Human Papillomavirus Vaccination in Males: The State of the Science

Human papillomavirus (HPV) is an extremely prevalent sexually transmitted infection that is typically acquired soon after onset of sexual activity. The burden of HPV-related malignant and nonmalignant disease is high in men and women. High-risk or oncogenic types of HPV cause cervical, vaginal, and vulvar cancer in women. These types have also been shown to cause penile cancer in men and a substantial proportion of oropharyngeal and anal malignancy in men and women. Low-risk types of HPV cause anogenital warts. Prevention of penile, anal, and oropharyngeal cancers and anogenital warts represents potential benefits of the HPV vaccine in men. This review focuses on HPV disease in men, existing data on HPV vaccination in men, and various factors associated with the decision to vaccinate boys and young men, as well as the timing of vaccination.     

Preventing HIV infection among young immigrant Latino men: results from focus groups using community-based participatory research

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). Using a community-based participatory research (CBPR) approach to problem identification and exploration, a total of 74 Latino men (mean age 22.3, range 18-37) residing in an urban city in northwest North Carolina participated in one of eight focus groups on sexual health. Among the findings of this study, >75% of participants reported Mexico as their country of origin; other participants reported being from Central and South American countries. Qualitative data analysis identified 13 themes, which were grouped into the following three domains: 1) psychosocial factors identified as influencing sexual risk health behaviors; 2) system-level barriers to sexual health; and 3) characteristics of potentially effective HIV prevention intervention approaches. The study findings suggest that community-based, male-centered interpersonal networks that provide individual and group education and skill-building and incorporate curanderos (Latino healers) and bilingual experts may be important elements of potentially effective intervention approaches to reach Latino men, who have been inaccessible to conventional HIV prevention programs.     

Reliability of energy expenditure prediction equations in the weight management clinic

Background:  Few weight management clinics have access to indirect calorimetry with which to measure energy expenditure. Instead, they use energy expenditure prediction equations, which were not designed for use in obesity. We aimed to establish the extent to which such equations overestimate and underestimate resting energy expenditure (REE) in overweight and obese individuals. Methods:  We compared the Schofield, Harris & Benedict, James & Lean and World Health Organisation (WHO) REE prediction equations with the clinical gold standard of indirect calorimetry in 28 males and 168 females, with a mean (SD) age of 28.9 (6.4) years and body mass index (BMI) of 19–67 kg m^?2. Results:  The mean REE estimated by indirect calorimetry, and the Schofield, Harris & Benedict, James & Lean and WHO equations were 8.09, 8.30, 8.09, 8.37 and 8.23 MJ day^?1 (1934, 1983, 1933, 2001 and 1966 kcal day^?1), respectively. Although rising BMI exerted only a small effect on the mean differences between indirect calorimetry and the predicted REE [Schofield: +272 kJ (+65 kcal)/10 units BMI, P = 0.02; Harris & Benedict: +42 kJ (+10 kcal)/10 units BMI, P = 0.69; James & Lean: +217 kJ (+52 kcal) 10 units BMI, P = 0.06 and WHO: +42 kJ (+10 kcal) BMI, P = 0.11], the variance among overweight and obese patients of BMI >25 was substantially higher compared to that among normal weight subjects of BMI <25, on whom the equations were based. The estimated REE by Schofield for an individual of BMI 35 kg m^?2, for example, could lie anywhere from 2.78 MJ (661 kcal) above the indirect calorimetry value to 2.59 MJ (618) kcal below it. Conclusions:  Prediction equations offer a quick assessment of energy needs for hypocaloric diets although, in reality, they run the random risk of excessive restriction or further weight gain.     

Internet-based surveillance of Influenza-like-illness in the UK during the 2009 H1N1 influenza pandemic

Background  

Internet-based surveillance systems to monitor influenza-like illness (ILI) have advantages over traditional (physician-based) reporting systems, as they can potentially monitor a wider range of cases (i.e. including those that do not seek care). However, the requirement for participants to have internet access and to actively participate calls into question the representativeness of the data. Such systems have been in place in a number of European countries over the last few years, and in July 2009 this was extended to the UK. Here we present results of this survey with the aim of assessing the reliability of the data, and to evaluate methods to correct for possible biases.     

Civil defence in a nuclear disaster

Any nuclear war would be horrific and our main aim should be universal abolition of nuclear weapons. Civil defence, with its medical attributes, could certainly increase the survival rate should a disaster occur. The effect of the explosion of a nuclear warhead is outlined, together with what could be done to reduce casualties. Nuclear winter is discussed and it is suggested that the results of computerization of doubtful surmises have been treated too much as proven facts. The possibility of its occurrence should not deter emergency planning. Civil defence can save lives, and the fact that medicine as we know it would cease to exist in an all‐out nuclear war does not excuse us from doing what we can to increase the survival rate, if the worst should happen. Action should therefore be taken now to plan decentralization of resources and to instruct the public in protection, first aid and self‐sufficiency.     

Improvements in Health Care Use Associated With Community Coalitions: Long-Term Results of the Allies Against Asthma Initiative

Objectives. We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control.Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model.Results. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use.Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.In a previous issue of the Journal,1 we reported the sustainable asthma-care policy and system improvements for low-income children achieved by 7 community coalitions participating in the Allies Against Asthma initiative. Allies coalitions worked in areas of high-level asthma burden to lead community- and system-wide efforts to improve the quality of care and health status of children with the condition. Engagement of stakeholders and activities constituting the coalitions’ collaborative work, beginning in 2002, were described in detail elsewhere.2 Collectively, the coalitions succeeded in implementing 93 institutional, organizational, and public policy changes addressing clinical practice, care coordination, environmental conditions, and asthma management by families. We also reported that their work resulted in significant decreases in asthma symptoms among children and increases in parents’ sense of control over the disease in families participating in Allies sponsored interventions versus a comparison group.1This article presents data assessing changes in health care use for asthma by children residing in neighborhoods with extensive Allies activities compared with those without this exposure. This health care utilization study acknowledged that emergency department (ED) use and hospitalizations create significant burden on families in low-income neighborhoods, especially in African American and Hispanic populations.3,4 Furthermore, the costs of urgent care for childhood asthma are exceedingly high5 and constitute a serious burden not only for families but for the health care system. An important marker of success of the initiative would be the decreased need of Allies children for urgent health services subsequent to the activities of the Allies coalitions compared with children living in non-Allies communities.The premise of the study presented was that the policy and system changes achieved by Allies coalitions would reach beyond the cohort of children followed to ascertain differences in symptoms and quality of life to affect much larger numbers of children with asthma residing in Allies neighborhoods. Furthermore, the assumption was that the impact of sustained policy and system changes engendered by Allies coalitions for these larger numbers of low-income children would be observable. Over time, there would be a community-wide decrease in the need for urgent asthma care services in the children with asthma.After a planning period, implementation of Allies activities began by 2002, and coalitions were fully operational through 2004. This effectiveness study examined health care use in low-income children with asthma in Allies communities measured against comparison neighborhoods from 2002 to 2006, including 2 follow-up years (2005 and 2006) to assess sustained coalition effects. Outcomes assessed were differences in ED visits, urgent care visits, and hospitalizations for asthma.