Knowledge and Awareness about Cervical Cancer and Human Papillomavirus among Women Living in Macon County, Alabama.

In Alabama, despite the high screening rates for cervical cancer in Blacks, they still have higher mortality rates compared to Whites. Our objective was to increase knowledge and awareness of cervical cancer with the intention to encourage more women to have Pap tests, Human Papillomavirus (HPV) tests and HPV vaccinations after a short-term educational-based intervention. Pre and post questionnaires were administered to collect data before and after a primary educational intervention in Macon County was taught by a team of experts in the subject area. Descriptive statistics were done using SAS software to generate frequency and chi-square tests. Out of the 100 participants: 9% had cervical cancer; 86% were Blacks; about 65% were over the age of 35 and earned less than $50,000/year; 62% lived in the Tuskegee community; 34% were students, staff or faculty of Tuskegee University; about 25% were either married or living with their partner; leaving about 75% of the women as single, divorced or widowed; and more than 80% were students between their first year of college and graduate school with only 40% working for pay. The short-term educational intervention increased participants' knowledge of: who knew what cervical cancer was; ever heard of HPV; and ever had an HPV-test by margins of 9%, 23% and 4% respectively. Participants who had ever heard of Pap test had the same knowledge of 97% before and after the intervention. There was a significant knowledge level increased: in understanding that cervical cancer was caused by 38% HPV infection; 39% of all HPV infections lead to cervical cancer; and cervical cancer has decreased in recent years by 50%. Significant differences were observed only among participants who had ever heard of Pap test before and after the educational intervention with p-values of 0.004 and 0.03 respectively, compared to participants who knew what cervical cancer was and who had ever heard of HPV test. Although some participants lacked knowledge in certain areas, this study showed an apparent increase in their knowledge and awareness following the educational intervention.

A quantitative risk assessment to evaluate the efficacy of mitigation strategies to reduce highly pathogenic avian influenza virus, subtype H5N1 (HPAI H5N1) in the Menoufia governorate, Egypt.

BACKGROUND: The poultry industry in Egypt has been suffering from endemic highly pathogenic avian influenza (HPAI) virus, subtype H5N1 since 2006. However, the emergence of H9N2, H5N8, and H5N2 in 2011, 2016, and 2019 respectively, has aggravated the situation. Our objective was to evaluate how effective are the mitigation strategies by a Quantitative Risk Assessment (QRA) model which used daily outbreak data of HPAI-H5N1 subtype in Egypt, stratified by different successive epidemic waves from 2006 to 2016. RESULTS: By applying the epidemiologic problem-oriented approach methodology, a conceptual scenario tree was drawn based on the knowledgebase. Monte Carlo simulations of QRA parameters based on outbreak data were performed using @Risk software based on a scenario-driven decision tree. In poultry farms, the expected probability of HPAI H5N1 prevalence is 48% due to failure of mitigation strategies in 90% of the time during Monte Carlo simulations. Failure of efficacy of these mitigations will raise prevalence to 70% with missed vaccination, while failure in detection by surveillance activities will raise it to 99%. In backyard poultry farms, the likelihood of still having a high HPAI-H5N1 prevalence in different poultry types due to failure of passive and active surveillance varies between domestic, mixed and reservoir. In mixed poultry, the probability of HPAI-H5N1 not detected by surveillance was the highest with a mean and a SD of 16.8 × 10-3 and 3.26 × 10-01 respectively. The sensitivity analysis ranking for the likelihood of HPAI-H5N1 in poultry farms due to missed vaccination, failure to be detected by passive and active surveillance was examined. Among poultry farms, increasing vaccination by 1 SD will decrease the prevalence by 14%, while active and passive surveillance decreases prevalence by 12, and 6%, respectively. In backyard, the active surveillance had high impact in decreasing the prevalence by 16% in domestic chicken. Whereas the passive surveillance had less impact in decreasing prevalence by 14% in mixed poultry and 3% in domestic chicken. CONCLUSION: It could be concluded that the applied strategies were not effective in controlling the spread of the HPAI-H5N1 virus. Public health officials should take into consideration the evaluation of their control strategies in their response.

A Comparative Study of Health Disparities in Cervical Cancer Mortality Rates Through Time Between Black and Caucasian Women in Alabama and the US.

Background: The main purpose of this study was to assess changes in cervical cancer mortality rates through time between Black and Caucasian women residing in Alabama and the US. Methods: Alabama cervical cancer mortality rates (MR), percentage differences, percentage changes and annual percentage changes for trends were compared with the US baseline and target rates. The US Baseline data and target objectives of utilization of cervical cancer screening and MR were obtained from Healthy People 2020. The cervical cancer behavioral risk factors and utilization of screening tests data were obtained from CDC's Behavioral Risk Factor Surveillance System (BRFSS). The cervical cancer MR data were obtained from the Surveillance, Epidemiology, and End Results (SEER). The analysis was done using SEER*Stat and Linear Trendlines analysis. Results: Although Blacks in Alabama had higher cervical cancer MR through times, a decreasing trend was noted for both races. However, in Alabama, there is no significant change in Blacks aged 65 years and older in cervical cancer MR, despite a high screening rate compared to Whites. In contrast, between 2002 and 2012, Whites in Alabama and the US made a significant progress toward the Healthy People 2020 goal. Conclusions: In Alabama, there exists cervical cancer MR disparity in Blacks despite the higher rates of screening for cervical cancer as would otherwise be expected. The state has not yet achieved the Healthy People 2020 goal. Public health officials should monitor progress toward reduction and/or elimination of these disparities by focusing in a follow up of screening.

Correction: Possible ramifications of climate variability on HPAI-H5N1 outbreak occurrence: Case study from the Menoufia, Egypt.

[This corrects the article DOI: 10.1371/journal.pone.0240442.].

Possible ramifications of climate variability on HPAI-H5N1 outbreak occurrence: Case study from the Menoufia, Egypt.

Long endemicity of the Highly Pathogenic Avian Influenza (HPAI) H5N1 subtype in Egypt poses a lot of threats to public health. Contrary to what is previously known, outbreaks have been circulated continuously in the poultry sectors all year round without seasonality. These changes call the need for epidemiological studies to prove or deny the influence of climate variability on outbreak occurrence, which is the aim of this study. This work proposes a modern approach to examine the degree to which the HPAI-H5N1disease event is being influenced by climate variability as a potential risk factor using generalized estimating equations (GEEs). GEE model revealed that the effect of climate variability differs according to the timing of the outbreak occurrence. Temperature and relative humidity could have both positive and negative effects on disease events. During the cold seasons especially in the first quarter, higher minimum temperatures, consistently show higher risks of disease occurrence, because this condition stimulates viral activity, while lower minimum temperatures support virus survival in the other quarters of the year with the highest negative effect in the third quarter. On the other hand, relative humidity negatively affects the outbreak in the first quarter of the year as the humid weather does not support viral circulation, while the highest positive effect was found in the second quarter during which low humidity favors the disease event.

Racial differences in 5-year relative survival rates of cervical cancer by stage at diagnosis, between African American (black) and white women, living in the state of Alabama, USA.

BACKGROUND: Our objective was to assess racial differences in the 5-year relative survival rates (RSRs) of Cervical Cancer (CerCancer) by stage at diagnosis, between Black and White women, living in Alabama, USA. METHODS: Data for 3484 Blacks and 21,059 Whites diagnosed with CerCancer were extracted from the 2004 to 2013 Surveillance, Epidemiology, and End Results (SEER) database. We incorporated age groups, CerCancer stages, county, and year of diagnosis to compare the RSR between Blacks and Whites, using SEER*Stat software. RESULTS: In urban, Black Belt (BB) and other rural counties, Whites diagnosed with localized stage of CerCancer always had better chances of survival because their RSRs were always more than 77%, compared to Blacks. Only exception was in Blacks living in other rural counties, who had a significantly higher RSR of 83.8% (95% Cl, 74.2-90.1). Which was the same as in Whites (83.8% (95% CI 74.5-89.9) living in BBC. Although, in other rural counties, Whites had a slightly lower RSR of 83.7% (95% CI 79.9-86.8%), their RSR was better compared to Blacks and Whites living in BB and other rural counties who had slightly higher RSRs of 83.8%. This was due to statistical precision, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error. In all the three county groups, Whites 15-44 years old diagnosed with localized stage of CerCancer had a higher RSR of 93.6% (95% CI 91.4-95.2%) for those living in urban and BB counties, and 94.6% (95% CI 93.6-95.4) for those living in other rural counties. The only exception was in Blacks 65-74 years old living in other rural counties who had the highest RSR of 96.9% (95% Cl, 82.9-99.5). However, Whites were considered to have a better RSR. This was also due to the statistical precision as mentioned above. CONCLUSION: There were significant racial differences in the RSRs of CerCancer. Overall, Black women experienced the worst RSRs compared to their White counterparts.

The Impact of Race and Geographical Location on the Treatment Options of Cervical Cancer in Black and White Women Living in the State of Alabama.

This study assesses the association between age, race, geographical-location, stage, and treatments of Cervical Cancer (CerCancer) in Black and White women, living in Alabama. Data from 2004-2013 was provided by the Alabama Cancer Registry. To perform Chi-square and logistic regression tests, SAS-software was used for analysis. In urban counties, Blacks 40-49 years old diagnosed with localized stage of CerCancer were the most likely to receive surgery (74.14%; P < .0001), followed by Whites 17-39 years old diagnosed with regional stage, were the most likely to receive radiation and surgery-radiation sequence (66.32 and 66.67%; P < .0001) respectively. Also, Whites 50 years and older diagnosed with regional stage were the most likely to receive chemotherapy (65.87%; P < .0001). In rural counties, Blacks 40-49 years old diagnosed with regional stage were the most likely to receive radiation (70.37%) and chemotherapy (83.33%) with P = .005 and .003 respectively, followed by Whites 17-39 years old diagnosed with localized stage were the most likely to receive surgery (76.81%; P < .0001). Adjusting for age, stage and county, Blacks had 1.12 (95% CI = .88-1.42) times the odds of receiving more radiation treatment. Blacks had .76 times adjusted odds (95% CI .59-.99) of receiving less surgery compared to Whites. Treatment disparities exist between Blacks and Whites in Alabama.

Disparities in Cervical Cancer Treatment Options between African American (Black) and White Women in Alabama.

There are disparities in cervical cancer treatment options between African American (Black) and White women in Alabama. The objective of this study was to identify and assess factors contributing to the prevailing inequalities in cervical cancer treatment options between Blacks and Whites, who are living in urban, rural Black Belt (BB), and other rural counties of Alabama. The data of our study population, which was comprised of 2,124 cases of cervical cancer in women 17 years and older, were extracted from the 2004 to 2013 dataset of the Alabama Department of Public Health (ADPH) Cancer Registry. For the analysis of frequency distributions, chi-square, and logistic regression tests SAS software was used. Racial disparities in cervical cancer treatment options for Blacks living within the same counties as Whites still exist. The study analysis showed that younger Blacks living in urban counties with advanced stages of cervical cancer were more likely to receive radiation treatment options but were less likely to undergo surgical treatment options (p-value <.0001). Younger Blacks living in the rural BB and other rural counties were mainly treated with radiation options for the early stages of cervical cancer (p-value 0.001), while older ones received surgery options (p-value <.0001), and combined therapy of surgery and radiation options (p-value 0.05). When adjusted for age, stage of cancer, and county of residence, Blacks had 2.76 (95% CI 0.90-8.86) times the odds ratio of receiving immunotherapy options compared to Whites. Blacks had 0.74 (95% CI 0.58-0.95) times adjusted odds ratio of undergoing less surgery option compared to Whites. Our study findings suggest that cervical cancer treatment options and control interventions targeted towards disadvantaged women, particularly Blacks living in the rural BB and other rural counties have the potential to reduce and/or eradicate this preventable disease.

The Relation of Age on HIV-Positive Women's Cluster of Differentiation 4, Antiretroviral Therapy, Papanicolaou Test, Human Papillomavirus test and Visual Inspection with Acetic Acid.

Despite increased life expectancy, mortality rates among women infected with HIV are 3-15 times higher than those in the overall population, HIV-infected women are also excessively affected by HPV and have increased risks of HPV-associated developments. This study's objective is to examine the relation between the ART treatment, CD4 levels, Pap, HPV and VIA tests with p16 detection among HIV-infected women. The data used in this study was collected by survey questionnaire instruments in 2009 in Kenya. Descriptive and explanatory statistics using frequency and chi-square/fisher's exact tests were performed for analysis using SAS-software. The data was stratified by age groups (30-39, 40-49, and 50 years and older). 75.28% of single HIV-positive women between the ages 30-39 participated significantly in the study, with a p-value of <0.0001. 52.24% of HIV-positive women 30-39 years old were most likely to receive ART treatment for less than two years by a margin of 11.2% compared to those who received the treatment for more than two years and those who were off treatment by a margin of 2.24% (p-value of 0.03). The HIV-positive women 30-39 years old had lower CD4 counts of less than 350 cells/µl (44%) and higher CD4 counts of 500 cells/µl or higher (46.64%). 45.3% of the HIV-positive women 30-39 years old were more likely to have positive VIA tests with a p-value of 0.05. 65.87% of HIV-positive women 30-39 years old were most likely to have positive VIA tests with a p-value of <0.05. HIV-positive women 30-39 years old were most likely to have high-risk HPV compared to their older counterparts. This study shows that incorporating screening strategies (Pap tests, VIA tests and HPV genotyping) in conjunction with ART treatment were more effective in preventing cervical cancer in HIV-positive young women 30-39 years old.

Epidemiology of influenza A 2009 H1N1 virus pandemic in the U.S.

A novel influenza, Influenza A 2009 H1N1 virus outbreak, emerged in mid-April 2009, and by December 2009, spread across the world. This epidemiologic analysis uses the epidemiologic problem oriented approach to gather information for, and develop a quantitative risk assessment model that evaluates the likelihood of an influenza outbreak in the U.S., utilizing weekly incidence rates (WIR) and case fatality rates (CFR) stratified by age and the 10 U.S. regions. In addition ArcGIS was used to show variability regarding morbidity rate and WIR. Using data from the Centers for Disease Control and Prevention (CDC) Emerging Infections Program and applying Monte Carlo simulations with @Risk software, the analysis revealed morbidity to be highest in region 8 (1.27×10-2) and lowest in region 2 (0.13×10-2). Heat map results revealed WIR were higher in younger children, for all regions. Case fatality rates were 10 times greater in younger people than in older people and children. Using these different temporal-spatial epidemiologic methods can help decision-makers identify high-risk population clusters and help in prevention and control of pandemics.