Safety, immunogenicity and efficacy of the self-amplifying mRNA ARCT-154 COVID-19 vaccine: pooled phase 1, 2, 3a and 3b randomized, controlled trials.

Combination of waning immunity and lower effectiveness against new SARS-CoV-2 variants of approved COVID-19 vaccines necessitates new vaccines. We evaluated two doses, 28 days apart, of ARCT-154, a self-amplifying mRNA COVID-19 vaccine, compared with saline placebo in an integrated phase 1/2/3a/3b controlled, observer-blind trial in Vietnamese adults (ClinicalTrial.gov identifier: NCT05012943). Primary safety and reactogenicity outcomes were unsolicited adverse events (AE) 28 days after each dose, solicited local and systemic AE 7 days after each dose, and serious AEs throughout the study. Primary immunogenicity outcome was the immune response as neutralizing antibodies 28 days after the second dose. Efficacy against COVID-19 was assessed as primary and secondary outcomes in phase 3b. ARCT-154 was well tolerated with generally mild-moderate transient AEs. Four weeks after the second dose 94.1% (95% CI: 92.1-95.8) of vaccinees seroconverted for neutralizing antibodies, with a geometric mean-fold rise from baseline of 14.5 (95% CI: 13.6-15.5). Of 640 cases of confirmed COVID-19 eligible for efficacy analysis most were due to the Delta (B.1.617.2) variant. Efficacy of ARCT-154 was 56.6% (95% CI: 48.7- 63.3) against any COVID-19, and 95.3% (80.5-98.9) against severe COVID-19. ARCT-154 vaccination is well tolerated, immunogenic and efficacious, particularly against severe COVID-19 disease.

Help-Seeking After Intimate Partner or Sexual Violence: Exploring the Experiences of International Student Women in Australia.

Research suggests that many international students experience intimate partner violence (IPV) or sexual violence (SV) whilst attending tertiary institutions. Yet, little is known about how they engage in help-seeking and what types of support they need following IPV/SV. In this paper, we present findings from a qualitative analysis of 30 in-depth interviews with international student women who experienced SV/IPV while studying in Australia. The findings highlight how isolation and structural factors can create significant barriers to help-seeking for international student women. Yet, the findings also highlight the agency and resourcefulness of international student women in overcoming challenges. The provision of culturally and linguistically appropriate and tailored support for international students is crucial in order to help reduce the harms of SV/IPV.

Between decolonization and recolonization: investigating Chinese doctoral students in Malaysia as a case of global South-South student mobility.

International student mobility has traditionally witnessed a global South-North pattern. In recent years, a shift has occurred as the appeal of alternative geographies waxes, with Malaysia being an exemplar of inbound student mobility destination. To facilitate a deep probe of the under-researched global South-South student mobility, this study utilized a qualitative method to delve into 10 Chinese doctoral students' emic perceptions of their sojourn in Malaysia. Guided by a theoretical framework incorporating decolonization and recolonization, this study unpacks how these sociohistorical forces penetrate into and shape the students' preparation and navigation of a doctoral sojourn. Findings of the study reveal that while taking advantage of the Southern niche to yield commensurate benefits, thereby delegitimizing the Western supremacy, the students' make-do mentality and self-subjugating resistance inadvertently reinforce the Western dominance. Besides, these macro effects generate interlocking and conflicting affective consequences, instilling simultaneously positivity and inclusivity, inferiority, and anxiety. Altogether, decolonization and recolonization are concretely registered at the emotional level and bear a broader social significance. This article concludes with an alert and a call to address covert yet compelling inequalities in international student mobility.

A Qualitative Investigation Into Chinese International Doctoral Students' Navigation of a Disrupted Study Trajectory During COVID-19.

This study delves into emic perceptions of Chinese international doctoral students' navigation of a disrupted study trajectory during the 2019 coronavirus pandemic. Drawing on semi-structured interviews with students and the conceptual framework of bioecological systems theory and needs-response agency, the article reveals a nuanced picture of how activities, relations and roles nested in a PhD study trajectory are impacted by and respond to the crisis. Specifically, the pandemic has instigated a ripple effect upon PhD study that is embedded within a complex system of person-environment factors in the microsystem, mesosystem, exosystem and macrosystem. Confronting these changes and challenges, the students enact needs-response agency to cope with these impacts so as to restore stability. The study concludes with some practical implications for related stakeholders in the bioecological system to generate conditions and support for students to harness possibilities for growth amidst and beyond the health crisis.

"Employability in context": graduate employability attributes expected by employers in regional Vietnam and implications for career guidance.

This article examines how graduate employability is viewed by employers in six economically disadvantaged mountainous provinces in Vietnam. The study reported in this article identified continuous self-learning, resilience, adaptability, devotion and empathy for the local people and local community to be among the main employability attributes expected of graduates in regional Vietnam. The findings of the study raise the importance of context situatedness in looking at employability and show how employability is characterised by the local structural conditions, demographic features and socio-cultural norms. The study provides significant implications for career guidance and graduate employability development, especially in relation to regional areas.

"L'employabilité dans son contexte ¼: Attributs attendus par les employeurs·euses dans la région du Vietnam et implications pour l'orientation professionnelle Cet article examine comment l'employabilité des diplômé·e·s est perçue par les employeurs·ses dans six provinces montagneuses économiquement défavorisées du Vietnam. L'étude rapportée dans cet article a identifié l'auto-apprentissage continu, la résilience, l'adaptabilité, le dévouement et l'empathie pour la population locale et la communauté locale comme étant parmi les principaux attributs d'employabilité attendus des diplômés dans le Vietnam régional. Les résultats de l'étude soulignent l'importance de la situation du contexte dans l'étude de l'employabilité et montrent comment l'employabilité est caractérisée par les conditions structurelles locales, les caractéristiques démographiques et les normes socioculturelles. L'étude fournit des implications significatives pour l'orientation professionnelle et le développement de l'employabilité, en particulier en ce qui concerne les zones régionales.

"Empleabilidad en contexto": Atributos esperados por los empleadores en Vietnam regional e implicaciones para la orientación profesional Este artículo examina cómo los empleadores ven la empleabilidad de los graduados en seis provincias montañosas económicamente desfavorecidas de Vietnam. El estudio reportado en este artículo identificó el autoaprendizaje continuo, la resiliencia, la adaptabilidad, la devoción y la empatía por la población local y la comunidad local como uno de los principales atributos de empleabilidad que se esperan de los graduados en la región de Vietnam. Los hallazgos del estudio plantean la importancia de la situación contextual para observar la empleabilidad y muestran cómo la empleabilidad se caracteriza por las condiciones estructurales locales, las características demográficas y las normas socioculturales. El estudio proporciona implicaciones significativas para la orientación profesional y el desarrollo de la empleabilidad, especialmente en relación con las áreas regionales.

Post-Graduation Work Visas and Loopholes: Insights into Support Provision for International Graduates from the Perspectives of Migration Agents, Universities, and International Graduates.

Background: Major host countries of international students such as Australia, Canada, New Zealand, the UK, and the US have introduced post-study work rights as a strategic policy to both enhance their destination attraction and support international students' post-graduation work experiences. While this policy is generally welcomed by both host institutions and international students, little is known about the support mechanism for the growing cohort of international student graduates who stay in their countries of study on temporary graduate visas, especially in relation to major concerns such as post-graduation work, visa application, and migration pathways. Objective: This article fills an important gap in the existing literature. It aims to assess the role of universities in supporting their international alumni on temporary visas. Research Design: It is derived from a study that includes 50 interviews with university staff, agents, and international graduates. It uses positioning theory as a conceptual framework. Results: The findings of the study raise concerns about the scope of university advice. It reports loopholes which legitimize the practices of migration agents to the conditions that enable them to exercise their exclusive rights in providing work-migration nexus advice to international students and graduates, making this cohort vulnerable to exploitation of unethical agents. The study provides the evidence base to develop recommendations for related stakeholders in improving the post-graduation experiences of international student graduates who remain in the host countries on temporary visas.

Secondhand Smoke Exposure in Lao People's Democratic Republic: Results From the 2015 National Adult Tobacco Survey.

Objectives: Second-hand smoke (SHS) exposure causes >600,000 deaths annually worldwide, however, information regarding SHS exposure in Lao People's Democratic Republic (Lao PRD) is limited; we report SHS exposure prevalence at home, inside workplaces, and indoor public spaces in Lao PDR. Methods: Data were from the 2015 Lao National Adult Tobacco Survey, a nationally representative sample of 7,562 participants aged ≥15 years recruited through a stratified 2-stage cluster sampling approach. Results: 88.3% (83.9% of non-smokers) reported SHS exposure at home and 63.0% (54.0% of non-smokers) at workplaces. Among non-smokers, women had greater exposure at home than men (86.6 vs. 77.0%). Lower education levels were associated with exposure at home or the workplace. 99.2% reported SHS exposure at any public place; specifically for restaurants/food stores 57.7%, government offices 56.2%, public transport 31.6%, and health care facilities 11.7%. Conclusion: SHS exposure at home and workplace in Lao PDR is among the highest in South-East Asia. Comprehensive smoke-free policies at government-owned workplaces and facilities, stricter enforcement of these smoke-free policies, and strategies to encourage smoke-free environments at homes and in public places are urgently needed.

Factors Associated with Cigarette Smoking Cessation in Lao People's Democratic Republic: Results from the 2015 National Adult Tobacco Survey.

Cigarette smoking represents a major public health problem in Lao People's Democratic Republic (Lao PDR). This study aims to examine factors associated with cigarette smoking cessation attempts and intention to quit. Data were from the Lao National Adult Tobacco Survey that consisted of 7562 participants ≥15 years old. Multivariable logistic regression models were used to evaluate the associations, adjusted for sex, age groups, education level, income per day, and smoking frequency. Results show that past quit attempts were associated with visiting a healthcare provider in the past year (adjusted odds ratio [AOR]: 1.74, 95% confidence intervals [CI]: 1.28-2.35), home smoking bans (AOR: 5.52, 95% CI: 2.13-14.33), noticing media-based messages informing the dangers of smoking or encouraging quitting (AOR: 3.25, 95% CI: 2.28-4.63), noticing health warnings on cigarette packages in the past 30 days (AOR: 3.33, 95% CI: 2.21-5.03), and believing that smoking is seriously harmful to their health (AOR: 3.45, 95% CI: 1.24-9.57). The Lao PDR government should continue implementing tobacco control policies that demonstrated associations with cessation attempts or intention to quit, such as smoke-free environments and required health warnings on cigarette packages. Tobacco cessation treatment programs are pressingly needed in Lao PDR.

Adults with systemic lupus exhibit distinct molecular phenotypes in a cross-sectional study.

BACKGROUND: The clinical and pathologic diversity of systemic lupus erythematosus (SLE) hinders diagnosis, management, and treatment development. This study addresses heterogeneity in SLE through comprehensive molecular phenotyping and machine learning clustering. METHODS: Adult SLE patients (n = 198) provided plasma, serum, and RNA. Disease activity was scored by modified SELENA-SLEDAI. Twenty-nine co-expression module scores were calculated from microarray gene-expression data. Plasma soluble mediators (n = 23) and autoantibodies (n = 13) were assessed by multiplex bead-based assays and ELISAs. Patient clusters were identified by machine learning combining K-means clustering and random forest analysis of co-expression module scores and soluble mediators. FINDINGS: SLEDAI scores correlated with interferon, plasma cell, and select cell cycle modules, and with circulating IFN-α, IP10, and IL-1α levels. Co-expression modules and soluble mediators differentiated seven clusters of SLE patients with unique molecular phenotypes. Inflammation and interferon modules were elevated in Clusters 1 (moderately) and 4 (strongly), with decreased T cell modules in Cluster 4. Monocyte, neutrophil, plasmablast, B cell, and T cell modules distinguished the remaining clusters. Active clinical features were similar across clusters. Clinical SLEDAI trended highest in Clusters 3 and 4, though Cluster 3 lacked strong interferon and inflammation signatures. Renal activity was more frequent in Cluster 4, and rare in Clusters 2, 5, and 7. Serology findings were lowest in Clusters 2 and 5. Musculoskeletal and mucocutaneous activity were common in all clusters. INTERPRETATION: Molecular profiles distinguish SLE subsets that are not apparent from clinical information. Prospective longitudinal studies of these profiles may help improve prognostic evaluation, clinical trial design, and precision medicine approaches. FUNDING: US National Institutes of Health.

Tobacco use in Lao People's Democratic Republic: Results from the 2015 National Adult Tobacco Survey.

INTRODUCTION: Tobacco use is a burden for Lao People's Democratic Republic (Lao PDR). No published report has examined determinants of various tobacco uses to inform appropriate policies and prevention strategies. This paper reports tobacco uses by sociodemographic characteristics using data from the most recent Lao National Adult Tobacco Survey (NATS) in 2015. METHODS: The NATS included a nationally representative sample of 7562 people aged ≥15 years, recruited through a stratified 2-stage cluster sampling approach in 18 provinces. All analyses were weighted. Multivariable logistic regression models were used to evaluate unadjusted and adjusted associations between variables of interest. RESULTS: The NATS results showed that 32.4% of Lao people aged ≥15 years were current tobacco users (men: 51.2%, women: 15.4%). Cigarette smoking accounted for approximately 95% of all tobacco use in men, while tobacco chewing accounted for 60% of tobacco use in women. Current tobacco use was strongly associated with older ages and lower education levels (p<0.001). There were interactions between sex, education level, and income associated with tobacco use; specifically, women were more likely to have a lower education level and lower income than men, and these women were more likely to use tobacco. CONCLUSIONS: Tobacco use prevalence in Lao PDR was among the highest in the region. There were variations in types and prevalence of tobacco use across sociodemographic subpopulations. The Lao government should continue current national tobacco control efforts and implement additional proven strategies to reduce tobacco use.

Intravaginal practices and genital human papillomavirus infection among female sex workers in Cambodia.

OBJECTIVES: Intravaginal practices (IVPs) include washing, wiping, or inserting something inside the vagina. This study investigates the associations between IVPs and genital human papillomavirus (HPV) infection. METHODS: We conducted a cross-sectional study of 200 female sex workers aged 18 to 35 years in Phnom Penh, Cambodia. From August to September 2014. Data on sociodemographic characteristics, IVPs, and other behaviors were collected through face-to-face interviews. Self-collected cervicovaginal specimens were tested for 37 HPV genotypes. RESULTS: Multivariable Poisson regression models showed that a lower number of infecting HPV genotypes were associated with intravaginal washing in the past 3 months (incident rate ratios [IRR] = 0.65, 95% confidence interval [CI]: 0.46-0.94) and often performing intravaginal washing shortly after sex (IRR = 0.89, 95% CI: 0.81-0.99). Intravaginal washing before vaginal sex, intravaginal wiping, and intravaginal insertion were not associated with HPV infection. CONCLUSION: These findings challenge the existing view that all types of vaginal cleansing are harmful. Specifically, intravaginal washing shortly after sex (mainly with water) may help prevent HPV infection in female sex workers, who have several partners and thus frequently expose to sources of HPV infection with different genotypes.

Prevalence of and Risk Factors for Oral Human Papillomavirus Infection With Multiple Genotypes in the United States.

BACKGROUND: This study investigated the prevalence of and risk factors for oral human papillomavirus (HPV) infection with multiple genotypes in the United States. METHODS: Data were from the nationally representative 2009-2012 National Health and Nutrition Examination Survey. This analysis comprised 9257 participants for whom data on oral HPV (37 genotypes) and associated risk factors were available. RESULTS: The weighted prevalence of multitype (2-6 types) oral HPV infection was 1.5% (2.5% for men, 0.4% for women) in the whole sample and 19.7% (22.0% for men, 12.1% for women) in those who had any type of oral HPV positivity. Most multitype oral HPV cases (83.8%) harbored one or more oncogenic types. In the adjusted multinominal logistic regression model, being male (relative risk ratio [RRR] = 3.69; 95% confidence interval [CI], 1.57-8.65), being a current cigarette smoker (RRR = 2.57; 95% CI, 1.23-5.36), and having a new sex partner in the past year (RRR = 2.10; 95% CI, 1.03-4.28) were associated with an increased risk of multitype oral HPV infection over single-type HPV infection. CONCLUSIONS: Men, smokers, and those who had new sexual partners were at a significantly higher risk for multitype oral HPV infection.

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study.

OBJECTIVE: This study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients. DESIGN: Data analysis from a cross-sectional survey. SETTING AND PARTICIPANTS: 894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014. MAIN OUTCOME MEASURES: Likelihood of routine alcohol enquiry; self-assessed confidence in assessing and managing alcohol issues in primary healthcare. RESULTS: Most GPs (87%) reported that they were likely to routinely ask patients about their alcohol consumption and had sufficient skills to manage alcohol issues (74%). Potential barriers to enquiring about alcohol included perceptions that patients are not always honest about alcohol intake (84%) and communication difficulties (44%). 'I usually ask about alcohol' was ranked by 36% as the number one presentation likely to prompt alcohol discussion. Altered liver function test results followed by suspected clinical depression were most frequently ranked in the top three presentations. Suspicious or frequent injuries, frequent requests for sickness certificates and long-term unemployment were ranked in the top three presentations by 20% or less. Confidence in managing alcohol issues independently predicted likelihood to 'routinely ask' about alcohol consumption. Lack of time emerged as the single most important barrier to routinely asking about alcohol. Lack of time was predicted by perceptions of competing health issues in patients, fear of eliciting negative responses and lower confidence in ability to manage alcohol-related issues. CONCLUSIONS: Improving GPs' confidence and ability to identify, assess and manage at-risk drinking through relevant education may facilitate greater uptake of alcohol-related enquiries in general practice settings. Routine establishment of brief alcohol assessments might improve confidence in managing alcohol issues, reduce the time burden in risk assessment, decrease potential stigma associated with raising alcohol issues and reduce the potential for negative responses from patients.

Association Between Vaginal Douching and Genital Human Papillomavirus Infection Among Women in the United States.

The very few studies that have examined the association between vaginal douching and genital human papillomavirus (HPV) infection have found contrary results. We investigated the associations between douching and numbers of HPV genotypes infecting 1271 participants aged 20-49 years in the 2003-2004 US National Health and Nutrition Examination Survey. After controlling for relevant covariates, douching in the past 6 months was significantly associated with infection by higher numbers of all genital HPV types (relative risk ratio, 1.26; 95% confidence interval, 1.03-1.54) and HPV high-risk types (1.40; 1.09-1.80).

Women's communication self-efficacy and expectations of primary male partners' cooperation in sexually transmitted infection treatment in Ho Chi Minh City, Vietnam: a cross-sectional study.

BACKGROUND: Effective control of sexually transmitted infections (STIs) depends on affected patients notifying their sexual partners, and partners following through with screening and treatment. Our study assessed high-risk-STI women's confidence in STI-diagnosis-related communications with their primary male partners in Ho Chi Minh City, Vietnam, and determined associated characteristics of the women and their partners. METHODS: We employed convenience and snowball sampling in a clinic-based setting to recruit 126 women from August to October 2013. All data were obtained from women's self-report. RESULTS: The proportions of participants who were "slightly confident" or "very confident" that they could disclose their STI positivity to partners, ask partners to have an STI examination or treatment, and give partners bacterial-STI medications were 70.3%, 62.1%, and 69.0%, respectively. The proportions who perceived that their partners would be "very likely" to have an STI examination and to take STI medications were 16.2% and 38.8%, respectively. Significantly lower self-efficacy was observed in women who had a lower education level, who had ever traded sex, or whose primary partners were not husbands or fiancés. CONCLUSIONS: Our results suggest potential for piloting STI-partner-targeted interventions. To be effective, these programs should improve women's self-efficacy and primary partners' cooperation with screening and treatment.

Intravaginal Practices in Female Sex Workers in Cambodia: A Qualitative Study.

Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phnom Penh, Cambodia. We conducted in-depth interviews using open-ended questions with 30 FSWs in July-August 2014. We analyzed data using thematic content analysis, with thematic codes based on the constructs of the theory of planned behavior. The results showed that the most common IVP was a combination of intravaginal washing and wiping, to which we refer as intravaginal cleansing. There was a clear and close connection between IVP and sex work. Perceived benefits of intravaginal cleansing were numerous, while the perceived risks were few. As a result, the attitude toward intravaginal cleansing was favorable. A common misperception of benefit was that intravaginal cleansing could prevent sexually transmitted infections. Local physicians considerably influenced the subjective norm related to IVP. Intention to quit IVPs was suboptimal. In conclusion, the psychological factors associated with IVPs in FSWs were somewhat different from those in the general population of Cambodian women and women in other countries. Behavioral beliefs, attitude, and subjective norms appeared salient and important factors in IVPs. Interventions aimed at reducing IVPs should target these constructs as well as the sex-work-associated economic motives. Local physicians may be an agent to change IVP and an effective channel to deliver interventions.

Self-reported oral health, oral hygiene, and oral HPV infection in at-risk women in Ho Chi Minh City, Vietnam.

OBJECTIVES: This study aimed to examine the relationships among self-reported oral health, oral hygiene practices, and oral human papillomavirus (HPV) infection in women at risk for sexually transmitted infections (STIs) in Ho Chi Minh City, Vietnam. STUDY DESIGN: Convenience and referral sampling methods were used in a clinic-based setting to recruit 126 women aged 18-45 years between August and October 2013. Behavioral factors were self-reported. Oral-rinse samples were tested for HPV DNA of 2 low-risk and 13 high-risk genotypes. RESULTS: A higher unadjusted prevalence of oral HPV infection was associated with poorer self-rated overall oral health (P = .001), reported oral lesions or problems in the past year (P = .001), and reported a tooth loss not because of injury (P = .001). Higher unadjusted prevalence of oral HPV infection was also associated with two measures of oral hygiene: lower frequencies of toothbrushing per day (P = .047) and gargling without toothbrushing (P = .037). After adjusting for other factors in multivariable logistic regression models, poorer self-rated overall oral health remained statistically associated with oral HPV infection (P = .042); yet the frequency of tooth-brushing per day did not (P = .704). CONCLUSION: Results corroborate the association between self-reported poor oral health and oral HPV infection. The effect of oral hygiene on oral HPV infection remains inconclusive.

Risk factors for high-risk and multi-type Human Papillomavirus infections among women in Ho Chi Minh City, Vietnam: a cross-sectional study.

BACKGROUND: Concurrent infection with multiple types of Human Papillomavirus (HPV) is associated with an increased risk of cervical cancer; yet, little is known about risk factors for concurrent HPV infection in Vietnam. This study investigated the prevalence of and risk factors for high-risk-type HPV and multi-type HPV infections among women in Ho Chi Minh City, Vietnam. METHODS: Data were collected from a population-based survey of 1,550 women (mean age = 42.4; SD = 9.5), using a multi-stage sampling process. Socio-demographic and behavioral variables were obtained by self-report. HPV genotypes in cervical specimens were identified using PCR protocols. RESULTS: The prevalence of any high-risk HPV infection was 9.0%, and of multi-type HPV infection was 1.9%. In the HPV+ subsample, the percentage of high-risk HPV was 84% and of multi-type HPV was 20%. All multi-type HPV infections were high-risk-type. Lifetime smoking and older age of first sex were significantly associated with any high-risk and multi-type HPV infections. Regular condom use was inversely associated with high-risk and multi-type HPV infection. CONCLUSIONS: Risk factors for high-risk and multi-type HPV infections were similar. Further research and intervention are needed to reduce HPV infections in order to prevent HPV-related cancers.