Uptake of the human papillomavirus vaccine in Kenya : testing the health belief model through pathway modeling on cohort data

Background: Many studies investigate HPV vaccine acceptability, applying health behavior theories to identify determinants; few include real uptake, the final variable of interest. This study investigated the utility of the Health Belief Model (HBM) in predicting HPV vaccine uptake in Kenya, focusing on the importance of promotion, probing willingness to vaccinate as precursor of uptake and exploring the added value of personal characteristics. Methods: Longitudinal data were collected before and after a pilot HPV vaccination program in Eldoret among mothers of eligible girls (N = 255). Through pathway modeling, associations between vaccine uptake and the HBM constructs, willingness to vaccinate and adequate promotion were examined. Adequate promotion was defined as a personal evaluation of promotional information received. Finally, baseline cervical cancer awareness and socio-demographic variables were added to the model verifying their direct, mediating or moderating effects on the predictive value of the HBM. Results: Perceiving yourself as adequately informed at follow-up was the strongest determinant of vaccine uptake. HBM constructs (susceptibility, self-efficacy and foreseeing father's refusal as barrier) only influenced willingness to vaccinate, which was not correlated with vaccination. Baseline awareness of cervical cancer predicted uptake. Conclusions: The association between adequate promotion and vaccination reveals the importance of triggers beyond personal control. Adoption of new health behaviors might be more determined by organizational variables, such as promotion, than by prior personal beliefs. Assessing users' and non-users' perspectives during and after implementing a vaccination program can help identifying stronger determinants of vaccination behavior

Patients' and clinicians' preferences in adjuvant treatment for high-risk endometrial cancer:Implications for shared decision making

Background. Decision making regarding adjuvant therapy for high-risk endometrial cancer is complex. The aim of this study was to determine patients' and clinicians' minimally desired survival benefit to choose chemoradiotherapy over radiotherapy alone. Moreover, influencing factors and importance of positive and negative treatment effects (i.e. attribute) were investigated. Methods. Patients with high-risk endometrial cancer treated with adjuvant pelvic radiotherapy with or without chemotherapy and multidisciplinary gynaecologic oncology clinicians completed a trade-off questionnaire based on PORTEC-3 trial data. Results. In total, 171 patients and 63 clinicians completed the questionnaire. Median minimally desired benefit to make chemoradiotherapy worthwhile was significantly higher for patients versus clinicians (10% vs 5%, p = 0.02). Both patients and clinicians rated survival benefit most important during decision making, followed by long-term symptoms. Older patients (OR 0.92 [95%CI 0.87 & ndash;0.97]; p = 0.003) with comorbidity (OR 0.34 [95% CI 0.12 & ndash;0.89]; p = 0.035) had lower preference for chemoradiotherapy, while patients with better numeracy skills (OR 1.2 [95%CI 1.05 & ndash;1.36], p = 0.011) and chemoradiotherapy history (OR 25.0 [95%CI 8.8 & ndash;91.7]; p < 0.001) had higher preference for chemoradiotherapy. & nbsp;Conclusions. There is a considerable difference in minimally desired survival benefit of chemoradiotherapy in high-risk endometrial cancer among and between patients and clinicians. Overall, endometrial cancer patients needed higher benefits than clinicians before preferring chemoradiotherapy. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)

ESA Voyage 2050 White Paper: Detecting life outside our solar system with a large high-contrast-imaging mission

In this white paper, we recommend the European Space Agency plays a proactive role in developing a global collaborative effort to construct a large high-contrast imaging space telescope, e.g. as currently under study by NASA. Such a mission will be needed to characterize a sizable sample of temperate Earth-like planets in the habitable zones of nearby Sun-like stars and to search for extraterrestrial biological activity. We provide an overview of relevant European expertise, and advocate ESA to start a technology development program towards detecting life outside the Solar system

Cerebral small vessel disease genomics and its implications across the lifespan

White matter hyperintensities (WMH) are the most common brain-imaging feature of cerebral small vessel disease (SVD), hypertension being the main known risk factor. Here, we identify 27 genome-wide loci for WMH-volume in a cohort of 50,970 older individuals, accounting for modification/confounding by hypertension. Aggregated WMH risk variants were associated with altered white matter integrity (p = 2.5×10-7) in brain images from 1,738 young healthy adults, providing insight into the lifetime impact of SVD genetic risk. Mendelian randomization suggested causal association of increasing WMH-volume with stroke, Alzheimer-type dementia, and of increasing blood pressure (BP) with larger WMH-volume, notably also in persons without clinical hypertension. Transcriptome-wide colocalization analyses showed association of WMH-volume with expression of 39 genes, of which four encode known drug targets. Finally, we provide insight into BP-independent biological pathways underlying SVD and suggest potential for genetic stratification of high-risk individuals and for genetically-informed prioritization of drug targets for prevention trials.Peer reviewe

Variability of EEG synchronization during a working memory task in healthy subjects

Working memory is associated with an increase in EEG theta synchronization and a decrease in lower alpha band synchronization. We investigated whether such changes in mean synchronization level are accompanied by changes in small scale fluctuations of synchronization. EEGs (19 channels; average reference; sample frequency 250 Hz) were recorded in 21 healthy subjects (12 males; mean age 62.5 years; S.D. 2.1) at rest and during a visual working memory condition. EEG synchronization was computed in six frequency bands (2-6; 6-10; 10-14; 14-18; 18-22; 22-50 Hz) using the synchronization likelihood. Variability of the synchronization was quantified with synchronization entropy. During the working memory condition synchronization increased in the 2-6 Hz band, and decreased in the 6-10, 14-18 and 18-22 Hz bands. Working memory was associated with increased variability in the 2-6 Hz band, and decreased variability in the 6-10 Hz band and, to a lesser extent, in the 14-18 and 18-22 Hz bands. Working memory is accompanied not only by characteristic changes in the mean level of interactions between neural networks, but also by changes in small scale fluctuations in such interactions. Strong, but rapidly fluctuating coupling between neural systems might provide a mechanism to optimize the balance between local differentiation and global integration of brain activity

The impact of education and globalization on sexual and reproductive health: retrospective evidence from eastern and southern Africa

The objective of this study is to qualify the relationship between sexual and reproductive health (SRH) and educational attainment in eastern and southern Africa (ESA). We hypothesize that the regional level of globalization is a moderating factor in the relationship between SRH and educational attainment. Using retrospective data from Kenya, Malawi, Tanzania, and Zambia, the associations between SRH (eight indicators), educational attainment, and globalization were examined using multilevel logistic regression analysis. It was found that the model fit for every SRH outcome indicator increased significantly after including the interaction between globalization and educational attainment, supporting the hypothesis. Depending on the level of globalization, three types of relationships between education and SRH were found: (1) for the indicators “more than four children,” “intercourse before 17 years,” “first child before 20 years,” and “one or more child died” education is risk-decreasing, and the reduction is stronger in more globalized regions; (2) for the indicators “condom use at last intercourse” and “current contraceptive use” education is risk-decreasing, and the reduction is stronger in less globalized regions; (3) for the indicators “HIV positive” and “more than four lifetime sexual partners” education is risk increasing, but only in less globalized regions. In conclusion, these effects are related to three types of access: (1) access to services, (2) access to information, and (3) access to sexual networks. The findings highlight the relevance of globalization when analyzing the association between SRH and education, and the importance of structural factors in the development of effective SRH promotion interventions

Nonlinear synchronization in EEG and whole-head MEG recordings of healthy subjects

According to Friston, brain dynamics can be modelled as a large ensemble of coupled nonlinear dynamical subsystems with unstable and transient dynamics. In the present study, two predictions from this model (the existence of nonlinear synchronization between macroscopic field potentials and itinerant nonlinear dynamics) were investigated. The dependence of nonlinearity on the method of measuring brain activity (EEG vs. MEG) was also investigated. Dataset I consisted of 10 MEG recordings in 10 healthy subjects. Dataset II consisted of simultaneously recorded MEG (126 channels) and EEG (19 channels) in 5 healthy subjects. Nonlinear coupling was assessed with the synchronization likelihood S and dynamic itinerancy with the synchronization entropy Hs. Significance was assessed with a bootstrap procedure ("surrogate data testing"), comparing S and Hs with their distribution under the null hypothesis of stationary, linear dynamics. Significant nonlinear synchronization was detected in 14 of 15 subjects. The nonlinear dynamics were associated with a high index of itinerant behaviour. Nonlinear interdependence was significantly more apparent in MEG data than EEG. Synchronous oscillations in MEG and EEG recordings contain a significant nonlinear component that exhibits characteristics of unstable and itinerant behaviour. These findings are in line with Friston's proposal that the brain can be conceived as a large ensemble of coupled nonlinear dynamical subsystems with labile and unstable dynamics. The spatial scale and physical properties of MEG acquisition may increase the sensitivity of the data to underlying nonlinear structure

EEG synchronization likelihood in mild cognitive impairment and Alzheimer's disease during a working memory task.

Contains fulltext : 57205.pdf (publisher's version ) (Closed access)OBJECTIVE: Synchronization likelihood analysis of resting state EEG has shown that cognitive dysfunction in Alzheimer's disease (AD) and its precursor mild cognitive impairment (MCI) are associated with a loss of functional connectivity in high (upper alpha and beta) frequency bands. Working memory tasks are known to change functional connectivity, but it is unknown whether this increases the differences between AD, MCI and healthy controls. Our objective was to investigate the behavior of synchronization likelihood of multichannel EEG in AD, MCI and cognitively healthy controls, both at rest and during a working memory task. METHODS: EEGs (200 Hz sample frequency, 21 channels, average reference) were recorded at rest as well as during a visual working memory task in 14 patients with AD according to the NINCDS-ADRDA criteria (mean age 76.4; SD 13.6), 11 patients with MCI according to the criteria of Petersen (mean age 78.4; SD 6.4) and 14 with subjective memory complaints but no demonstrable memory disturbance (mean age 61.6; SD 26.6). The synchronization likelihood was computed over 19 channels, comparing each channel with all the other channels for the 0.5-4, 4-8, 8-10, 10-12, 12-30, 30-50 Hz frequency bands. RESULTS: The synchronization likelihood was significantly decreased in the upper alpha (10-12) and beta (12-30) bands in AD compared to persons with subjective memory complaints. The working memory task scores strongly correlated with Mini-Mental State Examination scores. During the working memory task the synchronization likelihood was significantly higher in MCI compared to the control subjects in the lower alpha band (8-10 Hz). CONCLUSIONS: Decrease of beta band synchronization occurs in mild AD, both in a resting condition and during a working memory task. SIGNIFICANCE: Decrease of beta band synchronization in mild AD is a robust finding. The present study confirms our findings in a different cohort of patients, using alternative frequency bands. The diagnostic value of the synchronization likelihood in AD and MCI needs to be further established

Shared Decision Making in Prostate Cancer Care—Encouraging Every Patient to be Actively Involved in Decision Making or Ensuring the Patient Preferred Level of Involvement?

Purpose: The aims of this study were to 1) describe preferred and experienced roles in treatment decision making among patients with localized prostate cancer, 2) identify how often the roles experienced by patients matched their preferred roles and 3) determine whether active involvement in decision making regardless of role preferences or concordance between preferred and experienced roles would be the strongest predictor of more favorable patient reported outcomes. Materials and Methods: In this prospective, multicenter, observational study we obtained serial questionnaire data from 454 patients with newly diagnosed, localized prostate cancer (cT1-cT2, or Gleason 7 or less and prostate specific antigen 20 ng/ml or less). Questionnaires were completed prior to treatment and at the 3, 6 and 12-month posttreatment followups. Clinical data were obtained from the patient medical records. Active involvement and role concordance were operationalized using the CPS (Control Preferences Scale). ANOVA and effect sizes (small and medium Cohen d = 0.2 and 0.5, respectively) were used to compare patient knowledge of prostate cancer, decision conflict, decision regret and overall health related quality of life. Results: Of the patients 393 (87%) reported having been actively involved in treatment decision making. However, 78 patients (17%) indicated having had less or more involvement than preferred. Active involvement was significantly associated with more prostate cancer knowledge (d = 0.30), less decision conflict (d = 0.52) and less decision regret (d = 0.34). Role concordance was also but less strongly associated with less decision conflict (d = 0.41). Conclusions: Our findings support a policy of encouraging all patients with localized prostate cancer regardless of their stated role preferences to be actively involved in the treatment decision

Generalized synchronization of MEG recordings in Alzheimer's Disease: evidence for involvement of the gamma band

The purpose of this study was to investigate interdependencies in whole-head magnetoencephalography (MEG) of Alzheimer patients and healthy control subjects. Magnetoencephalograms were recorded in 20 Alzheimer patients (11 men; mean age, 69.0 years [standard deviation, 8.2 years]); Mini-Mental State Examination score, 21.3 points; range, 15 to 27 points) and 20 healthy control subjects (9 men; mean age, 66.4 years [standard deviation, 9.0 years]) during a no-task eyes-closed condition with a 151 channel whole-head MEG system. Synchronization likelihood (a new measure for linear as well as nonlinear interdependencies between signals) and coherence were computed for each channel in different frequency bands (2 to 6, 6 to 10, 10 to 14, 14 to 18, 18 to 22, 22 to 40 Hz). Synchronization was lower in Alzheimer patients in the upper alpha band (10 to 14 Hz), the upper beta band (18 to 22 Hz), and the gamma band (22 to 40 Hz). In contrast, coherence did not show significant group differences at the p<0.05 level. The synchronization likelihood showed a spatial pattern (high synchronization central, parietal and right frontal; low synchronization, occipital and temporal). This study confirms a widespread loss of functional interactions in the alpha and beta bands, and provides the first evidence for loss of gamma band synchronization in Alzheimer's disease. Synchronization likelihood may be more sensitive to detect such changes than the commonly used coherence analysis