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Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the US.The first HPV vaccine was introduced in 2006. There are three different HPV vaccines that commonly target high-risk HPV types. background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. Introduced in 2006, there are three different HPV vaccines which commonly target high risk HPV types. Objective: This study compares HPV vaccine efficacy based on alternative endpoints with the most recently available cervical cancer incidence data from the Surveillance, Epidemiology and End Results (SEER) program and SEER*Stat statistical software. Methods: The incidence of cervical cancer, mined from the most recent April 2021 SEER data set, was stratified according to age and racial groups. Trend analysis reporting cervical cancer incidence percentage change (PC) and annual percentage change (APC) was calculated by SEER*Stat statistical software. method: Cervical cancer incidence data, mined from the most recent April 2021 SEER data set., was categorized into age and racial groups. The corresponding SEER*Stat statistical software was used for trend analysis which reported percent change (PC) and annual percent change (APC). Results: A total of 46,583 cases of cervical cancer were reported, with an average of about 3,580 incidents of cervical cancer per year, with an overall decrement of about 60 cases over the period of 12 years. The percentage change according to age and race groups varied between -15.9 among 40-44 years old (yo) and +13.8 among 30-34 yo, and from -12 among non-Hispanic White women to +13 among Hispanic women. Statistically significant APC was observed for five of the nine age groups and four of the five racial groups. Conclusion: There seems to be little if any, correlation between cervical cancer incidence and the HPV vaccine program in the US. HPV vaccine efficacy based on alternative endpoints, such as nucleic acid testing and cytological, surgical, and seropositivity endpoints, is fair. Therefore, it is important to emphasize such alternative testing and surrogate endpoints. conclusion: HPV vaccine efficacy based on alternative endpoints, such as nucleic acid testing as well as cytological, surgical and seropositivity endpoints is fair. Therefore, it is important to emphasize such alternative testing and surrogate endpoints.

Highlights • Iron folic acid consumption can reduce anemia, but compliance remains low. • Interventions can promote interpersonal communication for behavior change. • Topic-specific and general interpersonal communication modalities appear effective. • Interpersonal communication mediated the intervention effect on iron supplement use., Objective More than half of Indian women of reproductive age are anemic. Regular iron folic acid uptake can prevent and treat anemia. This study investigated the effect of interpersonal communication on improving IFA use among women of reproductive age. Methods The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized trial that collected longitudinal data from control (n = 1896) and intervention (n = 1898) communities in Odisha, India at Time 1 and six months later at Time 2. Structural equation models assessed the effect of the intervention on iron folic acid use via multiple interpersonal communication pathways. Results Compared to the control arm, iron folic acid use significantly increased in the intervention arm. Both, general health interpersonal communication and anemia-specific interpersonal communication were augmented in the intervention communities. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication. Conclusion The RANI Project increased interpersonal communication among participants, resulting in increased iron folic acid use for anemia reduction. Practice implications Strategic use of targeted interpersonal communication to promote behavior change appears to be a viable strategy to increase iron folic acid use to reduce anemia.

With an increasing demand for healthcare jobs, there has been a corresponding surge in applications to medical schools. Typically, the advice extended to students is standardized rather than individually tailored to each applicant. The purpose of this chapter is to share resources and personal experiences regarding expectations, myths, and hurdles students may experience when applying to medical schools. The authors, pre-medical and medical students, along with their mentor, discuss how to manage both goal setting and failure as well as how to evaluate the process for application enhancement or reapplication. The intent is for pre-medical advisors to use this chapter as an ancillary resource to enhance the advisor-student relationship and leverage that relationship to improve the student's application.

The aim of this study is to examine diet diversity, predictors associated with it, and its associations with anemia among non-pregnant women of reproductive age in rural India. Baseline data from the Reductions in Anemia through Normative Innovations (RANI) project were used and included 980 non-pregnant women aged 15-49 years from Odisha, India. The Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) was used to assess diet diversity. Anemia was determined by hemoglobin level and categorized as normal (hemoglobin ≥ 12 g/dL), mild (11 ≤ hemoglobin

Diet diversity has an important role in the prevention and treatment of anemia. Based on formative research in the community and the theory of normative social behavior, we designed an intervention to improve diet diversity among women of reproductive age. Our study, the Reduction in Anemia through Normative Innovations (RANI) Project, investigated the effect of a social norms-based intervention on diet diversity among women of reproductive age. We randomized villages in Odisha, India, into treatment or control arms, with a minimum of one village buffer between them. We assessed exposure to the intervention by frequency of self-reported images seen from the participatory learning modules, videos watched, and number of hemoglobin tests administered. We assessed diet diversity with the Food and Agriculture Organization’s Minimum Dietary Diversity for Women (MDD-W) questionnaire. We used multiple logistic regression to examine the associations between intervention and diet diversity, adjusting for covariates. Compared with baseline, diet diversity score increased in both treatment and control groups. The odds of having a diverse diet was 47% higher in the treatment group. Higher level of exposure to the RANI intervention was associated with a better diet diversity score, indicating that the intervention was effective in improving diet quality.

OBJECTIVES: To investigate the effect of a social norms-based intervention on diet diversity among women of reproductive age. METHODS: Data from the Reduction in Anemia through Normative Innovations (RANI) Project were used. Up to three contiguous villages in Odisha, India were assigned to clusters, which were then randomized into treatment or control arm. Within each cluster, homes were randomly chosen in proportion to cluster size and one woman of reproductive age was randomly chosen from each selected home (N = 3797). The RANI intervention is based on the theory of normative social behavior and includes: participatory learning modules coupled with games; short videos shown to participating women and their families; and monthly hemoglobin testing followed by community discussion. Exposure to the intervention was assessed by the frequency of viewing images from the participatory learning modules, number of videos seen, and number of hemoglobin tests taken. Diet diversity was assessed by the Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W, score ranging 0–10 with MDD-W score ≥ 5 considered to represent a diverse diet). Multiple logistic regression examined the effect of exposure to the intervention on diet diversity. RESULTS: Compared to baseline, diet diversity score increased in both treatment and control groups by 13% and 8%, respectively. The odds of having a diet diversity score ≥ 5 was 47% higher in treatment group than the control group (P

Health sciences professionals work on diverse healthcare delivery teams and often face ethical dilemmas. Ethics education in an online environment is one way that such individuals can obtain relevant, easily accessible, and academically rigorous instruction on ethical decision-making and professional and research practices. In this chapter, the authors present existing empirical evidence of online ethics education, share their experiences teaching ethics online at The George Washington University, and provide recommendations for future pedagogical research relevant to diverse healthcare professionals. Based on their findings, the online format can be effectively utilized to teach ethics to current and future health sciences professionals.

Background In India, 50% of women of reproductive age, compared with 23% of men, have iron deficiency anemia. Extant research focuses on biological, not social, determinants of this disparity. Objectives The aim of this study was to examine how gender norms may affect anemia prevalence among women in rural India. Methods We conducted 16 focus group discussions (N = 124) with women of reproductive age, husbands, and mothers-in-law and 25 key informant interviews in four villages in Odisha, India. Results We identified the following themes that help explain how inequitable gender norms exacerbate anemia among women from different castes and tribes: Due to a double burden of work outside the home and completing the majority of unpaid work in the home, women lack time to visit health centers to get tested for anemia and to obtain iron supplements. Women are expected to prioritize the health of their family over their own, thus affecting their access to health care. Women's autonomy to leave the house to seek health care is limited. Men are the primary breadwinners for the family, but often spend their money on alcohol, rather than on iron-rich food for the household. Intra-household food allocation favors men, in-laws, and children, thus women serve their family first, often being left with little food. Conclusion Anemia reduction interventions need to include examination of the whole social context to successfully increase iron supplement use and iron-rich food intake. Understanding how gender norms contribute to anemia could change the narrative from a biomedical to a social justice issue., Highlights • In India, more than half of women have anemia compared with less than one-fourth of men. • We examined the pathways through which inequitable gender norms exacerbate this disparity. • Addressing inequitable gender norms may be an upstream approach to reducing anemia.

OBJECTIVES: Half of women of reproductive age in India have iron deficiency anemia compared to only 23% of men. Most research focuses on biological reasons for this discrepancy and access to iron-folic acid and iron-rich foods. However, recent research in India shows that inequitable gender norms may affect a woman's ability or desire to take iron supplements and to eat iron-rich food. The objective of this study is to examine how and why gender norms may be affecting high and persistent rates of anemia in India. METHODS: We conducted 25 key informant interviews and 16 focus group discussions with women of reproductive age, adolescents, husbands and mothers-in-law (n = 148) in Odisha, India. We purposively sampled key informants and randomly sampled focus group participants. We analyzed the data using applied thematic analysis in Nvivo software. RESULTS: Our data shows that unequal gender norms impact behaviors that are directly related to high rates of anemia. Women are often serving their husband, children, and in-laws first and “adjusting” to whatever is leftover which may be poor in nutritional qualities and less iron rich. Men are also the main breadwinners but often spend their money on alcohol, money that could be spent on iron-rich food for the household. Women reported that extreme fatigue is a normal part of being a woman and that a woman's plight is to take care of her family at any cost. Given that fatigue, the primary symptom of anemia is normalized; women may be less likely to seek treatment. Women tend to prioritize the health of their family over her own which could affect her ability or desire to go to the health center to get tested for anemia or to obtain iron supplements. Pregnant women are more likely to take iron supplements for the health of the baby, not her own health. While non-pregnant women of reproductive age who were not diagnosed with anemia were not focused on preventive health, only major illnesses and thus, were not taking supplements at all. CONCLUSIONS: More upstream barriers, like gender norms, may be impinging on a woman's ability to take iron folic acid and to eat iron rich foods. Understanding how gender norms contribute to anemia could change the narrative from a biomedical issue to a social justice issue. FUNDING SOURCES: The Bill and Melinda Gates Foundation. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

OBJECTIVES: More than half of women of reproductive age in India are anemic, a condition treatable through regular iron folic acid uptake. Previous studies have shown the importance of participatory interactions and interpersonal communication in improving women's health. The Reduction in Anemia through Normative Innovations (RANI) study investigated the effect of general health and anemia- specific interpersonal communication on improving iron folic acid use among women of reproductive age. METHODS: The RANI Project is a cluster randomized trial that collected longitudinal data from control (N = 1896) and treatment (N = 1898) communities in Odisha, India at baseline and at midline, 6 months later. Structural equation models assessed the intervention effect on iron folic acid use through both, general health interpersonal communication focused on “the health of women in the community” and anemia-specific interpersonal communication. RESULTS: Compared to the control arm, iron folic acid use significantly increased in the treatment arm; health communication and anemia-specific communication also increased. The impact of the intervention on iron folic acid use was mediated through anemia-specific interpersonal communication (p

This article was migrated. The article was marked as recommended. The efficacy of flipped classrooms on student learning is dependent on student motivation. We conducted a study on the impact of the flipped classroom on student performance and satisfaction among highly motivated students enrolled in a post-baccalaureate pre-medicine program for career-changers. Surprisingly, students in both traditional and flipped classrooms indicated lecture was the largest contributor to their learning. Additionally, students in the flipped classroom highlighted specific activities most useful to their engagement, comprehension, and exam performance. Thus for heterogeneous student populations in higher education, didactic lecture remains an integral component of learning. Based on our study and relevant literature, we suggest tips on how to effectively structure courses in higher education that are tailored to the learning needs and motivations of your specific student demographic.