Colombian Adolescents’ Perceptions of Violence and Opportunities for Safe Spaces Across Community Settings

During adolescence, access to safe environments is critical for healthy development. This study analyzed adolescents’ perceptions of safety in personal and public spaces in the semi-rural community of Santa Ana, Colombia on the Island of Barú (95.8% of inhabitants live in poverty). We used thematic analysis to explore adolescents’ experiences and reflections to identify the factors influencing their perception of safety across different community spaces. Four gender-segregated focus group discussions were held with 40 adolescents (20 male and 20 female) from ages 13 to 17 ( M = 14.4, SD = 1.2). Most of them self-identified as Black (86%). The more recurrent spaces in the adolescents’ conversations were the streets, the school, the local sports field, individual homes, and commercial sound system parties known as “Picos.” Adolescents perceived the school as the safest space, while the “Picos” were the most unsafe. The other spaces were considered mixed, meaning that their perceived safety shifts and depends on the presence of certain factors. These factors were risky behaviors, group affiliation, designated authority roles and the relevance of time. The authors discuss the importance of addressing the factors that inform adolescents’ safety perception, particularly within low resource settings cross-culturally.

A culture of care: How Lotus House Women's Shelter heals program participants through genuineness, space, high expectations, dignity, individualized attention, and community

The present study was designed to examine perceptions of Lotus House Women's Shelter from the perspective of former program participants, for the purpose of informing shelter programming and policies. Our qualitative research followed a community-based participatory research framework. Fifty diverse women graduates of Lotus House Women's Shelter participated in eight focus groups to discuss their experiences with Lotus House and other shelters. Findings from this study highlight the elements that create a "culture of care" within an organization. Participants described Lotus House shelter culture as genuine, defined by dignity and respect, having high expectations for guest independence and accountability, giving space to rest and recuperate, recognizing and accommodating individual needs and experiences, and fostering a sense of community. Creating an organizational "culture of care" is an avenue by which any shelter or related organization can enhance the experience of program participants.

Nonconsensual Porn as a Form of Intimate Partner Violence: Using the Power and Control Wheel to Understand Nonconsensual Porn Perpetration in Intimate Relationships

Over the last decade, nonconsensual porn (NCP), or the sharing of sexually explicit material without a person's consent, has become a growing problem with potentially far-reaching adverse consequences for victims. The purpose of this article is to propose and consider a framework for advancing the field's understanding of NCP within the context of intimate relationships including situating NCP relative to other forms of relational abuse. Specifically, we examined the extent to which NCP in intimate partner relationships was perpetrated using tactics from the Power and Control Wheel through a summative content analysis of U.S. news stories on NCP from 2012 to 2017. This analysis established that NCP has been perpetrated using all eight of the abuse metatactics in the Power and Control Wheel, with the three most common being emotional abuse, coercion and threats, and denial/blame/minimization. Treating NCP in relationships as a potential form of partner violence provides a basis on which to understand the etiology, manifestation, motives, and impact of this form of abuse and informs practitioners' ability to design prevention efforts and engage a trauma-informed response to survivors.

A Network Analysis of Domestic Violence Beliefs Among Young Adults in India

This study sought to describe the system of beliefs on gender, attitudes toward women, and wife beating, in young adults who live in Mysore, India. Furthermore, it identified structural sex differences in the interplay of values among these matters that can affect individual and community views toward domestic violence. Drawing from survey data gathered from 265 young adult Indian men and women, this study used network analysis to graph a correlation network of beliefs and attitudes toward domestic violence. Node, scale, and network structure descriptions allowed for comparisons among male and female participant responses. The findings support the assertion that there are sex differences among the system of beliefs toward wife beating among Indian young adults. Gender ideology, masculine role in relationships, and legal and social consequences of wife beating emerged as the most important values to focus on when addressing young men's beliefs of domestic violence and attitudes toward women. In contrast, values influencing women's perceptions of domestic violence are more complex and related to multiple beliefs about women's power, family structure, and social and legal implications of domestic violence. The results highlight the importance of recognizing gender differences in the connectivity between gender and wife beating beliefs when designing interventions. There is a need for efforts to accurately target these values and attitudes to more effectively address gendered attitudes and beliefs about domestic violence in this population.

Hispanic women's perceptions of teenage sexting: qualitative analyses using a sexual scripting framework

Research on sexting perceptions and practices among high school students is extensive; however, this work has focused on predominately White samples, ignoring Hispanic adolescent young women's experiences and interpretations related to sexting. This study used qualitative methods to examine Hispanic college women's reflections on their engagement in and perceptions of image-based sexting during high school. A total of 56 Hispanic college women participated in individual-interviews about high school sexting. Approximately 20% of participants reported sexting images of themselves during high school. The common perception among participants who did not sext was that girls who sent sexualised images of themselves in high school were attention seekers or responding to a request from a boy. Those who sent sexts reported having sent the images of themselves within the context of a romantic relationship. Teenage girls whose sexualised images were widely circulated were viewed negatively by both sexters and non-sexters and faced negative social repercussions. The results highlight the influence of traditional gendered sexual scripting norms on sexting perceptions irrespective of behavioural intentions.

Adolescent girls with a history of Commercial Sexual Exploitation (CSE): Perceptions and characteristics of social networks

BACKGROUND

Previous research has demonstrated that social support systems such as family, peers, or social services can play a role in adolescent girls' involvement in commercial sexual exploitation (CSE) (Hargreaves- Cormany & Patterson, 2016; Phillips, 2015, Reid & Piquero, 2016).

OBJECTIVES

Few studies have specifically explored the meanings adolescent girls with a history of CSE give to their social networks and how these may be associated with CSE vulnerability. The current study examines how important networks are labeled and characterized by these youth.

PARTICIPANTS

This study identifies the social networks used by eight racial/ethnic minority adolescent girls who have experienced CSE.

METHODS

Using individual interviews, participants were asked to identify individuals and systems with which they interact and provide meanings about these social supports' roles and value in their lives. Additionally, the degree to which participants viewed each source as influential was explored. Thematic analysis was used to analyze the data. Social Network Theory guided the analysis.

RESULTS

Two major themes emerged from the data: a) the social networks perceived as influential in the participants' daily lives and b) the perception of the social network's characteristics as negative or positive. Both positive and negative social networks contained some of the same members.

CONCLUSION

The current findings point to key social networks for racial/ethnic minority adolescent girls and the potential role of these networks regarding girls' CSE vulnerability. The duality of some network members illustrate the importance of viewing the role of social networks as both complex and dynamic for girls who have experienced CSE. Clinicians should take care to consider the role of intersectional factors when treating members of this community.

Using the Theory of Planned Behavior to Examine Beliefs About Verbal Sexual Coercion Among Urban Black Adolescents

This study used the theory of planned behavior to identify urban Black adolescents' beliefs about male-to-female verbal sexual coercion. Interviews were conducted with 91 urban, Black adolescents (53 boys and 38 girls) to identify their behavioral, normative, and control beliefs about verbal sexual coercion perpetration (for males) and resistance (for females). Boys reported that perpetrating verbal sexual coercion could result in negative relationship outcomes, and the main benefit of using this tactic was to obtain sex. Unsupportive peers and some male family members were seen as encouraging boys to use verbal sexual coercion, whereas parents were seen as opposed to the use of coercion. Being in a private context with a girl and having persuasive skill were seen as facilitating the use of coercion, whereas being with an experienced or skilled girl was a barrier. For girls, positive relationship outcomes and sexual health risks were the benefits and pitfalls of resisting verbal sexual coercion. "Real" friends and family were described as supporting girls' resistance to coercion, while "fake" friends, promiscuous girls, and male peers were seen as not supporting resistance. Girls believed being in a safe, public context would make it easier to resist coercion, while being in a stable relationship with an attractive and persistent partner would make it more difficult to resist. Knowing urban, Black adolescents' beliefs about verbal sexual coercion is the first step toward predicting and intervening on their perpetration and resistance behaviors.

An integrative behavior theory derived model to assess factors affecting HPV vaccine acceptance using structural equation modeling

The study examined factors that affect parental intention-to-vaccinate adolescent daughters with HPV vaccine in Mysore district, India. A cross-sectional study was conducted among 1609 parents of adolescent girls attending schools in Mysore District between February 2010 and October 2011. A validated questionnaire was used to assess parental attitudes, beliefs related with HPV infection, cervical cancer, HPV vaccine and vaccination in general. Structural equation modeling was used to estimate parameters and assess whether a model based on the integrative behavior theory would fit the current data. More than two-thirds (78.0%) of parents would accept vaccinating their daughters with HPV vaccine. Intention to HPV vaccination significantly increased with increase in the perception of parents about the benefits (standardized regression coefficient (β) = 0.39) or sources of information about HPV vaccine (β = 0.24), but intention decreased significantly with an increase in the perception about barriers to HPV vaccination β = -0.44). The effect of beliefs about severity of HPV infection or cervical cancer (β = 0.20), and beliefs about benefits (β = 0.20) or barriers (β = -0.25) to vaccination in general on intention to HPV vaccination were significantly mediated by parental attitudes and source of information about the vaccine. Geographical location significantly moderated the awareness about HPV on beliefs about severity of HPV infection or cervical cancer (β = 0.33), and the effect of religion on norms related to HPV vaccination (β = 0.19). Fit of the model to the data was acceptable. This study identified modifiable parental attitudes about HPV vaccine and beliefs related with HPV infection, cervical cancer and vaccination, which predicted parental intention-to-vaccinate their daughters with HPV vaccine in India. Health education interventions tailored to counter parental negative attitudes and beliefs about HPV vaccine and vaccination in general would be important for the community to promote HPV vaccination.

Knowledge, gender, and guidance: Factors influencing Indian mothers responses to Attention Deficit Hyperactivity Disorder (ADHD)

In the current study, we examined the socio-demographic characteristics and attitudes of Indian mothers, their knowledge about behaviors related to Attention Deficit Hyperactivity Disorder (ADHD) and the relationship with ADHD diagnosis among their children. Previous research showed 11.3% of primary school children in India have been diagnosed with ADHD, yet little research has been conducted on how mothers perceive these behaviors. A survey was completed by 100 mothers with children aged between 4-12 years. The Centers for Disease Control (CDC) ADHD Checklist for Children was used to assess the presence of ADHD symptoms in Indian children. The surveys were analyzed to identify maternal ADHD knowledge, socio-demographic characteristics and attitudes associated with ADHD within the context of Indian culture using SPSS. It was determined that the gender of the child, the geographical location the mother was raised, willingness of mother to seek professional help, mother's knowledge on handling child's behavior and mother's knowledge on ADHD were significantly associated with ADHD. Further analyses revealed that a lack of knowledge of ADHD and handling child's behavior were most associated with anADHD diagnosis based on the CDCADHD checklist.

Human Papillomavirus Vaccine Acceptability among Parents of Adolescent Girls in a Rural Area, Mysore, India

STUDY OBJECTIVE

The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India.

DESIGN

Cross-sectional.

SETTING

Mysore, India.

PARTICIPANTS

Parents of school-going adolescent girls.

INTERVENTIONS

Parents completed a validated self-administered questionnaire.

MAIN OUTCOME MEASURES

Parental willingness to vaccinate their daughters with HPV vaccine.

RESULTS

Of the 831 parents who participated in this study, 664 (79.9%) were willing to vaccinate their daughter with HPV vaccine sometime soon if they were invited to receive it. Higher odds of parental willingness to vaccinate their daughters with HPV vaccine was observed among those who believed that HPV vaccine is safe (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.01-4.45); their daughter might become sexually active (aOR, 1.84; 95% CI, 1.08-3.13); they have support of other family members to vaccinate their daughter (aOR, 2.86; 95% CI, 1.47-5.57); and that HPV infection causes severe health problems (aOR, 1.64; 95% CI, 1.04-2.57). In contrast, parents who believed that there is low risk that their daughter will get cervical cancer (aOR, 0.52; 95% CI, 0.29-0.95); that the family will disapprove of getting their daughter vaccinated (aOR, 0.45; 95% CI, 0.22-0.76); that the injection might cause pain (aOR, 0.53; 95% CI, 0.31-0.89), and were older-age parents (aOR, 0.96; 95% CI, 0.93-0.99) had lower odds of willingness to vaccinate daughters with HPV vaccine.

CONCLUSION

Acceptance of HPV vaccination for daughters was high among rural parents in Mysore, India. However, health education to reduce the belief that injection is painful and that daughters are at low risk to get cervical cancer is important to further improve parental HPV vaccine acceptability in Mysore. Public health education should target older-aged parents and extended family members.

Urban-Rural Inequities in the Parental Attitudes and Beliefs Towards Human Papillomavirus Infection, Cervical Cancer, and Human Papillomavirus Vaccine in Mysore, India

STUDY OBJECTIVE

The aim of this study was to compare the parental attitudes and beliefs about human papillomavirus (HPV), cervical cancer, and HPV vaccine between urban and rural areas, India.

DESIGN

Cross-sectional.

SETTING

Mysore, India.

PARTICIPANTS

Parents of school-going adolescent girls.

INTERVENTIONS

Parents completed a self-administered questionnaire.

MAIN OUTCOME MEASURES

Attitudes and beliefs about HPV, cervical cancer, and HPV vaccine.

RESULTS

A total of 1609 parents from urban (n = 778) and rural (n = 831) areas participated in this study. Most of the parents had never heard about HPV (73.6%), did not know that their daughters could get an HPV infection (62.7%) or cervical cancer (64.1%) in the future, and believed that HPV vaccine was not effective (67.1%). Parents living in the urban area were more likely to believe that HPV infection (adjusted odds ratio [aOR], 2.69; 95% confidence interval [CI], 1.43-5.06) and cervical cancer (aOR, 2.68; 95% CI, 1.83-3.91) could cause serious health problems than those living in the rural area. The odds of agreeing that HPV vaccination will make girls sexually active was lower among urban than rural parents (aOR, 0.55; 95% CI, 0.33-0.94). There was no significant difference among parents in the urban and rural areas in their beliefs about susceptibility of their daughter to HPV infection or cervical cancer, and beliefs about the safety and ability of HPV vaccine to protect against cervical cancer.

CONCLUSION

Rural parents might be reluctant to recommend behaviors that can help prevent HPV infection and cervical cancer such as HPV vaccination for their daughters.

Barriers to HPV Vaccination Among Unvaccinated, Haitian American College Women

Background: Haitian women residing in the United States are disproportionately affected by cervical cancer. Human papillomavirus (HPV) vaccine has been licensed in the United States since 2006. Vaccination rates are less than optimal overall, and the rates are particularly low among young black women. We investigated barriers to HPV vaccination in a sample of Haitian American college women. Methods: Thirty self-identified Haitian American women, aged 17-26 years, were recruited from a large university campus in southeastern United States (n=30). They completed in-depth face-to-face interviews. The research team analyzed the transcripts using thematic analysis. Results: More than half of the participants (n=18) had not yet initiated the HPV vaccine series. Most of the unvaccinated participants stated that they had received a provider recommendation for the vaccine. Lack of provider recommendation, negative vaccine perception and attitudes, and side effect concerns constituted barriers to vaccination. Conclusions: Haitian American college women at high risk of cervical cancer have cited several barriers to HPV vaccination, with the most prominent being lack of physician recommendation. Healthcare providers should continue recommending the vaccine to college women as many of them may not have received a recommendation. When recommending the HPV vaccine, discussions should be framed with the intent to positively influence HPV vaccine perceptions and ultimately vaccine attitudes.

Role of Healthcare Providers� Recommendation Style in HPV Vaccine Decision-Making among Haitian Parents and Female Patients

Background and Purpose: The strong influence of physician recommendation on vaccine uptake is well established in the literature. However, its influence on HPV vaccine decision-making among young Haitian women is understudied. This study investigated the role of healthcare providers� recommendation style in Haitian parents� and female patients� HPV vaccine decision-making. Methods: Thirty selfidentified Haitian women aged 17-26 years were recruited from a large university campus in the Southeastern United States (N=30). They completed in-depth face-to-face interviews regarding their HPV vaccine decision-making process. Transcripts were analyzed using thematic analysis. Results: Provider recommendation was cited as a major factor that influenced HPV vaccine uptake. Additionally, the framing of the HPV vaccine message greatly influenced vaccine decisions. Messages that framed the vaccine as a preventive measure for cervical cancer or as a preventive vaccine without an emphasis on the sexual transmission route of the virus were most effective. Messages that framed the vaccine as a preventive measure against a sexually transmitted infection did not positively influence young women to be vaccinated. Conclusions: These findings indicate that providers� recommendation style highly affects HPV vaccine decision. Thus, appropriate HPV vaccine framing is important for encouraging vaccine uptake in this ethnic group.

Addressing Prevention Among HIV-Uninfected Women in PMTCT Programs in South India

With nearly one million HIV-infected women in India, prevention of mother-to-child transmission (PMTCT) programs serve an important role. While PMTCT programs focus on mothers living with HIV infection, offering them to uninfected pregnant women may prevent maternal HIV infections. To inform future efforts to offer PMTCT programs to uninfected women, we conducted focus groups with 24 uninfected women in the South Indian state of Karnataka who had given birth within the previous 2 years to explore their perceptions and experiences about HIV education and screening during pregnancy. Although all the participants had undergone HIV testing at a public health facility during pregnancy, they reported little knowledge about HIV transmission or prevention. Revisions are needed in existing PMTCT program curricula and instruction methods before they can be offered to uninfected women as an HIV prevention strategy.

Influence of Parental Conflict Resolution Strategies on Hispanic College Women's Experiences With Verbal Aggression

The study investigates the relation between interparental verbal aggression, parent-daughter verbal aggression, and verbal aggression in female Hispanic college student's dating relationships ( N = 599). Results showed that mothers' high levels of verbal conflict with fathers were predictive of having high levels of verbal conflicts with their daughters. This in turn, predicted daughters' use of verbal conflict with their intimate partner. Similarly, fathers' high levels of verbal conflict with mothers were predictive of having high levels of verbal conflicts with their daughters. However, this was not found to be predictive of daughters' use of verbal conflict with their intimate partner.

Hispanic Parents’ Conflict Tactics Influence on College Women’s Verbal Aggression Victimization

Prior research has shown that college women in the United States are experiencing significantly high rates of verbal aggression (VA); approximately 20% to 30% of college women experience VA in their intimate relationships. Research has shown that familial conflict experiences directly influence these outcomes. Unfortunately, studies focusing on Hispanic college women’s experiences are almost nonexistent, despite the fact that they are members of the largest minority population on college campuses today. To address this void in the literature, the influence of parental conflict strategies on 905 Hispanic college women’s VA victimization in current romantic relationships was examined. Consistent with previous research, parental use of VA influenced VA victimization in participants’ current romantic relationship. This study provides important information about Hispanic college populations’ VA experiences, and the importance of familial processes in shaping these understandings.

Impact of Louisiana's HPV Vaccine Awareness Policy on HPV Vaccination Among 13- to 17-Year-Old Females

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) immunization for 11- to 12-year-old adolescents. In 2008, Louisiana required the school boards to distribute HPV vaccine information to parents or guardian of students in Grades 6 to 12. This article investigates the impact of this policy on HPV vaccination among 13- to 17-year-old female adolescents using National Immunization Survey-Teen (NIS-Teen) data. Drawing on the data from the 2008 to 2012 NIS-Teen, we compared the difference in proportions of females who have been vaccinated before and after the policy. Using difference-indifference estimation, we explored the change in vaccination rates before and after the policy implementation in Louisiana compared with Alabama and Mississippi, two states that did not have such a policy in place. The difference-in-differences estimates for HPV vaccination were not significant. Physician recommendation for HPV vaccination was significantly associated with vaccination among females in Louisiana and Alabama (adjusted odds ratio [aOR] = 7.74; 95% confidence interval [CI; 5.22, 11.5]), and for those in Louisiana and Mississippi (aOR = 7.05; 95% CI [4.6, 10.5]). Compared to the proportion of female adolescents who had received physician recommendation in Alabama or Mississippi, the proportion in Louisiana did not increase significantly in the postpolicy period. HPV vaccination rates did not increase significantly in Louisiana compared to Alabama or Mississippi following the implementation of the policy. Despite Louisiana's policy, physician recommendation remains the key determinant of HPV vaccination. HPV vaccine awareness does not necessarily result in HPV vaccination.

Factors Motivating HPV Vaccine Uptake Among Vaccinated and Nonvaccinated Hispanic Young Adult Women

Introduction:

To identify factors influencing human papillomavirus (HPV) vaccination up taking decision making among vaccinated and nonvaccinated Hispanic college women.

Participants:

Hispanic young women between the ages of 18 and 24 years ( N = 49). In total, 26 had not received the HPV vaccine, and 23 had started/completed the vaccine series.

Method:

Participants registered for the study via a psychology research pool at a large public university in the southeast United States after institutional review board approval. After completing a demographic information and HPV knowledge Web-based survey, participants were individually interviewed.

Results:

Differences in HPV vaccine knowledge emerged between vaccinated and nonvaccinated women. Fear of side effects, perceptions of risk, and sources of encouragement influenced willingness to be vaccinated against HPV. Health care providers played a central role in addressing concerns and promoting vaccination.

Conclusions:

Health care providers must address and integrate unique decision-making processes influencing Hispanic young adult women’s perceptions of HPV vaccination.

Social Networks Influencing Black Girls’ Interpretations of Chris Brown’s Violence Against Rihanna

This study identifies the social networks used by urban Black girls to interpret a highly publicized episode of dating violence and ensuing conflicts between hip-hop stars Chris Brown and Rihanna. Forty-three adolescent Black girls (age 11-17 years) were asked how they heard about the relationship conflicts and what they thought about them. The media, school peers, friends, and family members emerged as the key social networks participants relied on when gathering information about and interpreting reported incidents. The mainstream media was seen as portraying Brown, the perpetrator, negatively, whereas school peers, friends, and family were seen as portraying Brown in more mixed or positive ways. The degree to which participants viewed each source as influential depended on whether the source was seen as generally trustworthy and knowledgeable about hip-hop. While the media was a frequently cited source of information, participants did not trust the mainstream media’s analyses. In contrast, hip-hop media was viewed as the most unbiased and accurate information source. The importance of these networks in supporting healthy relationships for Black girls is discussed.

Social Networks Influence Hispanic College Women's HPV Vaccine Uptake Decision-making Processes

This qualitative study was designed to assess current and preferred social networks that influence human papillomavirus (HPV) vaccine decision making in a sample of Hispanic college women. Individual, semi-structured interviews were conducted with 41 Hispanic college women attending a large southeastern Hispanic-serving institution. Television commercials and discussions with mothers were found to be the most influential social networks for current HPV vaccination beliefs. Internet sites, close family members, and healthcare providers' communications were preferred social networks for HPV vaccine information. Perceived accessibility and sense of comfort influenced the order in which these social networks' communications would be accepted. Findings suggest that Hispanic college women utilize specific social networks to gather information and make decisions about HPV vaccination. Continued efforts are needed to promote further understanding of the purpose of the HPV vaccine via these preferred sources of information.

Young Hispanic Men and Human Papillomavirus Vaccination Choices

This exploratory descriptive study examined perceived vulnerabilities to human papillomavirus (HPV) and the correlation to factors influencing vaccine beliefs and vaccine decision making in young Hispanic males attending a large public urban university. Only 24% of participants believed that the HPV vaccine could prevent future problems, and 53% said they would not be vaccinated. The best predictors of HPV vaccination in young Hispanic men were agreement with doctor recommendations and belief in the vaccine's efficacy. Machismo cultural norms influence young Hispanic men's HPV-related decision making, their perceptions of the vaccine, and how they attitudinally act on what little HPV information they have access to. This study provides culturally relevant information for the development of targeted health education strategies aimed at increasing HPV vaccination in young Hispanic men.

Researching and Respecting the Intricacies of Isolated Communities

PURPOSE

Conducting research in a rural area can be challenging for nurses for a variety of different reasons. The task at hand can be especially difficult when it involves discussing a sensitive topic, such as Human Papillomavirus (HPV) vaccination. This study was conducted to describe parental perceptions of the HPV vaccine in rural areas, while simultaneously describing a method for engaging in successful nursing research in rural areas.

METHODS

A team of nurse researchers completed a planned process to first understand rural culture in southeastern Georgia, and then more specifically, the families living in these three separate counties. This process initially involved developing a connection and working relationship with key community leaders, such as school principals. Following this, researchers worked on establishing rapport and trust with local parents and research participants themselves. Qualitative methods were then used to collect focus group and interview data on parental views of HPV, HPV vaccination, and HPV-related cancers.

FINDINGS

Results indicated that parents had little knowledge of the HPV vaccine in rural Georgia, including misconceptions that the vaccine is for females only. In addition, many parents continually voiced the concern that the HPV vaccine would promote promiscuity in their children.

CONCLUSIONS

Providing consistent, timely, and open communication with the community members was crucial throughout the entire research process. This focused approach with respect to total community, culture, and religious value is essential in conducting research. Future studies conducted in rural areas should focus on specific intervention points that improve Parental HPV knowledge.

Cultural Values Influencing Immigrant Haitian Mothers' Attitudes Toward Human Papillomavirus Vaccination for Daughters

Although research has shown that mothers significantly influence daughters' willingness to be vaccinated against the human papillomavirus (HPV), cultural factors influencing immigrant Haitian mothers' willingness to have adolescent daughters to be vaccinated are unknown. This is of concern as this population experiences disproportionately higher rates of HPV infection and related cervical cancers. This study identifies cultural beliefs influencing 31 immigrant Haitian mothers' willingness to vaccinate their daughters against HPV using semistructured interviews. Mothers had low levels of HPV and HPV vaccine knowledge, and desired more information. Concerns centered on cultural values regarding adolescent sexuality and HIV/AIDS stigmas specific to Haitian communities. If vaccination were recommended by a physician, mothers are more likely to have their daughters vaccinated. HPV vaccination uptake efforts targeting Haitian months should emphasize physician involvement and incorporate culturally relevant health concerns.

The Role of Skin Color on Hispanic Women’s Perceptions of Attractiveness

This study relies on qualitative methods to investigate Hispanic women’s skin color perceptions. The primary goal is to identify the relevance of these perceptions on their beliefs about their own physical attractiveness. Thirty-four self-identified White-Hispanic women attending a large Hispanic Serving Institution in the southeastern United States were interviewed for this study. Unlike previous research findings on Hispanic women’s skin color preferences, findings identified a “tan” skin color as preferred; pale skin was viewed as “plain” and unattractive. This preference was associated with four themes about physical attractiveness: (1) desirability among their peer groups, (2) increased value in dating contexts, (3) sexual appeal to men, and (4) marker of Hispanic identity in social contexts. Findings from this study are important for those researchers addressing identity development and relationship issues among Hispanic populations in the United States.

Experience with high frequency oscillation ventilation during the 2009 H1N1 influenza pandemic in Australia and New Zealand

During the 2009 H1N1 pandemic, large numbers of patients had severe respiratory failure. High frequency oscillation ventilation was used as a salvage technique for profound hypoxaemia. Our aim was to compare this experience with high frequency oscillation ventilation during the 2009 H1N1 pandemic with the same period in 2008 by performing a three-month period prevalence study in Australian and New Zealand intensive care units. The main study end-points were clinical demographics, care delivery and survival. Nine intensive care units contributed data. During 2009 there were 22 H1N1 patients (17 adults, five children) and 10 non-H1N1 patients (five adults, five children), while in 2008, 18 patients (two adults, 16 children) received high frequency oscillation ventilation. The principal non-H1N1 high frequency oscillation ventilation indication was bacterial or viral pneumonia (56%). For H1N1 patients, the median duration of high frequency oscillation ventilation was 3.7 days (interquartile range 1.8 to 5) with concomitant therapies including recruitment manoeuvres (22%), prone ventilation (41%), inhaled prostacyclins (18%) and inhaled nitric oxide (36%). Seven patients received extracorporeal membrane oxygenation, six having H1N1. Three patients had extracorporeal membrane oxygenation concurrently, two as salvage therapy following the commencement of high frequency oscillation ventilation. In 2008, no high frequency oscillation ventilation patient received extracorporeal membrane oxygenation. Overall hospital survival was 77% in H1N1 patients, while survival in patients having adjunctive extracorporeal membrane oxygenation was similar to those receiving high frequency oscillation ventilation alone (65% compared to 71%, P = 1.00). Survival rates were comparable to published extracorporeal membrane oxygenation outcomes. High frequency oscillation ventilation was used successfully as a rescue therapy for severe respiratory failure. High frequency oscillation ventilation was only available in a limited number of intensive care units during the H1N1 pandemic.

Granulocyte-colony stimulating factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults

BACKGROUND

Granulocyte colony stimulating factor (G-CSF) is a naturally-occurring cytokine that has been shown to increase neutrophil function and number. Exogenous administration of recombinant G-CSF (filgrastim, pegfilgrastim or lenograstim) has found extensive use in the treatment of febrile neutropenia, but its role in the treatment of infection in non-neutropenic hosts is less well defined.

OBJECTIVES

We explored the role of G-CSF as an adjunct to antibiotics in the treatment of pneumonia in non-neutropenic adults.

SEARCH STRATEGY

For this updated review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2006); MEDLINE (1950 to January 2007); EMBASE (1988 to January 2007); and online databases of clinical trials (www.controlled-trials.com, updated 10 November, 2006).

SELECTION CRITERIA

We considered randomized controlled trials (RCTs) which included hospitalized adult patients with either community-acquired pneumonia or hospital-acquired pneumonia.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed trial quality. The primary outcome measure was 28-day mortality. Secondary outcome measures included other markers of mortality as well as markers of adverse events, including organ dysfunction. An assessment of methodological quality was made for each study.

MAIN RESULTS

Six studies with a total of 2018 people were identified. G-CSF use appeared to be safe with no increase in the incidence of total serious adverse events (pooled odds ratio (OR) 0.91; 95% confidence interval (CI): 0.73 to 1.14) or organ dysfunction. However, the use of G-CSF was not associated with improved 28-day mortality (pooled OR 0.81; 95% CI: 0.52 to 1.27).

AUTHORS' CONCLUSIONS

There is no current evidence supporting the routine use of G-CSF in the treatment of pneumonia. Studies in which G-CSF is administered prophylactically or earlier in therapy may be of interest.

Percutaneus translumbar inferior vena cava venous access in an intensive care patient

We report the case of a critically ill 30-year-old chronic haemodialysis patient with a history of intravenous substance abuse whose intravenous access sites had become exhausted. She subsequently underwent elective insertion of a percutaneous translumbar inferior vena caval paired Tesio catheter and peripherally inserted central catheter (PICC line). This technique has been used successfully in patients who require longstanding central venous access (hyperalimentation, chemotherapy, chronic renal hemodialysis patients). This approach could be an alternative where the standard access routes have become non-viable.

Terlipressin infusion in catecholamine-resistant shock

Catecholamine-resistant shock is not uncommon in intensive care. Bolus dose terlipressin (a vasopressin analogue) has been used successfully in this setting allowing cessation of other vasopressor agents. The relative vasopressin deficiency in combination with the restoration of the vascular tone (by blocking adenosine triphosphate potassium-sensitive channels) by exogenous vasopressin may be the explanation of these beneficial effects. We describe a case report where the use of a continuous terlipressin infusion was associated with a dramatic improvement. To our knowledge there have been no previous reports of the use of terlipressin by continuous infusion for the treatment of catecholamine-resistant shock.

Granulocyte-Colony Stimulating Factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults

BACKGROUND

Granulocyte colony stimulating factor (G-CSF) is a naturally-occurring cytokine that has been shown to increase neutrophil function and number. Exogenous administration of recombinant G-CSF (filgrastim, pegfilgrastim or lenograstim) has found extensive use in the treatment of febrile neutropaenia, but its role in the treatment of infection in non-neutropaenic hosts is less well defined.

OBJECTIVES

We explored the role of G-CSF as an adjunct to antibiotics in the treatment of pneumonia in non-neutropaenic adults.

SEARCH STRATEGY

We searched the following electronic databases in 2003 and updated the search in 2004: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004); MEDLINE (January 1966 to March Week 1, 2004); EMBASE (1998 to December 2003); online databases of clinical trials; and reference lists of articles. We also contacted study authors, manufacturers and distributors of G-CSF.

SELECTION CRITERIA

We considered randomised controlled trials (RCTs) which included hospitalised adult patients with either community acquired pneumonia or hospital-acquired pneumonia.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data and assessed trial quality. The primary outcome measure was 28 day mortality. Secondary outcome measures included other markers of mortality as well as markers of adverse events, including organ dysfunction. An assessment of methodological quality was made for each study.

MAIN RESULTS

Six studies with a total of 1984 people were identified. G-CSF use appeared to be safe with no increase in the incidence of total serious adverse events (pooled odds ratio (OR) 0.91; 95% confidence interval (CI): 0.73 to 1.14) or organ dysfunction. However, the use of G-CSF was not associated with improved 28 day mortality (pooled OR 0.86; 95% CI: 0.56 to 1.31).

REVIEWERS' CONCLUSIONS

There is no current evidence supporting the routine use of G-CSF in the treatment of pneumonia. Studies in which G-CSF is administered prophylactically or earlier in therapy may be of interest.

Eliminating disparities in HIV disease: community mobilization to prevent HIV transmission among Black and Hispanic young adults in Broward County, Florida

A coalition led by public health professionals adopted the PRECEDE-PROCEED model for community planning and health promotion to eliminate local disparities in HIV disease. Discussion groups and other formative evaluation activities conducted during the first year of the project maximized input from community members and community-based organizations. Twelve of 53 ZIP-code areas, which accounted for 73% of reported AIDS cases among Black and Hispanic young adults (18 to 39 years) from 1994 through 1999, were selected as the primary sites for intervention. Horizontal outreach to residents, vertical outreach to stakeholders and gatekeepers, strategic communications, and capacity building and infrastructure development, were chosen as the most promising activities to promote behavioral and social change. Results from baseline computer-assisted telephone-interview (CATI) surveys completed with 2,011 community residents in 2001, and first-year follow-up interviews with 2,381 in 2002, indicated that: awareness of program efforts had increased from 5.4% in 2001 to 6.7% in 2002; recognition of the extent of the HIV/AIDS problem had increased from 27.5% in 2001 to 35.3% in 2002; and participation in HIV-prevention efforts had increased significantly. Interventions are reaching the target audience, informing young adults of the risks of HIV infection, and encouraging them to take ownership and action.

Operation Bali assist--the Royal Darwin Hospital Intensive Care Unit

On October 12, 2002 the Bali bombing resulted in 62 severely injured patients being evacuated to Royal Darwin Hospital. This paper describes the planning and execution of the Intensive Care Unit disaster plan in the wake of the Bali bombing. There were a total of 20 patients from the Bali blast admitted to the Intensive Care Unit. The disaster operation was successful with all patients admitted, resuscitated, emergency treatment performed and then evacuated to interstate burns units in a timely and efficient manner.

Ear drops for the removal of ear wax

BACKGROUND

Problems attributed to the accumulation of wax (cerumen) are one of the most common reasons for people to present to their general practitioners with ear trouble (Sharp 1990). Treatment for this condition often involves use of a wax softening agent (cerumenolytic) in order to disperse the cerumen and reduce the need for syringing, or to facilitate syringing should it prove necessary, but there is no consensus on the effectiveness of the wide variety of cerumenolytics in use.

OBJECTIVES

To assess the effectiveness of ear drops (cerumenolytics) for the removal of symptomatic ear wax.

SEARCH STRATEGY

We searched the Cochrane ENT Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2003), and MEDLINE and EMBASE up to March 2003. Reference lists of all trials were also manually searched.

SELECTION CRITERIA

We identified all randomised controlled trials (with or without blinding) in which a cerumenolytic was evaluated in comparison with either no treatment, a placebo, or other cerumenolytics in participants with hard or impacted ear wax, and in which the proportion of participants with sufficient clearance of the external canal to make further mechanical clearance unnecessary (primary outcome measure) was stated or calculable. The full text articles of all the retrieved trials of possible relevance were reviewed by the two reviewers and the inclusion criteria applied independently. Any differences in opinion about which studies to include in the review were resolved by discussion.

DATA COLLECTION AND ANALYSIS

Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner by one reviewer and rechecked by the other reviewer, and where necessary investigators were contacted to obtain missing information. Meta-analysis was neither possible nor considered appropriate because of the heterogeneity of the treatments, treatment amounts and durations, trial procedures, and scoring systems. A narrative overview of the results is therefore presented.

MAIN RESULTS

Eight trials satisfied the inclusion criteria, the majority of which were of poor quality. In all, 587 participants received one of nine different cerumenolytics. One trial compared active treatments with no treatment, two trials compared active treatments with water or a saline 'placebo', and all eight trials placed two or more active treatments in head-to-head comparisons. Seven trials included syringing as a secondary treatment where necessary.Overall, results were inconclusive. One trial found a significant difference between one of three active agents (Cerumol) in comparison to no treatment, but no statistically significant difference was found between these three agents (sodium bicarbonate ear drops; Cerumol; sterile water). In two trials no statistical difference was found between the effectiveness of either sodium bicarbonate ear drops, Cerumol, Cerumenex or Colace versus a sterile water or saline 'placebo'. Three trials (from the same source) found statistically significant differences in favour of the same active agent (Exterol) in comparison to glycerol and Cerumol. Three trials found no statistically significant difference between two or more cerumenolytics (Otocerol versus Cerumol; Audax versus Earex; sodium bicarbonate ear drops versus Cerumol). Two trials comparing the same two cerumenolytics (Cerumenex versus Colace) also failed to show any significant benefit of one over the other. No serious adverse effects were reported from any of the interventions.

REVIEWER'S CONCLUSIONS

Trials to date have been heterogeneous and of poor quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic ear wax. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo and/or no treatment.

An audit of the use of granulocyte colony-stimulating factor in septic shock

BACKGROUND

Granulocyte colony-stimulating factor (G-CSF) stimulates the production of neutrophils and modulates the function and activity of developing and mature neutrophils. In septic shock, the immune system can be considered one of the failing organ systems. G-CSF improves immune function and may be a useful adjunctive therapy in patients with septic shock.

AIM

To evaluate the introduction of G-CSF as an adjunct to our standard treatment for community-acquired septic shock.

METHODS

We performed a prospective data collection and analysis to determine whether the addition of G-CSF to our standard treatment for community-acquired septic shock was associated with improved hospital outcome, compared with an historical cohort of similar patients. We included all patients admitted to the Intensive Care Unit (ICU) with community-acquired septic shock between December 1998 and March 2000. Patients received 300 microg G-CSF intravenously daily for 10 days in addition to our standard treatment for community-acquired septic shock. G-CSF was discontinued early if the patient was discharged from ICU before 10 days or if the absolute neutrophil count exceeded 75 x 10(6)/mL.

RESULTS

A total of 36 patients with community-acquired septic shock, an average Apache 2 score of 26.7, and a predicted mortality of 0.79, were treated with G-CSF from December 1998 to March 2000. Hospital mortality was 31% compared with an historical cohort of 11 similar patients with a hospital mortality of 73% (P = 0.018). In the subgroup of patients with melioidosis septic shock, the hospital survival improved from 5% to 100% (P < 0.0001). No significant adverse events occurred as a result of the administration of G-CSF.

CONCLUSION

G-CSF is a safe adjunctive therapy in community-acquired septic shock and may be associated with improved outcome. The use of G-CSF in septic shock should undergo further investigation to define subgroups of patients who may benefit from G-CSF. The use of G-CSF in patients with septic shock due to Burkholderia pseudomallei is recommended.

Influence of isometric exercise on blood flow and sweating in glabrous and nonglabrous human skin

The distribution of the reflex effects of isometric exercise on cutaneous vasomotor and sudomotor function is not clear. We examined the effects of isometric exercise by different muscle masses on skin blood flow (SkBF) and sweat rate (SR) in nonglabrous skin and in glabrous skin. The latter contains arteriovenous anastomoses (AVAs), which cause large fluctuations in SkBF. SkBF was measured by laser-Doppler flowmetry (LDF) and reported as cutaneous vascular conductance (CVC; LDF/mean arterial pressure). SR was measured by capacitance hygrometry. LDF and SR were measured at the sole, palm, forearm, and ventral leg during separate bouts of isometric handgrip (IHG) and isometric leg extension (ILE). CVC and its standard deviation decreased significantly during IHG and ILE in the palm and sole (P < 0.05) but not in the forearm or leg (P > 0.05). Only palmar SR increased significantly during IHG and ILE (P < 0.05). We conclude that the major reflex influences of isometric exercise on the skin include AVAs and palmar sweat glands and that this is true for both arm and leg exercise.

The influence of topical capsaicin on the local thermal control of skin blood flow in humans

To test whether heat-sensitive receptors participate in the cutaneous vascular responses to direct heating, we monitored skin blood flow (SkBF; laser Doppler flowmetry) where the sensation of heat was induced either by local warming (T(Loc); Peltier cooling/heating unit) or by both direct warming and chemical stimulation of heat-sensitive nociceptors (capsaicin). In part I, topical capsaicin (0.075 or 0.025%) was applied to 12 cm(2) of skin 1 h before stepwise local warming of untreated and capsaicin-treated forearm skin. Pretreatment with 0.075% capsaicin cream shifted the SkBF/T(Loc) relationship to lower temperatures by an average of 6 +/- 0.8 degrees C (P < 0.05). In part II, we used a combination of topical capsaicin (0.025%) and local warming to evoke thermal sensation at one site and only local warming to evoke thermal sensation at a separate site. Cutaneous vasomotor responses were compared when the temperatures at these two sites were perceived to be the same. SkBF differed significantly between capsaicin and control sites when compared on the basis of actual temperatures, but that difference became insignificant when compared on the basis of the perceived temperatures. These data suggest heat-sensitive nociceptors are important in the cutaneous vasodilator response to local skin warming.

Diurnal variation in cutaneous vasodilator and vasoconstrictor systems during heat stress

It is not clear whether the diurnal variation in the cutaneous circulatory response to heat stress is via the noradrenergic vasoconstrictor system or the nonadrenergic active vasodilator system. We conducted whole body heating experiments in eight male subjects at 0630 (AM) and 1630 (PM). Skin blood flow was monitored by laser-Doppler flowmetry at control sites and at sites pretreated with bretylium (BT) to block noradrenergic vasoconstriction. Noninvasive blood pressure was used to calculate cutaneous vascular conductance. The sublingual temperature (T(or)) threshold for cutaneous vasodilation was significantly higher in PM at control and at BT-treated sites (both P < 0.01), suggesting the diurnal shift in threshold depends on the active vasodilator system. The slope of cutaneous vascular conductance as a percentage of its maximum with respect to T(or) was significantly lower in AM at control sites only. Also, in the AM, the slope at control sites was significantly lower than that at BT-treated sites (P < 0.05), suggesting that the diurnal change in the sensitivity of cutaneous vasodilation depends on vasoconstrictor system function. Overall, the diurnal variation in the reflex control of skin blood flow during heat stress involves both vasoconstrictor and active vasodilator systems.

Nonnoradrenergic mechanism of reflex cutaneous vasoconstriction in men

We tested for a nonnoradrenergic mechanism of reflex cutaneous vasoconstriction with whole body progressive cooling in seven men. Forearm sites (<1 cm(2)) were pretreated with: 1) yohimbine (Yoh; 5 mM id) to antagonize alpha-adrenergic receptors, 2) Yoh plus propranolol (5 mM Yoh-1 mM PR id) to block alpha- and beta-adrenergic receptors, 3) iontophoretic application of bretylium tosylate (BT) to block all sympathetic vasoconstrictor nerve effects, or 4) intradermal saline. Skin blood flow was measured by laser Doppler flowmetry and arterial pressure by finger photoplethysmography; cutaneous vascular conductance (CVC) was indexed as the ratio of the two. Whole body skin temperature (T(SK)) was controlled at 34 degrees C (water-perfused suit) for 10 min and then lowered to 31 degrees C over 15 min. During cooling, vasoconstriction was blocked at BT sites (P > 0.05). CVC at saline sites fell significantly beginning at T(SK) of 33.4 +/- 0.01 degrees C (P <0.05). CVC at Yoh-PR sites was significantly reduced beginning at TSK of 33.0 +/- 0.01 degrees C (P < 0.05). After cooling, iontophoretic application of norepinephrine (NE) confirmed blockade of adrenergic receptors by Yoh-PR. Because the effects of NE were blocked at sites showing significant reflex vasoconstriction, a nonnoradrenergic mechanism in human skin is indicated, probably via a sympathetic cotransmitter.

Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature

In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 86% (43 of 50 patients) among those with septic shock. Pneumonia accounted for 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%), soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk factors included diabetes (37%), excessive alcohol intake (39%), chronic lung disease (27%), chronic renal disease (10%), and consumption of kava (8%). Only 1 death occurred among the 51 patients (20%) with no risk factors (relative risk, 0.08; 95% confidence interval, 0.01-0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality. Strategies are needed to decrease the high mortality with melioidosis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.

Influence of female reproductive hormones on local thermal control of skin blood flow

Progesterone and estrogen modify thermoregulatory control such that, when both steroids are elevated, body temperature increases and the reflex thermoregulatory control of cutaneous vasodilation is shifted to higher internal temperatures. We hypothesized that the influence of these hormones would also include effects on local thermal control of skin blood flow. Experiments were conducted in women in high-hormone (HH) and low-hormone (LH) phases of oral contraceptive use. Skin blood flow was measured by laser-Doppler flowmetry, and local temperature (T(loc)) was controlled over 12 cm(2) around the sites of blood flow measurement. T(loc) was held at 32 degrees C for 10-15 min and was then decreased at one site from 32 to 20 degrees C in a ramp over 20 min. Next, T(loc) was increased from 32 to 42 degrees C in a ramp over 15 min at a separate site. Finally, T(loc) at both sites was held at 42 degrees C for 30 min to elicit maximum vasodilation; data for cutaneous vascular conductance (CVC) are expressed relative to that maximum. Whole body skin temperature (T(sk)) was held at 34 degrees C throughout each study to minimize reflex effects from differences in T(sk) between experiments. Baseline CVC did not differ between phases [8.18 +/- 1.38 (LH) vs. 8. 41 +/- 1.31% of maximum (HH); P > 0.05]. The vasodilator response to local warming was augmented in HH (P < 0.05, ANOVA). For example, at T(loc) of 40-42 degrees C, CVC averaged 76.41 +/- 3.08% of maximum in HH and 67.71 +/- 4.43% of maximum in LH (P < 0.01 LH vs. HH). The vasoconstrictor response to local cooling was unaffected by phase (P > 0.05). These findings indicate that modifications in cutaneous vascular control by female steroid hormones include enhancement of the vasodilator response to local warming and are consistent with reports of the influence of estrogen to enhance nitric oxide-dependent vasodilator responses.