Project HOPE

Functional asymmetry and sensorimotor control impairments often persist in patients following total knee arthroplasty (TKA), yet they remain under-evaluated in routine clinical settings using simple, scalable tools. Understanding the relationship between these deficits and postoperative outcomes is critical for optimizing rehabilitation strategies. To assess the prevalence and degree of functional asymmetry in individuals 6-12 months post-TKA using standardized physical therapy assessments, and to evaluate the predictive value of asymmetry and sensorimotor deficits on both functional performance and patient-reported outcomes. A cross-sectional study was conducted on 125 patients aged 55-80 years, 6-12 months after unilateral primary TKA. Functional asymmetry was measured using the Single-Leg Sit-to-Stand (SLSST), Step-Down Test, and modified Star Excursion Balance Test (mSEBT). Functional outcomes included the Timed Up and Go (TUG) and 30-Second Chair Stand Test (30CST). In contrast, self-reported outcomes were assessed he KOOS-ADL and the KOOS-Function in Sport and Recreation (KOOS-Sport/Rec) subscales were administered. Correlations and multiple regression models were used to analyze relationships between asymmetry measures and outcomes. Significant correlations were found between asymmetry measures and both functional and self-reported outcomes (e.g., SLSST asymmetry and TUG: r = 0.47, p = 0.005; KOOS-ADL: r = -0.45, p = 0.007). Regression models identified SLSST, Step-Down, and mSEBT asymmetry as significant predictors of TUG (R2 = 0.48, p < 0.001) and KOOS-ADL (R2 = 0.53, p < 0.001). Patients with high asymmetry exhibited significantly poorer outcomes across all measures (all p < 0.01). Functional asymmetry and sensorimotor deficits are independently associated with poorer mobility and self-reported function post-TKA and can be effectively identified using clinically accessible tools, supporting their integration into routine postoperative assessment and rehabilitation planning.

Cervical cancer remains a major public health challenge in sub-Saharan Africa (SSA), mainly due to low screening uptake. Mass media exposure (including radio, newspapers, and television) can play a key role in promoting health services utilisation; however, little is known about its relationship with cervical cancer screening uptake in SSA. This study examined the association between mass media exposure and cervical cancer screening uptake among women aged 30-49 years in four SSA countries. This cross-sectional study utilized data from the Demographic and Health Surveys conducted between 2022 and 2023 in four SSA countries: Ghana, Kenya, Mozambique, and Tanzania. A pooled weighted sample of 26,936 women aged 30-49 years was analysed. Univariable and multivariable logistic regression models were fitted to assess the association between mass media exposure and cervical cancer screening uptake. Adjusted odds ratios with their corresponding 95% confidence intervals were estimated. The pooled prevalence of cervical cancer screening was 15.2% (95% CI: 14.5-15.9), with the lowest rate in Ghana at 7.3% and highest in Kenya at 27.0%. The multivariable analysis revealed that women exposed to mass media were 74% more likely to have been screened for cervical cancer (AOR: 1.74; 95% CI: 1.40-2.16.) compared to those without media exposure. This study demonstrated a positive association between mass media exposure and uptake of cervical cancer screening among women in SSA. This highlights the important role that mass media can play in promoting the uptake of screening in the region. Thus, increasing access to media platforms, such as radio, television, and newspapers could enhance awareness and participation in cervical cancer screening services, ultimately helping reduce the disease burden in SSA.

Examine treatment responses to and safety of onabotulinumtoxinA for the preventive treatment of chronic migraine (CM) among diverse racial groups. Evidence suggests there are differences in headache treatment patterns, symptom profiles, and burden based on race. However, limited data are available describing the response to preventive migraine treatments among these groups. The Chronic Migraine OnabotulinuMtoxinA Prolonged Efficacy open Label (COMPEL) trial was a single-arm, open-label, multicenter, prospective study (January 23, 2012-November 16, 2015) that enrolled adults of various races with CM to receive onabotulinumtoxinA 155 U every 12 weeks over 108 weeks. These analyses assessed White, Asian (primarily Republic of Korea residents), and Black/African American subgroups based on self-report. Pacific Islander/American Indian/Alaska Native and Hispanic/Latinx subgroups were not analyzed separately because of the small sample sizes and potential overlap with predefined racial categories (e.g., Hispanic/Latinx White) for the latter. Analyses of baseline demographics and clinical characteristics, including headache features, across the subgroups were performed. Change from baseline in the number of monthly headache days (MHDs), including proportions with ≥50% reduction in MHDs, and change from baseline scores on the 6-item Headache Impact Test (HIT-6), Migraine Disability Assessment (MIDAS) absenteeism, presenteeism, and total scores, and Migraine-Specific Quality of Life questionnaire version 2.1 (MSQ v2.1) Role Function-Restrictive (RFR), Emotional Function (EF), and Role Function-Preventive (RFP) domains were evaluated for each subgroup. Of 716 enrolled participants, 582 (81.3%) were White, 89 (12.4%) were Asian, 41 (5.7%) were Black/African American, and 4 (0.6%) were Pacific Islander/American Indian/Alaska Native. Withdrawal from the study occurred for 50.5% of the White subgroup, 32.6% of the Asian subgroup, and 48.8% of the Black/African American subgroup. The most common reasons for study discontinuation were participant withdrawal of granted consent (12.8%) and lost to follow-up (11.5%). After treatment with onabotulinumtoxinA 155 U every 12 weeks, all subgroups demonstrated significant reductions from baseline in MHDs at all time points to week 108 (all p < 0.001) and 60.3%-73.3% experienced ≥50% reduction from baseline in MHDs at week 108. Each analyzed subgroup demonstrated significant reductions from baseline to week 108 in HIT-6 total (all p < 0.001), MIDAS total (White, p < 0.001; Asian, p < 0.001; Black/African American, p = 0.0062), MIDAS absenteeism (White, p < 0.001; Asian, p < 0.001; Black/African American, p = 0.002), MIDAS presenteeism (all p < 0.001), MSQ v2.1 RFR (all p < 0.001), MSQ v2.1 EF (White, p < 0.001; Asian, p < 0.001; Black/African American, p = 0.009), and MSQ v2.1 RFP (all p < 0.001) scores. Results in the total population were similar to those in the subgroups. Treatment-related adverse events were consistent with the known safety profile of onabotulinumtoxinA. OnabotulinumtoxinA safely reduced MHD frequency and patient-reported disability and improved quality of life as a preventive treatment of CM among diverse subgroups, with results directionally consistent among groups. COMPEL, ClinicalTrials.gov identifier: NCT01516892.

The need for organs suitable for transplantation has continued to rise as need outweighs availability. Increased demand has driven innovation in the field. Over the past ten years, donation after circulatory death (DCD) donors have become a greater portion of the donor pool. This method of donation includes a period of warm ischemia time to the organs. Thus, its use is dependent on recovery methods. Historically, extracorporeal membrane oxygenation (ECMO) was one of the first pumping technologies to enhance organ preservation in the potential donor. Subsequently, the adoption of normothermic regional perfusion (NRP) technology has also shown promise in organ transplantation. These technologies have increased utilization of organs and enhanced the pool of donor organs. This review seeks to summarize the literature supporting in situ technologies (ECMO and NRP) utilized in procurement of solid organs from DCD donors. The benefit of in situ perfusion in DCD organ recovery is that these technologies increase the number of organs available for transplantation by reducing ischemic injury. The disadvantages include the added technical aspect, added operating room time, and the increased ethical concerns surrounding these technologies compared to conventional methods of organ recovery.

BackgroundMedication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events.ObjectiveThis study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women’s MIL and decision self-efficacy.MethodsA randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping×time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial.ResultsA total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time×group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time×group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively).ConclusionsWeb-based medication education courses based on the theory of planned behavior can effectively improve pregnant women’s MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685

Maternal and infant mortality is one of the most urgent public health priorities facing the United States. It reflects endemic structural determinants of health that engender health inequities, resulting in Black women being nearly three times as likely to die of pregnancy-related causes than white women. Black infants are more than twice as likely to die as white infants. In Washington, District of Columbia, Black birthing people constitute roughly half of all births, but account for 90% of all pregnancy-related deaths. In 2020, MedStar Health — in partnership with community-based health centers and organizations Community of Hope and Mamatoto Village — launched the D.C. Safe Babies Safe Moms (SBSM) initiative to improve maternal and infant health outcomes and promote health equity in the District. SBSM introduces an integrated care continuum model across preconception, prenatal, postpartum, and early infancy health care. SBSM has shown that it is possible to reduce disparities in birth outcomes using targeted, evidence-based strategies.

BackgroundIn Chicago, Illinois, USA, Black and Latinx populations experienced disproportionate rates of COVID-19 mortality compared to White populations. By February 2023, Black residents had the lowest levels of completing the primary vaccine series of any racial or ethnic group. The Chicagoland CEAL Program surveyed an urban minoritized population about COVID-19 beliefs and vaccination status. The purpose of this study was to evaluate this association and to determine if it could be explained by health care connectedness and discrimination.MethodsResponses were collected from December 2021 to February 2023. Descriptive statistics were used to examine differences by vaccination status. Logistic regression was used to determine associations between each of the eight COVID-19 beliefs and not completing the primary vaccine series. Models were adjusted for sociodemographic factors, health care connectedness, and discrimination.ResultsFrom 760 surveys analyzed, 76% had completed the primary vaccine series. Most participants were women (74%), identified as nH Black (61%), and did not complete higher education (70%). Individuals who agreed that the vaccine was developed too quickly (aOR: 1.55 (0.99–2.43, p = 0.05)) and that the vaccine went against religious beliefs (aOR: 2.72 (1.67–4.43, p = < 0.0001)) had a greater likelihood of not completing the vaccine series.ConclusionBuilding and sustaining trustworthiness should be at the center of messaging surrounding vaccine uptake for Black and Latinx residents in an urban setting. Messaging should consider the importance of religion on vaccine uptake and collaborate with trusted messengers to address negative sentiment towards health behavior recommendations.

ABSTRACT Little is known about the pre-implementation context for a preventive HIV vaccine. We conducted interviews of individuals in Philadelphia recruited at Penn clinics and community-based organizations serving LGBTQ-identifying persons of color who 1) were cisgender men who had sex with men, or were transgender-identified, 2) had a sexually transmitted infection in the last 12 months, or sex with multiple partners within the last two weeks. We assessed acceptability, facilitators, and barriers to a hypothetical HIV vaccine using an integrated analysis approach. We interviewed 30 individuals between 2/2023-9/2023. Participants were supportive of an HIV vaccine and reported that they would strongly consider receiving one if one became available. Participants contextualized a hypothetical vaccine with the current HIV prevention context, primarily pre-exposure prophylaxis (PrEP), indicating that they would evaluate any future vaccine in comparison to their experience within the PrEP landscape. Reported facilitators for a hypothetical HIV vaccine included vaccine access, knowledge, and understanding; their risk for HIV exposure; and perceived benefits of the vaccine. Barriers included lack of understanding of the purpose of a vaccine, stigma surrounding HIV and sexual practices that may surface towards people who seek vaccination, and potential issues with effectiveness, side effects, or lack of availability.