Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

BACKGROUND: Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES: The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN: This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS: Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS: Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier

Experiences and Perspectives of Traditional Bullying and Cyberbullying Among Adolescents in Mainland China-Implications for Policy

The prevalence of traditional bullying and cyberbullying is high among Chinese adolescents. The aims of this study are to explore: (1) characteristics of children who are targets or perpetrators of traditional bullying or cyberbullying; (2) causes of bullying in middle school; (3) reactions and coping strategies of bullying victims; and (4) impacts of bullying on victims' psychosocial well-being. Students were selected based on the findings of previous quantitative research at schools in Zhejiang, Henan, and Chongqing. Snowball sampling led to identification of more informants. Semi-structured interviews were conducted with students involved in traditional bullying and cyberbullying as perpetrators, victims, and bystanders. Forty-one students aged 12–16 years (21 boys and 20 girls) from 16 schools in three provinces participated. Data collection and analysis followed a grounded theory approach. Among these students traditional bullying was much more common than cyberbullying, but there was a large overlap between the two types. The results informed a conceptual framework which identified the main causes of bullying in these settings: these included lack of education about bullying, inadequate classroom and dormitory management, and teachers' failure to recognize and punish bullying. Children with specific characteristics (such as being unattractive or low-achieving), were more likely to be bullied. Most victims lacked support of parents and teachers even when requested, leading to poor psychosocial well-being, difficulties with socialization, and poor academic performance. Our findings suggest that schools need to address bullying culture, through multi-faceted locally-appropriate approaches, based on zero tolerance. It is crucial to ensure that students, teachers and parents recognize the importance of such interventions

Palliative care medical student education: a cross-sectional medical school survey in mainland China

OBJECTIVE According to the 2015 Quality of Death Index, China ranks 71st in terms of quality of palliative care out of 80 countries. Lack of palliative care education for health professionals is regarded as largely responsible. The study aims to evaluate the status of palliative care education for medical students in mainland China. METHODS A list of all medical schools was obtained from the Ministry of Education. A telephone survey of associate deans responsible for medical education at all 282 medical schools in mainland China was conducted in May 2019, following a standardised protocol. Telephone interviews focused on attitudes to palliative care teaching and the extent and manner in which palliative care is incorporated into the curriculum. RESULTS Associate deans from 173 (61.2%) of the 282 medical schools responded. A total of 120 schools (42.5%) completed the interview, while 53 (18.7%) evaded direct questions related to palliative care. Of the responding deans, 92 (76.7%) regarded palliative care education as very important. However, only 11 (9.2%) provided specific teaching on palliative care. A few schools (n=18) integrated palliative care education within required curricula, such as medical ethics and nursing science. The main reason reported for not providing palliative care education was that the medical curriculum dictated by the Ministry of Education does not require it. CONCLUSION A very small minority of medical schools in mainland China have any formal teaching about palliative care. Clearly, national standards for didactic and clinical teaching in palliative care for medical students and other health professionals are needed

Children\u27s physical activity and screen time : qualitative comparison of views of parents of infants and preschool children

BackgroundWhile parents are central to the development of behaviours in their young children, little is known about how parents view their role in shaping physical activity and screen time behaviours.MethodsUsing an unstructured focus group design, parental views and practices around children&prime;s physical activity and screen time (television and computer use) were explored with eight groups of new parents (n=61; child age &lt;12 months) and eight groups of parents with preschool-aged (3&ndash;5 year old) children (n=36) in Melbourne, Australia.ResultsParents generally believed children are naturally active, which may preclude their engagement in strategies designed to increase physical activity. While parents across both age groups shared many overarching views concerning parenting for children&prime;s physical activity and screen time behaviours, some strategies and barriers differed depending on the age of the child. While most new parents were optimistic about their ability to positively influence their child&prime;s behaviours, many parents of preschool-aged children seemed more resigned to strategies that worked for them, even when aware such strategies may not be ideal.ConclusionsInterventions aiming to increase children&prime;s physical activity and decrease screen time may need to tailor strategies to the age group of the child and address parents&prime; misconceptions and barriers to optimum parenting in these domains.<br /

High-Resolution Mass Spectrometry Based Proteomic Analysis of the Response to Vancomycin-Induced Cell Wall Stress in Streptomyces coelicolor A3(2).

Understanding how bacteria survive periods of cell wall stress is of fundamental interest and can help generate ideas for improved antibacterial treatments. In this study we use tandem mass tagging to characterize the proteomic response of vancomycin resistant Streptomyces coelicolor to the exposure to sublethal levels of the antibiotic. A common set of 804 proteins were identified in triplicate experiments. Contrasting changes in the abundance of proteins closely associated with the cytoplasmic membrane with those taking place in the cytosol identified aspects of protein spatial localization that are associated with the response to vancomycin. Enzymes for peptidoglycan precursor, mycothiol, ectoine and menaquinone biosynthesis together with a multisubunit nitrate reductase were recruited to the membrane following vancomycin treatment. Many proteins with regulatory functions (including sensor protein kinases) also exhibited significant changes in abundance exclusively in the membrane-associated protein fraction. Several enzymes predicted to be involved in extracellular peptidoglycan crossbridge formation became significantly depleted from the membrane. A comparison with data previously acquired on the changes in gene transcription following vancomycin treatment identified a common high-confidence set of changes in gene expression. Generalized changes in protein abundance indicate roles for proteolysis, the pentose phosphate pathway and a reorganization of amino acid biosynthesis in the stress response.HJH was supported by the Royal Society (516002.K5877/ROG) and by grant number GO700141 from the Medical Research Council.This is the final version of the article. It first appeared from ACS Publications via http://dx.doi.org/10.1021/acs.jproteome.5b0024

Widespread illegal sales of antibiotics in Chinese pharmacies – a nationwide cross-sectional study

BACKGROUND: Access to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China. METHODS: Using the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered. RESULTS: Complete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19). CONCLUSIONS: It is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign

Incidence, risk factors and psychosomatic symptoms for traditional bullying and cyberbullying in Chinese adolescents

Introduction: The objectives were to determine the prevalence and risk factors of traditional bullying and cyberbullying in Chinese middle school children, and to explore the association between bullying and psychosomatic symptoms. Methods: This cross-sectional study was conducted in urban and rural areas in Chongqing, Henan and Zhejiang provinces in 2018. A self-completion questionnaire was completed by students in the classroom setting. Results: There were 3774 completed questionnaires: the mean age of respondents was 13.58 (SD 0.87). For traditional bullying, 1332 (35.6%) identified as victims, and 341 (9.5%) as perpetrators. For cyberbullying, 1170 (31.4%) identified as victims, and 622 (16.6%) as perpetrators. After controlling for confounders, risks for traditional victimization were being male, attending boarding school, low academic performance, and a poor relationship with parents. Traditional perpetrators were more likely to be male, and have a poor relationship with parents. Risks for being a victim or perpetrator of cyberbullying were the same: male sex, attending boarding school, and having a poor relationship with parents. Compared to non-victims, traditional victims and cyber victims were at least 1.5 times more likely to report headache and sleep problems; traditional victims were 1.3 times more likely, and cyber victims 1.4 times more likely to report abdominal pain. Conclusions: Schools must take measures to raise awareness of bullying, to identify bullies and victims, and especially to protect the most vulnerable adolescents