Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis.

BACKGROUND: This systematic literature review aims to summarize global research on parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations. METHODS: The literature search was conducted in PubMed, Web of Science and Scopus, and included publications from 2006 to 2023. Study quality was assessed using the Newcastle-Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Meta-analyses were performed using random-effects models to estimate pooled parental acceptance of HPV vaccinations. Studies were stratified by study years, and a subgroup analysis was conducted to estimate vaccine acceptance rates by world regions. Additionally, sensitivity analyses examined the role of parents in accepting HPV vaccinations for children of different sexes. RESULTS: Based on 86 studies, we found that parents generally supported HPV vaccinations for their children, yet HPV vaccine acceptance rates showed high variation (12.0 to 97.5%). The subgroup analysis revealed geographical variations in pooled parental HPV vaccine acceptance rates, with the highest rate observed in Africa (79.6%; 95% CI: 73.5-85.2; I² = 98.3%; p < 0.01) and the lowest in North America (56.7%; 95% CI: 49.3-64.0; I² = 99.4%; p < 0.01). Sensitivity analyses showed that acceptance was higher for daughters than for sons, with mothers more willing to get their daughters vaccinated. The proportion of parents reporting barriers or benefits regarding HPV vaccinations varied widely (0.3-95.8%) between study regions. Across all world regions, fear of adverse effects and concerns about vaccine safety were the main barriers, whereas the desire to protect their children from cancer was a significant predictor of vaccine acceptance. Knowledge levels varied widely (6.5 to 100%) between world regions and according to the questions asked. In most studies, knowledge e.g., that HPV is sexually transmitted, and that HPV vaccination provides protection against cervical cancer, ranged from moderate to high. CONCLUSIONS: The results indicated moderate parental acceptance of HPV vaccines. Public knowledge of HPV infection should be promoted, and special efforts should be made to minimize the existing barriers and increase vaccination accessibility and uptake.

Evaluation of a portable oxygen concentrator to provide fresh gas flow to dogs undergoing anesthesia.

This study evaluated the ability of a portable oxygen concentrator (POC) to provide fresh gas to an anesthetic machine via an Ayre's T-piece or a Bain circuit. Fraction of inspired oxygen (FiO2) was compared at flows of 0.5 to 3.0 L/min. Measured FiO2 was 96% at flow rates ≥ 1 L/min. Mean battery life at 1.0, 2.0, and 3.0 L/min was 4.21 ± 0.45, 2.62 ± 0.37 and 1.5 ± 0.07 hours, respectively. The POC proved to be useful and effective during 2 power outages. The POC was sufficient to prevent rebreathing in 70% of dogs using a T-piece circuit and 20% of dogs with a Bain circuit. A significant negative correlation between inspired CO2 and O2 flow rates was noted. A significant positive correlation between inspired CO2 and ETCO2 was documented. The occurrence of hypercarbia was associated with low O2 flow. Battery back-up was essential during power outages. The POC can be effectively used for delivery of anesthesia.

Évaluation d'un concentrateur d'oxygène portable pour fournir une circulation de gaz frais aux chiens subissant une anesthésie. Cette étude a évalué la capacité d'un concentrateur d'oxygène portable (COP) à fournir du gaz frais à l'aide d'une pièce en T d'Ayre ou d'un circuit de Bain. La fraction d'oxygène inspiré (FiO2) a été comparée à des débits de 0,5 à 3,0 L/min. La FiO2 mesurée était de 96 % à des taux de débit de ≥ 1 L/min. La durée de vie moyenne de la batterie à 1,0, à 2,0 et à 3,0 L/min était de 4,21 ± 0,45, de 2,62 ± 0,37 et 1,5 ± 0,07 heures, respectivement. Le COP s'est avéré utile et efficace durant deux pannes d'électricité. Le COP a été suffisant pour prévenir la réinspiration chez 70 % des chiens en utilisant un circuit de pièce en T et un circuit de Bain chez 20 % des chiens. Une corrélation négative importante entre le CO2 inspiré et les taux de débit d'O2 a été observée. Une corrélation positive importante entre le CO2 inspiré et l' ETCO2 a été documentée. L'occurrence de l'hypercarbie était associée à un faible débit d'O2. Une batterie de secours était essentielle durant les pannes d'électricité. Le COP peut être efficacement utilisé pour fournir de l'anesthésie.(Traduit par Isabelle Vallières).

The role of breast MRI in the management of patients with breast disease.

Breast MRI has paved the way for new thinking regarding the workup of women recently diagnosed with breast cancer and the screening of high-risk women. The routine use of MRI preoperatively is advocated, particularly in young patients and women with dense breasts where mammography is significantly less sensitive for the detection of malignancy. Additionally, MRI is particularly helpful in those women who have core biopsy results showing extensive intraductal component (>25%) orinvasive lobular carcinoma, and in those women with increased risk of positive margins. However, as with any imaging modality, breast magnetic resonance has limitations. Because breast magnetic resonance has lower specificity than some modalities, clinicians must be selective in identifying those women most likely to benefit from this additional imaging. Many recent publications show that MRI does not unduly raise the false-positive biopsy rate while providing specificity similar to that of mammography and higher than that of ultrasound. Positive margin rates for breast conservation therapy range from 30% to 50% and the achievement of negative margins is directly related to low recurrence rates. Magnetic resonance provides improved preoperative staging, which in turn may reduce recurrence rates and improve patient outcome. Breast MRI should be used in concert with other modalities, such as mammography and ultrasound, for the highest sensitivity for detecting malignancy. Long-term studies are needed to validate the impact of screening and diagnostic breast MRI on patient outcomes.

Application of fast-track surgery principles to evaluate effects of atipamezole on recovery and analgesia following ovariohysterectomy in cats anesthetized with dexmedetomidine-ketamine-hydromorphone.

OBJECTIVE: To evaluate the effects of atipamezole hydrochloride on recovery and analgesia following ovariohysterectomy in cats anesthetized with a dexmedetomidine hydrochloride, ketamine hydrochloride, and hydromorphone hydrochloride combination, in accordance with fast-track surgery principles. DESIGN: Prospective, randomized, clinical trial. ANIMALS: 44 cats. PROCEDURES: Cats were anesthetized with a combination of dexmedetomidine (15 µg/kg [6.8 µg/lb]), ketamine (5 mg/kg [2.3 mg/lb]), and hydromorphone (0.05 mg/kg [0.023 mg/lb]), IM, supplemented with isoflurane in oxygen. Immediately after ovariohysterectomy, cats received meloxicam (0.2 mg/kg [0.09 mg/lb]) SC and either atipamezole (75 µg/kg [34.1 µg/lb]) or an equivalent volume of saline (0.9% NaCl) solution IM. Pain and sedation were scored at baseline (prior to surgery) and at predetermined intervals after surgery. Time to sternal recumbency was recorded. RESULTS: The atipamezole group recovered to sternal recumbency faster (median, 15 minutes; range, 5 to 60 minutes) than the saline solution group (median, 60 minutes; range, 15 to 90 minutes]). Pain scores did not differ between groups or at any time, compared with baseline, and were below the intervention threshold for most cats. Sedation scores were significantly greater in the saline solution group (median, 0; range, 0 to 2) at 2 hours after surgery, compared with the atipamezole group (median, 0; range, 0 to 0). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that administration of atipamezole, compared with saline solution, allowed for a faster recovery from anesthesia with dexmedetomidine-ketamine-hydromorphone in cats following ovariohysterectomy without compromising analgesia. These findings have implications for the provision of appropriate postoperative analgesia following ovariohysterectomy in cats.