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To meet lofty human papillomavirus (HPV) immunization goals in Tanzania, the Ministry of Health integrated HPV vaccination with adolescent health services using a school-based approach. A qualitative study was conducted in June–July 2021, examining the feasibility and sustainability of an integrated service package, HPV Plus. In-depth interviews with 46 programme implementers (i.e. health-care workers and teachers) and planning stakeholders (i.e. government officials and school administrators) in Dar es Salaam and Njombe Regions explored enablers and constraints to HPV Plus programme implementation, including resource and staffing requirements. Two facilitators and three barriers to HPV Plus feasibility and sustainability were identified from thematic analysis of interviews. Interviewed stakeholders emphasized the programme’s feasibility, especially if the efficiencies offered by a school-based platform were optimized. Implementation facilitators included (1) optimized service delivery efficiency through a school-based platform and (2) resources saved by combining adolescent health services and HPV immunization into a single programme package. Key barriers to HPV Plus feasibility and sustainability were (1) time, space and resource constraints (e.g. commodity stockouts and challenges delivering the complete service package to large cohorts of students within allotted times); (2) human resource gaps and increased workloads within the health workforce and (3) insufficient referral mechanisms linking schools to health facilities. Scaling up HPV Plus will require proactive commodity procurement and security; resource mobilization to reach ambitious service delivery targets and close co-ordination of programme implementation with school administrators.

The vaccine decision-making process of pregnant and lactating women is complex. Regarding COVID-19, pregnant women are at increased risk for severe disease and poor health outcomes. While pregnant and lactating women were excluded from COVID-19 vaccine trials, available evidence suggests that COVID-19 vaccines are safe and protective during pregnancy. In this study, we used a socio-ecological approach to explore factors influencing the decision-making process for COVID-19 vaccines in pregnant and lactating women in Kenya, for the purpose of informing demand generation strategies. As pregnant and lactating women are influenced by many factors, we conducted 84 in-depth interviews with a variety of stakeholders, including 31 pregnant or lactating women, 20 healthcare workers such as nurses, midwives, doctors, and frontline workers, 25 male family members of pregnant or lactating women, and 8 gatekeepers such as community leaders and faith-based leaders. These individuals were recruited from six communities in Kenya: three urban, and three rural. We applied a grounded theory approach to identify emerging themes and organized emerging themes using the SAGE Vaccine Hesitancy model, which includes three categories of determinants of vaccine acceptance, including contextual influences, individual and group influences, and vaccine and vaccination specific issues. Myths, interpersonal norms, and religion emerged as themes related to contextual influences. Safety, risk perception, and the role of the healthcare worker emerged as themes related to individual and group influences. For vaccine and vaccination specific issues, emerging themes included availability, accessibility, and eligibility. While maternal immunization can substantially reduce the effect of infectious diseases in mothers and infants, vaccine acceptance is critical. However, vaccines do not save lives; vaccination does. We hope the results of this study can be used to tailor communication efforts to increase vaccine demand among pregnant and lactating women.

WHO recommends human papillomavirus (HPV) testing and same-day treatment for cervical screening in low-income and middle-income countries (LMICs); however, few published data exist on the validity of the strategy. We aimed to evaluate the clinical performance, treatment completion rates, adverse events profile, and acceptability of a fully integrated strategy, comprising point-of-care HPV DNA testing of self-collected specimens and same-day thermal ablation, for screening of cervical cancer in women in Papua New Guinea.HPV-STAT was a large-scale, prospective, single-arm intervention trial conducted at two clinical sites in Papua New Guinea. Cervical screening clinics with an on-site consultant gynaecologist were selected in consultation with national and provincial health authorities, church health services, and local stakeholders. Eligible participants were women aged 30-59 years attending cervical screening services at the two clinics, who were willing to comply with study procedures and able to provide written informed consent. Women self-collected vaginal specimens for point-of-care GeneXpert testing (Cepheid, Sunnyvale, CA, USA) for oncogenic HPV types. Women testing positive for HPV underwent pelvic examination followed by same-day thermal ablation or referral for gynaecology review. All HPV-positive women and a 15% random sample of HPV-negative women provided a clinician-collected cervical specimen for liquid-based cytology. The primary outcome was clinical performance (ie, sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of the strategy for the detection of high-grade squamous intraepithelial lesion (HSIL) or worse. This trial is registered with ISRCTN, ISRCTN13476702.Between June 5, 2018, and Jan 6, 2020, we recruited 4285 women, 3638 (84·9%) of whom tested negative for HPV and 647 (15·1%) tested positive for one or more oncogenic HPV type. Sensitivity of the algorithm to detect HSIL or worse was 85·4% (95% CI 81·0-89·6), with specificity 89·6% (88·6-90·6), PPV 35·2% (31·6-39·0), and NPV 98·9% (98·6-99·2). Among HPV-positive women, 602 (93·0%) received same-day thermal ablation and 42 (6·5%) were referred for gynaecology review, 37 (88·1%) of whom attended. Acceptability was high among both HPV-positive and HPV-negative women. Among the 329 HPV-positive women who attended a 3-month follow-up visit, 51 (15·5%) reported mild adverse symptoms that resolved in all cases by the follow-up visit. There were no serious adverse events.We conducted the first real-world evaluation of a fully integrated point-of-care HPV self-collect, test, and treat strategy for same-day cervical screening in a LMIC and found it to be effective, acceptable, and safe when implemented at scale in primary health-care facilities in Papua New Guinea. Our findings support the introduction and scale-up of HPV screening and treatment for the control and elimination of cervical cancer in LMICs, as recommended by WHO.Australian National Health and Medical Research Council.

To evaluate the evidence describing how the controlled temperature chain approach for vaccination could lead to improved equitable immunization coverage in low- and middle-income countries.We created a theory of change construct from theWe evaluated 34 articles, describing 22 unique controlled temperature chain or closely related experiences across four World Health Organization regions. We identified a strong demand for this approach among service delivery providers; however, generating an equal level of demand among policy-makers requires greater evidence on economic benefits and on vaccination coverage gains, and use case definitions. Consistent evidence supported safety of the approach when integrated into special vaccination programmes. Feasible training and supervision supported providers in complying with protocols. Time-savings were the main evidence for efficiency gains, while cost-saving data were minimal. Improved equitable coverage was reported where vaccine storage beyond the cold chain enabled access to hard-to-reach populations. No evidence indicated an inferior vaccine effectiveness nor increased adverse event rates for vaccines delivered under the approach.Synthesized evidence broadly supported the initial theory of change. Addressing evidence gaps on economic benefits and coverage gains may increase future uptake.Évaluer les preuves exposant la manière dont la chaîne de température contrôlée pourrait constituer l'approche idéale pour garantir une couverture vaccinale plus équitable dans les pays à revenu faible et intermédiaire.Nous avons élaboré un concept basé sur la théorie du changement figurant dansNous avons examiné 34 articles décrivant 22 chaînes de température contrôlée ou d'autres expériences similaires dans quatre régions de l'Organisation mondiale de la Santé. Nous avons identifié une forte demande pour cette approche chez les fournisseurs de services; cependant, pour déclencher une demande identique chez les législateurs, il faut plus d'arguments axés sur les retombées économiques et l'amélioration de la couverture vaccinale, ainsi que des définitions de cas d'utilisation. De nombreux éléments probants ont confirmé que l'approche était sûre lorsqu'elle est intégrée dans des programmes de vaccination spéciaux. Assurer un niveau de formation et de supervision acceptable a permis aux fournisseurs de se conformer aux protocoles. Le gain de temps est le principal atout en termes d'efficacité, tandis que les données sur la réduction des coûts sont limitées. Stocker les vaccins au-delà de la chaîne du froid a rendu la couverture vaccinale plus équitable car les populations difficiles à atteindre ont ainsi pu y avoir accès. Rien n'a permis d'indiquer une diminution de l'efficacité des vaccins ou un taux d'effets indésirables plus élevé pour les vaccins fournis dans le cadre de cette approche.La synthèse des preuves a largement corroboré la théorie du changement. Apporter des arguments supplémentaires pour démontrer ses bienfaits en matière d'économie et de couverture vaccinale pourrait favoriser l'adhésion.Evaluar las pruebas que describen cómo el enfoque de la cadena de temperatura controlada para la vacunación podría suponer una mejora de la cobertura de inmunización equitativa en los países de ingresos bajos y medios.Se creó un constructo de teoría del cambio a partir de laSe evaluaron 34 artículos, que describían 22 experiencias específicas de cadena de temperatura controlada o muy relacionadas en cuatro regiones de la Organización Mundial de la Salud. Se identificó una fuerte demanda de este enfoque entre los prestadores de servicios; sin embargo, para generar un nivel igual de demanda entre los responsables de formular políticas se requieren mayores pruebas sobre los beneficios económicos y de la cobertura de vacunación, así como definiciones de casos de uso. Las pruebas consistentes apoyan la seguridad del enfoque cuando se integra en programas especiales de vacunación. La formación y la supervisión factibles ayudaron a los prestadores a cumplir los protocolos. El ahorro de tiempo fue la principal prueba de los beneficios de eficiencia, mientras que los datos de ahorro de costes fueron mínimos. Se informó de una mayor cobertura equitativa cuando el almacenamiento de vacunas más allá de la cadena de frío permitió el acceso a poblaciones de difícil acceso. No hay pruebas que indiquen una menor eficacia de las vacunas ni un aumento de las tasas de efectos adversos de las vacunas suministradas mediante este enfoque.La síntesis de las pruebas apoyaron ampliamente la teoría inicial del cambio. Resolver las deficiencias de las pruebas sobre los beneficios económicos y de cobertura podría aumentar su adopción en el futuro.تقييم الأدلة التي تصف كيف يمكن لأسلوب التطعيم بسلسلة درجات الحرارة الخاضعة للتحكم، أن يؤدي إلى تحسين تغطية التحصين المتكافئة في الدول ذات الدخل المنخفض والدخل المتوسط.لقد وضعنا نظرية لبناء التغيير من سلسلة درجات الحرارة الخاضعة للتحكم: خارطة طريق استراتيجية للقاحات ذات الأولوية 2017 إلى 2020، وتحتوي على أربعة قطاعات: (1) استيعاب الأسلوب والطلب عليه؛ و(2) الامتثال والاستخدام الآمن للأسلوب؛ و(3) مكاسب الكفاءة البرنامجية من هذا الأسلوب؛ و(4) تغطية التحصين المُحسّنة والمتكافئة. للتحقق من نظرية التغيير وتحسينها، قمنا بتطبيق طريقة مراجعة واقعية لتحليل التوصيفات المنشورة لسلسلة درجات الحرارة الخاضعة للتحكم، أو التجارب وثيقة الصلة.قمنا بتقييم 34 مقالاً، تصف 22 سلسلة فريدة لدرجات الحرارة الخاضعة للتحكم، أو تجارب وثيقة الصلة عبر أربع مناطق تابعة لمنظمة الصحة العالمية. لقد حددنا طلبًا قويًا على مثل هذا الأسلوب بين جهات تقديم الخدمات؛ إلا أن توليد مستوى مكافئ من الطلب بين واضعي السياسات يتطلب أدلة أكبر على الفوائد الاقتصادية، ومكاسب تغطية التحصين، وتعريفات حالة الاستخدام. دعمت الأدلة المتسقة سلامة الأسلوب عند دمجها في برامج التحصين الخاصة. ساعد كل من التدريب العملي والإشراف جهات تقديم الخدمات في الامتثال للبروتوكولات. كان التوفير في الوقت هو الدليل الرئيسي على مكاسب الكفاءة، بينما كانت بيانات توفير التكاليف عند حدها الأدنى. تم الإبلاغ عن تغطية مُحسّنة ومتكافئة حينما أتاح تخزين اللقاح خارج سلسلة التبريد، الوصول إلى السكان الذين يصعب الوصول إليهم. لا يوجد دليل يشير إلى فعالية أقل للقاح، ولا زيادة معدلات الأحداث السلبية للقاحات التي يتم تقديمها بموجب هذا الأسلوب.دعمت الأدلة المجمعة بشكل واضح النظرية الأولية للتغيير. إن التعامل مع فجوات الأدلة على الفوائد الاقتصادية ومكاسب التغطية، قد يؤدي إلى زيادة الاستيعاب في المستقبل.旨在评估有关疫苗受控温度链方法如何促使中低收入国家提高公平免疫接种率的证据。.我们根据我们评估了 34 篇文章，了解了世界卫生组织四个地区的 22 种独特的受控温度链或密切相关经验。我们发现服务提供商强烈要求采用这种方法；但是，如要促使同样多的政策制定者认同此类需求，则需要有更多的证据来证明经济效益以及疫苗接种率提高和用例定义。证据一致性表明将该方法纳入特殊疫苗接种计划时能够确保安全性。切实可行的培训和监督支持提供商遵守协议。节省时间是表明效率提高的主要依据，但成本节约相关数据很少。据报道，如果非冷链存储疫苗能够供难以触及的人群使用，则可提高公平接种率。并无任何证据表明采用该方法提供的疫苗效果较差或不良事件发生率升高。.综合证据广泛支持初始变革理论。解决经济效益和接种率升高方面的证据差距可能会导致未来采用率提高。.Оценить фактические данные, описывающие, как подход к вакцинации в рамках системы с регулируемой температурой может привести к обеспечению справедливого охвата иммунизацией в странах с низким и средним уровнем дохода.Авторы создали теорию преобразований на основеАвторы проанализировали 34 статьи, описывающие 22 уникальные системы с регулируемой температурой или подобный опыт в четырех регионах Всемирной организации здравоохранения. Авторы выявили высокий спрос на такой подход среди поставщиков услуг, однако для создания равного уровня спроса со стороны лиц, ответственных за разработку политики, требуется больше фактических данных об экономической пользе и увеличении охвата вакцинацией, а также определении сценариев. Убедительные данные подтверждают безопасность этого подхода при его включении в специальные программы по вакцинации. Поставщикам услуг предоставлялось возможное обучение и контроль при соблюдении протоколов. Данные об экономии времени были основными данными повышения эффективности, в то время как данные об экономии расходов были минимальными. Сообщалось об улучшении справедливого охвата там, где хранение вакцин за пределами холодовой цепи обеспечивало доступ к труднодоступным группам населения. Нет данных, указывающих на более низкую эффективность вакцины или повышенную частоту нежелательных явлений для вакцин, вводимых в рамках данного подхода.Объединенные данные в целом поддерживают первоначальную теорию преобразований. Устранение пробелов в фактических данных об экономической пользе и расширении охвата может увеличить вероятность использования подхода в будущем.

The mind-body problem is intuitively familiar, as mental and physical entities mysteriously interact. However, difficulties arise when intertwining concepts of the self with mental and physical traits. To avoid confusion, I propose instead focusing on three categories, with the mental matching the mind and physical the body with respect to raw inputs and outputs. The third category, the self, will experience and measure the others. With this new classification, we can see difficulties clearly, specifically five questions covering interaction and correlation. We break down the problem using both existing theories and a hypercube topology representing the solution. We show any satisfactory theory must explain both spatial interaction and content correlation, and that we cannot escape our topology, whatever our preferred fundamental substance and mind-body movement permutation. We conclude by looking outside the hypercube, noting how solutions such as existential monism, priority monism, and will-based cosmic-idealism avoid the dangers involved.

The climatic, hydrographic, and environmental regimes of terminal Pleistocene and Holocene northwestern Mongolia are reconstructed using archaeological and pedological data sets at Bayan Nuur, a lake on the northwestern perimeter of the Altan Els dune field in eastern Uvs Province, Mongolia. The archaeological data consist of land-use patterns controlled for time via time-sensitive, diagnostic artifacts. The pedological data consist of soil classifications and radiocarbon dating of paleosols that track lake levels and water table. These data are combined using a geographic information system (GIS) to ascertain site and paleosol geographic relationships to modern lake levels at Bayan Nuur. They point to a more xeric Younger Dryas than previously recognized, significant Holocene lake regressions, and to Mid- to Late Holocene lake standstills/transgressions, the scale of which had previously been unrecognized. Combined, these data point to a complex late Quaternary picture of paleoclimate and paleoenvironment across the region and the importance of using multiple proxies, including archaeological data, in paleoecological reconstructions.

Integration of vaccination against human papillomavirus (HPV) with other essential health services for adolescents has been proposed in global strategies and tested in demonstration projects in low- and middle-income countries (LMIC). Published experiences, global guidance, and one key example, the implementation of "HPV Plus" in Tanzania, all demonstrate the need for greater operational evidence to guide future implementation and policy. Review of experiences earlier in the life course, integrating post-partum family planning with infant immunization, show lessons from 13 LMICs that can apply to provision of adolescent health information and services alongside HPV vaccination. Three distinct models of integration emerge from this review comprising: 1) multiple tasks and functions by health staff providing vaccination and other care, or 2) secondary tasks added to the main function of vaccination, or 3) co-location of matched services provided by different staff. These models, with strengths and weaknesses demonstrated in family planning and immunization experiences, apply in different ways to the three main platforms used for HPV vaccination: school, facility or community. For HPV vaccination policy and programming, an initial need is to combine the existing evidence on vaccine service delivery - including coverage, efficiency, cost, and cost-effectiveness information - with what is known on how integration works in practice; the operational detail and models employed. This synthesis may enable assessment which models best suit the different service delivery platforms. An additional need is to link this with more tailored local assessments of the adolescent burden of disease and other determinants of their well-being to develop new thinking on what can and cannot be done to integrate other services alongside HPV vaccination. New approaches placing adolescents at the center are needed to design services tailored to their preferences and needs. The potential synergies with cervical cancer screening and treatment for older generations of women, also require further exploration. Coordinated action aligning HPV vaccination with broader adolescent health and wellbeing will generate social, economic and demographic benefits, which in themselves are sufficient justification to devote more attention to integrated approaches.

A WHO global strategy launched in November 2020 sets out an ambitious pathway towards the worldwide elimination of cervical cancer as a public health problem within the next 100 years. Achieving this goal will require investment in innovative approaches. This review aims to describe integrated approaches that combine human papillomavirus (HPV) vaccination and cervical cancer screening in low- and middle-income countries (LMIC), and their efficacy in increasing uptake of services. A systematic review was conducted analyzing relevant papers from Embase, Medline, CINAHL and CAB Global Health databases, as well as grey literature. Narrative synthesis was performed on the included studies. Meta-analysis was not appropriate due to the heterogeneity and nature of included studies. From 5,278 titles screened, 11 uncontrolled intervention studies from four countries (from Africa and east Asia) were included, all from the past 12 years. Four distinct typologies of integration emerged that either increased awareness of HPV and/or cervical cancer screening, and/or coupled the delivery of HPV vaccination and cervical cancer screening programs. The synthesis of findings suggests that existing HPV vaccination programs can be a useful pathway for educating mothers and other female caregivers about cervical cancer screening; through in person conversations with care providers (preferred) or take-home communications products. Integrated service delivery through outreach and mobile clinics may overcome geographic and economic barriers to access for both HPV vaccination and cervical cancer screening, however these require significant program and system resources. One study promoted HPV vaccination as part of integrated service delivery, but there were no other examples found that examined use of cervical cancer screening platforms to promote or educate on HPV vaccination. This review has demonstrated gaps in published literature on attempts to integrate HPV vaccination and cervical cancer screening. The most promising practices to date seem to relate to integrated health communications for cervical cancer prevention. Future research should further explore the opportunities for integrated health communications to support the efforts towards the new global cervical cancer elimination agenda, and costs and feasibility of integrated service delivery for underserved populations.

The introduction of the Human papillomavirus (HPV) vaccine has shown potential to not only prevent cervical cancer but also drive adolescents’ access to other health care services, even in low-income countries. Few studies have been conducted to date to identify best practices and estimate the acceptance, operational challenges and benefits of including broader adolescent health interventions into immunization efforts, knowledge which is essential to supporting widespread integration. In this paper we review the efforts undertaken by the government of Togo to integrate adolescent health programming with the HPV vaccination roll out. With the support of partners (GAVI, WHO, UNFPA and UNICEF), the country successfully completed, in 2017, two years of an HPV vaccine demonstration project, which entailed vaccinating 10-year-old girls against HPV in two selected districts of the country and integrating a health education component focused on puberty education / menstrual hygiene and hand washing practice. Our study is a post-implementation program evaluation, using mixed methods to assess key questions of feasibility and acceptability of an integrated adolescent package of care. It showed that the HPV vaccination in conjunction with the health education sessions was well received by the majority of health care providers, teachers and parents. Our study confirmed that in Togo it proved feasible to combine education and HPV vaccination in school-based service delivery. However, more operational research is neded to understand how to increase the impact and sustainability of the co-delivery of interventions. We did not analyze the health impact and cost implications of the intervention, which will be an important consideration for scaling up such integration efforts alongside routine immunization.

According to most contemporary theorists, free riding on the cooperative contributions of others is unfair. At the same time, obligations to contribute to cooperative schemes can compel conformity with conventional practices, and can do so to a degree that poses a real threat to individuality. This paper exposes this tension between fairness and individuality, and proposes a way to resolve it. The resolution depends on an alternative approach to understanding fairness—one that appeals to the relational goods fairness is meant to maintain. In particular, norms of fairness protect against the interactions within a relationship becoming disrespectful. Many instances of free riding are indeed disrespectful and hence unfair. But this is not always so: one can choose to live a lifestyle that fails to return the benefits their community provides without disrespecting one's fellows. It is thus possible to free ride without being unfair, and so duties of fairness need not add to those already formidable forces that threaten to extinguish valuable individuality.

In situ sensors are needed to further our understanding of phosphate flux dynamics in marine environments during short term events such as tidal cycles, algae blooms and runoff periods. Here, we present a fully automated in situ phosphate analyzer based on an inlaid microfluidic absorbance cell technology. The microfluidic device employs colorimetric absorbance spectrophotometry, using the phosphomolybdenum blue (PMB) assay modified by the addition of polyvinylpyrrolidone (PVP), to measure phosphate concentrations in seawater. Bench top calibrations were performed with both copper(II) sulfate dye and the PMB assay, as well as temperature sensitivity studies to characterize the sensor’s performance in a range of conditions. It achieves a limit of detection of 15.2 nM, a limit of quantification of 50.8 nM, and a high in situ precision with a relative standard deviation of less than 1.5% across three consecutive measurements. Two consecutive field deployments are conducted as assessments for its intended in situ applications. The sensor is first deployed from a pier at a depth of 6 m, with simultaneous bottle samples taken to perform cross-validation. It is next deployed on the Stella Maris testbed, a multi-sensor seabed platform (MSSP), 100 m offshore and 9 m deep in the inlet to the Bedford Basin in Nova Scotia, Canada. Over 300 successful phosphate measurements were acquired, showing the influence of the tidal cycle, and confirming the sensor’s viability in observing nutrient flux dynamics with nanomolar variations.

Alors que les économies des Tonga et des Fidji se développent, la présentation de tribut continue d’y avoir lieu. Cet article étudie les offrandes de dons et de tribut qui sont faites de nos jours au roi des Tonga et aux chefs fidjiens. Il définit le sens profond du concept de tribut dans ces zones du Pacifique. La théorie de l’efflorescence qui émerge des études faites en Papouasie Nouvelle-Guinée permet de tester les relations qui existent entre les dons, les tributs et les marchandises. Différentes formes d’exchanges répondent de façon diverses au développement.

India experiences a substantial burden of cervical cancer and accounts for nearly one third of cervical cancer deaths worldwide. While human papillomavirus (HPV) vaccines have been introduced subnationally in some states, HPV has not yet been rolled out nationally. Given the target age group, schools are the most common delivery channel for HPV vaccines, but this fails to account for local girls who never attended or no longer attend school. We conducted a qualitative, design-informed, community-based study conducted in Uttar Pradesh, India. We assessed facilitators and barriers among out-of-school girls and proposed program characteristics to inform the design of pro-equity HPV vaccine delivery programs for out-of-school girls. Programs should improve parental knowledge of the risk of cervical cancer, engage vaccinated girls as vaccine champions, utilize varied media options for low-literacy populations, and ensure that HPV vaccine services are accessible and flexible to accommodate out-of-school girls. In areas with poor or irregular school attendance among adolescent girls, HPV vaccine coverage will remain suboptimal until programs can effectively address their needs and reach this priority population. Our findings present a meaningful opportunity for program planners to purposefully design HPV vaccination programs according to these parameters, rather than modifying existing programs to include HPV vaccine. Adolescent girls, their parents, and other community members should be involved in program design to ensure that the program can effectively meet the needs of adolescent girls who are not in school.

Background the rare occurrence of collagenous gastritis (CG) makes its epidemiology difficult to investigate. We designed a study to determine the demographic and clinical characteristics as well as the associations of CG with other upper gastrointestinal diseases in a large national clinicopathological database. Methods from the IDEA database we extracted all patients with histopathologically documented CG and, in a case-control study, we compared 168 subjects with and 1,286,165 subjects without CG using odds ratios (OR) with their 95% confidence intervals (CI). Results the prevalence of CG was 13 per 100,000 EGDs. CG was significantly more common among female than male patients (OR: 1.69, 95% CI: 1.20–2.39) and was characterized by a bi-modal age distribution (first peak in patients aged 10–19, second peak primarily in females aged >60 years). CG patients presented with diarrhea (18%), anemia (12%), weight loss (11%), and vomiting (10%). CG was significantly associated with other lymphocytic disorders of the upper gastrointestinal tract, including celiac sprue (2.12, 1.55–2.88), duodenal intraepithelial lymphocytosis (3.71, 2.30–5.98), and lymphocytic gastritis (23.2, 10.9–49.5). CG persisted in 69% of patients who underwent multiple consecutive endoscopies. Conclusions the epidemiologic features of collagenous gastritis reflect on different etiologies contributing to its occurrence in children and adults.

National Immunization Technical Advisory Committees (NITAGs) are tasked with the responsibility of guiding ministries of health and national immunization programmes in their policy development processes. Many NITAGs rely on evidence reviewed by the World Health Organization's (WHO) Strategic Group of Experts(SAGE) on immunization and aim to adapt WHO's recommendations to their respective contexts. This relationship took on exceptional importance since the onset of the COVID-19 pandemic, during which NITAGs have expressed a notable struggle to craft appropriate policies on population prioritization and vaccine utilization in the face of supply constraints and complex programmatic and delivery logistics. This online survey was conducted to assess the usefulness of the SAGE guidance documents for COVID-19 vaccine policies and to examine the persisting needs and challenges facing NITAGs. Results confirmed that SAGE recommendations concerning COVID-19 vaccines are easy to access, understand, and adapt. They have been found to be comprehensive and timely under the data and time constrained circumstances confronting SAGE. The Global NITAG Network (GNN) appears to be the most popular vehicle for addressing questions among high income countries, in contrast to lower income countries who favour WHO Country or Regional Offices. NITAGs place much value on interaction with other NITAGs, which requires facilitation and could benefit from increased opportunities, especially within regions. It is further noted that some NITAGs have had to tackle issues during the pandemic not typically considered by SAGE, such as supply chain logistics and vaccine demand. Learning from the COVID-19 experience offers opportunities to strengthen NITAGs and the pandemic recovery effort through the development of more concrete procedures and consideration of more varied types of data, including implementation effectiveness and uptake data. There is also an opportunity for an increasing involvement of Country Office WHO personnel to support NITAGs, while ensuring information and evidence needs of countries are adequately reflected in SAGE deliberations.

The beginning of the Anthropocene, a proposed geological epoch denoting human-caused changes to Earth’s systems, and what metrics signify its onset is currently under debate. Proposed initiation po...

Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.

Cervical cancer, caused by HPV infection, is responsible for more than 311 000 preventable deaths every year. A global call to accelerate efforts to eliminate this disease has generated a new global strategy proposing ambitious, but achievable, targets for HPV vaccination of girls, and screening and treatment of women. The present paper addresses the suboptimal access to HPV vaccination in low‐income and lower‐middle‐income countries (LICs/LMICs), where the burden of disease weighs most heavily, in part through co‐infection with HIV. A proposed framework for action was formulated by first reviewing the reasons underlying gaps in HPV vaccine coverage. Good practices from recent introductions of HPV vaccine at scale in LICs/LMICs were then assessed based on targeted literature reviews and the experience and views of the authors. Difficulties in uptake and coverage of the HPV vaccine relate to the costs of the vaccine and service delivery, lack of prioritization, the challenges of vaccinating adolescents, and shortage of vaccines as the supply failed to keep pace with the rapid expansion in global demand, including from LICs/LMICs. The framework for action calls for new strategic thinking to consolidate global learning and invigorate operationalization at a country level., The elimination of cervical cancer calls for better innovation, investment, integration, information, and influence to boost vaccination against human papilloma virus infection.

Since materially opulent lifestyles are a significant cause of environmental degradation, environmentalists often call for us to live more simply. This call is typically focused on consumption. But...