Cervical Visual Inspection with Acetic Acid (VIA) and Oncogenic Human Papillomavirus Screening in Rural Indigenous Guatemalan Women: Time to Rethink VIA.

Single-visit "screen-and-treat" strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3-8 September 2017, trained nurses examined 222 women aged 23-58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 "…using HPV DNA detection as the primary screening test rather than VIA or cytology".

Self-reported factors associated with dental care utilization among Hispanic migrant farmworkers in South Florida.

OBJECTIVES: To explore patterns of dental care utilization among adult Hispanic migrant farmworkers utilizing the Andersen Behavioral Model of Health Services. METHODS: In 2010, 278 Hispanic migrant workers participated in the oral health assessment. Hierarchical logistic regression modeling was used to assess the effects of multiple factors on having a past-year dental visit. Predisposing variables included age, education, and knowledge toward preventing tooth decay. Enabling factors included medical insurance, place for medical care, and social support. Need measures included oral health problems and treatment. RESULTS: Only 20.5 percent of Hispanic migrant farmworkers reported a past-year dental visit. More than one-half (52.5 percent) needed oral health treatment and nearly two-thirds (61.2 percent) stated that they perceived their mouth to be in poor condition. The final model indicated that those who reported preventing tooth decay by brushing and flossing, brushed their teeth once a day, and stated a good condition of their mouth were more likely to have had a past-year dental visit. CONCLUSIONS: Most Hispanic migrant farmworkers in south Florida have not had a past year dental visit. Similar to other ethnic minorities in the United States, migrant farmworkers experience poor oral health outcomes and have inadequate access to health-care services.

Methodological challenges in intervention studies.

Parental substance abuse is a risk factor for child maltreatment, neglect and multi-generational drug abuse. Developing efficacious, cost-efficient interventions is critical to addressing this growing problem. This article by Brian Porter, Luz Porter, Virginia McCoy, Mayra Lima, Clare Pryce and Sachin Nunnewar highlights lessons learned during the first year of a study based in Florida to evaluate a novel parenting intervention targeting substance-abusing mothers and their babies.

Blended Infant Massage-Parenting Enhancement Program on Recovering Substance-Abusing Mothers' Parenting Stress, Self-Esteem, Depression, Maternal Attachment, and Mother-Infant Interaction.

PURPOSE: This study aimed to determine whether a blended Infant Massage-Parenting Enhancement Program (IMPEP) improved maternal psychosocial health outcomes (parenting stress, depressive symptoms, self-esteem, maternal attachment) and maternal-infant interaction among substance-addicted mothers (SAMs) actively engaged in outpatient rehabilitation. METHODS: Designed as a randomized, three-group controlled trial testing two levels of psychoeducational intervention (IMPEP vs. PEP) and a control group (standard care parenting resources), the study was conducted in two substance abuse centers in southeast Florida on a convenience sample of 138 recovering SAM-infant pairs. IMPEP or PEP classes were held weekly on Weeks 2-5, with data collected at baseline (Week 1), Week 6, and Week 12 via structured interviews, observation (Observation Checklist on Maternal-Infant Interaction), and self-administered questionnaires (Abidin Parenting Stress Index, Beck Depression Inventory, Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory), analyzed descriptively and inferentially using Kruskall-Wallis analysis of variance and post hoc Wilcoxon rank sum and Mann-Whitney U tests. RESULTS: Both IMPEP and PEP groups had significantly increased Parenting Stress Index scores (decreased parenting stress) and decreased Beck Depression Inventory scores (decreased depressive symptoms) compared to controls at Week 12, whereas there were no clinically meaningful differences among study groups in Rosenberg Self-Esteem Scale, Muller's Maternal Attachment Inventory, or Observation Checklist on Maternal-Infant Interaction scores. Only the IMPEP group showed significant improvements in both psychological and physical (waist-hip ratio) measures of parenting stress over time. CONCLUSIONS: The findings suggest that infant massage blended into a structured parenting program has value-added effects in decreasing parenting stress and maternal depressive symptoms, but not on SAM's self-esteem, attachment, or maternal-infant interaction.

Mammography use among Haitian women in Miami, Florida: an opportunity for intervention.

When compared to other racial/ethnic minorities and immigrants in Miami, Florida, Haitian women are more likely to be diagnosed with late-stage breast cancer when the prognosis for survival is poor. This disparity likely reflects mammography underutilization. Previous research has not examined the frequency of mammography use among Haitian women in Miami. Our study addresses this gap. In 2007, Community Health Workers (CHWs) recruited nearly 1,000 Haitian women from community venues across Little Haiti, the predominantly Haitian area in Miami, to participate in Rapid Assessment Surveys (RAS). RAS are a quick, cost-efficient method for assessing the prevalence of health behaviors in communities with high-rates of illiteracy and/or distrust of research. Our data indicate Haitian women are less likely than other women in Florida to report regular mammography. Such findings, though not surprising, suggest that grouping all black persons, regardless of ancestry, into one research category may mask variation in disease risk.