Primary Care Physiciansʼ Adherence to Expert Recommendations for Cervical Cancer Screening and Prevention in the Context of Human Papillomavirus Vaccination

BACKGROUND: Expert recommendations do not recommend using Papanicolaou (Pap) or human papillomavirus (HPV) test results to determine whether unvaccinated women should receive HPV vaccine, nor do they recommend using vaccine receipt to inform cervical cancer screening practices. This study characterizes physicians' HPV vaccine recommendations and practices in the context of HPV and Pap testing. METHODS: We surveyed family physicians and obstetrician-gynecologists randomly selected from the American Medical Association Masterfile in 2011 (n = 574). Physicians used a 5-point scale (never to always) to report the frequency of (1) using HPV testing results to decide whether to recommend HPV vaccine, and (2) recommending HPV vaccination to women (≤26 years) who had an abnormal Pap test. Physicians also reported (3) intention to change Pap screening frequency for vaccinated women. RESULTS: Across both specialties, 80% correctly reported rarely or never using HPV testing results to guide vaccine recommendations; 66% often or always recommended vaccination to patients with an abnormal Pap result; and 77% did not plan to change Pap screening frequency for vaccinated women. About 41% reported recommendation-consistent practices with all 3 measures. In multivariable analysis, obstetrician-gynecologist specialty and private practice type were associated with higher average overall adherence to recommendations. CONCLUSIONS: Contrary to expert recommendations, a considerable minority of physicians reported recommending HPV vaccination based on HPV and Pap test results. If these clinical practices persist, many young adult women will not realize the benefits of HPV vaccination. Additional efforts are needed to ensure all young women are screened and vaccinated appropriately

The content and context of physicians' communication with males about human papillomavirus vaccination

A physician's recommendation for human papillomavirus (HPV) vaccine is a key predictor of vaccine uptake; however, little is known about how physicians communicate about HPV vaccine with male patients. We sought to describe physicians' HPV vaccine communication practices with males who are of vaccine-eligible age (9-26 years). We surveyed representative samples of pediatric and family medicine physicians in Florida, and assessed whether physicians present HPV vaccine as optional or routine, and as a vaccine that prevents cancer. We also assessed the type of visit during which physicians discuss HPV vaccine with adolescent males and whether other healthcare providers in the practice discuss HPV vaccine or make the initial recommendation. We received 367 completed surveys (50.7% response rate). Few physicians (29.9%) reported they typically present HPV vaccine as routine to males ages 11-12 years, who constitute the target group for routine vaccination. When discussing HPV vaccination, many physicians reported somewhat or strongly emphasizing cancer prevention (80.0%). Physicians most often discussed HPV vaccine when they saw patients for well-child visits (93.0%) and least often at acute care visits (15.3%). Over half reported that at least one other healthcare professional in their practice discusses (56.1%) or makes the initial recommendation for (54.9%) HPV vaccination. Many physicians in our sample are presenting HPV vaccine as optional rather than routine and are missing opportunities to communicate with males about the vaccine. Our findings identify areas for future interventions to improve physicians' HPV vaccine communication and, ultimately, increase the use of this cancer-preventing vaccine

Clinical Research and Development of Tuberculosis Diagnostics: Moving From Silos to Synergy

The development, evaluation, and implementation of new and improved diagnostics have been identified as critical needs by human immunodeficiency virus (HIV) and tuberculosis researchers and clinicians alike. These needs exist in international and domestic settings and in adult and pediatric populations. Experts in tuberculosis and HIV care, researchers, healthcare providers, public health experts, and industry representatives, as well as representatives of pertinent US federal agencies (Centers for Disease Control and Prevention, Food and Drug Administration, National Institutes of Health, United States Agency for International Development) assembled at a workshop proposed by the Diagnostics Working Group of the Federal Tuberculosis Taskforce to review the state of tuberculosis diagnostics development in adult and pediatric populations

A Drosophila-centric view of protein tyrosine phosphatases

AbstractMost of our knowledge on protein tyrosine phosphatases (PTPs) is derived from human pathologies and mouse knockout models. These models largely correlate well with human disease phenotypes, but can be ambiguous due to compensatory mechanisms introduced by paralogous genes. Here we present the analysis of the PTP complement of the fruit fly and the complementary view that PTP studies in Drosophila will accelerate our understanding of PTPs in physiological and pathological conditions. With only 44 PTP genes, Drosophila represents a streamlined version of the human complement. Our integrated analysis places the Drosophila PTPs into evolutionary and functional contexts, thereby providing a platform for the exploitation of the fly for PTP research and the transfer of knowledge onto other model systems

Comprehensive Community Initiatives (CCI): A Comparison of Community Implementation Plans

People in crisis often require multiple community services. A homeless person may need medical health care and behavioral health care, along with shelter. A woman who is the victim of domestic abuse may need help with childcare, transportation, food, and emergency housing. Comprehensive community initiatives (CCIs) attempt to provide this interrelated range of community services. CCIs developed as a part of community building efforts in the late 1980’s (Kubisch, 1996; Stagner and Duran, 1997). “Comprehensive” can either refer to an initiative that incorporates social, educational, cultural, physical, and economic development in a community or to an initiative whose purpose is to coordinate a system of services, rather than offer isolated services (Kubisch; Parachini and Covington, 2001; Stagner and Duran). The “community” involved in a CCI may be a neighborhood, city, or county. The goal of some initiatives is to build a strong community by developing local capacity that will be effective in dealing with problems the community may face in the future (Kubisch, 1996). Other initiatives aim to pool funding from separate programs (O’Brien, 1997) and coordinate social services across programs to make them more available to all people in need (Stagner and Duran, 1997). CCIs may focus on a broad goal, such as better and more responsive services, or a more specific goal, such as decreasing teen pregnancy rates (Stagner and Duran)

Fusion Project Evaluation (2006-2009)

The Fusion Project, funded through a grant from the Office of Refugee Resettlement (U.S. Department of Health and Human Services), was a three year project in Lincoln, Nebraska targeting four refugee ethnic communities: African; Asian; Eastern European; and Middle Eastern. The project’s goals were for: • the refugee communities to work together to share and learn about developing vibrant ethnic communities; • each refugee family to achieve self-sufficiency and social and civic integration into their new country and community; and • Lincoln’s mainstream community to be better equipped to work with refugees. The University of Nebraska Public Policy Center served as the project evaluator to assess Fusion’s success in reaching the stated goals. Stories and perceptions of the project’s activities and their impact were related by Fusion Project participants and served as the basis of the evaluation. Twelve semi-structured interviews were conducted with project staff members and representatives of participating mainstream community organizations. Interviewees were asked about their experiences with the Fusion Project, the perceived impact of the project, what was successful, what wasn’t as effective, and if they had suggestions for what might be done differently

Fusion Project Evaluation (2009-2010)

Begun in 2006, the Fusion Project connects new refugees and their communities with local community resources in Lincoln, Nebraska. One of three goals of the Fusion Project is equipping Lincoln’s mainstream community to work with four refugee communities: African, Asian, Eastern European, and Middle Eastern. The University of Nebraska Public Policy Center evaluated the Fusion Project with respect to this goal using the information gathered through two facilitated focus groups. Representatives of local agencies and attendees at Fusion educational events were invited to attend the groups... Responses from the eleven participants were compiled and analyzed to identify major themes. The results from the focus groups were compared to the results from an earlier evaluation of the Fusion Project

Expanded Learning Opportunities Updated Fund Mapping 2010

In January 2008, Nebraska Governor Dave Heineman hosted the Governor’s Summit for Expanded Learning Opportunities. The Summit explored collaborative efforts of schools and community leaders to create expanded learning opportunities for Nebraska’s children and youth. Following the event, Governor Heineman asked the Nebraska Children and Families Foundation and the Nebraska Community Learning Centers Network to map funding for expanded learning opportunities in Nebraska. Fund mapping ties into the long term goal of the Nebraska Children and Families Foundation and the Nebraska Community Learning Centers Network to promote greater efficiencies through increased coordination, advocate for additional support for projects that meet the needs of children, families, and communities, and enhance the ability to build a broad constituency for additional, stable cross-sector funding for such community-based initiatives. In August 2008 a report, Expanded Learning Opportunity Fund Mapping Project, was released. The report summarized federal and state funding available for expanded learning opportunities, and summarized surveys of Nebraska expanded learning opportunities programs’ reports of their financial support. The 2008 report was used to identify funding opportunities and build collaborations with non-traditional expanded learning opportunities partners. Federal funding opportunities, particularly those available through the American Recovery and Reinvestment Act of 2009 (ARRA), along with feedback from state and local partners, created a desire to update the Fund Mapping report. The updated report, Expanded Learning Opportunities: Updated Fund Mapping, updates funding figures, includes ARRA funding, includes additional state funding information, and reorganizes the content for easier reading. Copies and subsequent updates to this report, along with profiles of community-based programs in Nebraska and additional information about expanded learning opportunities, may be found at the Nebraska Children and Families Foundation website: http://www.nebraskaclcnetwork.org

NE211 Web Site Includes Link to Summer Food Service Program Locations

A reminder that the NE211 Web site includes link to summer food service program locations

NE211 Web Site Includes Link to Summer Food Service Program Locations

A reminder that the NE211 Web site includes link to summer food service program locations