Public Education Interventions and Uptake of Human Papillomavirus Vaccine: A Systematic Review.

CONTEXT: Human papillomavirus (HPV) vaccine uptake remains suboptimal in the United States. Public education is considered an important aspect of increasing vaccination rates. OBJECTIVES: We systematically reviewed the literature on the impact of public education on HPV vaccine uptake. DESIGN: PubMed was searched to identify studies published between January 1, 2007, and April 30, 2018, meeting the following inclusion criteria: the study was conducted in the US, education was directed toward the public, and the research included HPV vaccine uptake and/or completion as outcomes. RESULTS: A total of 3764 studies were screened, and 30 published studies were included in the review. Among those, 13 focused on parent/guardian education, 8 on young adults, 6 on parent/daughter dyads, 1 focused only on adolescents, and 2 studies recruited a mixed-age population. Studies that included parents and young adults and were delivered by experts led to increased uptake of HPV vaccination (n = 14). A majority of the studies included female and Non-Hispanic White population (n = 20). Less than a third of studies included minority groups: Hispanic (n = 4), African American (n = 1), Cambodian American (n = 1), Indian American (n = 1), Korean American (n = 1), and combined Haitian and African American (n = 1) population. Minority group interventions that provided individually tailored messages, addressed misconceptions, removed barriers to vaccination, and engaged parents and community members improved HPV vaccine acceptance (n = 5). CONCLUSION: Interventions that delivered HPV-related education by authoritative sources and included parents improved HPV vaccination rates among adolescents and young adults. Community engagement played an important role in vaccine uptake among minority populations. Future studies should focus on male participants and minority populations to reduce disparities in HPV-related cancer incidence and HPV vaccine coverage.

Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort.

AIMS: To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether the effects varied by race/ethnicity. METHODS: We performed post hoc analyses among non-Hispanic black, non-hispanic white and Hispanic participants, with and without MetS, in the Systolic Blood Pressure Intervention Trial (SPRINT), who were randomized to a systolic blood pressure (SBP) target of <120 mm Hg (intensive group, N = 4544) or an SBP target of <140 mm Hg (standard group, N = 4553). The median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction, stroke, heart failure, non-myocardial infarction acute coronary syndrome or CV death. RESULTS: Overall, 3521/9097 participants (38.7%) met the criteria for MetS at baseline. Baseline characteristics were similar in the two SBP target groups within each MetS subgroup, except body mass index was slightly higher in the standard arm of the MetS subgroup (33.3 ± 5.6 vs 33.0 ± 5.3 kg/m2 ; P < .01), but were similar across treatment arms in the non-MetS subgroup. The hazard ratio for the primary outcome was similarly reduced in participants with or without baseline MetS: 0.75 (95% confidence interval [CI] 0.57, 0.96) and 0.71 (95% CI 0.57, 0.87), respectively (adjusted P value for treatment by subgroup interaction = .98). Similarly, there was no evidence of treatment × MetS subgroup interaction for all-cause mortality (adjusted interaction P value = .98). The findings were also similar across race/ethnic subgroups. CONCLUSIONS: In this analysis the CV benefit of intensive SBP control did not differ among participants by baseline MetS status, regardless of race/ethnicity.

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis.

Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

Listeria monocytogenes Meningitis After Treatment With Infliximab in an 8-Year-Old Pediatric Patient With Crohn's Disease.

Anti-tumor necrosis factor-alpha agents are used for the treatment of inflammatory bowel disease. Central nervous system infections are rare adverse effects of these medications, and to the best of our knowledge, there are only 2 case reports from the pediatric patient population. We report a case of an 8-year-old patient with Crohn's disease who developed Listeria meningitis while on infliximab.

Urogenital Manifestations of Metastatic Crohn's Disease in Children: Case Series and Review of the Literature.

Although cutaneous manifestations are the most common extraintestinal manifestation of inflammatory bowel disease, metastatic Crohn's disease (MCD) is rare. MCD is defined as the presence of noncaseating granulomatous inflammation and perivascular infiltrate in the cutaneous tissue that is noncontiguous to the gastrointestinal tract. MCD rarely involves the genitourinary tract in children. When it does, it can present as external genitalia swelling, erythema, plaques, or ulcerations. Here we present three pediatric cases of MCD involving the genitourinary tract. In addition to discussion of the presented cases, we have reviewed the literature on the genitourinary presentation of MCD in the pediatric population.

Rare Neurological Manifestation of Celiac Disease.

Celiac disease (CD) is an immune-mediated disease characterized by permanent gastrointestinal tract sensitivity to gluten in genetically predisposed individuals. It has varied clinical manifestations, ranging from gastrointestinal to extraintestinal, including neurological, skin, reproductive and psychiatric symptoms, which makes its diagnosis difficult and challenging. Known neurological manifestations of CD include epilepsy with or without occipital calcification, attention deficit hyperactivity disorder and ataxia, headache, neuropathies and behavior disorders. We present the case of a 14-year-old female with headaches and blurred vision for 1 year; she was noted to have papilledema on ophthalmic examination with increased cerebrospinal fluid opening pressure on lumber puncture and was diagnosed as a case of pseudotumor cerebri (PTC). Meanwhile her workup for chronic constipation revealed elevated tissue transglutaminase IgA and antiendomysial IgA antibodies. Upper gastrointestinal endoscopy with duodenal biopsy confirmed the diagnosis of CD. The patient was started on a gluten-free diet, leading to resolution of not only gastrointestinal symptoms but also to almost complete resolution of symptoms of PTC. This report describes the correlation of CD and PTC as its neurological manifestation.