Results from Two HPV-Based Cervical Cancer Screening-Family Planning Integration Models in Malawi: A Cluster Randomized Trial.

We conducted a cluster randomized trial of two models for integrating HPV self-collection into family-planning (FP) services at 16 health facilities in Malawi between March 2020-December 2021. Model 1 involved providing only clinic-based HPV self-collection, whereas Model 2 included both clinic-based and community-based HPV self-collection. An endline household survey was performed in sampled villages and households between October-December 2021 in the catchment areas of the health facilities. We analyzed 7664 surveys from 400 villages. Participants from Model 2 areas were more likely to have ever undergone cervical cancer screening (CCS) than participants from Model 1 areas, after adjusting for district, facility location (urban versus rural), and facility size (hospital versus health center) (adjusted odds ratio = 1.73; 95% CI: 1.29, 2.33). Among participants who had ever undergone CCS, participants from Model 2 were more likely to report having undergone HPV self-collection than participants from Model 1 (50.5% versus 22.8%, p = 0.023). Participants from Model 2 were more likely to be using modern FP (adjusted odds ratio = 1.01; 95% CI: 1.41, 1.98) than Model 1 participants. The integration of FP and HPV self-collection in both the clinic and community increases CCS and modern FP uptake more than integration at the clinic-level alone.

Incorporating prosocial behavior to promote physical activity in older adults: rationale and design of the Program for Active Aging and Community Engagement (PACE).

Despite the benefits of regular physical activity among older adults, physical activity rates are low in this population. The Program for Active Aging and Community Engagement (PACE) is an ongoing randomized controlled trial designed to compare the effects of two interventions on physical activity at 12 months among older adults. A total of 300 men and women aged 55 years or older will be randomized into either a healthy aging (HA) control intervention (n = 150), which is largely based upon educational sessions, or a prosocial behavior physical activity (PBPA) intervention (n = 150), which incorporates structured physical activity sessions, cognitive-behavioral counseling, and opportunities to earn food for donation to a regional food bank based on weekly physical activity and volunteering. The PBPA intervention is delivered at a local YMCA, and a regional grocery store chain donates the food to the food bank. Data will be collected at baseline, 3, 6, and 12 months. The primary outcome is physical activity as assessed by the Community Healthy Activities Model Program for Seniors (CHAMPS) Questionnaire at 12 months. Secondary outcomes include physical function and health-related quality of life. If successful, the PACE study will demonstrate that prosocial behavior and volunteerism may be efficaciously incorporated into interventions and will provide evidence for a novel motivating factor for physical activity.

Effects of backpack load and task demand on trunk forward lean: Pilot findings on two boys.

Trunk forward lean (TFL) has been identified as a postural adaptation to increases in backpack load, and spinal forces have been presumed based on TFL. This pilot project examined the combined effects of increasing backpack load and task demand on TFL. Two boys with typical development, aged 11 and 9, were participants. Peak5 Motion Analysis Videography was used to gather 2D kinematic data under three levels of backpack load (0%, 8.5% and 17% body weight) and three levels of task demand (stand, walk and run). Passive reflective markers were placed on anatomical landmarks, and TFL was calculated by the angle formed by a line joining the right acromion and right greater trochanter and a vertical reference line. Descriptive statistics were performed to compare TFL under the nine experimental conditions. Although TFL most often increased with increases in backpack load and task demand, TFL was not dose dependent. Postural patterns varied between participants, and the findings supported a ceiling effect. In conclusion, to compensate for changes in inertia and center of gravity when wearing a backpack, TFL represents a dynamic emergent strategy that varies based on task demand and characteristics of the individual. Further research on TFL is warranted, and clinicians should be cautious when recommending safe carrying loads for children based on posture.