Human papillomavirus vaccination and social inequality: results from a prospective cohort study.

We investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007-2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.

A survey of adolescent experiences of human papillomavirus vaccination in the Manchester study.

BACKGROUND: There is little information on girls' experiences of human papillomavirus (HPV) vaccination in the prevention of cervical cancer. We investigated the views of adolescent girls who had been offered the vaccine as part of a feasibility study conducted in Manchester. METHODS: All 12 to 13-year-old girls in two primary care trusts were offered three doses of Cervarix (manufactured by GlaxoSmithKline). A letter was sent to 1084 parents who had consented to research follow-up. It requested parents to pass a questionnaire regarding HPV vaccination to their daughters to complete and post back in a prepaid envelope. RESULTS: A total of 553 girls completed the questionnaire. Altogether, 77% (422) had shared with their parents in the vaccine decision. In all, 42% (n=13) of girls, whose parents refused vaccination, stated that they wanted the vaccine, whereas 10% (50) of those who were vaccinated did not want the vaccine. Although 54% (277) said the vaccine was very important to them, 39% (153) of vaccinated girls thought they might not recommend it to others. The vaccine was perceived to be painful and there were exaggerated rumours of serious adverse events and needle scares. A total of 79% (420) of girls agreed with a statement that vaccination reminded them of the risks of sexual contact, but 14% (73) agreed they might take more sexual risks because they had been vaccinated. CONCLUSION: Girls of this age form their own views on HPV vaccination but parental support for vaccination remains important, especially for completing the three doses. By discussing the vaccine, parents can encourage their daughters to determine the importance and implications of HPV vaccination.

Maintenance of responding by fixed-interval schedule of electric shock presentation in squirrel monkeys.

After stabilization of response rates engendered by a free-operant avoidance contingency, the lever-pressing of two squirrel monkeys was maintained for several months by a fixed-interval schedule of electric shock presentation. Initially, response-contingent shocks produced substantial increases in response rates. Continued exposure to the schedule resulted in a reduced overall rate accompanied by a change in the temporal patterning of responses. There was a pause in responding after most shock deliveries; the rate of responding then increased during the interval to reach a terminal value preceding shock presentation. Omission of shocks for part of the daily session led to higher rates of responding; the reintroduction of response-contingent shocks produced a lower overall rate and reinstated the temporal patterning of responding characteristic of the fixed-interval schedule.

Parental attitudes and information needs in an adolescent HPV vaccination programme.

We sent a questionnaire to 38% (1084) of 2817 parents whose daughters had been offered human papillomavirus vaccination and who had agreed to participate. Of these, 60% (651) returned a questionnaire. Responses suggested that fact sheets and parent information evenings confirmed, rather than changed, consent decisions. The views of active refusers on safety and efficacy may be difficult to change, lowering vaccine coverage.

Rib impingement in first class cricketers: case reports of two patients who underwent rib resection.

Two first class cricket bowlers presented with costoiliac pain secondary to rib impingement. In both patients, conservative management of the injury had failed to improve symptoms. Surgical resection of the affected rib was undertaken. At follow up, both patients had made a good recovery and had returned to competitive cricket.

Effect of different types of cricket batting pads on the running and turning speed in cricket batting.

The aim of this study was to compare a batsman's running and turning speed during three runs while wearing either traditional batting pads or one of two models of newly designed cricket batting pads. Fifteen cricketers participated. The running and turning speeds were measured on three different days with players using the three pairs of batting pads for each trial in random order. The weights of the pads were 1.85 kg, 1.70 kg and 1.30 kg for P1, P2 and P3 respectively. Each player had to run three runs (3 x 17.68m), with the times recorded at the completion of each run, as well as the time to cover the distance from 5 m before and after the turn at the end of the first run. The fastest time from two trials for each pair of pads was retained for analysis. An analysis of variance (ANOVA) with repeated measures was used to determine the differences between the mean times of the three trials. The results showed no significant differences between the types of batting pads and the time to complete the run-three-runs test (P1 = 10.67 +/- 0.48 s; P2 = 10.67 +/- 0.43; P3 = 10.69 +/- 0.44 s), the turning time (P1 = 2.34 +/- 0.18 s; P2 = 2.32 +/- 0.18 s; P3 = 2.35 +/- 0.19 s) and to complete the third run (P1 = 3.49 +/- 0.44 s; P2 = 3.53 +/- 0.34 s; P3 = 3.51 +/- 0.36 s). Of the 45 trials of three runs used for analysis, P1 recorded the fastest time on 16 trials (36%), P2 on 19 trials (42%) and P3 on 10 trials (22%). The results showed no significant differences in the running or turning speeds, although there may be some practical relevance to using the newly designed cricket batting pads.

Methods for injury surveillance in international cricket.

BACKGROUND: The varying methods of cricket injury surveillance have made direct comparison of published studies in this field impossible. METHODS: A consensus regarding definitions and methods to calculate injury rates in cricket was sought between researchers in this field. This was arrived at through a variety of face to face meetings, email communication, and draft reviews between researchers from six of the major cricket playing nations. RESULTS: It is recommended that a cricket injury is defined as any injury or other medical condition that either (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team's captain. Recommended definitions for injury incidence (for matches, training sessions, and seasons) and injury prevalence are also provided. It is proposed that match injury incidence is calculated using a denominator based on a standard time estimated for player exposure in matches, for the purposes of simplicity. This will allow all injury surveillance systems, including those with limited resources, to make calculations according to a standard definition. CONCLUSION: The consensus statement presented provides a standard which, if followed, allows meaningful comparison of injury surveillance data from different countries and time periods, which will assist in the possible identification of risk factors for injury in cricket.

Methods for injury surveillance in international cricket.

BACKGROUND: The varying methods of cricket injury surveillance projects have made direct comparison of published studies in this field impossible. METHODS: A consensus regarding definitions and methods to calculate injury rates in cricket was sought between researchers in this field. This was arrived at through a variety of face-to-face meetings, email communication and draft reviews between researchers from six of the major cricket-playing nations. RESULTS: It is recommended that a cricket injury is defined as any injury or other medical condition that either: (a) prevents a player from being fully available for selection for a major match or (b) during a major match, causes a player to be unable to bat, bowl or keep wicket when required by either the rules or the team's captain. Recommended definitions for injury incidence (for matches, training sessions and seasons) and injury prevalence are also provided. It is proposed that match injury incidence is calculated using a denominator based on a standard time estimated for player exposure in matches, for the purposes of simplicity. This will allow all injury surveillance systems, including those with limited resources, to make calculations according to a standard definition. CONCLUSION: The consensus statement presented provides a standard which, if followed, allows meaningful comparison of injury surveillance data from different countries and time periods, which will assist in the possible identification of risk factors for injury in cricket.

A comparison of the ball rebound characteristics of wooden and composite cricket bats at three approach speeds.

The primary aim of this study was to compare the rebound characteristics of wooden and composite cricket bats. The rebound characteristics of two 'experimental' bats manufactured from composite material were compared with three English willow bats and one Kashmir willow bat. The bats were tested using a specially designed testing rig, which propelled a 156 g Kookaburra cricket ball at three impact speeds: fast-medium, 67 km x h(-1); fast, 101 km x h(-1); and express, 131 km x h(-1) on to the bats mounted in position so that the ball impacts occurred at the position where the blade of the bats was the thickest. The rebound characteristics of the bats were calculated by measuring the approach and rebound speeds of the ball as it passed through a light beam positioned a short distance away from the point of impact. The statistical software package SAS was used to test for significant differences (p < 0.05) between the average rebound characteristics of the bats. Further, Scheffé's method was used as a post hoc comparison to determine whether differences existed between the composite and willow bats. When the composite and traditional willow bats were compared, the results showed no significant differences between the three average approach speeds, while the composite bats showed significantly smaller rebound speeds and coefficient of restitution at all three approach speeds. Thus, the rebound characteristics of the composite bats were significantly less than the traditionally designed English willow wooden bats and would not enhance performance by allowing the batsman to hit the ball harder, assuming all other factors, such as bat speed, mass distribution and the impact point, were the same for the bats. Further study is required to determine the physical properties of composite and wooden bats to enhance their impact characteristics.

Pharmacological modification of experimental depression in infant macaques.

This study provides evidence that mother--infant separation in macaques is a useful experimental model of depression. At the age of 6--8 months, seven M.fascicularis infants underwent two consecutive separations from their mothers lasting 21 and 15 days, respectively. The frequency and duration of a set of individual and social behaviours were recorded throughout each of the following experimental conditions: baseline, separation, reunion. In response to maternal separation, the infants showed marked increased in frequency of behaviours reflecting distress, self-directed activity or anxiety (e.g. vocalization, locomotion, body play). Both individual and social play behaviours were markedly suppressed in separated infants. During the second separation, one group of subjects was given, in a 'double blind' fashion, daily doses of 5 mg/kg of an antidepressant, desmethylimipramine (DMI), i.m. Treatment with DMI markedly diminished most of the behavioural alterations induced by separation. In particular, the increases in distress and self-directed behaviours as well as the suppression of play activities were prevented or antagonized. Plasma levels of DMI after 5 days of administration were in the range of 50--150 ng/ml.

Psychosocial readjustment of Canadian Vietnam veterans.

A survey study was conducted on the psychosocial readjustment of 164 of the estimated 10,000-40,000 Canadians who served in Vietnam with the U.S. military. Results indicate significantly greater rates of posttraumatic stress disorder (PTSD) compared with U.S. Vietnam veterans. Evidence of other psychosocial adjustment problems such as depression, inability to handle frustration and anger, difficulty in getting along with and trusting others, and family and marital problems, as well as poor physical health, was also found. Results suggest these problems are due, in part, to prolonged isolation from other Vietnam veterans, lack of recognition, and no readily available treatment for PTSD in Canada.

Drug-induced reinstatement of extinguished self-administration behavior in monkeys.

Responding was established in squirrel monkeys under a modified progressive ratio schedule of IV d-amphetamine or cocaine self-administration. Subsituation of saline for the drug solutions resulted in extinction of the self-administration behavior. IV injections of certain doses of d-amphetamine or cocaine, immediately prior to test sessions in which response-contingent saline infusions were delivered, reinstated the rate and pattern of responding observed during sessions in which drug was self-administered. Presession IV injections of several doses of pentobarbital or chlorpromazine failed to consistently reinstate responding. These results were interpreted in terms of the discriminative control of drug self-administration behavior by the current drug state of the subject.

Methylphenidate and stimulus control of avoidance behavior.

The introduction of a warning signal that preceded a scheduled shock modified the temporal distribution of free-operant avoidance responses. With response-shock and shock-shock intervals held constant, response rates increased only slightly when the response-signal interval was reduced. The result is consistent with Sidman's (1955) findings under different conditions, but at variance with Ulrich, Holz, and Azrin's (1964) findings under similar conditions. Methylphenidate in graded doses increased response rates, modifying frequency distributions of interresponse times. Drug treatment may have disrupted a "temporal discrimination" formed within the signal-shock interval. More simply, methylphenidate influenced response rates by increasing short response latencies after signal onset; this effect was more prominent than the drug's tendency to increase the frequency of pre-signal responses. When signal-onset preceded shock by 2 sec, individual differences in performance were marked; methylphenidate suppressed responding in one rat as a function of increasing dose levels to a greater degree than in a second animal, but both subjects received more shocks than under control conditions.

Some effects of methylphenidate on stimulus control of ratio avoidance behavior in the rat.

After exposure to an avoidance schedule which included a warning signal, a rat was placed on a multiple schedule in which the first component was the same as before, i.e., a single response reset the response-shock interval, delaying shock, and the second component differed only in that four bar-presses were required to postpone shock. A fixed ratio requirement of four responses (FR 4) generated behavior resembling a fixed ratio requirement of one response (FR 1) since responding was controlled by the warning signal but more shocks were received. At a dosage of 2 mg/kg, methylphenidate given intraperitoneally decreased shock frequency during FR 4 periods while FR 1 behavior was not affected; at 4 mg/kg, stimulus control of avoidance responding was impaired during both components. Results at 4 mg/kg were partially confirmed by two animals exposed to an FR 4 avoidance schedule which included a warning signal but with different parameters. Response distributions showed that methylphenidate increased response rates in the absence of the warning signal, i.e., stimulus control of ratio-avoidance behavior was impaired although the increased response rates reduced shock frequency. One hour later responses again occurred more frequently during the signal than in its absence but shocks were less frequent than during control (non-drug) periods.

Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.

BACKGROUND: Bone stress reaction is prevalent among cricket fast bowlers. Few studies have addressed the sensitivity and specificity of imaging for diagnosis, and follow up assessment has been poorly investigated. OBJECTIVE: To determine whether there was an association between back pain and bone stress reaction as measured by computed tomography (CT) scan in young cricket fast bowlers. METHODS: Ten young cricket fast bowlers were included in the study. Nine bowlers presented to a physiotherapy practice with low back pain and were later diagnosed with lumbar stress fractures, while one was an experienced bowler with no pain. All players had a CT scan after presenting to the physiotherapy practice. Pain was assessed according to a subjective scale (0-10) where 10 represented the player's subjective, maximum pain score. Recovery and rehabilitation of all players was monitored until they returned to full participation. RESULTS: There was no consistency in the relationship between pain and CT scan results. For example, one subject had evidence of un-united stress fractures after 15 months of rest but had experienced moderate pain for only 2 weeks after the onset of symptoms, in contrast to another subject who had intermittent pain for 11 months even though CT scan showed multiple stress fractures ranging from partially healed to fully healed status at 3 months. CONCLUSION: There is dissociation between back pain and bone stress reaction as measured by CT scan. Therefore, CT scan does not provide objective evidence for ongoing management or decision concerning return to sport in cricket fast bowlers.

Psychological and physical health effects of sexual assaults and nonsexual traumas among male and female United States Army soldiers.

Lifetime trauma history was assessed in a health study of active duty United States Army soldiers. Five hundred fifty-five male and 573 female soldiers in the sample were asked whether they had ever experienced 14 different potentially traumatic experiences, including sexual assaults, violent stressors to self, and terrifying events that occurred to others and were secondarily traumatic through exposure by gaining information or as a witness to the event. Most soldiers had experienced multiple traumas, and premilitary exposure to events was much more common than exposure to events after entering the military. Global measures of current psychological distress and physical health symptoms were predicted by the lifetime number of sexual assaults and traumas to self. Social support from military unit leaders moderated the relationship between accumulated exposure to traumas and both health measures, whereas unit cohesion was directly associated with fewer mental health problems.

Psychological health and trauma in male and female soldiers.

This study assessed the effect of premilitary and military trauma on the psychological health of more than 1,000 female and male active duty soldiers. Questionnaire data provided information on demographics, history of trauma exposure, and general psychological health as assessed by the Brief Symptom Inventory (BSI). The results indicated that females reported experiencing more sexual traumas and males reported more nonsexual traumas. BSI subscale scores indicated poorer psychological health among all of the subjects compared with BSI normative groups and other Army soldiers. The need for military norms for the BSI is discussed.

Effects of premilitary and military trauma on the development of post-traumatic stress disorder symptoms in female and male active duty soldiers.

We surveyed more than 1,000 female and male active duty soldiers to assess the effect of premilitary and military trauma on their psychological well-being. Questionnaire data were obtained on pertinent demographic information, history of trauma exposure, and symptoms of post-traumatic stress disorder (PTSD). The results indicated significant gender differences in the types of traumatic events experienced, with females reporting more sexual traumas and males reporting more nonsexual traumas. In addition, males reported experiencing more military-related traumas, whereas females reported experiencing more premilitary traumas. The prevalence of PTSD symptoms was 8.6% for females and 5% for males. Recommendations are presented that may help mitigate development of PTSD symptoms in the future.

Prevalence and timing of sexual assaults in a sample of male and female U.S. Army soldiers.

OBJECTIVE: This study was designed to assess the prevalence and timing of sexual assault experiences in a sample of U.S. Army soldiers. METHODS: Self-administered surveys were completed by 555 male and 573 female soldiers in combat service and combat service support units. RESULTS: One-fifth of the women reported a completed rape (22.6%), and 50.9% of women and 6.7% of men reported any sexual assault. The majority of sexual assaults occurred before the soldiers entered the military, and 25% of women and 1% of men reported an attempted or completed rape during childhood. Sexual assault history also varied by sociodemographic characteristics. CONCLUSION: Results suggest that a history of childhood sexual abuse may be more widespread among female soldiers than among civilian women, and that ascribed and achieved status characteristics may differentially expose soldiers to sexual assaults both before and after they enter the military. Health care assessments should include details of a soldier's sexual assault history.

Physical health symptomatology of Gulf War-era service personnel from the states of Pennsylvania and Hawaii.

We present data on physical health and possible "Gulf War syndrome" from a Congressionally mandated study of over 4,000 active duty and reserve service members from the states of Hawaii and Pennsylvania who served during Operation Desert Storm. We found that deployed veterans report significantly more physical health symptoms than non-deployed veterans that cannot be explained by reasons other than deployment alone. We also identified a subgroup of 178 deployed veterans at risk for possible Gulf War syndrome. We recommend that services collect baseline information from units likely to deploy in the future and update that information regularly.