Cervical Cancer in Cameroon: A Three Pronged Approach to Increase Awareness, Vaccination, Screening and Treatment

Problem: Cameroon has a disproportionately high burden of cervical cancer due to low awareness that the disease is preventable with prophylactic vaccines, lack of screening and treatment of pre-cancerous lesions, and high prevalence of human immunodeficiency virus (HIV). Between 2007-2013, the Cameroon Baptist Convention Health Services (CBCHS) devised three programs to: (1) increase awareness about cervical cancer; (2) immunize girls aged 9-13 years against human papilloma virus (HPV); and (3) conduct cervical cancer screening and treatment. Approaches: In collaboration with clinicians and researchers at University of Massachusetts and Northeastern University, CBCHS conducted education programs about HPV vaccine and cervical cancer for parents, adolescents, health care workers, and community members. The HPV vaccination demonstration project was implemented in three settings: schools, healthcare facilities, and in communities. CBCHS conducted cervical cancer screening in six sites using a “see and treat approach”. Findings: Following approval by the Ministry of Health, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage. A total of 6,851, 6,517 and 5,876 girls were immunized with first, second and third doses, respectively. Achieving an 84.6% 3-dose completion rate. Since 2007, 30,617 women have been screened with visual inspection with acetic acid and digital cervicography. Women with precancerous lesions were treated with cryotherapy or loop electrical excision procedure. Lesions suspicious for cancer were biopsied for histology. Of those screened, 3,015 (10%) self reported HIV-positivity, 19,837 (64%) were HIV-negative, and the HIV status of the remaining women was unreported (25%). The percentage of HIV infected women diagnosed with cancer was consistently higher than the percentage of HIV uninfected women diagnosed with cancer. Lessons Learned: The project demonstrated that, with adequate education of stakeholders, HPV vaccination and cervical cancer screening programs are acceptable and feasible methods to improve cervical cancer outcomes in Cameroon

Observation of interstellar lithium in the low-metallicity Small Magellanic Cloud

The primordial abundances of light elements produced in the standard theory of Big Bang nucleosynthesis (BBN) depend only on the cosmic ratio of baryons to photons, a quantity inferred from observations of the microwave background. The predicted primordial 7Li abundance is four times that measured in the atmospheres of Galactic halo stars. This discrepancy could be caused by modification of surface lithium abundances during the stars' lifetimes or by physics beyond the Standard Model that affects early nucleosynthesis. The lithium abundance of low-metallicity gas provides an alternative constraint on the primordial abundance and cosmic evolution of lithium that is not susceptible to the in situ modifications that may affect stellar atmospheres. Here we report observations of interstellar 7Li in the low-metallicity gas of the Small Magellanic Cloud, a nearby galaxy with a quarter the Sun's metallicity. The present-day 7Li abundance of the Small Magellanic Cloud is nearly equal to the BBN predictions, severely constraining the amount of possible subsequent enrichment of the gas by stellar and cosmic-ray nucleosynthesis. Our measurements can be reconciled with standard BBN with an extremely fine-tuned depletion of stellar Li with metallicity. They are also consistent with non-standard BBN.Comment: Published in Nature. Includes main text and Supplementary Information. Replaced with final title and abstrac

Is the EGRET source 3EG J1621+8203 the radio galaxy NGC 6251?

We discuss the nature of the unidentified EGRET source 3EG J1621+8203. In an effort to identify the gamma-ray source, we have examined X-ray images of the field from ROSAT PSPC, ROSAT HRI, and ASCA GIS. Of the several faint X-ray point sources in the error circle of 3EG J1621+8203, most are stars or faint radio sources, unlikely to be counterparts to the EGRET source. The most notable object in the gamma-ray error box is the bright FR I radio galaxy NGC 6251. If 3EG J1621+8203 corresponds to NGC 6251, then it would be the second radio galaxy to be detected in high energy gamma rays, after Cen A, which provided the first clear evidence of the detection above 100 MeV of an AGN with a large-inclination jet. If the detection of more radio galaxies by EGRET has been limited by its threshold sensitivity, there exists the exciting possibility that new high energy gamma-ray instruments, with much higher sensitivity, will detect a larger number of radio galaxies in the future.Comment: 7 pages, 6 figures. Accepted for publication in The Astrophysical Journal, August 2002 issu

Factors associated with inconsistent condom use in adolescents with negative or unknown HIV status in Northwest Cameroon

The purpose of this study is to evaluate the association between utilization of HIV testing and condom use amongst Cameroonian youths/adolescents who are not known to be HIV-infected. Worldwide, HIV is spreading most quickly amongst youths/adolescents. Between 44% and 82% of sexually active youths in Cameroon report inconsistent condom use. Data regarding utilization of HIV testing and condom use are lacking. A cross-sectional survey was administered to 431 youths ages 12-26 years in Cameroon from September 2011 to December 2011. Data on sociodemographics, sexual risk behaviors, self-reported HIV status, and condom use were collected. We compared rates of inconsistent condom use between those with known HIV negative status who utilized testing (HIV-N) and those with unknown status due to unutilized testing (HIV-U). Inconsistent condom use was defined as responding never, sometimes, or usually, while consistent condom use was defined as responding always to questions regarding frequency of condom use. Generalized estimating equations were applied to assess the association between HIV testing and inconsistent condom use, adjusting for other confounders. Of 414 eligible respondents, 205 were HIV-U and 209 were HIV-N. HIV-U subjects were younger (mean age - 16.4 vs. 17.9, p \u3c 0.001) and more likely to report living in an urban area (p - 0.002) than HIV-N subjects. Seventy-two percent (137/191) of sexually active youths reported inconsistent condom use. After adjusting for potential confounders, HIV-U status (odds ratio [OR] = 3.97, 95% confidence interval [CI] = 1.68-6.01) was associated with inconsistent condom use. Similarly, female gender (OR = 3.2, 95% CI = 1.29-7.89) was associated with inconsistent condom use, while older age at sexual debut was associated with a decreased risk for inconsistent condom use (OR = 0.67, 95% CI = 0.56-0.81). Cameroonian adolescents report high rates of inconsistent condom use which we found to be associated with self-reported unknown HIV status due to unutilized HIV testing. Successful HIV prevention programs among African youths/adolescents may benefit from expanded HIV testing programs

Using HbA1c to improve efficacy of the American Diabetes Association fasting plasma glucose criterion in screening for new type 2 diabetes in American Indians. The Strong Heart Study

WSTĘP. Celem badania jest określenie optymalnej krytycznej linii FPG-HbA1c, umożliwiającej rozpoznanie cukrzycy w grupie chorych z nieprawidłowym stężeniem glukozy na czczo (IFG, impaired fasting glucose) i poprawa skuteczności oznaczenia glikemii na czczo (FPG, fasting plasma glucose), stosowanego jako samodzielne badanie przesiewowe w kierunku cukrzycy u Indian amerykańskich. MATERIAŁ I METODY. Analizowano oznaczenia stężenia glukozy na czczo i 2 godziny po doustnym obciążeniu glukozą (2hPG) oraz HbA1c w grupie 2389 Indian amerykańskich w wieku 45-74 lat, którzy dotychczas nie byli leczeni z powodu cukrzycy, u których wcześniej nie rozpoznawano cukrzycy, a których poddano wyjściowej i powtórnej ocenie w ramach badania SHS (Strong Heart Study). Zgodnie z kryteriami American Diabetes Association cukrzycę rozpoznawano, gdy stężenie glukozy na czczo było równe lub wyższe niż 126 mg/dl lub gdy wartość 2hPG wynosiła 200 mg/dl lub więcej. Nieprawidłowe stężenie glukozy na czczo rozpoznawano, gdy mieściło się ono w przedziale 110 Ł FPG < 126 mg/dl, a jako wartość prawidłową (NFG, normal fasting glucose) przyjęto stężenie glukozy na czczo niższe niż 110 mg/dl. Do rozpoznawania cukrzycy w grupie badanych z IFG (2hPG ł 200 mg/dl) zastosowano modele regresji logistycznej. Najlepszy model wybrano na podstawie porównania pól pod krzywymi ROC (receiver operating characteristic) utworzonymi w oparciu o różne modele regresji logistycznej. Do wyznaczenia optymalnych wartości krytycznych użyto funkcji przydatności opartej na najlepszym modelu oraz współczynniku koszt/korzyść. Dane z drugiego badania wykorzystano do oceny wpływu czasu, jaki upłynął pomiędzy dwoma kolejnymi badaniami przesiewowymi, zarówno na kryterium FPG, jak i na optymalną krytyczną linię FPG-HbA1c. WYNIKI. W grupie chorych z nowo rozpoznaną cukrzycą, u 37% w badaniu wyjściowym oraz u 55,2% w badaniu powtórnym stwierdzono wartości 2hPG większe bądź równe 200 mg/dl, przy wartościach FPG mniejszych niż 126 mg/dl. Zarówno w wyjściowym, jak i w drugim oznaczeniu u znacznej części pacjentów z IFG rozpoznano cukrzycę (odpowiednio: 19,3 i 22,9%). Porównanie pól pod krzywymi ROC dla poszczególnych modeli regresji logistycznej wykazało, że największa wartość pola odpowiada łącznemu oznaczeniu FPG i HbA1c. Wartość ta była znamiennie wyższa od wartości pola dla oznaczenia FPG (p = 0,0008). Dla współczynnika koszt/korzyść = 0,23888 optymalna linia krytyczna o największej użyteczności miała wartość równą 0,89 × HbA1c + 0,11 × FPG = 17,92. U chorych, u których wartości FPG i HbA1c znajdowały się na tej linii lub powyżej, zalecano wykonanie doustnego testu tolerancji glukozy (OGTT, oral glucose tolerance test) w celu rozpoznania lub wykluczenia cukrzycy. Optymalne wartości krytyczne w badaniu powtórzonym po 4 latach były mniejsze. WNIOSKI. Według kryteriów American Diabetes Association cukrzycę rozpoznaje się, gdy wartość FPG jest większa lub równa 126 mg/dl albo gdy wartość 2hPG wynosi 200 mg/dl lub więcej. Wykonanie badania FPG jest proste i zaleca się je jako badanie przesiewowe. Natomiast stosowanie w praktyce OGTT w celu uzyskania wartości 2hPG jest kłopotliwe, szczególnie u chorych, u których stwierdza się wartość FPG poniżej 126 mg/dl. Wykonywanie OGTT jako badania przesiewowego u każdego pacjenta również jest niepraktyczne. Uzyskane dane wskazują, że u 37% osób z nowo wykrytą cukrzycą w badaniu wyjściowym i u 55,2% w oznaczeniu drugim stężenie glukozy w OGTT wynosiło 200 mg/dl lub więcej, podczas gdy wartość FPG była niższa niż 126 mg/dl. W takich wypadkach, na podstawie oznaczenia wyłącznie FPG jako badania przesiewowego, cukrzyca nie zostałaby rozpoznana. Mimo że odsetek chorych na cukrzycę w grupie NFG jest mały i może zostać zignorowany (4,7% w pierwszym i 6,5% w drugim oznaczeniu), to częstość przypadków cukrzycy stwierdzonych w grupie IFG w trakcie niniejszego badania (ok. 20%) wymaga uwzględnienia w dyskusji na temat metody badań przesiewowych. Wydaje się, że u części chorych z nieprawidłowym stężeniem glukozy na czczo, wybranych na podstawie optymalnych krytycznych wartości FPG-HbA1c, warto wykonać OGTT. Wyznaczenie optymalnej linii krytycznej i odstępu między kolejnymi testami przesiewowymi wymaga dalszych badań.INTRODUCTION. To find an optimal critical line in the fasting plasma glucose (FPG)-HbA1c plane for identifying diabetes in participants with impaired fasting glucose (IFG) and thereby improve the efficacy of using FPG alone in diabetes screening among American Indians. RESEARCH DESIGN AND METHODS. We used FPG, 2-h postload glucose (2hPG), and HbA1c measured in the 2,389 American Indians (aged 45&#8211;74 years, without diabetes treatment or prior history of diabetes) in the Strong Heart Study (SHS) baseline (second) examination. Participants were classified as having diabetes if they had either FPG &#163; 126 mg/dl or 2hPG &#8805; 200 mg/dl, as having IFG if they had 110 &#163; FPG < 126 mg/dl, and as having normal fasting glucose (NFG) if they had FPG < 110, according to the American Diabetes Association (ADA) definition. Logistic regression models were used for identifying diabetes (2hPG &#8805; 200 mg/dl) in IFG participants. The areas under the receiver operating characteristic (ROC) curves generated by different logistic regression models were evaluated and compared to select the best model. A utility function based on the best model and the cost-to-benefit ratio was used to find the optimal critical line. The data from the second examination were used to study the effect of the time interval between the successive diabetes screenings on both the FPG criterion and the optimal critical line. RESULTS. A total of 37% of all subjects with new diabetes at baseline and 55.2% of those in the second exam had 2hPG &#8805; 200 but FPG < 126. There was a very large portion of IFG participants with diabetes (19.3 and 22.9% in the baseline and second exam, respectively). Among the areas under the ROC curves, the area generated by the logistic regression model on FPG plus HbA1c is the largest and is significantly larger than that based on FPG (P = = 0.0008). For a cost-to-benefit ratio of 0.23888, the optimal critical line that has the highest utility is: 0.89 × HbA1c + 0.11 × FPG = 17.92. Those IFG participants whose FPG and HbA1c were above or on the line were referred to take an oral glucose tolerance test (OGTT) to diagnose diabetes. The optimal critical line is lower if a successive diabetes screening will be conducted 4 years after the previous screening. CONCLUSIONS. FPG &#8805; 126 and 2hPG &#8805; 200, as suggested by the ADA, are used in-dependently to define diabetes. The FPG level is easy to obtain, and using FPG alone is suggested for diabetes screening. It is difficult to get physicians and patients to perform an OGTT to get a 2hPG level because of the many drawbacks of the OGTT, especially in those patients who already have FPG < 126. It is also impractical to conduct an OGTT for everyone in a diabetes screening. Our data show that 37% of all subjects with new diabetes in the SHS baseline exam and 55.2% of those in the second exam have 2hPG &#8805; 200 but FPG < 126. These cases of diabetes cannot be detected if FPG is used alone in a diabetes screening. Therefore, although the small portion of diabetes in the NFG group (4.7% in the base-line and 6.9% in the second exam) may be ignored, those cases of diabetes among IFG participants (~20% in our data) need further consideration in a diabetes screening. It may be worthwhile for those IFG participants identified by the optimal critical line to take an OGTT. The optimal critical line and time interval between successive diabetes screenings need further study

Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood Pressure

Whether metabolic factors and their change over time influence development of arterial hypertension in adults with initially optimal blood pressure (BP) is unknown. We analyzed associations of BP in the optimal range (<120/80 mm Hg), metabolic risk factors, and their changes over 4-year follow-up, with 8-year incident hypertension, in a cohort of American Indians with a high prevalence of obesity. At baseline, 967 participants with optimal BP and no prevalent cardiovascular disease (69.5% women; mean age, 54±7 years) were evaluated and reexamined after 4 (second examination) and 8 years to evaluate predictors of 8-year incident arterial hypertension. In participants with normal glucose tolerance, baseline BP and decrease in high-density lipoprotein cholesterol from baseline to the second examination were the most potent predictors of 8-year arterial hypertension (both P <0.0001), with additional effects of baseline waist circumference and its increase, increase in BP, and presence of diabetes at the second examination (all P <0.04). In participants with impaired glucose tolerance or diabetes, the most potent predictor of 8-year incident hypertension was diabetes at the second examination ( P <0.0001) followed by a increase in BP and LDL cholesterol over the first 4 years (both P <0.001). Thus, incident arterial hypertension can be predicted by initial metabolic profile and unfavorable metabolic variations over time, in addition to initial BP. At optimal levels of initial BP, increasing abdominal obesity, and abnormal lipid profile are major predictors of development of arterial hypertension. Possible implications of these findings for primary cardiovascular prevention should be tested in prospective studies

Intermediate- and High-Velocity Ionized Gas toward zeta Orionis

We combine UV spectra obtained with the HST/GHRS echelle, IMAPS, and Copernicus to study the abundances and physical conditions in the predominantly ionized gas seen at high (-105 to -65 km/s) and intermediate velocities (-60 to -10 km/s) toward zeta Ori. We have high resolution (FWHM ~ 3.3-4.5 km/s) and/or high S/N spectra for at least two significant ions of C, N, Al, Si, S, and Fe -- enabling accurate estimates for both the total N(H II) and the elemental depletions. C, N, and S have essentially solar relative abundances; Al, Si, and Fe appear to be depleted by about 0.8, 0.3-0.4, and 0.95 dex, respectively. While various ion ratios would be consistent with collisional ionization equilibrium (CIE) for T ~ 25,000-80,000 K, the widths of individual high-velocity absorption components indicate that T ~ 9000 K -- so the gas is not in CIE. Analysis of the C II fine-structure excitation equilibrium yields estimated densities (n_e ~ n_H ~ 0.1-0.2 cm^{-3}), thermal pressures (2 n_H T ~ 2000-4000 cm^{-3}K), and thicknesses (0.5-2.7 pc) for the individual clouds. We compare the abundances and physical properties derived for these clouds with those found for gas at similar velocities toward 23 Ori and tau CMa, and also with several models for shocked gas. While the shock models can reproduce some features of the observed line profiles and some of the observed ion ratios, there are also significant differences. The measured depletions suggest that \~10% of the Al, Si, and Fe originally locked in dust in the pre-shock medium may have been returned to the gas phase, consistent with predictions for the destruction of silicate dust in a 100 km/s shock. The near-solar gas phase abundance of carbon, however, seems inconsistent with the predicted longer time scales for the destruction of graphite grains.Comment: 50 pages, 9 figures; aastex; accepted by Ap

Tiny-Scale Molecular Structures in the Magellanic Clouds (Part 1)

We report on the {\small FUSE} detections of the HD and CO molecules {\bf on the lines of sight towards three Large Magellanic stars}: Sk $-$67D05, Sk $-$68D135, and Sk $-$69D246. HD is also detected for the first time {\bf on the lines of sight towards two Small Magellanic Cloud stars}: AV 95 and Sk 159. While the HD and CO abundances are expected to be lower in the Large Magellanic Cloud where molecular fractions are a third of the Galactic value and where the photodissociation flux is up to thousands times larger, we report an average HD/H$_2$ ratio of 1.4$\pm$0.5 ppm and CO/H$_2$ ratio ranging from 0.8 to 2.7 ppm similar to the Galactic ones. We tentatively identify a deuterium reservoir (hereafter D--reservoir) towards the Small Magellanic Cloud, along the light path to AV 95. We derive a D/H ratio ranging from 1. 10$^{-6}$ to 1.1 10$^{-5}$.Comment: 34 pages, 10 tables, 12 figures, accepted for publication in A&

FUSE Observations of Molecular Hydrogen in Translucent Interstellar Clouds: The Line of Sight Toward HD 73882

We report the results of initial FUSE observations of molecular hydrogen (H2) in translucent clouds. These clouds have greater optical depth than any of the diffuse clouds previously observed for far-UV H2 absorption, and provide new insights into the physics and chemistry of such regions. Our initial results involve observations of HD 73882, a well-studied southern hemisphere star lying behind substantial interstellar material (E(B-V) = 0.72; A_V = 2.44). We find a total H2 column density, N(H2) = 1.2 x 10^{21} cm^{-2}, about three times larger than the values for diffuse clouds previously measured in the far-UV. The gas kinetic temperature indicated by the ratio N(J=1)/N(J=0) is 58 +/- 10 K. With the aid of ground-based data to calculate an appropriate multi-component curve of growth, we have determined column densities for all rotational levels up to J = 7. The J >= 2 states can be reasonably fitted with a rotational excitation temperature of 307 +/- 23 K. Both the kinetic and rotational temperatures are similar to those found in previous investigations of diffuse clouds. The ratios of carbonaceous molecules to hydrogen molecules are also similar to ratios in diffuse clouds, suggesting a similar chemistry for this line of sight.Comment: 7 pages, 3 figures, to appear in ApJ Letters (FUSE first-results issue

Tobacco Use and Cardiovascular Disease among American Indians: The Strong Heart Study

Tobacco use among American Indians has a long and complicated history ranging from its utilization in spiritual ceremonies to its importance as an economic factor for survival. Despite this cultural tradition and long history, there are few studies of the health effects of tobacco in this population. The Strong Heart Study is a prospective observational study of cardiovascular disease (CVD) in 13 American Indian tribes in Arizona, Oklahoma, and North and South Dakota with 4,549 participants. Baseline examinations were followed by two examinations at regular intervals and 16 years of morbidity and mortality follow-up. Hazard ratios (HRs) for non-fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.94, 95% CI 1.54 to 2.45) and men (HR = 1.59, 95% CI 1.16 to 2.18). Hazard ratios for fatal CVD for current smokers vs. non-smokers after adjusting for other risk factors were significant in women (HR = 1.64, 95% CI 1.04 to 2.58), but not in men. Individuals who smoked and who were diagnosed with diabetes mellitus, hypertension or renal insufficiency were more likely to quit smoking than those without these conditions. On average, American Indians smoke fewer cigarettes per day than other racial/ethnic groups; nevertheless, the ill effects of habitual tobacco use are evident in this population