HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening.

INTRODUCTION: Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV. OBJECTIVES: This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana. METHODS: Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana. RESULTS: Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive). CONCLUSIONS: There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.

Psychometric evaluation of the Psychache Scale: A multigroup comparison between white and hispanic undergraduate student drinkers.

With psychache being an integral aspect of suicidal and addictive behavior, there is a need for efficient assessment, including generalizability across various racial and ethnic identities. Multigroup Confirmatory Factor Analysis of the Psychache Scale was conducted in the context of 1537 undergraduate college student drinkers (White = 1,171, Hispanic = 366). The alternative bifactor model was a better solution compared to other competing models suggesting that the Psychache Scale is sufficiently unidimensional. There was sufficient support for measurement invariance, which implies that the scale is measuring the same construct across groups. The Hispanic group had a significantly higher latent mean overall psychache score compared to their counterparts. The association of psychache with various adjustment outcomes was also similar across groups. The measure demonstrated robust properties to capture psychological pain. Additional studies need to be done to examine factors influencing psychache, especially among the Hispanic population.

Thermodynamics, kinetics and isothermal studies of chromium (VI) biosorption onto Detarium senegalense stem bark extract coated shale and the regeneration potentials.

A low-cost adsorbent (Detarium senegalense stem bark extract coated shale (DSMS)) comprising pristine shale (PSH) coated with D. senegalense stem bark extract was prepared and utilized for the adsorption of Cr(VI). The DSMS and PSH were characterized by the SEM, XRD, FTIR, EDX, TGA, and BET. The batch adsorption experiment results showed that DSMS exhibited an excellent ability to adsorb chromium with a maximum removal occurring at pH 2, dosage of 0.05 g and 180 min contact time. The adsorption process was best described by the pseudo-second-order for DSMS and Elovich model for PSH which depicts chemisorption as the major mechanism responsible for the uptake of Cr(VI) onto the adsorbents. Langmuir model provided the best fit to the isotherm analysis on both materials. The maximum adsorption capacity of DSMS and PSH were 64.98 mg g-1 and 29.97 mg g-1 respectively. The thermodynamics revealed that the adsorption of Cr(VI) was feasible, endothermic and entropy driven. Furthermore, after five cycles of reuse, both DSMS and PSH demonstrated effective regeneration and reusability for Cr(VI) uptake. The structural properties, reusability, and high adsorption capabilities of DSMS indicate that they could be used as low-cost adsorbents in large-scale Cr(VI) wastewater treatment. Novelty statement Plant extracts are packed with a variety of polyphenolic compounds, such as aldehydes, alcohols, carboxylics, ethers, ketones, and phenols which contains several functionalities useful in the adsorption of toxic metals. Despite this, research on the use of plant extracts in the modification of adsorbent materials for enhanced adsorption is rare. This study reports for the first time the use of Detarium senegalense stem bark extract coated shale adsorbent for the efficient uptake of Cr(VI) ion.

Self-Forgiveness and Self-Condemnation in the Context of Addictive Behavior and Suicidal Behavior.

Addictive behavior and suicidal behavior are serious individual- and public-level health concerns. For those struggling with either or both, self-condemnation is a common experience, especially with respect to shame, guilt, and self-stigma. Self-forgiveness, a construct common to both religiousness/spirituality and positive psychology, may be an effective tool in addressing the self-condemnation inherent to those struggling with addictive behavior and suicidal behavior. In this review paper, we discuss (1) the nature and definition of forgiveness, (2) theoretical modeling developed regarding the general association of forgiveness with health, (3) theoretical modeling developed regarding the specific association of forgiveness with better outcomes related to addictive and/or suicidal behavior, (4) the relevance of shame, guilt, and self-stigma to the development and maintenance of addictive and suicidal behavior, and (5) the role of self-forgiveness in addressing self-condemnation, especially shame, guilt, and self-stigma. Little work explicitly focused on the association of self-forgiveness with shame, guilt, and/or self-stigma has been done. However, empirical evidence is accumulating in support of other associations proposed in the Forgiveness-Addiction-Recovery Association (FARA) Model described herein. As such, it is likely that similar support will be found when the focus is deliberately turned to shame, guilt, and self-stigma.

Growing and Learning Together in Fostering Multisectoral Participation for Sustaining Interventions: Lessons from 3 Successive Integrated Multidisciplinary Interventions in Rural Ghana.

Despite the recognition of nutrition as a multisectoral development issue, institutional silos persist as barriers to addressing community nutrition challenges effectively and sustainably. Over the past 2 decades, 3 integrated agriculture, livelihood, nutrition, and health interventions have been implemented in rural communities across Ghana, aimed at nurturing multisectoral collaborations to enhance institutional capacity, women's empowerment, children's diets and nutritional status, and general household well-being. Using information from published articles on the interventions, workshop reports, informal institutional engagements, and field notes, insights are presented on the efforts to garner multisectoral participation to sustain these interventions. Challenges and opportunities encountered in the process of growing and learning together relative to overcoming institutional cultures, building trust, empathizing with partners' institutional challenges, making collective decisions, and building common ownership and accountability are explored. Fostering effective multisectoral participation is a dynamic process of continuous learning.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana.

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives. Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed. Funding: None declared.

Sources of Information and Health Care Experiences Related to COVID-19 among Women Involved in Criminal Legal System in Three U.S. Cities.

Women in the United States criminal legal (CL) system are at the nexus of several drivers of the COVID-19 pandemic, including incarceration, poverty, chronic illness and racism. There are 1.25 million women incarcerated or on community supervision (probation or parole) in the U.S. We present findings regarding the impact of COVID-19 on women in the CL system (N=344) during the early days of the pandemic. Participants were drawn from community settings in an ongoing study of cervical cancer risk in three U.S. cities: Birmingham, Alabama, Oakland, California and Kansas City, which straddles the states of Kansas and Missouri. Regional differences were found in COVID-19 testing and perceived susceptibility to the virus, but not in COVID-related disruptions to health care. We found differences by race/ethnicity in trusted sources of information about COVID. Black women had higher odds of choosing TV as their most trusted source of information, while White women were more likely to cite government or social service agencies as their most trusted source. Notably, 15% of women said they did not trust any source of information regarding COVID-19. COVID-19 disproportionately impacts populations with high levels of mistrust towards medical and government institutions, a result of the twin legacies of medical mistreatment and structural racism. Our findings underscore the need for innovative strategies to reach these groups with accurate and timely information.

Characterization of Human Papillomavirus prevalence and risk factors to guide cervical cancer screening in the North Tongu District, Ghana.

INTRODUCTION: This population-based study aimed to fill the knowledge gap on Human Papillomavirus (HPV) prevalence and associated sociodemographic risk factors of the general population in the North Tongu District, Ghana. These results are needed to guide cervical cancer prevention efforts, as the leading type of female cancers. METHODS: A cross-sectional study including 2002 women in the North Tongu District, Ghana investigated HPV prevalence and associated sociodemographic risk factors. Women were recruited by geographical distribution through the local community-based health system and samples collected using a self-sampling device. For HPV genotyping BSGP5+/6+-PCR with Luminex-MPG readout was used. Multivariate logistic regression analyzed sociodemographic risk factors for HPV positivity. RESULTS: Of 2002 self-collected samples, 1943 were eligible, contained sufficient DNA and provided valid HPV genotyping results. Prevalence of single high risk HPV types was 32.3% and of multiple high risk types 9.7%. The five most common detected HPV types were HPV16 (7.4%; 95%CI: 6.3-8.7), HPV52 (7.2%; 95%CI: 6.1-8.5), HPV35 (4.8%; 95%CI: 3.9-5.8), HPV59 (4.7%; 95%CI: 3.8-5.8), HPV56 (3.9%; 95%CI: 3.1-4.8). Highest prevalence was observed among women aged 18-24 years, while age 25-54 years was inversely associated with high risk HPV positivity in multivariate analysis. Sociodemographic risk factors identified were i) having any sexual partner, ii) more partners increased the odds for high risk HPV positivity, iii) independently from this marital status, in particular not being married. DISCUSSION & CONCLUSION: Most importantly, the high risk HPV prevalence detected from this study is higher than estimates reported for Western Africa. This needs be considered, when deciding on the cervical cancer screening algorithms introduced on a wider scale. Follow-up and triage, depending on the methods chosen, can easily overburden the health system. Self-sampling worked well and provided adequate samples for HPV-based screening. Women with increasing number of sexual partners and not being married were found to have higher odds of being high risk HPV positive, therefore could be a higher prioritized screening target group.

Dynamics of genotype-specific HPV clearance and reinfection in rural Ghana may compromise HPV screening approaches.

Persistent Human Papillomavirus (HPV) infection is a prerequisite for cervical cancer development. Few studies investigated clearance of high-risk HPV in low-and-middle-income countries. Our study investigated HPV clearance and persistence over four years in women from North Tongu District, Ghana. In 2010/2011, cervical swabs of 500 patients were collected and HPV genotyped (nested multiplex PCR) in Accra, Ghana. In 2014, 104 women who previously tested positive for high-risk HPV and remained untreated were re-tested for HPV. Cytobrush samples were genotyped (GP5+/6+ PCR & Luminex-MPG readout) in Berlin, Germany. Positively tested patients underwent colposcopy and treatment if indicated. Of 104 women, who tested high-risk HPV+ in 2010/2011, seven (6,7%; 95%CI: 2.7-13.4%) had ≥1 persistent high-risk-infection after ~4 years (mean age 39 years). Ninety-seven (93,3%; 95%CI: 86.6-97.3%) had cleared the original infection, while 22 (21.2%; 95%CI: 13.8-30.3%) had acquired new high-risk infections with other genotypes. Persistent types found were HPV 16, 18, 35, 39, 51, 52, 58, and 68. Among those patients, one case of CIN2 (HPV 68) and one micro-invasive cervical cancer (HPV 16) were detected. This longitudinal observational data suggest that single HPV screening rounds may lead to over-referral. Including type-specific HPV re-testing or additional triage methods could help reduce follow-up rates.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed

Development and evaluation of a questionnaire to evaluate clinical dental teachers (ECDT).

OBJECTIVES: To develop and test the psychometric properties (validity and reliability) of a questionnaire to evaluate clinical dental teachers. METHODS: An item (question) pool was generated with the use of a literature review, feedback from faculty staff, and from focus group discussions with dental students. Following factor analysis the validity and reliability of a revised questionnaire was assessed. This involved 148 dental students and 453 assessments of 29 clinical dental teachers. RESULTS: Effective clinical dental teaching (ECDT) scores were associated with 'global ratings' of the effectiveness of clinical dental teaching (P<0.01), indicating strong criterion validity. In comparison analysis there was strong agreement between students regarding ratings of individual clinical dental teachers, indicating good construct validity. Reliability was assessed by examining internal consistency of sub-scales and overall ECDT scale, and found to be good (Cronbach alpha's > 0.80). CONCLUSION: A valid and reliable measure to evaluate clinical dental teachers has been developed for use in a clinical academia setting, and has potential use as a quality assurance measure.

Assessing the needs of substance abusing women. Psychometric data on the psychosocial history.

The Psychosocial History (PSH) is a comprehensive multidisciplinary interview designed to assess the status, history, and needs of women in substance abuse treatment. The PSH retains the fundamental scoring structure of the Addiction Severity Index (ASI), while adding supplemental questions considered clinically useful and relevant for predicting outcomes. The present study examined the psychometric properties and general utility of both instruments with a sample of women enrolled in substance abuse treatment. Initially, the instruments were tested independently and found to have excellent test-retest reliability and acceptable internal consistency. A reliability trial between the instruments found that the composite scores (CS) of the ASI and PSH yielded satisfactory correlations among four of the six CS domains. The PSH had higher CS scores than the ASI across domains, which may reflect the comprehensive nature of the PSH items that prompt greater disclosure of problems and needs. Validity analyses showed significant correlations of PSH and ASI psychiatric CSs with Symptom Checklist-90-Revised totals. These results suggest that the PSH yields reliable and valid assessment data similar to the ASI. Moreover, the PSH provides a more comprehensive assessment than the ASI in the area of pregnancy, family issues, and victimization.

Peri-implant bone loss: management of a patient.

This clinical report presents the prosthodontic management of early peri-implant bone loss in a partially edentulous patient. Two narrow Brånemark implants (3.3 mm in diameter) were placed to retain a mandibular implant prosthesis in the area of the mandibular left second premolar and first molar. Two weeks after the prosthesis was put into function, the distal implant exhibited soft tissue reactions. Radiographically, bone corresponding to 4 threads and 7 threads was lost at the mesial and distal sites, respectively. After occlusal load reduction was made to the existing prosthesis, bone was observed to have regenerated sufficiently to restore the defect radiographically, though not to the original level. The bone remained at a similar level at 36 months after treatment.

Changes in life quality following third molar surgery--the immediate postoperative period.

OBJECTIVES: This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. METHODS: One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK, were administered to the study group prior to surgery. Standardized surgical and analgesic protocols were followed. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days, completing both OHIP-14 and OHQoLUK daily. RESULTS: Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P<0.01) and this remained evident on POD2 (P<0.01), POD3 (P<0.01), POD4 (P<0.01) and POD5 (P<0.05). By POD6 and POD7 there was no significant difference in quality of life compared with preoperative status (P>0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. CONCLUSION: The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.

Biopsychosocial characteristics and treatment outcomes of pregnant cocaine-dependent women in residential and outpatient substance abuse treatment.

The purpose of this descriptive study was to compare the characteristics and treatment outcomes of pregnant cocaine-dependent women and their infants enrolled in residential (N=32) and outpatient (N=32) treatment settings. Biopsychosocial characteristics and issues that influenced the women's multiple treatment outcomes are highlighted. Comparisons of retention and infant birth outcomes found no significant differences between treatment programs, whereas abstinence and patterns of attrition showed meaningful differences favoring residential treatment. Further research is needed to evaluate whether the reported treatment outcomes are markers of improved life functioning that hold promise for the women in treatment, their families and the community.

Pre-operative diflunisal for pain relief following third molar surgery under general anaesthesia.

In order to find out whether long-acting non-narcotic analgesics given pre-operatively reduce the post-operative pain and decrease the narcotic analgesic requirements following third molar surgery under general anaesthesia, thirty Hong Kong Chinese patients undergoing this procedure were randomly given either diflunisal or placebo one hour prior to anaesthesia. Pain reduction was monitored for ten hours from the end of surgery using visual analogue scales. Except in the first hour, pain reduction at each hour was significantly better in the diflunisal group than in the placebo group. Furthermore, only one patient required narcotic analgesics in the diflunisal group compared with five in the placebo group. In patients who had multiple tooth sectioning or very difficult surgery of one or both lower third molars, the requirement for post-operative analgesics was high in the placebo group.

A study of the comparative efficacy of three common analgesics in the control of pain after third molar surgery under local anaesthesia.

BACKGROUND: The aim of this study was to evaluate the comparative efficacy of three commonly used analgesics (Panadeine, Diflunisal and Etodolac) in the control of pain after third molar surgery under local anaesthesia. METHODS: A randomized control study. Outcome of primary efficacy was judged by overall assessment of the area under the curve of graphs for pain intensity, measured from serial visual analogue scales over a 24-hour period. Other measures of efficacy included the number (per cent) of patients who took 'additional' analgesics and the incidence of adverse effects occurring in each treatment group over the study period. RESULTS: The three drugs were effective in the control of post-operative pain (p<0.01). Variations in pain intensity and the use of additional medication between the treatment groups were observed over the study period. The Diflunisal group experienced less pain than the Panadeine or Etodolac group (p<0.01). Furthermore, a lesser number of those in the Diflunisal group used additional medication compared to the other two groups (p<0.01). The incidence of side effects from all three drugs was low. CONCLUSION: Diflunisal is superior in the control of pain following third molar surgery under local anaesthesia than either Panadeine or Etodolac, and has few side effects.

The edentulous mandible opposed by natural maxillary teeth: a report of six cases treated with implant-retained prostheses.

Dental restoration of the edentulous mandible opposing natural maxillary teeth is often associated with a number of problems, particularly in the occlusion, and an accelerated rate of alveolar bone resorption in the edentulous mandible resulting from occlusal loading. The advent of osseointegrated implants would seem to provide a new means of treating these cases. Accordingly, the cases of six patients for whom either fixed partial dentures or over-dentures supported by Brånemark implants were provided, are reviewed. Three of the mandibles were normal and three had bone grafts. Results so far indicate that this is a viable alternative for treating such cases.

Methylphenidate in the treatment of coma.

While there is significant morbidity and mortality involving patients in semicomatose and comatose states, the care of such patients has traditionally been limited to supportive measures. We report two cases of patients treated with methylphenidate hydrochloride: the first, a patient in a semicomatose state resulting from traumatic brain injury, and the second, a patient in a comatose state secondary to a subdural hematoma that occurred after a fall. Treatment with methylphenidate may provide neurostimulations by augmenting the activity of injured neuronal tissue within the reticular activating system, and by amplifying the net effect of the reduced number of viable neurons. Methylphenidate is a low-cost, potentially efficacious intervention for reducing the duration of comas, for preventing life-threatening and costly complications of prolonged unconsciousness, and for promoting early ambulation and recovery. Further research using more rigorous research designs to ascertain the effectiveness of methylphenidate in the treatment of patients in semicomatose and comatose states is needed.

Armed-disarmed effect on the stability of cysteine thioglucosides.

Thioglucosides of cysteine show variable stability depending on the nature of the protecting groups on the glycosyl donor. Armed protecting groups (benzyl) lead to products that decompose readily while disarmed protecting groups (acetyl) lead to more stable products. Since this armed/disarmed effect of the protecting group on the stability of the thioglucosides is more pronounced for cysteine with an unprotected carboxylic group, the proposed mechanism is that decomposition is initiated by an intramolecular protonation of glycosyl sulfide and subsequent displacement of the sulfide by adventitious nucleophiles.