A global matchmaking web platform facilitating equitable institutional partnerships and mentorship to strengthen health workforce training capacity

The critical human resources deficit in the healthcare sector in low-resource settings (LRS) has an overwhelming impact on health outcomes and disparities in growth and development of the global healthcare workforce. There is a lack of qualified trainers and mentors and this makes it challenging to connect existing capacity gaps with existing expertise and established programs. Through global health partnerships, training programs, and mentorship, individuals and institutions from around the globe can connect to share training resources and strengthen clinical and research capacity in LRSs. Global health partnerships focused on capacity building face many challenges including; unequal access to information about potential partners and training opportunities, a lack of transparency regarding each institutions training priorities, and inequity and absent reciprocity within global health partnerships that have disproportionate power division between high-resource and LRSs. This initiative, the Consortium of Universities for Global Health Capacity Strengthening Platform (CUGH-CPS) (CUGHCapacityBuilding.org), aims to empower institutions and individuals in LRSs to address these challenges and drive partnership engagement through avenues that are beneficial to the LRS agent needs and context by leading the prioritization of training capacity development across clinical and research domains. The CUGH-CPS helps to identify and create a platform for the dissemination of training and mentorship needs from LRS institutions and share this information with the global community. This manuscript describes this new initiative officially launched to a global audience at the April 2023 CUGH meeting

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Survival Disparity in Black & White Women with Ovarian Cancer: The Role of Mediators & Contextual Factors

Ovarian cancer remains one of the most lethal of all cancers. While the incidence of ovarian cancer is higher among White women, survival is significantly poorer among Black women. Yet the reasons for this disparity are not well-understood. This project evaluated predictors of late-stage diagnosis to determine if there were significant racial differences in these predictors that might explain the disparity in survival. In addition, this project examined whether factors related to socioeconomic environment, tumor characteristics, and risk factors associated with longer lifetime ovulation and higher gonadotropin levels are mediators of the racial disparity in ovarian cancer survival. Data were obtained from women diagnosed with ovarian cancer in Cook County, Illinois. Socioeconomic environment was assessed using two well-established measures: concentrated disadvantage and concentrated affluence. Tumor characteristics included tumor grade, histologic sub-type, and residual lesion status. Hormonal and reproductive risk factors included length of ovulatory period and HRT history.The proportion of the survival disparity explained by these factors was estimated by rescaling coefficients from logistic regression using the method of Karlson, Holm, and Breen (2010). Age at diagnosis, poverty, an index of socioeconomic status, pathologic grade, and histologic sub-type were all significant predictors of late-stage diagnosis. However, race was not a significant predictor of late-stage diagnosis, which suggests that other factors may account for the racial disparity in survival. More Black women than White women survived less than five years following their diagnoses (63% vs. 48%, respectively, p = 0.004). Tumor characteristics explained 37% percent of the racial disparity in five-year survival (p = 0.03). Socioeconomic environment accounted for 35% of the racial disparity in survival (p = 0.39). Risk factors that may be associated with more aggressive tumors accounted for 15% of the disparity in survival (p = 0.13). Together, these factors explained 65% of the survival disparity (p = 0.20). Differences in tumor grade and histology were shown to be important mediators in the relation between race and disparate ovarian cancer survival. Socioeconomic environment and factors associated with longer lifetime ovulation and higher levels of gonadotropins may also explain a portion of this disparity

Association between adverse childhood experiences and later-life allostatic load in UK Biobank female participants

Background: Adverse childhood experiences during key developmental periods have been shown to impact long-term health outcomes. Adverse childhood experiences may include psychological, physical, or sexual abuse; neglect; or socioeconomic factors. Adverse childhood experiences are linked with an increase in poor health behavior such as smoking and alcohol consumption, and may also influence epigenetic changes, inflammatory response, metabolic changes, and allostatic load. Objective: We sought to explore associations between adverse childhood experiences and allostatic load in adult female participants in the UK Biobank. Design: The UK Biobank is a multisite cohort study established to capture lifestyle, environment, exposure, health history, and genotype data on individuals in the United Kingdom. Methods: Adverse childhood experiences were assessed from the Childhood Trauma Screener, which measures abuse and neglect across five items. Biological measures at enrollment were used to construct allostatic load, including measures of metabolic, inflammatory, and cardiovascular function. Females with a cancer diagnosis prior to enrollment were removed as it may influence allostatic load. Poisson regression models were used to assess the association between adverse childhood experiences and allostatic load, accounting for a priori confounders. Results: A total of 33,466 females with complete data were analyzed, with a median age at enrollment of 54 (range = 40–70) years. Among the study sample, the mean allostatic load ranged from 1.85 in those who reported no adverse childhood experiences to 2.45 in those with all adverse childhood experiences reported. In multivariable analysis, there was a 4% increase in average allostatic load among females for every additional adverse childhood experience reported (incidence rate ratio = 1.04, 95% confidence interval = 1.03–1.05). Similar results were observed when assessing individual adverse childhood experience components. Conclusion: This analysis supports a growing body of evidence suggesting that increased exposure to early life abuse or neglect is associated with increased allostatic load in females

A qualitative study of primary care clinician’s approach to ending cervical cancer screening in older women in the United States

The United States Preventive Services Task Force (USPSTF) recommends that cervical cancer screening end in average-risk patients with a cervix at 65 years of age if adequate screening measures have been met, defined as having 1) at least three normal consecutive cytology (Pap) tests, or 2) two normal cytology tests and/or two negative high-risk human papillomavirus tests between ages 55-65; the last test should be performed within the prior 5 years. Up to 60 % of all women aged 65 years and older who are ending screening do not meet the criteria for adequate screening. The objective of this study was to understand the process and approach that healthcare clinicians use to determine eligibility to end cervical cancer screening. In 2021 we conducted semi-structured interviews in San Francisco, CA with twelve healthcare clinicians: two family medicine physicians, three general internal medicine physicians, two obstetrician/gynecologists and five nurse practitioners. Thematic analysis, using inductive and deductive coding, was utilized. Three major themes emerged: following guidelines, relying on self-reported data regarding prior screening, and considering sexual activity as a factor in the decision to end screening. All interviewees endorsed following the USPSTF guidelines and they utilized self-report to determine eligibility to end screening. Clinicians' approach was dependent in part on their judgement about the reliability of the patient to convey their screening history. Sexual activity of the patient was considered when making clinical recommendations. Shared decision-making was often utilized. Clinicians voiced a strong reliance on self-reported screening history to end cervical cancer screening

Efficacy of a food safety comic book on knowledge and self-reported behavior for persons living with AIDS.

INTRODUCTION:Persons living with AIDS are highly vulnerable to foodborne enteric infections with the potential for substantial morbidity and mortality. Educational materials about foodborne enteric infections intended for this immunocompromised population have not been assessed for their efficacy in improving knowledge or encouraging behavior change. METHODS/RESULTS:AIDS patients in four healthcare facilities in Chicago, New Orleans, and Puerto Rico were recruited using fliers and word of mouth to healthcare providers. Those who contacted research staff were interviewed to determine food safety knowledge gaps and risky behaviors. A food safety educational comic book that targeted knowledge gaps was created, piloted, and provided to these patients who were instructed to read it and return at least 2 weeks later for a follow-up interview. The overall food safety score was determined by the number of the 26 knowledge/belief/behavior questions from the survey answered correctly. Among 150 patients who participated in both the baseline and follow-up questionnaire, the intervention resulted in a substantial increase in the food safety score (baseline 59%, post-intervention 81%, p<0.001). The intervention produced a significant increase in all the food safety knowledge, belief, and behavior items that comprised the food safety score. Many of these increases were from baseline knowledge below 80 percent to well above 90%. Most (85%) of the patients stated they made a change to their behavior since receiving the educational booklet. CONCLUSION:This comic book format intervention to educate persons living with AIDS was highly effective. Future studies should examine to what extent long-term behavioral changes result

Barriers and Facilitators to HPV Vaccine Uptake Among US Rural Populations: A Scoping Review [Post-Print]

Author Post-print. Full text available June 2021.Purpose: Compared to US urban populations, rural residents have a higher incidence of HPV-related cancer and lower HPV vaccine coverage. This study determined what is known about barriers and facilitators to vaccine uptake in US rural settings. Methods: A scoping review was conducted to describe individual, interpersonal, organizational, and community/societal barriers and facilitators to HPV vaccine initiation and completion among US rural populations and to identify gaps in the current research. A systematic search was conducted using PubMed/MEDLINE and CINAHL databases. Results: A total of 1,083 abstracts were reviewed and 13 articles met the inclusion criteria. Major themes at the individual-level included caregiver and vaccine-recipient demographics, other immunizations received, pap test history, awareness/knowledge of cervical cancer, HPV vaccine, or HPV infection, attitudes and motivation to vaccinate, STD diagnosis, sexual behavior, cervical cancer history, contraceptive use, and cancer fatalism. Interpersonal themes focused on provider influence and communication, caregiver and peer influence, and social support for the caregiver. At the organizational-level, themes included health insurance, provider characteristics, school-based interventions, and provider/practice-based interventions. The only community/societal factor examined related to a social marketing campaign. Conclusion: Additional research is needed on interpersonal, organizational, and community/societal factors, as well as an expanded focus on rural males. Future studies should account for rural heterogeneity by expanding the geographic areas studied. Our findings detailing factors found to be associated with HPV vaccine uptake will help inform future clinical, health services, and community research, as well as interventions and policy efforts. Keywords: Disparities; HPV vaccine; HPV vaccine uptake; Human papillomavirus; Rural health. </p

Society of behavioral medicine supports increasing HPV vaccination uptake: an urgent opportunity for cancer prevention

Human papillomavirus (HPV) vaccine coverage remains low in the USA. The Society for Behavioral Medicine (SBM) supports the goals outlined by Healthy People 2020, the President\u27s Cancer Panel, and the National Vaccine Advisory Committee to increase vaccination coverage among both males and females. SBM makes the following recommendations in support of efforts to reduce structural and other barriers to HPV vaccination services in order to increase rates of series completion. We encourage legislators and other policymakers to improve administration authority, insurance coverage, and reimbursement rates to healthcare providers who make the HPV vaccine available to adolescents; provide instrumental support to fund the development of school curricula on HPV vaccination; and increase public awareness that HPV vaccination can prevent cancer. We urge healthcare providers and healthcare systems to increase the strength, quality, and consistency of HPV vaccination recommendations for all eligible patients; to treat HPV vaccination as a routine preventive service; employ culturally appropriate communication strategies in clinical settings to educate eligible patients, parents, and guardians about the importance, effectiveness, and safety of HPV vaccination; and to strengthen and better coordinate the use of electronic medical records and immunization information systems

Illustration of the conceptual framework for Black men and dental provider misalignment.

Illustration of the conceptual framework for Black men and dental provider misalignment.</p