BackgroundInformation about women’s acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women’s acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV.MethodsWomen were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling.ResultsA sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30–65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling.ConclusionEducational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.

The World Health Organization recently advocated a two-stage strategy with human papillomavirus (HPV) testing followed by visual inspection of the cervix with acetic acid (VIA) as a suitable option for cervical cancer screening. However, its accuracy has never been directly assessed in the context of primary screening. To evaluate effectiveness of HPV testing on selfobtained specimens (self-HPV) followed by VIA (sequential testing) in a low-income setting, we recruited 540 women aged between 30 and 65 years in two Cameroonian periurban areas. Eligible women were counseled about cervical cancer and how to perform self-sampling. HPV positive and a random sample of HPV-negative women were called back for VIA and biopsy. Disease was defined by interpretation of cervical intraepithelial neoplasia Grade 2 or worse (CIN21). Performances of VIA, self-HPV and sequential testing were determined after adjustment for verification bias. HPV prevalence was 27.0%. VIA positivity was 12.9% and disease prevalence was 5%. Sensitivity and specificity of VIA for CIN21 were 36.4% [95% confidence interval (CI Cervical cancer is an important public health issue in lowincome settings. Eighty-eight percent of yearly about 530,000 new cervical cancer cases are diagnosed in developing countries where 240,000 women die from this disease every year. 1 In Cameroon-a central African country-age-standardized cervical cancer incidence and mortality rates are estimated at 24/100,000 and 17/100,000 per year, respectively. 2 Main reason for this imbalance is the absence of cervical cancer screening programs like in most low-income settings. 3 In major cities of Cameroon, sporadic screening options exist using Papanicolaou smear (Pap test) or visual inspection of the cervix after application of acetic acid (VIA) or Lugol's iodine (VILI). However, Pap test traditionally used in developed countries for primary screening, shows sensitivity for high-grade cervical lesions of 50-60%, which necessitates regularly repeated controls. 4 The method requires highly specialized laboratories, well-trained pathologists to analyze the specimens and adequate conditions during samples transport. Therefore, Pap test is hardly feasible on a large scale in low-income settings. 5 In contrast, VIA has the advantage of being low-cost and facile to perform. It can easily be carried out by nurses or midwifes after a short training. 6 Yet, even though VIA is easy to conduct its interpretation is challenging. A recent metaanalysis showed that VIA sensitivity for cervical intraepithelial neoplasia Grade 2 or worse (CIN21) ranged between 41 and 92% and its specificity between 49 and 98%. 7 Thus, the informative value of a positive or negative VIA result emerged to be highly dependent of the examiner's experience.Another option recommended by the World Health Organization (WHO) is testing of cervical or vaginal swabs for the

Purpose To consider the rationale, methods, and potential benefits of nurturing the growth of resilience in school-aged children who stutter. Stuttering in childhood can have negative psychological consequences for some, including the development of a negative attitude toward their speech from a young age (Vanryckeghem, Brutten, & Hernandez, 2005) and possible co-occurring psychopathology in adolescence and adulthood, in particular, anxiety disorders (Blood, Blood, Maloney, Meyer, & Qualls, 2007; Iverach & Rapee, 2014; McAllister, Kelman, & Millard, 2015). Children who stutter also frequently report teasing and bullying by their peers (Blood & Blood, 2007; Boyle, 2011; Langevin, Packman, & Onslow, 2009), which can have a significant impact on children's confidence and psychological well-being. However, the capacity of children who stutter to cope or “bounce back” from adversity is not routinely explored or incorporated in therapy for stuttering. Method This clinical focus article will explore the construct of resilience and consider why it may be important for children who stutter and their parents. A framework for understanding resilience in relation to stuttering is used, drawing from the Reaching In Reaching Out Resiliency Program (for children aged under 8 years and their parents) and the Penn Resiliency Program (for children aged 8 years and over). Conclusions The role of parents is key in modeling resilient responses to children and creating a resilience-rich environment. As children who stutter may be more vulnerable to adversity, some may benefit from targeted support to build their resilience, in order to enhance their ability to overcome challenges and thrive.