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Participatory implementation science to enhance knowledge and build the capacity to increase the uptake and sustainability of HPV vaccination among girls in Nigeria
Get PDFBackground Human papillomavirus (HPV) vaccination can prevent cancer in low- and middle-income countries (LMICs), but its uptake remains low, especially in Nigeria. Understanding participatory approaches can help identify local strategies to increase, build capacity for, and sustain vaccine uptake. This study evaluated the effectiveness of an innovation bootcamp in enhancing the knowledge and skills of youth implementers about HPV and cervical cancer as a strategy to increase vaccine uptake among Nigerian girls aged 9–14 years. An innovation bootcamp is an intensive training program that engages end users to build capacity and skills. Methods This was a five-week hybrid bootcamp guided by Youth Participatory Action Research (YPAR) and the PEN-3 cultural model at the Nigerian Institute of Medical Research in Lagos, Nigeria. Data were collected using pre- and post-training surveys to assess sociodemographic characteristics, participant preparation, motivations, support needs, baseline learning barriers, the bootcamp process, and knowledge and implementation science research skills (using 9-item and 22-item self-reported scales, respectively). We conducted descriptive analyses of quantitative data and thematic analysis for qualitative, open-ended responses, and we estimated changes in knowledge and skills using the Wilcoxon Signed-Rank test. Results Five teams comprised of 16 participants attended the bootcamp, and 13 completed the post-survey. Of the 16 participants, most were female (81%) with an average age of 22 years and resided in the following states: Osun (n = 5), Abuja (n = 4), Lagos (n = 2), Kwara (n = 2), Oyo (n = 2), and Plateau (n = 1). The PEN-3 cultural model highlighted the importance of training and enabling resources. Following the bootcamp, the median knowledge score increased from 34 (IQR 31.0–35.0) to 37 (IQR 35.0–40.0), but this change was not statistically significant (p = 0.086). In contrast, there was a significant increase in research skills score from 54 (IQR 43.0–61.0) to 82 (IQR 73.0–96.0) (p = 0.011). Conclusions The bootcamp demonstrated that culturally structured participatory approaches can enhance engagement, knowledge, and skills while cultivating participatory learning communities. Empowering young people with appropriate resources and mentorship can propel sustainable HPV vaccination in Nigeria
Network analysis of antiseizure medication use, efficacy, and safety in epilepsy: A retrospective cohort study in a tertiary care center.
Get PDFAntiseizure medications (ASMs) remain the cornerstone of epilepsy treatment, yet data on prescription patterns, effectiveness, and safety in low- and middle-income countries are limited. This retrospective cohort study analyzed changes in ASM use, efficacy, and adverse effects across 10 years in a tertiary care center in Mexico, comparing two phases: 2011-2013 (n = 100) and 2021-2023 (n = 128). Data on seizure freedom, adverse effects, and ASM patterns were analyzed using descriptive statistics and comparative tests. Network analysis and centrality measures were performed with MATLAB Version 9.12.0 to explore the relationships among prescribed ASMs and their influence on outcomes. A total of 228 patients were included. Seizure freedom rates increased from 9 % in the first phase to 25.8 % in the second (p = 0.001). Valproic acid remained the most frequently prescribed ASM, while levetiracetam use markedly increased (49 %). Adverse effects rose from 10 % to 17 % despite a modest reduction in polytherapy (93 % to 87.5 %). The network analysis revealed clusters of ASMs commonly prescribed together that were associated with seizure freedom (valproic acid, lamotrigine, topiramate), whereas combinations including phenobarbital and lamotrigine were linked to more adverse effects. Valproate continues to play a key role in seizure control due to its efficacy, accessibility, and broad-spectrum profile. Despite advances in newer ASM use and improved seizure outcomes, adverse effects remain a concern. Continued monitoring of ASM combinations is warranted to better understand evolving treatment patterns and guide epilepsy management in resource-limited settings
Global prioritised indicators for measuring WHO’s quality-of-care standards for small and/or sick newborns in health facilities: development, global consultation and expert consensus
Get PDFOBJECTIVES: The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels. DESIGN: Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels. SETTING: The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur. PARTICIPANTS: The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts. RESULTS: The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9). CONCLUSIONS: The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country's health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set
Characterization of two co-regulated response regulators in Clostridioides difficile.
Get PDFAs an obligate anaerobe, Clostridioides difficile grows exclusively in the host intestinal tract, necessitating mechanisms to sense and respond to the gut environment. The atypical signal transduction system encoded by cmrRST includes two OmpR-family response regulators, CmrR and CmrT. These regulators control multiple important phenotypes in C. difficile, including cell chaining, colony morphology, swimming motility, and biofilm formation. CmrR has a typical receiver domain with key conserved residues for phosphotransfer and conformational change, while CmrT is missing conserved residues and is likely a pseudoreceiver. Here, we used multiple methods to investigate dimer formation, including bacterial two-hybrid systems in both Escherichia coli and C. difficile and pull-down assays in E. coli. We detected CmrR homodimers and found that CmrR recognizes a specific DNA sequence found in multiple places in the genome, including upstream of cmrRST. CmrT formed homodimers in multiple assays, and mutation analysis of residues in its unusual active site suggests multiple mutations are needed to maximally reduce CmrT activity. Our data also suggest that CmrR and CmrT can form heterodimers, though the biological relevance of CmrR-CmrT heterodimers remains unclear. Our results suggest that CmrR and CmrT work together in transcriptional responses to stimuli. IMPORTANCE Two-component systems are nearly ubiquitous among bacteria and are one of the primary ways that bacteria respond to their environment. Atypical two-component proteins and systems are being identified in diverse bacteria, and studying these proteins helps us to understand the underlying mechanisms of these systems. CmrRST is an unusual two-component system that regulates many important phenotypes in Clostridioides difficile. This work begins to untangle the complex regulatory mechanisms by which CmrRST controls gene expression and furthers our understanding of the fundamental biology of C. difficile
Simulated burn pit smoke condensates cause sustained impact on human airway epithelial cells
Get PDFInhalation of smoke from burn pits during military deployment is associated with several adverse pulmonary outcomes. We exposed human airway epithelial cells to smoke condensates from burn pit waste materials. Single and repeated exposure of condensates triggered unique and common responses in terms of gene expression, that sustained through the recovery phase. Source material and combustion condition influenced the outcome. Intensified response in female donor cells indicated a determining role of biological sex. The observations indicate a lasting impact of burn pit smoke exposure on epithelial gene expression, potentially contributing to disease pathogenesis
The role of epidemiologists in addressing the public health consequences of the United States criminal legal system
Get PDFExposure to the United States criminal legal system - whether through contact with law enforcement, incarceration in a jail or prison, or community supervision - is associated with a range of adverse health outcomes. There is mounting evidence that mass incarceration drives health inequities, particularly for Black, Indigenous, and People of Color. However, relative to its outsized impacts on health and health inequities, the criminal legal system has received limited attention in epidemiology. In this commentary, we use a public health prevention framework to highlight opportunities for epidemiological research aiming to: 1) reduce the number of people entering the criminal legal system (primary prevention), 2) improve conditions of confinement (secondary), and 3) reduce recidivism and re-involvement in the system (tertiary). We describe common biases (confounding, selection, measurement, and missingness) encountered in research at each prevention level and identify ways in which epidemiologists can help to address these challenges. Our goal is to emphasize the unique strengths that epidemiologists can bring to investigating and intervening on the wide-ranging health consequences of a societal system that disproportionately impacts its most marginalized members
Safe Water Is Rapidly Becoming a Private Good in the United States
Get PDFIn the United States, the public increasingly views water supplies and drinking water safety with suspicion. Negative perceptions of tap water safety may be particularly acute for some communities, especially among minorities or in lower-income populations. A 2023 systematic review of 33 peer-reviewed studies from the United States (1990−2023) on public views of tap water suggested a sustained trend of eroding trust. There are numerous drivers behind these trends, including greater awareness and focus on contaminants (e.g., lead and per- and polyfluoroalkyl substances (PFAS)) and increasing concern among minoritized or low-income populations that disproportionately bear the burdens of poor infrastructure services. The trends are global, possibly reflecting broader changes, including reduced faith in institutions and public infrastructure, greater access to information about potential risks, and an erosion of government commitment to expanding water access to all who need it. Dissatisfaction with the SARS-CoV-2 pandemic response may have accelerated distrust in institutions
Sticks and Stones... Bias and Readability Assessment in Large Language Model-Generated Patient Education for Anterior Cruciate Injury
Get PDFOBJECTIVE: To (1) explore sex/gender/ethnic/socioeconomic status (SES)-related bias in large language models (LLM)-generated anterior cruciate ligament (ACL) patient education materials (PEMs) and (2) assess the accuracy, consistency, and understandability of the information provided. DESIGN: Cross sectional METHODS: Four LLMs provided PEMs on ACL injury following ten unique personas. Readability was assessed via Flesch-Kincaid Grade Level. Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) assessed understandability and actionability. The Linguistic Inquiry and Word Count dictionary assessed language differences to measure sex/gender/ethnic/SES-related bias. A qualitative analysis assessed accuracy and robustness. RESULTS: Forty LLM-generated responses were analyzed. Mean Flesch-Kincaid Grade Level ranged between 9.9 (SD 0.8; Low-SES persona) and 11.4 (SD 1.5; Boy persona). Thirty-six (90%) and 27 (67.5%) responses scored above the 70% adequate PEMAT-P threshold for understandability and actionability, respectively. The Kruskal-Wallis test and Mann-Whitney U-Test revealed no statistically significant language differences between personas, across LLMs (p>.05). Linguistic analysis revealed 37 (92.5%) persona responses had a negative tone. CONCLUSION: The LLM-generated PEMs were adequately understandable with minimal sex/gender/ethnic/SES-related bias and provided actionable information. The difficult reading level may limit generalizability. Crucial information was lacking from PEMs and the negative tone may unintentionally increase patient fear
Correction to: Yes, in my backyard (YIMBY) and yours, too: women entrepreneurs’ leadership for a sustainable future of a small Japanese town
Get PDFCorrection to: Yes, in my backyard (YIMBY) and yours, too: women entrepreneurs’ leadership for a sustainable future of a small Japanese tow
Building Equitable Cancer Research Infrastructure: Successful Transfer of Patient-Derived Xenograft Technology to a Historically Black University
Get PDFAim Availability of pancreatic ductal adenocarcinoma (PDAC) xenografts is a recognized medical research need. Patient-derived xenograft (PDX) mouse models are a valuable tool for studying PDAC, as they preserve the molecular, histological, and often stromal features of the primary tumor. However, access to PDX technologies is nationally limited, particularly at Historically Black Colleges and Universities (HBCUs). We aimed to establish a self-sustained PDX biorepository at Florida A&M University (FAMU), a HBCU, through a partnership with two NCI-designated cancer centers and the CaRE2 Health Center. Methods FAMU faculty and trainees received training in xenograft implantation, tumor excision, cryopreservation, and biorepository management. The University of Florida shipped frozen tumor tissues from two PDAC patients to FAMU; one was implanted at FAMU and serially passaged across generations for experimental needs and to produce reproducible early generation PDX. Trainees gained experience in both laboratory and translational workflows and participated in documenting standard operating procedures for sustaining the biorepository. Results Engraftment success was observed across murine generations (G): G0 (66%, mean volume 196.5 mm3), G1 (50%, 283.0 mm3), G2 (60%, 321.4 mm3), and G3 (80%, 416.3 mm3). All viable tumors were cryopreserved and archived in FAMU's newly established PDX biorepository. The repository now supports two active PDAC projects focused on drug response and biomarker discovery and can passage the second PDAC tumor. Conclusion Our successful collaboration and transfer of advanced cancer modeling technology to a HBCU strengthens FAMU's institutional research capacity. The collaboration also offers translational cancer research training, preparing trainees for careers in oncology medicine and biomedical science