Stakeholders' perspectives on barriers to and facilitators of school-based HPV vaccination in the context of COVID-19 pandemic-related disruption: a qualitative mixed methods study.

Despite successfully implementing the Human Papilloma Virus Vaccine (HPVV) program, Saskatchewan (SK) struggled to improve HPVV uptake rates. This suboptimal uptake of HPVV with a status quo of HPV-linked cervical cancer incidence rate is mainly because HPVV's impact on cancer prevention has not been realized adequately by vaccine providers and receivers. Further exploration of determinants of HPVV uptake is required to uncover high-resolution quality improvement targets for investment and situate contextually appropriate policies to improve its uptake. The study undertook a qualitative inquiry into understanding stakeholders' perspectives on HPVV experience through school-based programmes. It collected data through semi-structured initial interviews (N = 16) and follow-up interviews (N = 10) from across Saskatchewan's four Integrated Service Areas. Document analysis was conducted on all publicly available documents that included information on HPVV from January 2015 to July 2023. Thematic analysis of the data identified that inadequate information, awareness and education about HPV infection and HPVV among several groups, especially, parents, youth and school staff, was the main barrier to optimal HPVV uptake. Vaccine-related logistics, including the technical and text-heavy vaccine information sheet, understaffing, and time constraints, were other important factors that impeded HPVV uptake. A person-centred approach could educate parents in multiple dimensions.

Barriers to and facilitators of human papillomavirus vaccination in an ethnically diverse group of migrant parents: A qualitative mixed methods study.

A disparity in the uptake of the Human papillomavirus vaccine (HPVV) among immigrants and refugees leads to a social gradient in health. Recognizing that immigrants and refugees may encounter unique barriers to accessing prevention and care, this study seeks to determine barriers to and facilitators of HPVV among these subgroups to uncover high-resolution quality improvement targets of investment for under-immunized pockets of the population. The study undertook a qualitative inquiry into understanding immigrant and refugee parents' perspectives on HPV infection and HPVV experience through school-based programs. We collected data first through short online surveys (N = 15) followed by one-on-one interviews (N = 15) and then through detailed online surveys (N = 16) followed by focus group discussions (N = 3) with 4-6 participants per group discussion from different groups: Black, South Asian and West Asian. Analysis of surveys and interviews identified that: information, awareness, and education about HPV infection and HPVV were among the most cited barriers that impede the uptake of HPVV. Moreover, vaccine-related logistics were equally important, including not having immunization information packages in different languages and relying solely on the child to bring home packages in paper copies from school-based vaccine programs. A multi-component intervention remains instrumental in enhancing HPV immunization rates, given the inconsistent uptake of HPVV by these subgroups who voice unique barriers and facilitators. An educational campaign that involves educating parents who consent for their child(ren) for HPVV, the children receiving the vaccination, and training staff providing HPVV through school-based immunization programs would be paramount.

Barriers and facilitators in uptake of human papillomavirus vaccine across English Canada: A review.

Human Papillomavirus (HPV) is a highly contagious sexually transmitted infection that leads to preventable cancers of the mouth, throat, cervix, and genitalia. Despite the wide availability of HPV Vaccine (HPVV) in Canada, its uptake remains suboptimal. This review aims to identify factors (barriers and facilitators) in HPV vaccine uptake across English Canada at three levels (provider, system, and patient). We explored academic and gray literature to examine factors involved in HPVV uptake and synthesized results based on interpretive content analysis. The review identified the following factors of prime significance in the uptake of the HPV vaccine (a) at the provider level, 'acceptability' of the HPV vaccine, and 'appropriateness' of an intervention (b) at the patient level, the 'ability to perceive' and 'knowledge sufficiency' (c) at the system level, 'attitudes' of different players in vaccine programming, planning and delivery. Further research is needed to conduct population health intervention research in this area.

A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach.

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems-Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Does AGE-RAGE Stress Play a Role in the Development of Coronary Artery Disease in Obesity?

This article deals with the role of AGE (advanced glycation end products)-RAGE (receptor for AGE) stress (AGE/sRAGE) in the development of coronary artery disease (CAD) in obesity. CAD is due to atherosclerosis in coronary artery. The serum/plasma levels of AGE and sRAGE are reduced, while AGE-RAGE stress and expression of RAGE are elevated in obese individuals. However, the levels of AGE are elevated in obese individuals with more than one metabolic syndrome. The increases in the AGE-RAGE stress would elevate the expression and production of atherogenic factors, including reactive oxygen species, nuclear factor-kappa B, cytokines, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, endothelial leukocyte adhesion molecules, monocyte chemoattractant protein-1, granulocyte-macrophage colony-stimulating factor, and growth factors. Low levels of sRAGE would also increase the atherogenic factors. The increases in the AGE-RAGE stress and decreases in the levels of sRAGE would induce development of atherosclerosis, leading to CAD. The therapeutic regimen for AGE-RAGE stress-induced CAD in obesity would include lowering of AGE intake, prevention of AGE formation, degradation of AGE in vivo, suppression of RAGE expression, blockade of AGE-RAGE interaction, downregulation of sRAGE expression, and use of antioxidants. In conclusion, the data suggest that AGE-RAGE stress is involved in the development of CAD in obesity, and the therapeutic interventions to reduce AGE-RAGE would be helpful in preventing, regressing, and slowing the progression of CAD in obesity.

Sentinel Riparian Spiders Predict Mercury Contamination of Riverine Fish.

Mercury (Hg) is a widespread and toxic environmental contaminant. It is challenging to determine the level of Hg contamination of food chains and fish within the millions of water bodies in the United States. Mercury contamination can vary 10-fold between ecosystems, even those in the same region. Therefore, aquatic ecosystems need to be individually monitored for Hg contamination to determine which ecosystems are most contaminated and pose the greatest risk to human and wildlife health. One approach to monitoring Hg is to use sentinel species, defined as biological monitors that accumulate a contaminant in their tissues without significant adverse effects. Riparian spiders such as long-jawed orb weavers (Tetragnathidae) have been proposed as sentinels of persistent bioavailable contaminants, like Hg, in aquatic systems. Long-jawed orb weavers feed on emergent aquatic insects and have concentrations of Hg that reflect levels of Hg contamination in the aquatic food web. Previous studies have documented elevated contaminant concentrations in long-jawed orb weavers from shorelines of aquatic ecosystems, suggesting that they could be used as sentinels of chemical contaminants in aquatic ecosystems. We demonstrate for the first time that long-jawed orb weavers can be used as sentinels to identify aquatic systems that contain fish with elevated concentrations of Hg. Environ Toxicol Chem 2022;41:1297-1303. © 2022 SETAC.

Cardiovascular Events After Partner Bereavement, What is the Role of Low Dose Aspirin and Beta-Blockers?

Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

AIM: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS: The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

Comparison of Perioperative Chemotherapy versus Postoperative Chemoradiotherapy for Operable Stomach Cancer: A Western Canadian Province Experience.

BACKGROUND: The standard approaches for resectable stomach cancer are postoperative chemoradiotherapy (PCR) or perioperative chemotherapy (PC). Limited evidence is available regarding the superiority of one of the two approaches. We aimed to compare the survival of patients with operable stomach cancer who were treated with PC or PCR. METHODS: In this retrospective cohort study, patients with operable stomach cancer diagnosed between 2005-2015 in the province of Saskatchewan were identified and, based on type of treatment, were placed into PCR and PC groups. A Cox proportional multivariate analysis was performed to assess independent prognostic variables, including survival advantage of PC over PCR. RESULTS: A total of 88 eligible patients with a median age of 66 (56-71) and a male to female ratio of 1:0.44 were identified. Seventy-three (83%) patients had pathologically node positive disease. Sixty-seven (76%) patients received PCR, while 21 (24%) patients received PC. The median overall survival of the whole group was 34 months, with 38 months (95% CI 24.6-51.3) in the PCR group vs. 30 months (14.3-45.7) in the PC group (p = 0.29). Median relapse-free survival was 34 months (20.7-47.3) in the PCR group vs. 23 months (6.7-39.3) in the PC group (p = 0.20). Toxicities were comparable. On multivariate analysis, T ≥ 3 tumor (HR, 3.57 (1.39-8.56)), neutrophil to lymphocyte ratio (LNR) > 2.8 (HR, 1.85 (1.05-3.25)), and positive resection margins (HR, 1.89 (1.06-3.37)) were independently correlated with inferior survival. CONCLUSIONS: This well-designed population based cohort study suggests a lack of survival benefit of PC over PCR. Both treatment options remain viable approaches for resectable stomach cancer.

Prevalence of Hormone-Related Cancers (HRCs) at Two-Time Points in Rural Saskatchewan: The Saskatchewan Rural Health Study (SRHS).

OBJECTIVE: This study aimed to determine the prevalence of hormone-related cancers (HRCs) among Saskatchewan rural dwellers and explore associated risk factors. METHODS: Data were analyzed from the Saskatchewan Rural Health Study (SRHS), which was a prospective cohort (2010 to 2014). Completed questionnaires were obtained from 4624 (2797) households, with information about 8261 (4867) individuals more than or equal to 18 years at baseline (follow-up). The crude prevalence of HRCs was calculated using appropriate formulae. Adjusted prevalence was calculated using logistic regression based on the generalized estimating equation (GEE). RESULTS: Crude prevalence of HRCs was 3.0% at the baseline. Variables significantly associated with HRCs were: exposure to radiation comprising ultraviolet radiation from sunlight as well as ionizing radiation (odds ratio [OR] 3.39; 95% confidence interval [CI]: 2.23, 4.84), previous history of cancer in sibling (OR = 1.51, 95% CI: 1.11, 2.07) and in father (OR = 1.37; 95% CI = 1.01, 1.86). CONCLUSIONS: The study informs the Saskatchewan Health Region for health care resource allocation.

Knowledge, Attitude and Practice on Disposal of Sharps Waste at Home Among Patients with Diabetes and their Caregivers.

INTRODUCTION: A recent CDC report estimates that only 17.2% people with diabetes receive insulin. The aim of this study was to evaluate the knowledge, attitude and practice of patients with diabetes and their caregivers towards sharps waste disposal at home. METHODS: A cross-sectional study was conducted from February to July 2019 at the two main diabetes specialist centers in Taif, Saudi Arabia. Data collected using an interviewer-administered questionnaire, which was designed after a thorough literature review, were used to assess knowledge, attitude and practice using a total of 36 items. RESULTS: 406 patients comprised of mostly females and those who were unemployed, with a mean age of 53.2 +18.5 years and a mean DM duration of 13.6 +8.7 years were included. Approximately <10% reported sharing used insulin needles or lancets as well as accidental family member sticks by the used needle or lancet. More than half of the respondents answered, "I don't know" regarding the knowledge of transmission of hepatitis B or C and HIV by sharing lancet or insulin needles. 52.5%, 51.7% and 47.0% of participants were considered to have high knowledge, high attitude and good practice levels, respectively. 78.8% of participants stated that they disposed of sharps waste in public household garbage bags, and one-third disagreed that they safely collected and brought their used sharps to a hospital. The highest score in the practice section was on optimal needle recap. A partial correlation adjusting to determine the relationship of practice levels with knowledge and attitude levels after controlling for baseline characteristics and duration of DM showed a statistically significant positive correlation between practice and knowledge levels (r = .172, P = .001) while a statistically significant negative correlation between practice and attitude levels (r = - .116, P = .021). CONCLUSION: Patients with type 1 diabetes exhibited a significantly higher mean score in practice only compared to patients with type 2 diabetes. A partial correlation showed a statistically significant positive correlation between practice and knowledge and a negative correlation between practice and attitude level.

Flaxseed and Its Components in Treatment of Hyperlipidemia and Cardiovascular Disease.

This paper describes the effects of flaxseed and its components (flax oil, secoisolariciresinoldiglucoside[SDG], flax lignan complex [FLC], and flax fibers] on serum lipids (total cholesterol [TC], low-density lipoprotein-cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides [TG]) in animals and humans. Ordinary flaxseed reduces TG, TC, LDL-C, and TC/HDL-C levels in a dose-dependent manner in animals. In humans, it reduces serum lipids in hypercholesterolemicpatients but has no effects in normocholesterolemicpatients. Flax oil has variable effects on serum lipids in normo- and hypercholesterolemic animals. Flax oil treatment, with a dosage containing greater than 25 g/day of α-linolenic acid, reduces serum lipids in humans. Although FLC reduces serum lipids and raises serum HDL-C in animals, its effects on serum lipids in humans are small and variable. Flax fibers exert small effects on serum lipids in humans. Crop Development Centre (CDC)-flaxseed, which contains low concentrations of α-linolenic acid, has significant lipid lowering effects in animals. Pure SDG has potent hypolipidemic effects and raises HDL-C. In conclusion, flaxseed and pure SDG have significant lipid-lowering effects in animals and humans, while other components of flaxseed have small and variable effects.

Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19.

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

After COACT trial-new perspectives for the management of non-ST elevation myocardial infarction: early versus late cardiac catheterization post cardiac arrest.

Out-of-hospital cardiac arrest (OHCA) is the leading cause of death in the United States, as 90% of them are fatal per the 2018 American Heart Association statistics. As many as fifty-percent of cardiac arrest events display an initial rhythm of pulseless ventricular tachycardia (pVT) and ventricular fibrillation (VF), and of those, coronary artery disease (CAD) is found in 60-80% of patients. Following return of spontaneous circulation, patients who present with ST-elevation myocardial infarction (STEMI) should undergo an early invasive strategy and primary intervention, which is well-established guideline-based management. The support of such a strategy in patients suspected to have underlying cardiac cause but without ST-elevation has been waxing and waning in the literature. The Coronary Angiography after Cardiac Arrest (COACT) trial was designed to compare survival between an immediate or delayed coronary angiography strategy in non-STEMI (NSTEMI) OHCA patients, following successful resuscitation. We present a systematic review of the history of management strategies in OHCA and propose guidelines to manage such patients in light of the COACT trial.

Benefits of Using the i-Port System on Insulin-Treated Patients.

BACKGROUND: Insulin-treated patients demonstrate low adherence to insulin injections, which results in poor glycemic control. The i-Port Advance is a new advanced injection method. Our aim was to evaluate patient satisfaction, glycemic control, and adherence with this device. METHODOLOGY: This prospective study examined i-Port use in 55 insulin-treated patients. Baseline characteristics and Diabetes Treatment Satisfaction Questionnaire status (DTSQs) scores were collected at baseline and at the end of the follow-up period. All patients were trained to use the i-Port. Patients were divided into two groups: regular users of the i-Port, who used it for ≥3 months, and irregular users, who used it for <3 months. Local complications during use of the i-Port were recorded. RESULTS: Of the 55 patients, 92.7% had type 1 diabetes, the mean age was 14.96 ± 8.95 years, and 92.7% used an insulin pen. The patients were divided into 27 regular users and 28 irregular users. Irregular users had a longer duration of diabetes (P = 0.901) at baseline compared to regular users, were less likely to report noncompliance with insulin usage (P = 0.338), were more likely to self-inject insulin (P = 0.038), and had a lower A1C (P = 0.056). There were no statistical differences between groups in mean DTSQs treatment satisfaction scores or mean glycemic control scores. At the end of the follow-up period, regular i-Port usage improved compliance with insulin usage (P = 0.028), reduced diabetes-related hospitalizations (P <0.001), and reduced the frequency of hypoglycemia (P = 0.184). Scarring at the i-Port site was the most common complication. CONCLUSION: Regular i-Port usage improved compliance and decreased hospitalizations and hypoglycemic episodes, with a nonsignificant 0.73% reduction in A1C.