Chapter 25: Education, training, and communication for HPV vaccines

As human papillomavirus (HPV) vaccines come to market, they will face education and training challenges similar to those of other new vaccines, along with HPV-specific issues. Recent studies document stark knowledge gaps about HPV at all levels--among policy makers, healthcare providers, parents, and teens--in both the industrialized and developing worlds. Pharmaceutical companies, public health advocates, medical trainers, and health educators need to understand their diverse audiences and respond appropriately to the needs of each. They also must use research-based communication strategies and materials to most effectively, and accurately, convey the need for an HPV vaccine and to manage expectations about how the vaccine can, and cannot, protect women and men.     

Serum cardiac troponin-I elevation in neonatal cardiac surgery is lesion-dependent

OBJECTIVE: Serum cardiac troponin-I (cTn-I) is a marker for myocardial injury in adults that undergoes developmental isoform change. To determine its utility as a myocardial injury marker in neonates, the authors examined the perioperative pattern of cTn-I elevation in neonates undergoing surgical repair for hypoplastic left-heart syndrome (HLHS) and transposition of great arteries (TGA). DESIGN: A prospective cohort study. SETTING: The study was performed in a tertiary teaching hospital that is a major referral center for congenital cardiac surgery. PATIENTS: Forty-five neonates were enrolled, 17 with HLHS, 15 with TGA with intact septum (TGA + IVS), 8 with TGA with ventricular septal defect (TGA + VSD), and 5 neonates undergoing extracardiac surgery who did not require cardiopulmonary bypass (CPB). INTERVENTIONS: None. RESULTS: Preoperative cTn-I was elevated in all neonates undergoing cardiac surgery with CPB. Increases in postoperative cTn-I correlated with duration of aortic cross-clamp application and CPB. Peak elevation in serum cTn-I occurred between 6 and 24 hours postoperatively in all neonates after cardiac surgery. The perioperative pattern of cTn-I was different in TGA + VSD (peak cTn-I = 10.9 +/- 5.9 ng/mL) compared with HLHS (peak cTn-I = 4.62 +/- 3.4 ng/mL) and TGA + IVS (peak cTn-I = 4.46 +/- 3.5 ng/mL). CONCLUSION: It was found that perioperative elevations in serum cTn-I in neonates with TGA and HLHS were influenced by duration of aortic cross-clamp application, CPB, and the presence of VSD.     

Prostate-specific antigen values in diabetic and nondiabetic US men, 2001-2002

Recent studies have shown that diabetic men have a lower risk of prostate cancer and that this association may be related to time since diagnosis. The authors examined the association between diabetes and prostate-specific antigen (PSA) levels, controlling for potential confounders, in a nationally representative cross-sectional survey of the US population (National Health and Nutrition Examination Survey 2001-2002). Diabetes classification was self-reported, and undiagnosed diabetes was determined with fasting plasma glucose measurements. Controlling for age, men with self-reported diabetes had a 21.6% lower geometric mean PSA level than men without diabetes. The difference increased with years since diagnosis (>10 years: 27.5% lower geometric mean PSA level). Overweight men who had had diabetes for more than 10 years had a predicted geometric mean PSA level 40.8% lower than that of nondiabetic, normal-weight men. These results are consistent with the hypothesis that long-term diabetes is associated with a lower risk of prostate cancer. The mechanism of this association may involve the regulation of PSA by androgens, although the authors are unable to confirm this assertion. Better understanding of the determinants of PSA level is needed to make the distinction between factors affecting the PSA test's accuracy and those altering the risk of prostate cancer.     

Phase 1/2 study of hypofractionated intensity-modulated radiation therapy for prostate cancer including simultaneously integrated boost

Purpose

This study evaluates the safety and efficacy of moderately hypofractionated radiation therapy (RT) with simultaneous integrated boost (HSIB) intensity modulated RT (IMRT) that includes coverage of the seminal vesicles (SVs) and pelvic lymph nodes (LNs).

Exploring gender differences among treatment-seekers who use opioids versus alcohol and other drugs

ABSTRACT

Identifying clinical differences between opioid users (OU) and alcohol and other drug users (AOD) may help to tailor treatment to OU, particularly among the majority of OU who are not on opioid agonist treatments. Given the dearth of research on these differences, this study explored gender differences in demographic and clinical characteristics between OU and AOD. Participants (N = 506) were from a multisite, randomized controlled clinical trial of an Internet-delivered psychosocial intervention conducted in 2010–2011. Logistic regression models explored differences in demographic and clinical characteristics by substance use category within and between women and men. Women OU were more likely to be younger, White, employed, benzodiazepine users, and less likely to have children or use cocaine and cannabis than women AOD. Men OU, compared to men AOD, were more likely to be younger, White, younger at first abuse/dependence, benzodiazepine users, and reported greater psychological distress, but were less likely to be involved in criminal justice or use stimulants. Interactions by gender and substance use were also detected for age of first abuse/dependence, employment, and criminal justice involvement. These findings provide a nuanced understanding of gender differences within substance use groups to inform providers for OU seeking treatment.     

Factors associated with human papillomavirus vaccination among young adult women in the United States

Background

Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases.

Objective

To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18–30 years.

Methods

Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18–26 (n = 1866) and 27–30 years (n = 1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression.

Results

Overall, 23.2% of women age 18–26 and 6.7% of women age 27–30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18–26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18–26 years (n = 490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n = 920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine.

Conclusions

HPV vaccination coverage among women age 18–26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.     

Use of human papillomavirus vaccines among young adult women in the United States: an analysis of the 2008 National Health Interview Survey

BACKGROUND:

The Centers for Disease Control and Prevention recommends catch‐up administration of human papillomavirus (HPV) vaccines to girls and women ages 13 to 26 who have not been vaccinated previously. In response to debate regarding catch‐up vaccination of young adult women, this study examined whether 18‐ to 26‐year‐old women most likely to benefit from catch‐up vaccination were aware of the HPV vaccine, and initiated the vaccine series by the end of 2008.

METHODS:

We used data from the 2008 National Health Interview Survey to assess HPV vaccine awareness and use, and reasons for not vaccinating, among women aged 18‐26 years (n = 1583). Sociodemographic, health care access, and health history factors associated with vaccine initiation were assessed using multivariate logistic regression.

RESULTS:

Overall, 11.7% of women aged 18‐26 years reported receiving at least 1 dose of the HPV vaccine by the end of 2008. In multivariate analyses, younger age, history of previous HPV infection, unmarried status, health insurance, flu shot in the past year, and receipt of 1 or more recommended lifetime vaccines were significantly associated with HPV vaccine initiation. Two‐fifths (39.6%) of unvaccinated women were interested in receiving the HPV vaccine (n = 1327). Primary reasons for lack of interest in the vaccine were belief that it was not needed, not knowing enough about it, concerns about safety, and not being sexually active.

CONCLUSION:

HPV vaccine coverage among young adult women was low, and lower among the uninsured than the insured. Public financing and care provision programs have the potential to expand vaccine coverage among uninsured women, who are at increased risk of cervical cancer. Cancer 2011;. © 2011 American Cancer Society.