Does Intervening in the Level of Knowledge About Cervical Cancer Increase Screening and Vaccination in Zambia?

Cancer of the cervix can be prevented by primary and secondary prevention methods. In order for these prevention methods to be practiced it is imperative that women are made aware of cervical cancer and the existing vaccination and cervical screening services available to them. A small intervention study to inquire on the effect of showing a short video about cervical cancer and its prevention proved to be an effective means of increasing awareness and knowledge among Zambian women residing in Lusaka. This brief report follows up on the 2017 intervention study in order to determine to what extent the increased knowledge has led to increased screening and vaccination practices among Zambian women and their daughters after a 3-year period. It is concluded that awareness of prevention services increases women's likeliness to seek screening services when given enough time. Unfortunately, we found no evidence of in an increase of the number of daughters vaccinated in this study.

Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial.

OBJECTIVES: To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). METHODS: Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). RESULTS: In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. CONCLUSIONS: ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03793972.

The Food Identity of Countries Differs Between Younger and Older Generations: A Cross-Sectional Study in American, European and Asian Countries.

Current generations have been strongly influenced by mass communication and massive immigration flows, which may change local lifestyles and perceptions of inhabitants towards traditional foods and beverages (TFBs). TFBs constitute a core element of the cultural identity of a country, although some of them are losing their appeal. In this study, the authors explored the TFBs perceptions of inhabitants in nine countries to determine if their food identity is changing by analysing the TFBs most frequently mentioned by different age cohorts within a country. Six countries were found to have a distinctive core of TFBs shared across age cohorts (homogenous), whereas the remaining showed a heterogeneous pattern. Correspondence and cluster analyses usually grouped younger generations together implying higher similarities among these cohorts. Furthermore, the binary logistic regression analyses performed identified significant differences in the probability of mentioning a specific TFBs across age cohorts per country. Data collected show younger cohorts focusing on TFBs categorised as snacks and foods on-the-go, whereas older cohorts more often refer to time-consuming savoury preparations. The results suggest that lifestyles and current societal trends in food consumption, for example, convenience and healthiness, are impacting the food culture and identity of countries, and therefore play an important role in the variation of TFBs perception and consumption between age cohorts within countries. The results obtained in this study could not only be used by food policymakers and nutritionists to distinguish the current trends that are reshaping the food identity and eating behaviours of the population but also to improve or develop new dietary strategies by age cohorts in the countries studied.

Blood-based kynurenine pathway alterations in schizophrenia spectrum disorders: A meta-analysis.

INTRODUCTION: The kynurenine pathway (KP) has been proposed as indirect link between systemic immune responses and clinical symptom development in schizophrenia spectrum disorders (SSD). Empirical evidence for such immune-related KP shifts in SSD has however resulted in divergent findings. METHODS: We conducted a systematic literature search in PubMed. Thirty papers (total number of patients n = 1506; controls: n = 1432) reported on peripheral concentrations of KP metabolites in SSD patients versus controls. Six KP metabolites were included in a meta-analysis, with secondary analysis of covariate and subgroup effects of patients' symptomatic state, age and duration of illness. RESULTS: Tryptophan (SMD: -0.30; p = .003) and Xanthurenic Acid (SMD: -0.80; p < .001) were significantly decreased in SSD compared to controls, while Quinolinic Acid (SMD: -0.40; p = .08) and Kynurenic Acid (SMD: -0.39; p = .04) were only significantly decreased in patients with acute or highly symptomatic illness. Finally, in relatively older patient cohorts Kynurenine (SMD: -0.31; p = .02) and Kynurenic Acid (SMD: -0.40; p = .002) were found to be decreased. CONCLUSION: A partial downregulation of the KP is observed in SSD patients, in particular during acute symptomatic states and in older age, effects that were independent from each other. In contrast, younger and stable or remitted patients display limited to no KP metabolite abnormalities. The current meta-analysis illustrates the dynamic nature of KP abnormalities. It should be noted that all included studies investigated peripheral KP metabolites, which do not necessarily reflect central KP metabolite abnormalities in schizophrenic patients.

Assessing chronic fatigue syndrome: Self-reported physical functioning and correlations with physical testing.

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; no biomarkers have thus far been identified or physical tests designed to underpin its diagnosis. Assessment mainly uses Fukuda's criteria and is based on the exclusion of symptoms related to other diseases/syndromes, subjective self-reporting, and outcomes of self-report questionnaires. In order to improve the baseline assessment and progress evaluation of individuals suspected of CFS and using an association-oriented research strategy and a cross-correlational design, this study investigates possible associations between the performance on two physical tests, i.e. 'Timed Loaded Standing' (TLS), assessing trunk-arm endurance, and the 'Stops Walking with Eyes Closed while performing a secondary Cognitive Task' (SWECCT), measuring impaired automaticity of gait, and the results of two self-report questionnaires, the Checklist Individual Strength (CIS, total score and fatigue subscale score) and the physical functioning and vitality subscales of the Short Form Health Survey (SF-36) to gauge the participants' subjective feelings of fatigue and beliefs regarding their abilities to perform daily-life activities. Comparisons of the outcomes obtained in 27 female patients with a confirmed diagnosis of CFS revealed that trunk-arm endurance as measured with the TLS correlated with the SF-36 physical functioning subscale only (raw p value: 0.004). None of the other correlations were statistically significant. It is concluded that the TLS may have potential as an objective assessment tool to support the diagnosis and monitoring of treatment effects in CFS.

Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men.

BACKGROUND: In Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks. METHODS: A cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women (N = 300) and men (N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent's knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression). RESULTS: Less than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors. CONCLUSIONS: The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters.

Using Film to Disseminate Information on Cervical Cancer Prevention in Lusaka: Results from a Small Intervention Study.

In order to prevent the spread of cervical cancer, people must be aware and knowledgeable about the available preventive practices such as screening and vaccination. The purpose of this study was to determine the extent that film is effective in disseminating information on cervical cancer and its prevention to women and men in Lusaka. A pilot intervention study was carried out at churches in Lusaka city from August to September 2017. A sample size of 38 women and 43 men filled in both baseline and follow-up questionnaires. A knowledge grade (range, 1-10 points) which linked causes to risk factors for cervical cancer was used to assess the knowledge of a respondent. Significant results (p < 0.01) were obtained at follow-up for watching the film and having awareness and knowledge. The main finding is that a short informational film can be an effective means of disseminating information on cervical cancer and its prevention to women and men.

The impact of the social environment on Zambian cervical cancer prevention practices.

BACKGROUND: Cervical cancer which is preventable by screening and vaccination is the most common cancer in Zambia among both the female and male population. In this article we aim to determine how the key players of the sociocultural and political environment recognize cervical cancer as a public health problem and therefore impact the provision of cervical cancer prevention services (screening and vaccination). METHODS: Qualitative data in the form of interviews with stakeholders (health care providers, teachers and religious leaders), special interest groups (advocacy groups and non-governmental organizations) and policy makers, was collected as part of a mixed methods study from February to May 2016. RESULTS: The views expressed by the respondents were coded into predetermined themes (cervical cancer in general, screening, vaccination) and an organizational chart of the administration of cervical cancer prevention services in Zambia was developed. CONCLUSIONS: It is evident that the Zambian cervical cancer prevention system has targeted several areas and multiple sectors of society to reduce cervical cancer cases. However, awareness, knowledge, social support and facilities are factors that can be improved.

Research design: the methodology for interdisciplinary research framework.

Many of today's global scientific challenges require the joint involvement of researchers from different disciplinary backgrounds (social sciences, environmental sciences, climatology, medicine, etc.). Such interdisciplinary research teams face many challenges resulting from differences in training and scientific culture. Interdisciplinary education programs are required to train truly interdisciplinary scientists with respect to the critical factor skills and competences. For that purpose this paper presents the Methodology for Interdisciplinary Research (MIR) framework. The MIR framework was developed to help cross disciplinary borders, especially those between the natural sciences and the social sciences. The framework has been specifically constructed to facilitate the design of interdisciplinary scientific research, and can be applied in an educational program, as a reference for monitoring the phases of interdisciplinary research, and as a tool to design such research in a process approach. It is suitable for research projects of different sizes and levels of complexity, and it allows for a range of methods' combinations (case study, mixed methods, etc.). The different phases of designing interdisciplinary research in the MIR framework are described and illustrated by real-life applications in teaching and research. We further discuss the framework's utility in research design in landscape architecture, mixed methods research, and provide an outlook to the framework's potential in inclusive interdisciplinary research, and last but not least, research integrity.

Smartphone Apps Using Photoplethysmography for Heart Rate Monitoring: Meta-Analysis.

BACKGROUND: Smartphone ownership is rising at a stunning rate. Moreover, smartphones prove to be suitable for use in health care due to their availability, portability, user-friendliness, relatively low price, wireless connectivity, far-reaching computing capabilities, and comprehensive memory. To measure vital signs, smartphones are often connected to a mobile sensor or a medical device. However, by using the white light-emitting diode as light source and the phone camera as photodetector, a smartphone could be used to perform photoplethysmography (PPG), enabling the assessment of vital signs. OBJECTIVE: The objective of this meta-analysis was to evaluate the available evidence on the use of smartphone apps to measure heart rate by performing PPG in comparison with a validated method. METHODS: PubMed and ISI Web of Knowledge were searched for relevant studies published between January 1, 2009 and December 7, 2016. The reference lists of included studies were hand-searched to find additional eligible studies. Critical Appraisal Skills Programme (CASP) Diagnostic Test Study checklist and some extra items were used for quality assessment. A fixed effects model of the mean difference and a random effects model of Pearson correlation coefficient were applied to pool the outcomes of the studies. RESULTS: In total, 14 studies were included. The pooled result showed no significant difference between heart rate measurements with a smartphone and a validated method (mean difference -0.32; 99% CI -1.24 to 0.60; P=.37). In adults, the Pearson correlation coefficient of the relation between heart rate measurement with a smartphone and a validated method was always ≥.90. In children, the results varied depending on measuring point and heart rate. The pooled result showed a strong correlation that was significant (correlation coefficient .951; 95% CI 0.906-0.975; P<.001). The reported limits of agreement showed good agreement between a smartphone and a validated method. There was a moderately strong significant negative correlation between the year of publication of the included studies and the mean difference (r=-.69; P<.001). CONCLUSIONS: Smartphone apps measuring heart rate by performing PPG appear to agree with a validated method in an adult population during resting sinus rhythm. In a pediatric population, the use of these apps is currently not validated.

A recommendation for applied researchers to substantiate the claim that ordinal variables are the product of underlying bivariate normal distributions.

A simulation study was carried out to study the behaviour of the polychoric correlation coefficient in data not compliant with the assumption of underlying continuous variables. Such data can produce relatively high estimated polychoric correlations (in the order of .62). Applied researchers are prone to accept these artefacts as input for elaborate modelling (e.g., structural equation models) and inferences about reality justified by sheer magnitude of the correlations. In order to prevent this questionable research practice, it is recommended that in applications of the polychoric correlation coefficient, data is tested with goodness-of-fit of the BND, that such statistic is reported in published applications, and that the polychoric correlation is not applied when the test is significant.

Screening and vaccination as determined by the Social Ecological Model and the Theory of Triadic Influence: a systematic review.

BACKGROUND: Vaccination and screening are forms of primary and secondary prevention methods. These methods are recommended for controlling the spread of a vast number of diseases and conditions. To determine the most effective preventive methods to be used by a society, multi-level models have shown to be more effective than models that focus solely on individual level characteristics. The Social Ecological Model (SEM) and the Theory of Triadic Influence (TTI) are such models. The purpose of this systematic review was to identify main differences and similarities of SEM and TTI regarding screening and vaccination in order to prepare potentially successful prevention programs for practice. METHODS: A systematic review was conducted. Separate literature searches were performed during January and February 2015 using Medline, Ovid, Proquest, PubMed, University of Antwerp Discovery Service and Web of Science, for articles that apply the SEM and TTI. A Data Extraction Form with mostly closed-end questions was developed to assist with data extraction. Aggregate descriptive statistics were utilized to summarize the general characteristics of the SEM and TTI as documented in the scientific literature. RESULTS: A total of 290 potentially relevant articles referencing the SEM were found. As for the TTI, a total of 131 potentially relevant articles were found. After strict evaluation for inclusion and exclusion criteria, 40 SEM studies and 46 TTI studies were included in the systematic review. CONCLUSIONS: The SEM and TTI are theoretical frameworks that share many theoretical concepts and are relevant for several types of health behaviors. However, they differ in the structure of the model, and in how the variables are thought to interact with each other, the TTI being a matrix while the SEM has a ring structure. The main difference consists of the division of the TTI into levels of causation (ultimate, distal and proximal) which are not considered within the levels of the SEM. It was further found that in the articles studied in this systematic review, both models are often considered effective, while the empirical basis of these (and other) conclusions reached by their authors is in many cases unclear or incompletely specified.

Interpersonal violence against children in sport in the Netherlands and Belgium.

The current article reports on the first large-scale prevalence study on interpersonal violence against children in sport in the Netherlands and Belgium. Using a dedicated online questionnaire, over 4,000 adults prescreened on having participated in organized sport before the age of 18 were surveyed with respect to their experiences with childhood psychological, physical, and sexual violence while playing sports. Being the first of its kind in the Netherlands and Belgium, our study has a sufficiently large sample taken from the general population, with a balanced gender ratio and wide variety in socio-demographic characteristics. The survey showed that 38% of all respondents reported experiences with psychological violence, 11% with physical violence, and 14% with sexual violence. Ethnic minority, lesbian/gay/bisexual (LGB) and disabled athletes, and those competing at the international level report significantly more experiences of interpersonal violence in sport. The results are consistent with rates obtained outside sport, underscoring the need for more research on interventions and systematic follow-ups, to minimize these negative experiences in youth sport.

A longitudinal study of changes in noticing and treating patients' overweight by Dutch GPs between 1997 and 2007.

BACKGROUND: One of the stakeholders in tackling the rise and health consequences of overweight and obesity is the general practice physician (GP). GPs are in a good position to inform and give nutrition guidance to overweight patients. OBJECTIVE: Assessment of working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs [linear analysis of structural relations (LISREL) path model] in a longitudinal study. METHODS: This longitudinal study measured data in 1992, 1997 and 2007. The 1992 LISREL path model (Hiddink GJ, Hautvast J, van Woerkum CMJ, Fieren CJ, van t'Hof MA. Nutrition guidance by primary-care physicians: LISREL analysis improves understanding. Prev Med 1997; 26: 29-36.) demonstrated that 'noticing patients' overweight and guidance of treatment' was directly and indirectly influenced by predisposing factors, driving forces and perceived barriers. This article defines and discusses the path analysis of the 2007 data (compared with 1997). RESULTS: This analysis shows both similarity and differences in working mechanism of determinants of noticing patients' overweight and guidance of treatment between 1997 and 2007. The backbone of the mechanism with four predisposing factors is the similarity. The number of driving forces and of paths through intermediary factors to the dependent variable constitutes the difference. CONCLUSIONS: The backbone of the working mechanism of determinants of the nutrition guidance practice: noticing patients' overweight and guidance of treatment by GPs was similar in 2007 and 1997. The influence of GPs task perception on noticing patients' overweight and guidance of treatment considerably increased in 2007 compared to 1997. The longitudinal character of this article gives a strong practice-based evidence for weight management by GPs.

On the (In)Consistency of Citizen and Municipal Level Indicators of Social Capital and Local Government Performance.

We study the empirical consistency of survey based (micro level) indicators of social capital and local government performance on the one, and municipality based (aggregate level) measures of these two concepts on the other hand. Knowledge about the behavior of these indicators is helpful for evaluating the value of studies carried out in isolated contexts, that is, with access to data on either, but not both, levels. The method is by comparing data collected by Statistics Belgium on Flemish municipalities, to data collected at citizen level by means of a face-to-face survey. The available evidence supplies at best a meager basis for presupposing a shared component of the indicators under study.

Estimation of the Wing-Kristofferson model for discrete motor responses.

A number of estimation methods for the variance components in the Wing-Kristofferson model for inter-response times are examined and compared by means of a simulation study. The estimation methods studied are the method of moments, maximum likelihood, and an alternative approach in which the Wing-Kristofferson model is recognized as a moving average model.