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Background: Much of the research on African-Americans' HPV vaccine acceptance has largely focused on racial/ethnic differences related to cognitive, socio-economical, and structural factors that contribute to differences in HPV vaccine acceptance and completion. A growing body of literature suggest that cultural factors, such as mistrust of healthcare providers (HCPs) and the healthcare system, religion, and social norms related to appropriate sexual behaviors, also plays a prominent role in their HPV vaccine acceptance. However, these studies were limited in their use of theoretical approaches necessary to conceptualize and operationalize culture., Objective: To explore the influence of culture on African-American mothers' and daughters' HPV vaccine acceptance using the PEN-3, a culturally-centered conceptual framework., Methods: Grounded theory techniques were used to explore cultural factors that influenced the acceptance of the HPV vaccine among African-American mothers (n = 28) and their daughters (n = 34)., Results: Positive attitudes towards vaccination stemmed from beliefs that the HPV vaccine has cancer prevention benefits and that vaccinations in general protected against infectious diseases. Negative attitudes stemmed from beliefs that the HPV vaccine was too new, not effective, daughters were too young, and that vaccines were not a one-size-fits-all intervention. Majority of mothers and daughters indicated that their religious doctrine did not impede their HPV vaccination decisions. For a few mothers, religious beliefs could not be separated from their HPV vaccination decisions and ultimately deterred HPV vaccine acceptance. HCP recommendations were valued however mothers were often dissatisfied with the detail of information communicated. Support networks provided both positive and negative types of social support to mothers and daughters. The media highlighted the cancer prevention benefits of the HPV vaccine and unintentionally communicated negative information of the HPV vaccine, which deterred HPV vaccine acceptance., Conclusion: Study findings can inform the development of culturally appropriate interventions that advances the evidence on cervical cancer prevention.

The purpose of this study was to investigate the effect of three process variables: distribution of hydroxypropyl methylcellulose (HPMC) within the tablet matrix, amount of water for granulation, and tablet hardness on drug release from the hydrophilic matrix tablets. Tablets were made both by direct compression as well as wet granulation method. Three formulations were made by wet granulation, all three having the exact same composition but differing in intragranular:intergranular HPMC distribution in the matrix. Further, each formulation was made using two different amounts of water for granulation. All tablets were then compressed at two hardness levels. Dissolution studies were performed on all tablets using USP dissolution apparatus I (basket). The dissolution parameters obtained were statistically analyzed using a multilevel factorial-design approach to study the influence of the various process variables on drug release from the tablets. Results indicated that a change in the manufacturing process could yield significantly dissimilar dissolution profiles for the same formulation, especially at low-hardness level. Overgranulation could lead to tablets showing hardness-dependent drug-release characteristics. Studies showed that intergranular addition of a partial amount of HPMC (i.e., HPMC addition outside of granules) provided a significant advantage in making the formulation more robust over intragranular addition (i.e., that in which the entire amount of HPMC was added to the granules). Dissolution profiles obtained for these tablets were relatively less dependent on tablet hardness irrespective of the amount of water added during granulation.

This study investigates the effects of three factors: (1) use of a mixture of two different grades of hydroxypropyl methylcellulose (HPMC), (2) apparent viscosity, and (3) tablet hardness on drug release profiles of extended-release matrix tablets. The lot-to-lot apparent viscosity difference of HPMC K15M on in vitro dissolution was also investigated. Four test formulations were made, each containing 10% of a very water-soluble active pharmaceutical ingredient (API), 32% HPMC K15M, or a mixture of HPMC K100LV and HPMC K100M, 56% diluents, and 2% lubricants. Each formulation was made at two hardness levels. A 2(3) full factorial design was used to study various combinations of the three factors using eight experiments conducted in a randomized order. Dissolution studies were performed in USP apparatus I. The values of t50% (time in which 50% drug is released) and tlag (lag time, the time taken by the matrix tablet edges to get hydrated and achieve a state of quasi-equilibrium before erosion and the advance of solvent front through the matrix occur) were calculated from each dissolution profile. The similarity factor (f2) was also calculated for each dissolution profile against the target dissolution profile. A simple Higuchi-type equation was used to analyze the drug release profiles. Statistical analysis using analysis of variance (ANOVA) and similarity factor (f2) values calculated from the data indicated no significant difference among the t50% values and dissolution profiles respectively for all formulations. Within the 3.3-6 kp hardness range investigated, dissolution rates were found to be independent of tablet hardness for all the formulations. Although significantly shorter lag times were observed for the tablets formulated with low- and high-viscosity HPMC mixtures in comparison to those containing a single grade of HPMC, this change had no significant impact on the overall dissolution profiles indicated by the similarity factor f2 values. From this study it can be concluded that lot-to-lot variability in apparent viscosity of HPMC should not be a concern in achieving similar dissolution profiles. Also, results indicated that within the viscosity range studied (12,000-19,500 cps) an HPMC mixture of two viscosity grades can be substituted for another HPMC grade if the apparent viscosity is comparable. Also, the drug release is diffusion-controlled and depends mostly on the viscosity of the gel layer formed.

This paper presents a conceptual model describing the relationships between quality of life outcomes following traumatic brain injury (TBI), coping patterns, and beliefs regarding self-efficacy to assist health-care professionals in understanding the complexity of social and psychological sequelae of TBI. The mode hypothesizes that long-lasting cognitive, behavioural, emotional psychiatric, and interpersonal after-effects of TBI may create a real life 'learned helplessness' with consequent deficits in coping, and altered locus of control beliefs. As a result, TBI patients are at risk for developing self-limiting belief systems about their effectiveness in altering significant events that may result in over-generalizing the effects that TBI has in their day-to-day lives. Subsequently, a feedback loop may be set up where their beliefs in not being able to influence outcomes are not tested, life chances are further restricted, outcomes are suboptimal, and quality of life is reduced. The clinical and theoretical implications of this model are discussed, and an expanded model with future research directions is suggested.

In this exploratory study, the cognitive beliefs of 19 severely traumatically brain-injured (TBI) patients were assessed to determine their association with post-injury employment status (that is, full-time, part-time or unemployed). Cognitive measures included the Multidimensional Health Locus of Control (MHLC) scale, the Revised Internal-External Scale (RIES) and the Beck Hopelessness Scale (BHS). Patients who did not return to their pre-injury level of employment (n = 10) were found to have lower MHLC Internal, higher RIES Powerful Others locus of control beliefs, and higher BHS scores as compared with a group of patients who returned to their pre-injury employment status (n = 9). In addition, longer lengths of post-traumatic amnesia, longer hospital stays and lower-prestige occupations post-injury were associated with poorer employment status. No differences were present between the groups in age, years of education, Glasgow Coma Scale on admission, length of coma, months post-injury, or pre-injury occupation. These results suggest that cognitive beliefs are a potential target for further research in TBI outcome.

Central nervous system (CNS) trauma can produce a multitude of physical and psychological sequelae, depending on the neurological level of injury. Clinicians have long recognized the adjustment difficulties posed in marriages of CNS trauma victims, yet there is little research documentation for this observation. The marital relationships of moderate (n = 31) and severe (n = 17) head injury (HI) groups and a spinal cord injury (SCI) group (n = 24) were assessed through spouses' self-reports in interview and through standardized questionnaires. Analyses indicated that the three groups were not statistically different in age, number of months post-injury, pre- and post-injury occupational status, and level of income. In the post-injury marital relationship, the severe HI group was significantly lower than the moderate HI and SCI groups on standardized and validated scales assessing affectional expression (p less than 0.002), dyadic satisfaction (p less than 0.001), dyadic cohesion (p less than 0.01), and total dyadic adjustment (p less than 0.001). On a scale of social role functioning, the severe HI group's performance was significantly lower than the moderate HI and SCI groups (p less than 0.005). These results empirically substantiate the clinical observation that adjustment difficulties may be more intense for wives of the severely head injured than the moderately injured or the SCI, as they must deal with neuropsychological as well as physical fall-out from the injury.

Cluster-analytic techniques were used to categorize coping strategies (CS) measured by the Ways of Coping--Revised Scale, and locus of control (LOC) beliefs measured by the Multidimensional Health Locus of Control Scale in 53 male traumatically brain-injured (TBI) persons. A cluster characterized by comparatively higher use of self-controlling and positive reappraisal CS and lower external LOC was associated with significantly lower mood disturbance and physical difficulties and a trend to be less depressed. The age of the neurologically injured patient and Taylor's (1983) cognitive adaptation theory may be important aspects of recovery from TBI and other neurological conditions.

We retrospectively investigated long-term, multi-dimensional quality-of-life outcomes in 68 male patients who suffered pure head injuries and 63 male head-injured patients with associated multiple trauma. Results indicated that patients sustaining associated multiple trauma were significantly younger and more deeply comatose on admission. Trends were found to suggest that patients sustaining associated multiple trauma also remain in coma longer, and experience more difficulties in social interaction and overall psychosocial functioning, but less difficulties in mobility compared with pure-head-injured patients. These findings should be taken into account in the evaluation of results of treatment as well as in the planning and allocation of resources for head-injured patients.

Survival from significant closed head injury (CHI) is frequently associated with cognitive defects, physical impairment, personality change, interpersonal difficulty and, in general, some degree of social dependence. Here we report a multidimensional assessment of quality of life of a sample of 131 male head-injury patients suffering a range of severities of insult with specific emphasis on vocational outcome. Of those patients who sustained a severe injury and were employed full-time prior to the CHI, only 55% were able to return to this level of employment. No differences were found between the moderate and severe groups in pre- or post-CHI occupational status, as measured by the Blishen (1967) quantitative social economic index, although both groups declined from pre- to post-CHI. Lower post-CHI occupational status was associated with lower GCS on admission and longer lengths of post-traumatic amnesia, with patient self-report of physical, cognitive and psychosocial difficulties, including spousal reports of confusion, belligerance, verbal expansiveness and the decreased ability to perform socially-expected activities. Stepwise multiple regression analysis accounted for 38% of variance in post-injury vocational status, with lower pre-injury vocational status, greater age, high physical and psychological difficulties and lower admission Glasgow Coma Scale score variables forming the regression equation. Implications are discussed in terms of rehabilitation issues, including vocational programming and planning.

Head injury frequently produces physical and psychological sequelae involving cognitive, behavioural, and personality disturbances which are chronic and perhaps even permanent. Clinically, it is apparent that the marital relationships of head injury patients face initial disruption as well as ongoing challenges in dealing with the physical, neuropsychological, and emotional changes post-injury. However, there is little empirical data to substantiate these observations. In this study, the marital relationships of 55 male head injury patients were assessed, based on the spouse's self-report obtained through interview and questionnaires. The sample was divided into three groups according to the severity of the injury: mild (N = 10), moderate (N = 25) and severe (N = 20). Based on a one-way multivariate analysis of variance, dyadic consensus, affectional expression, and overall dyadic adjustment were significantly lower for wives in the severe group than the moderate group. Affectional expression was also lower in the severe group than the mild group. Stepwise multiple regression analysis determined that 47% of the variance of overall dyadic adjustment could be accounted for by three variables (multiple R = 0.69, p less than 0.001). Dyadic adjustment was greater when wives reported a lower level of financial strain, perceived their spouse to have a relatively low level of general psychopathology or maladjustment, and when the injury was relatively mild based on GCS scores. The implications for intervention in rehabilitation at the marital level are highlighted.

This study examined the effects of coping strategies as moderators of long-term psychosocial and emotional adjustment following closed-head injury. Cluster analysis was used to separate 69 CHI patients into three clinically relevant groups on the basis of responses to the revised Ways of Coping questionnaire. The groups were then compared on a series of validation measures. There were no differences apparent between the three clusters in age, Glasgow Coma Scale score on admission to hospital, or in relatives' ratings of psychiatric symptomatology among the patients. However, the cluster characterized by a generally high use of a wide range of coping strategies had higher ratings of depression, as well as more psychosocial, cognitive and physical difficulties than the other groups. As with other chronic illnesses, it appears that the use of cognitive mechanisms that act as reality 'buffers' may be an important component of improved adjustment to closed-head injury.