95% CI, −0.07 to 0.00]); however, when limited to trials at low risk of bias, the RR estimate was 0.96 (95% CI, 0.84 to 1.11). The overall RR estimate for RRT was 0.74 (95% CI, 0.51 to 1.08; RD, −0.07 [95% CI, −0.12 to −0.01]). However, in an analysis limited to trials at low risk of bias, RR was 0.70 (95% CI, 0.53 to 0.92, P for interaction = .77). There were no significant differences in the pooled risks for other outcomes. Conclusions and Relevance In this systematic review and meta-analysis, the addition of vasopressin to catecholamine vasopressors compared with catecholamines alone was associated with a lower risk of atrial fibrillation. Findings for secondary outcomes varied