Public health preparedness and response synergies between institutional authorities and the community: a qualitative case study of emerging tick-borne diseases in Spain and the Netherlands.

BACKGROUND: Communities affected by infectious disease outbreaks are increasingly recognised as partners with a significant role to play during public health emergencies. This paper reports on a qualitative case study of the interactions between affected communities and public health institutions prior to, during, and after two emerging tick-borne disease events in 2016: Crimean-Congo Haemorrhagic Fever in Spain, and Tick-Borne Encephalitis in the Netherlands. The aim of the paper is to identify pre-existing and emergent synergies between communities and authorities, and to highlight areas where synergies could be facilitated and enhanced in future outbreaks. METHODS: Documentary material provided background for a set of semi-structured interviews with experts working in both health and relevant non-health official institutions (13 and 21 individuals respectively in Spain and the Netherlands), and focus group discussions with representatives of affected communities (15 and 10 individuals respectively). Data from all sources were combined and analysed thematically, initially independently for each country and then for both countries together. RESULTS: Strong synergies were identified in tick surveillance activities in both countries, and the value of pre-existing networks of interest groups for preparedness and response activities was recognised. However, authorities also noted that there were hard-to-reach and potentially vulnerable groups, such as hikers, foreign tourists, and volunteers working in green areas. While the general population received preventive information about the two events, risk communication or other community engagement efforts were not seen as necessary specifically for these sub-groups. Post-event evaluations of community engagement activities during the two events were limited, so lessons learned were not well documented. CONCLUSIONS: A set of good practices emerged from this study, that could be applied in these and other settings. They included the potential value of conducting stakeholder analyses of community actors with a stake in tick-borne or other zoonotic diseases; of utilising pre-existing stakeholder networks for information dissemination; and of monitoring community perceptions of any public health incident, including through social media. Efforts in the two countries to build on the community engagement activities that are already in place could contribute to better preparedness planning and more efficient and timely responses in future outbreaks.

Methodology for assessment of public health emergency preparedness and response synergies between institutional authorities and communities.

BACKGROUND: This paper describes a participatory methodology that supports investigation of the synergistic collaboration between communities affected by infectious disease outbreak events and relevant official institutions. The core principle underlying the methodology is the recognition that synergistic relationships, characterised by mutual trust and respect, between affected communities and official institutions provide the most effective means of addressing outbreak situations. METHODS: The methodological approach and lessons learned were derived from four qualitative case studies including (i) two tick-borne disease events (Crimean-Congo haemorrhagic fever in Spain, 2016, and tick-borne encephalitis in the Netherlands, 2016); and (ii) two outbreaks of acute gastroenteritis (norovirus in Iceland, 2017, and verocytotoxin-producing Escherichia coli [VTEC] in Ireland, 2018). An after-event qualitative case study approach was taken using mixed methods. The studies were conducted in collaboration with the respective national public health authorities in the affected countries by the European Centre for Disease Prevention and Control (ECDC). The analysis focused on the specific actions undertaken by the participating countries' public health and other authorities in relation to community engagement, as well as the view from the perspective of affected communities. RESULTS: Lessons highlight the critical importance of collaborating with ECDC National Focal Points during preparation and planning and with anthropological experts. Field work for each case study was conducted over one working week, which although limiting the number of individuals and institutions involved, still allowed for rich data collection due to the close collaboration with local authorities. The methodology enabled efficient extraction of synergies between authorities and communities. Implementing the methodology required a reflexivity among fieldworkers that ackowledges that different versions of reality can co-exist in the social domain. The method allowed for potential generalisability across studies. Issues of extra attention included insider-outsider perspectives, politically sensitivity of findings, and how to deal with ethical and language issues. CONCLUSIONS: The overall objective of the assessment is to identify synergies between institutional decision-making bodies and community actors and networks before, during and after an outbreak response to a given public health emergency. The methodology is generic and could be applied to a range of public health emergencies, zoonotic or otherwise.

Enablers and Barriers to Community Engagement in Public Health Emergency Preparedness: A Literature Review.

Public health emergency preparedness (PHEP) all too often focusses only on institutional capabilities, including their technical expertise and political influence, while overlooking community capabilities. However, the success of institutional emergency preparedness plans depends upon communities and institutions working together to ensure successful anticipation, response and recovery. Broader community engagement is therefore recommended worldwide. This literature review was carried out to identify enablers and barriers to community and institutional synergies in emergency preparedness. Searches were undertaken across bibliographic databases and grey literature sources. The literature identified was qualitative in nature. A qualitative, 'best fit' framework approach using a pre-existing framework was used to analyse the literature, whereby themes were added and changed as analysis progressed. A working definition of community was identified, based on a 'whole community' approach, inclusive of the whole multitude of stakeholders including community residents and emergency management staff. Given the diversity in community make-up, the types of emergencies that could be faced, the socio-economic, environmental and political range of communities, there are no set practices that will be effective for all communities. The most effective way of engaging communities in emergency preparedness is context-dependent and the review did draw out some important key messages for institutions to consider.

Development of a public health emergency preparedness competency model for European Union countries.

In 2017, the European Centre for Disease Prevention and Control (ECDC) developed a competency model for individuals who work in public health emergency preparedness (PHEP) in European Union (EU) countries. The model serves as the basis for developing competency-based training programmes to support professionals in PHEP efforts at the country level. The competency model describes the knowledge and skills professionals need when working in national-level PHEP, such as preparedness committee members or their equivalents. In order to develop the model, existing competency statements were reviewed, as well as case studies and reports. Fifty-three professionals from the EU and other countries provided feedback to the model by participating in a three-stage consultation process. The model includes 102 competency, 100 knowledge and 158 skill statements. In addition to specifying the appropriate content for training programmes, the proposed common competency model can help to standardise terminology and approaches to PHEP training.

Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial.

OBJECTIVE: To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis (OA). DESIGN: Single-blind randomized controlled trial. SETTING: Exercise gymnasium and community dwellings. PARTICIPANTS: Individuals with medial compartment knee OA (N=40). INTERVENTIONS: Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention (nonintervention group). MAIN OUTCOME MEASURES: Dynamic balance was measured using the Community Balance and Mobility Scale (CB&M), and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale. Secondary outcomes included knee pain, fear of movement, knee joint proprioception, and muscle strength. RESULTS: Forty individuals underwent baseline testing, with 36 participants completing follow-up testing. Adherence to exercise in the training group was high, with 82.2% of all home-based exercise sessions completed. No significant changes were observed in any outcome in the nonintervention group at follow-up. Significant improvements in self-reported pain, physical function, and fear of movement were observed in the training group when compared with the nonintervention group. No other within- or between-group differences were observed. CONCLUSIONS: A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain, physical function, and fear of movement; however, there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance.

The Biomechanical Demands on the Hip During Progressive Stepping Tasks.

Hatfield, GL, Charlton, JM, Cochrane, CK, Hammond, CA, Napier, C, Takacs, J, Krowchuk, NM, and Hunt, MA. The biomechanical demands on the hip during progressive stepping tasks. J Strength Cond Res 31(12): 3444-3453, 2017-Functional hip strengthening exercises are important components of lower extremity (LE) rehabilitation and include single-leg squats (SLS), step-downs (SD), and step-ups (SU). The biomechanical demand of these tasks is unclear. This repeated-measures study determined hip biomechanical demands in a healthy population. Twenty individuals (10 men, 26.6 ± 5.1 years, 22.1 ± 2.3 kg·m) participated. Three-dimensional motion, ground reaction force data, and surface electromyograms (EMG) were recorded during 4 randomly ordered tasks. Outcomes included frontal and sagittal plane hip moment impulses and muscle activity for each task. Repeated measures analysis of variance models (alpha = 0.05) determined between-task differences. Step-down and SLS were most biomechanically demanding, with significantly higher hip flexion and adduction moment impulses, and gluteus medius (GM) and quadriceps activity compared with half step-down (HSD) and SU. No significant difference was found between SD and SLS, indicating minimal difference in demand between the 2 tasks, likely due to kinematic similarities in performance; there were no significant differences in knee or hip sagittal plane angle excursion, or peak pelvic obliquity angle between the 2 tasks. Step-up was least demanding, with the lowest hip flexion and adduction moment impulses and GM, quadriceps, and hamstrings activity. Step-up was least demanding on the hip and would be a good starting task for hip strengthening protocols. Step-down and SLS were most demanding, requiring higher hip moments and muscle activity. These results provide evidence, which may be used in planning of progressive rehabilitation programs for patients with LE pathologies.

Social Attitudes Toward Adoption by Same-Sex Couples in Europe.

By examining social attitudes on same-sex adoption in 28 European countries, we highlighted individual and country-level factors that can determine the level of social acceptance or rejection of this specific kind of adoption. This article contributes to the literature on social acceptance of lesbian women, gay men, and their adoption practices in Europe and directs attention to several previously under-researched aspects of social attitudes on same-sex parenting rights. The empirical base of this study was the fourth round of the European Values Study, conducted in 2008-2010. Using ordered logistic regressions, we examined the impact of several individual and country-level characteristics on the agreement level with the statement that "Homosexual couples should be able to adopt children." We found strong relationships between social attitudes towards adoption by same-sex couples and the existence of legislation permitting same-sex adoption practices at the country-level, as well as some individual attitudes, including those related to traditional family formation practices, "justification of homosexuality," and (non-) preference for homosexual neighbors. Our findings indicate a shift within the potential interpretational contexts of adoption by same-sex couples from a narrow sexuality-based framework to a different and possibly much wider context of family and parenting practices.

Factors Associated With Dynamic Balance in People With Knee Osteoarthritis.

OBJECTIVE: To identify potential neuromuscular factors associated with dynamic balance in individuals with knee osteoarthritis (OA). DESIGN: Cross-sectional observational study; backward stepwise multiple linear regression was used to identify factors associated with dynamic balance in 2 statistical models. SETTING: University clinical research laboratory. PARTICIPANTS: Individuals aged ≥50 years (N=52) with osteoarthritic changes on radiograph participated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Dynamic balance was assessed using the Community Balance and Mobility Scale (CB&M). Potentially modifiable neuromuscular factors associated with dynamic balance were measured, including the sum of concentric and eccentric lower-extremity muscle strength, 2 quadriceps-hamstrings muscle strength ratios, knee joint proprioception (joint position sense), anticipatory postural control velocity, and knee joint range of motion. RESULTS: The first model for explaining variance in CB&M scores consisted of eccentric lower-extremity muscle strength and knee joint range of motion as factors. The model containing these 2 variables explained 50% of the variance in CB&M scores. The second model adjusted for descriptive variables, including age, body mass index, and knee pain, contained only the neuromuscular variables eccentric lower-extremity muscle strength, and explained 68% of the variance in CB&M scores. CONCLUSIONS: These results suggest that muscle strength and, to a lesser extent, knee joint range of motion are important factors associated with dynamic balance as measured by the CB&M and should be considered in dynamic balance interventions.

Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis.

OBJECTIVE: To compare performance error and perceived difficulty during toe-out gait modification in people with knee osteoarthritis (OA) across 3 different types of visual feedback: mirror, raw video, and real-time biofeedback of toe-out angle. DESIGN: Repeated-measures, within-subject trial. SETTING: University motion analysis laboratory. PARTICIPANTS: Individuals with knee OA (N=20; 11 women; mean age, 65.4±9.8y) participated in this study. Seven participants had mild knee OA, 9 had moderate knee OA, and 4 had severe knee OA. INTERVENTIONS: Participants were trained to walk on a treadmill while matching a target indicating a 10° increase in stance phase toe-out compared with toe-out angle measured during self-selected walking. The target was provided visually via the 3 types of feedback listed above and were presented in a random order. MAIN OUTCOME MEASURES: Kinematic data were collected and used to calculate the difference between the target angle and the actual performed angle for each condition (toe-out performance error). Difficulty was assessed using a numerical rating scale (0-10) provided verbally by participants. RESULTS: Toe-out performance error was significantly less when using the real-time biofeedback method than when using the other 2 methods (P=.025; mean difference vs mirror=2.05°; mean difference vs raw video=1.51°). Perceived difficulty was not statistically different between the groups (P=.51). CONCLUSIONS: Although statistically significant, the 2° difference in toe-out gait performance error may not necessitate the large economic and personnel costs of real-time biofeedback as a means to modify movement in clinical or research settings.

Co-creation of a patient engagement strategy in cancer research funding.

BACKGROUND: As research teams, networks, and institutes, and health, medical, and scientific communities begin to build consensus on the benefits of patient engagement in cancer research, research funders are increasingly looking to meaningfully incorporate patient partnership within funding processes and research requirements. The Canadian Cancer Society (CCS), the largest non-profit cancer research funder in Canada, set out to co-create a patient engagement in cancer research strategy with patients, survivors, caregivers and researchers. The goal of this strategy was to meaningfully and systematically engage with patients in research funding and research activities. METHODS: A team of four patient partners with diverse cancer and personal experiences, and two researchers at different career stages agreed to participate as members of the strategy team. Ten staff members participated in supportive roles and to give context regarding different departments of CCS. The strategy was co-developed in 2021/2022 over a series of 7 workshops using facilitation strategies such as ground rules and consensus building, and methods such as Design Thinking. The strategy was subjected to 3 rounds of validation. RESULTS: The co-creation and validation process resulted in a multi-faceted strategy with actionable sections, including vision, guiding principles, engagement methods, 13 prioritized engagement activities spanning the spectrum of research funding, and an evaluation framework. The experience of co-creating the strategy was captured using the Patient and Public Engagement Evaluation Tool and revealed a positive, supportive experience. CONCLUSIONS: Lessons learned included the value of an emphasis on a co-creation process from day one, the utility of facilitation techniques such as ground rules for dialogue, consensus building and Design Thinking, and the importance (and challenge) of designing for and incorporating equity when drafting the strategy. Future work will include implementation and evaluation of the strategy, as well as an examination of further ways to meaningfully and systematically engage diverse voices in research and research funding.

As researchers and healthcare providers see benefits of patient engagement in cancer research, research funders are also looking to engage with patients in their funding processes and research activities. The Canadian Cancer Society (CCS), the largest non-profit cancer research funder in Canada, set out to co-create a patient engagement in cancer research strategy with patients, survivors, caregivers and researchers. The goal of this strategy was to meaningfully and systematically engage with patients in research funding and research activities. Four patient partners and two researchers were supported by ten CCS staff members to co-create the strategy in 2021/2022 over a series of 7 workshops. They used facilitation strategies such as ground rules and consensus building, and methods such as Design Thinking. The strategy was then validated. Co-creation resulted in an easy-to-use strategy with actionable sections, including vision, guiding principles, engagement methods, 13 prioritized activities, and an evaluation framework. The experience of co-creating the strategy was captured using a well-regarded evaluation tool and revealed a positive, supportive experience.    Lessons learned during the process included making sure the co-creation process started on day one, the usefulness of facilitating the process, and the importance of considering issues of equity when drafting the strategy.

Voicing women in Eastern Europe-an introduction.

This special issue maps out real and symbolic spaces of women who are attracted to women in Eastern Europe, and highlights some of the challenges they face. One of the main themes emerging from the articles is that constructing spaces for women outside the heterosexual mainstream can be a useful political strategy in societies where non-conventional sexual interests, attractions, and gender expression have discriminative consequences. All of the eight articles in this special issue represent different voices, while demonstrating that there are many similar tendencies concerning the main goals and difficulties of lesbian, gay, bisexual, and transgender (LGBT) and lesbian movements of the region, in terms of legal and social developments related to the most heated issues of same-sex marriage and parenting on the one hand, and the violent attacks against pride marches and political backlash on the other.

Engaging Women With Lived Experience: A Novel Cross-Canada Approach.

Women with heart disease, stroke, and vascular cognitive impairment (VCI) experience gender inequities across the health care continuum. The Heart and Stroke Foundation of Canada conducted needs assessment to inform its approach in addressing health inequities experienced by women with heart disease, stroke, and VCI across the continuum of care. Although specific input is confidential, this article outlines the engagement methods used and the evaluation results. The 3-stage engagement process consisted of an internal content review, 18 in-person discussion groups via a cross-Canada tour, 14 expert interviews, and a collaboration session. In total, 204 and 57 participants were recruited for the cross-Canada tour and collaboration session, respectively. Using the Public and Patient Engagement Evaluation Tool, participants scored the engagement processes positively and found participation to be a valuable use of their time. This undertaking highlighted aspects to consider when engaging people with lived experience and how engagement can support the recovery journey. Insights presented throughout this article can help inform future research that seeks to engage stakeholders at a national level.

Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review.

BACKGROUND: Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring. OBJECTIVE: The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations. METHODS: A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles' titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses. RESULTS: This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes). CONCLUSIONS: Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design.

HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe.

Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.

"Unnatural Fornication" Cases Under State-Socialism: A Hungarian-Slovenian Comparative Social-Historical Approach.

This comparative social-historical study examines different versions of state-socialist body politics manifested in Hungary and Slovenia mainly during the 1950s by using archive material of "unnatural fornication" court cases. By analyzing the available Hungarian "természet elleni fajtalanság" and Slovenian "nenaravno obcevanje" court cases, we can shed light on how the defendants were treated by the police and the judiciary. On the basis of these archive data that have never been examined before from these angles, we can construct an at least partial picture of the practices and consequences of state surveillance of same-sex-attracted men during state-socialism. The article explores the functioning of state-socialist social control mechanisms directed at nonnormative sexualities that had long-lasting consequences on the social representation of homosexuality in both countries.

Factor Analysis of the Community Balance and Mobility Scale in Individuals with Knee Osteoarthritis.

BACKGROUND AND PURPOSE: The clinical assessment of balance is an important first step in characterizing the risk of falls. The Community Balance and Mobility Scale (CB&M) is a test of balance and mobility that was designed to assess performance on advanced tasks necessary for independence in the community. However, other factors that can affect balancing ability may also be present during performance of the real-world tasks on the CB&M. It is important for clinicians to understand fully what other modifiable factors the CB&M may encompass. The purpose of this study was to evaluate the underlying constructs in the CB&M in individuals with knee osteoarthritis (OA). METHODS: This was an observational study, with a single testing session. Participants with knee OA aged 50 years and older completed the CB&M, a clinical test of balance and mobility. Confirmatory factor analysis was then used to examine whether the tasks on the CB&M measure distinct factors. Three a priori theory-driven models with three (strength, balance, mobility), four (range of motion added) and six (pain and fear added) constructs were evaluated using multiple fit indices. RESULTS: A total of 131 participants (mean [SD] age 66.3 [8.5] years, BMI 27.3 [5.2] kg m-2 ) participated. A three-factor model in which all tasks loaded on these three factors explained 65% of the variance and yielded the most optimal model, as determined using scree plots, chi-squared values and explained variance. The first factor accounted for 49% of the variance and was interpreted as lower limb muscle strength. The second and third factors were interpreted as mobility and balance, respectively. DISCUSSION: The CB&M demonstrated the measurement of three distinct factors, interpreted as lower limb strength, balance and mobility, supporting the use of the CB&M with people with knee OA for evaluation of these important factors in falls risk and functional mobility. Copyright © 2016 John Wiley & Sons, Ltd.

Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: an exploratory randomized crossover study.

BACKGROUND: Pronated foot posture is associated with many clinical and biomechanical outcomes unique to medial compartment knee osteoarthritis (OA). Though shoe-worn insole treatment, including lateral wedges, is commonly studied in this patient population, their effects on the specific subgroup of people with medial knee OA and concomitant pronated feet are unknown. The purpose of this study was to evaluate whether lateral wedge insoles with custom arch support are more beneficial than lateral wedge insoles alone for knee and foot symptoms in people with medial tibiofemoral knee osteoarthritis (OA) and pronated feet. METHODS: Twenty-six people with pronated feet and symptomatic medial knee OA participated in a randomized crossover study comparing five degree lateral wedge foot insoles with and without custom foot arch support. Each intervention was worn for two months, separated by a two-month washout period of no insoles wear. Main outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function subscales, the revised short-form Foot Function Index (FFI-R) pain and stiffness subscales, and the timed stair climb test. Regression modeling was conducted to examine treatment, period, and interaction effects. RESULTS: Twenty-two participants completed the study, and no carryover or interaction effects were observed for any outcome. Significant treatment effects were observed for the timed stair climb, with greater improvements seen with the lateral wedges with arch support. Within-condition significant improvements were observed for WOMAC pain and physical function, as well as FFI-R pain and stiffness with lateral wedges with arch support use. More adverse effects were reported with the lateral wedges alone, while more people preferred the lateral wedges with arch support overall. CONCLUSIONS: Addition of custom arch support to a standard lateral wedge insole may improve foot and knee symptoms in people with knee OA and concomitant pronated feet. These preliminary findings suggest further research evaluating the role of shoe-worn insoles for treatment of this specific sub-group of people with knee OA is warranted. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02234895.

"Condoms are reliable but I am not": A qualitative analysis of AIDS-related beliefs and attitudes of young heterosexual adults in Budapest, Hungary, and St. Petersburg, Russia.

HIV and STD prevention is an essential component of public health initiatives in countries throughout Central and Eastern Europe. Liberalization in sexual values, declining age at first sex, higher levels of sexual activity, and inconsistent condom use have been well-documented among young people in the region following the political, economic, and cultural transitions after the end of the state socialism era. Less well-understood are the reasons for high-risk sexual behavior and psychosocial factors that must be addressed in the development of effective HIV/STD prevention programs. This study recruited members of 12 high-risk social networks of young adult men and women (n= 66 participants) in two cities, St. Petersburg, Russia, and Budapest, Hungary. In-depth focus groups were conducted with all members of each network, and qualitatively analyzed to examine factors surrounding high-risk sexual behavior. Main themes that emerged were that STDs are less known and less feared than AIDS, HIV risk factors were relatively well known among young adults in both countries but vulnerability is perceived differently, pregnancy prevention is a more immediate concern than protection from HIV or STDs, condom use declines quickly following first sex with a new partner, reintroducing condom use in a relationship is very difficult, and young adults report many barriers to condom use including those related to alcohol or other substance use. HIV/STD prevention programs are needed that extend beyond risk education alone and that also address critical psychological, social, and relationship factors related to sexual risk behavior.

Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet.

UNLABELLED: This study compared immediate changes in knee and ankle/subtalar biomechanics with lateral wedge orthotics with and without custom arch support in people with knee osteoarthritis and flat feet. Twenty-six participants with radiographic evidence of medial knee osteoarthritis (22 females; age 64.0 years [SD 8.0 years], BMI 27.2 kg/m(2) [4.2]) and flat feet (median foot posture index = + 5) underwent three-dimensional gait analysis for three conditions: Control (no orthotic), lateral wedge, and lateral wedge plus arch support. Condition order was randomized. Outcomes included frontal plane knee and ankle/subtalar biomechanics, and comfort. Compared to the control, lateral wedge and lateral wedge with arch support reduced the knee adduction moment impulse by 8% and 6%, respectively (p < 0.05). However, the lateral wedge resulted in a more everted foot position (4.3 degrees) than lateral wedge plus arch support (3.2 degrees) (p < 0.05). In contrast, lateral wedge plus arch support reduced foot frontal plane excursion compared to other conditions (p < 0.05). Participants self-reported significantly more immediate comfort with lateral wedge plus arch support compared to the control, whereas there was no difference in self-reported comfort between lateral wedge and control. No immediate changes in knee pain were observed in any condition. CLINICAL SIGNIFICANCE: Rather than prescribing lateral wedges to all patients with knee osteoarthritis, those who have medial knee osteoarthritis and flat feet may prefer to use the combined orthotic to reduce loads across the knee, and to minimize the risk of foot and ankle symptoms as a consequence of orthotic treatment. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1597-1605, 2016.

Vaccine hesitancy among healthcare workers in Europe: A qualitative study.

Healthcare workers (HCWs) are often referred to as the most trusted source of vaccine-related information for their patients. However, the evidence suggests that a number of HCWs are vaccine-hesitant. This study consists of 65 semi-structured interviews with vaccine providers in Croatia, France, Greece, and Romania to investigate concerns HCWs might have about vaccination. The results revealed that vaccine hesitancy is present in all four countries among vaccine providers. The most important concern across all countries was the fear of vaccine side effects. New vaccines were singled out due to perceived lack of testing for vaccine safety and efficacy. Furthermore, while high trust in health authorities was expressed by HCWs, there was also strong mistrust of pharmaceutical companies due to perceived financial interests and lack of communication about side effects. The notion that it is a doctor's responsibility to respond to hesitant patients was reported in all countries. Concerns were also seen to be country- and context-specific. Strategies to improve confidence in vaccines should be adapted to the specific political, social, cultural and economic context of countries. Furthermore, while most interventions focus on education and improving information about vaccine safety, effectiveness, or the need for vaccines, concerns raised in this study identify other determinants of hesitancy that need addressing. The representativeness of the views of the interviewed HCWs must be interpreted with caution. This a qualitative study with a small sample size that included geographical areas where vaccination uptake was lower or where hesitancy was more prevalent and it reflects individual participants' beliefs and attitudes toward the topic. As HCWs have the potential of influencing patient vaccination uptake, it is crucial to improve their confidence in vaccination and engage them in activities targeting vaccine hesitancy among their patients.