Objectives: Few studies examine the influence that different sources of medical information has on human papillomavirus (HPV)–related knowledge. We examined the relationship between the primary source of medical information and knowledge about HPV in young adults aged 18–26 years. Study design: This study used cross-sectional data from the Health Information National Trends Survey. Methods: Respondents (n = 404) self-reported their knowledge about HPV-related diseases and vaccinations and their sources of medical information. Sources of medical information included electronic/print media, family/friends, or a healthcare provider. Bivariate and multivariate analyses were used to examine the association between the source of information and HPV knowledge. Results: Fifty-six percent of respondents used electronic or print media as their primary source of medical information. A greater proportion of Hispanic (40.0%) and black (36.0%) respondents received medical information from their family/friends than white respondents (20.0%). Respondents who received medical information from family/friends had 4.34 (95% confidence interval [CI]: 2.14, 8.79), 4.06 (95% CI: 2.05, 8.04), and 2.35 (95% CI: 1.10, 5.04) times higher odds than those who received information from healthcare providers of not knowing that HPV causes cervical cancer, knowing HPV is a sexually transmitted infection, and hearing about the HPV vaccine, respectively. Conclusion: Source of medical information was significantly associated with knowledge of HPV. Receiving medical information from family/friends negatively influenced young adults' HPV knowledge. These findings may guide future interventions to target peer and familial influence on medical decisions.

Idag erbjuds alla kvinnor mellan åldern 23 – 70 gratis gynekologisk cellprovtagning i Sverige. Trots detta är det bara 63,7% i åldersgruppen 23 – 29 som deltar i screeningen. Kallelse till besök kommer via posten. I denna studie har det undersökts om man med hjälp av visualiseringar kan få fler kvinnor att delta i gynekologisk cellprovtagning samt att minska obehaget inför ett besök. Under studiens gång har gestaltningsförslag tagits fram med målet att öka deltagandet. Tidigare studier kring varför kvinnor i Sverige avböjer att delta i gynekologisk cellprovtagning och hälsokommunikation tillsammans med bilder samt teorier inom kognition, perception, bild och text i samspel har legat till grund för hela arbetet. Metoder som intervju, dokumentanalys och skiss har använts för att motivera gestaltningsförslagets utformning. Allt detta resulterade i ett gestaltningsförslag i form av ett informationsblad som skickas med det brev den nuvarande kallelse kommer i, till de kvinnor som inte tidigare har valt att delta i provtagningen i Sverige. Informationsbladet innehåller illustrationer som komplement till information om vad HPV är, hur det sprids, varför det är viktigt att delta och hur själva provtagnings processen går till. Resultatet pekar mot att större andel av målgruppen hade övervägt att delta i screeningen samt att de upplever att obehaget skulle minskas vid användande av illustrationer. / Nowadays all women between the ages of 23 - 70 get offered free pap smear in Sweden. Despite this, only 63,7% attend the screening between the ages of 23 – 29. The women receive a mail that include a call notice for the visit. This study is going to explore how visualization could help increase the amount that attend the pap smear and reduce the discomfort before a visitation.  During the study, an artefact was created. Previous studies about why women in Sweden do not participate in pap smear testing, images in health communication and theories about cognition, perception and image and text in interaction laid the foundation for the work. Methods like interviews, documentation analysis and sketches were used to motivate the artefact design. All of this concluded in an artefact representing an information sheet, which is supposed to be sent out alongside the mail of the current call notice to all women in Sweden who have decided to not attend the pap smear. The information sheet includes information about what HPV is, how it spreads, why it is important to attend, and how the actual process of the testing is done, with illustrations as a supplement. The results point toward an indication that more women in Sweden would consider attending the pap smear, and that the discomfort about the process is reduced.

Human Papilloma Viruses (HPVs) are a large family of viruses with a capsid constituted by the L1 and L2 proteins, which bind to receptors of the basal epithelial cells, thus promoting virus entry. The majority of sexually active people become exposed to HPV, which is the most common cause of cervical cancer affecting more than 600.000 women every year. Moreover, every year more than 13.000 new cases of HPV-related cancers, including anal, penile and head and neck cancers, are diagnosed in men. Three vaccines are available based on the L1 capsid protein, which self-assembles and forms virus-like particles (VLPs) when expressed in yeast and insect cells. Although very effective, these vaccines are HPV type-restricted, and their costs limit broad vaccination campaigns, especially in low- and middle- income countries. Recently, vaccine candidates based on the conserved L2 epitope from serotypes 16, 18, 31, 33, 35, 6, 51 and 59 were shown to elicit broadly neutralizing anti-HPV antibodies, reaching a protection around 90% against all the HPV serotypes. During my research activity, we have tested whether E. coli Outer Membrane Vesicles (OMVs) could be successfully decorated with L2 polytopes and whether the engineered OMVs could induce neutralizing antibodies. OMVs represent an attractive vaccine platform for their intrinsic adjuvanticity and their low production costs. We show that strings of L2 epitopes could be efficiently expressed on the surface of the OMVs and a polypeptide constituted by the L2 epitopes from serotypes 18, 33, 35 and 59 provided broad cross-protective activity against a large panel of HPV serotypes as judged by the in vitro pseudovirus neutralization assay. In order to better characterize the vesicle and in perspective of future clinical studies of our HPV candidate vaccine, we also worked on the setting-up of a simple and reproducible production process at laboratory scale ready to be transferred at industrial level.Moreover, we focused our attention on the strategy used for the engineering of the OMVs with the L2 epitopes and in particular on the carrier used for the delivery of the fusion construct in the surface of the vesicle. More in detail, since part of the carrier is a human cancer epitope, we tested whether a similar scaffold, with less homologies to the human gene could maintain the same properties in terms of: i) expression level of the fused epitopes in the OMVs, ii) localization on the surface of the vesicle and iii) 9 immunogenicity and efficiency to stimulate the immune system in order to produce anti L2 antibodies. Considering all the results described in this work combined with the points of strength of the OMV-based vaccine platform, as the simplicity of the production process, the yields of vaccine doses and the low cost/dose, our data provide a very promising prototype of universal anti-HPV vaccine.

Infektionen mit Humanen Papillomviren (HPV) sind eine weltweit häufig auftretende Erkrankung. In den meisten Fällen heilt diese folgenlos aus, in rund 10% der Fälle kommt es aber zu einer verlängerten Persistenz des Virus im Gewebe. Eine maligne Transformation ist möglich und gilt als ätiologische Bedingung für die Entstehung des Zervixkarzinoms. HPV sind ebenfalls an der Pathogenese andere anogenitaler Krebserkrankungen (Vaginal-, Vulva-, Anal-, Peniskarzinom) und an der Entstehung eines Anteils von Oropharynxkarzinomen beteiligt. Auch Genitalwarzen werden durch eine Infektion mit HPV ausgelöst. Weltweit sind jährlich knapp 700.000 Krebsneuerkrankungen auf eine Infektion mit HPV zurückzuführen. In Deutschland sind pro Jahr ca. 7.500 neu aufgetretene Krebserkrankungen HPV-attributabel. Eine HPV-Infektion ist nicht kausal therapierbar. Seit einigen Jahren sind Schutzimpfungen gegen HPV verfügbar. Die drei in der EU zugelassenen Impfstoffe decken allesamt die epidemiologisch dominanten Hochrisikotypen 16 und 18 ab, zwei der Impfstoffe ebenfalls auch die Niedrigrisikotypen 6 und 11 als Schutz vor Genitalwarzen. Internationale Studien belegen eine deutliche Abnahme der Inzidenz des Zervixkarzinoms bei geimpften Populationen. Die bei Studiendurchführung aktuelle Impfempfehlung der Ständigen Impfkommission (STIKO) des Robert Koch-Instituts (RKI) umfasst alle Personen im Alter von 9 bis 14 Jahren, Nachholimpfungen sollen bis zum 17. Lebensjahr erfolgen. Trotz eines guten Sicherheitsprofils der Impfstoffe sind die Impfquoten in Deutschland bisher niedrig, vor allem im jüngeren Altersbereich. Gründe für die niedrige Impfbereitschaft liegen beispielsweise in einer geringen Risikoperzeption auf Elternseite, der Angst vor Nebenwirkungen der Impfung oder fehlendem Vertrauen in medizinische Versorgungsstrukturen. Zielgerichtete Beratung und Aufklärung der Eltern haben sich als wichtige Antwort auf diese Bedenken erwiesen. Erfahrungen aus anderen Ländern legen nahe, dass insbesondere auch Schulimpfprogramme ein niederschwelliger Ansatz zur Erhöhung der Impfquoten sein können. Basierend auf diesen Erfahrungen wurde 2018 das HPV-Schulimpfprojekt in Sachsen gegründet. Es hat zum Ziel, die Impfrate bei 9- bis 14-Jährigen durch ein niederschwelliges Impfangebot in der Schule zu erhöhen. Dazu werden an ausgewählten Schulen Informationselternabende und Impftermine vor Ort angeboten. Ziel der vorliegenden Arbeit war es, den Erfolg des HPV-Schulimpfprojektes im Zeitraum des Schuljahres 2020/21 zu evaluieren. Dazu wurden die Impfquoten nach Projektende erhoben und mit den Impfsurveillancedaten des RKI verglichen. Weiterhin erfolgten eine Befragung der Eltern mittels Fragebogen und eine statistische Analyse zur Detektion von Unterschieden zwischen einzelnen demografischen Gruppen. Am Modell des begleiteten HPV-Schulimpfprojektes wurden Erkenntnisse und Handlungsempfehlungen abgeleitet. Im besagten Impfjahr wurden acht Schulen vom HPV-Schulimpfprojekt besucht. Die Anzahl der geimpften Kinder wurde durch das ärztliche Personal auf einem Prüfbogen dokumentiert. Die Impfquoten wurden berechnet und tabellarisch und grafisch aufbereitet. Danach erfolgte zunächst die deskriptive statistische Auswertung des Fragebogens. Um eine genauere Beantwortung einzelner Forschungsfragen in fünf Themenblöcken zu ermöglichen, führten wir anschließend Vergleiche zwischen dichotom gruppierten Teilen des Studienkollektivs durch. Alle Ergebnisse aus der Berechnung der Impfquoten, sowie der Auswertung des Studienfragebogens sind in der Arbeit ausführlich dargestellt. In der anschließenden statistischen Analyse wurde untersucht, ob Unterschiede im Antwortverhalten zwischen dichotomen demografischen Gruppen bestehen. Als statistisch signifikant stellte sich unter anderem heraus, dass die Eltern von Kindern aus Klassenstufe 4 die Möglichkeit der Impfung in der Schule besser bewerteten als die Eltern von Fünftklässler:innen, ebenfalls wurde diese von Eltern mit akademischem Hintergrund und Eltern, deren Kinder eine Schule innerhalb Leipzigs besuchen, befürwortet. Eltern ohne Impfwunsch hatten einen geringeren Bedarf an Informationen zu Impfungen im Schulkontext. Die Eltern von Jungen änderten ihre Einstellung zur HPV-Impfung häufiger als die Eltern von Mädchen. Diese und weitere Erkenntnisse können dabei helfen, Gruppen zu identifizieren, die von einer gezielten Ansprache profitieren, und Handlungsbereiche zu definieren, die bei zukünftiger Projektdurchführung optimiert werden können. Im Rahmen des HPV-Schulimpfprojektes konnten die Impfquoten im Altersbereich zwischen 9 und 11 Jahren gegenüber den in der RKI-Impfsurveillance ermittelten Daten gesteigert werden. Ebenfalls konnten bei Jungen und Mädchen nahezu gleich hohe Impfraten erreicht werden. Schulbasiertes Impfen bietet insbesondere für Eltern jüngerer Kinder ein niederschwelliges Angebot, welches laufende Präventionsstrategien ergänzen kann. Um eine flächendeckende Erhöhung der Impfquote zu erhalten, müssen Schulimpfprojekte langfristig etabliert und in der öffentlichen Gesundheitsfürsorge verankert werden. Aus der begleitenden Fragebogenstudie wurde ersichtlich, dass ein Teil der Elternschaft die Möglichkeit des schulbasierten Impfens begrüßt und der Wunsch nach mehr Informationen und Angeboten zum Thema Impfungen besteht. Insbesondere für die Eltern von Jungen zeigte sich, dass der Informationselternabend einen Einfluss auf die Impfentscheidung hatte. Schulbasiertes Impfen bietet einen Ansatz, Versorgungslücken in der Präventionsmedizin zu schließen. Gezielte Strategien zur Ansprache von Eltern mit Bedenken müssen in Folgestudien weiter exploriert werden. Die Beobachtungen der Studie können modellhaft für die Planung weiterer Schulimpfprojekte in Betracht gezogen werden. Zur weiteren Optimierung wurden Erkenntnisse und Handlungsvorschläge entwickelt, welche die gezeigten Erfolgschancen schulbasierten Impfens weiter erhöhen sollen. Langfristiges Ziel bleibt die wissenschaftlich begleitete flächendeckende Etablierung und Implementierung von Schulimpfprogrammen zur Erhöhung der HPV-Impfraten. Dies kann zukünftig die Krankheitslast durch HPV-assoziierte Krebserkrankungen, Vorläuferläsionen und Genitalwarzen deutlich verringern.:Tabellenverzeichnis 1 Abbildungsverzeichnis 2 Abkürzungsverzeichnis 3 1. Einführung 5 1.1. Humane Papillomviren und assoziierte Erkrankungen 5 1.1.1. Entdeckung, Struktur, HPV-Typen 5 1.1.2. HPV-assoziierte Erkrankungen, Pathogenese 7 1.1.2.1 Neoplasien und Vorstufen (Zervix, Anogenitalregion, Kopf-Hals) 7 1.1.2.2. Genitalwarzen (Condylomata acuminata) 10 1.1.3. Epidemiologie (Deutschland, weltweit) 10 1.1.3.1. HPV-Infektionen 10 1.1.3.2. HPV-attributable Karzinome und Vorstufen 11 1.1.3.3. Genitalwarzen 13 1.1.4. Diagnostik und Risikofaktoren 13 1.1.5. Therapie 14 1.2. Schutzimpfung 15 1.2.1. Zugelassene Impfstoffe, Funktionsweise 15 1.2.2. Aktuelle Impfempfehlung für Deutschland 17 1.2.3. Impfquoten der RKI-Impfsurveillance in Deutschland 18 1.2.4. Verträglichkeit der Impfung, Nebenwirkungen 21 1.2.5. Gründe für geringe Impfquoten, Lösungsansätze 21 1.2.6. Strukturierte Impfprogramme 24 1.3. HPV-Schulimpfprojekt 26 1.4. SARS-CoV-2-Pandemie, aktuelle Herausforderungen 27 2. Aufgabenstellung 29 3. Materialien und Methoden 30 3.1. Studienkollektiv, Projektablauf 30 3.2. Studiendokumente 31 3.3. Statistische Auswertung 33 3.3.1. Erster Studienteil: Impfquoten 33 3.3.2. Zweiter Studienteil: Befragung der Eltern 35 3.3.3. Analysen zum Gruppenvergleich 35 4. Ergebnisse 38 4.1. Charakterisierung der Grundgesamtheit 38 4.2. Erster Studienteil: Impfquoten 39 4.3. Zweiter Studienteil: Befragung der Eltern 45 4.3.1. Studienablauf und -beteiligung 45 4.3.2. Charakterisierung des Studienkollektivs 46 4.3.3. Deskriptive Auswertung des Studienfragebogens 48 4.3.3.1. Impfentscheidung 48 4.3.3.2. Item 4 - Einstellung zur Schulimpfung 51 4.3.3.3. Item 5 - Einstellung zur HPV-Impfung nach Elternabend 51 4.3.3.4. Item 6 - Impfmotivation ohne Schulimpfprojekt 53 4.3.3.5. Item 7 - Informationsmenge 54 4.3.3.6. Items 8 und 9 - Vorwissen zur Erkrankung und Impfung 54 4.3.3.7. Item 10 - Risikoskala 56 4.3.3.8. Items 11 bis 14 - generelle Einstellung zum Impfen 57 4.3.3.9. Item 15 - Auswirkung der SARS-CoV-2-Pandemie 60 4.3.4. Analyse von Zusammenhängen zwischen Merkmalen, Gruppenvergleiche 61 4.3.4.1. Themenblock 1: Projektteilnahme und Impfwunsch 61 4.3.4.2. Themenblock 2: Einstellung zu Impfangeboten im schulischen Kontext 62 4.3.4.3. Themenblock 3: Einfluss des Projektes auf die Impfentscheidung 64 4.3.4.4. Themenblock 4: Vorwissen zu HPV 66 4.3.4.5. Themenblock 5: Einstellung zu impfrelevanten Fragestellungen 67 5. Diskussion 70 5.1. Impfquoten und Teilnahmemotivation 70 5.1.1. Ergebnisinterpretation von Impfquoten verschiedener Teilgruppen 70 5.1.2. Impfmotivation, Datengrundlage, Erreichen des Projektziels 74 5.1.3. Vergleich zum Ausland, Einfluss der strukturellen Gegebenheiten 75 5.1.4. Unsicherheiten und Limitationen bei der Ergebnisinterpretation 76 5.2. Ergebnisinterpretation zweiter Studienteil 78 5.2.1. Interpretation der deskriptiven Auswertung 79 5.2.2. Interpretation der statistischen Analyse, Gruppenvergleiche 82 5.2.3. Unsicherheiten und Limitationen 86 5.3. Evaluationserkenntnisse, Gesamteinschätzung 86 5.3.1. Abgeleitete Erkenntnisse und Handlungsempfehlungen 86 5.3.2. Einschätzung zum Untersuchungsziel, Hürden und kritische Reflexion 88 5.3.3. Pandemiesituation 89 5.3.4. Ausblick und zukünftige Herausforderungen 90 5.4. Fazit 91 6. Zusammenfassung der Arbeit 93 7. Literaturverzeichnis 98 8. Anlagen 107 Einwilligungserklärung zur Teilnahme an der Begleitstudie I Studienfragebogen II Prüfbogen für Impfärztinnen III Selbstständigkeitserklärung IV Lebenslauf V Publikationsübersicht VI Danksagung VII

Made available in DSpace on 2011-11-09T14:45:40Z (GMT). No. of bitstreams: 2 license.txt: 1648 bytes, checksum: e095249ac7cacefbfe39684dfe45e706 (MD5) 000238.pdf: 759139 bytes, checksum: d93f97e93a35ffbd923409758cca2b7b (MD5) Previous issue date: 2008 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / A citologia convencional apresenta importantes limitações em relação a sua sensibilidade e cobertura populacional, o que limita a maior redução das taxas de mortalidade por câncer de colo do útero. Por estas razões, métodos diagnósticos moleculares como a Captura Híbrida têm sido apontados como possíveis substitutos ou complementos do rastreio primário do câncer cervical. O objetivo desse estudo foi investigar a adesão de uma população feminina, residente da comunidade do Morro dos Macacos, Vila Isabel, Rio de Janeiro, ao método da autocoleta da Captura Híbrida em comparação ao método da citologia oncótica cervical. Realizamos um ensaio clínico controlado randomizado no qual mulheres recrutadas através de visitas domiciliares foram aleatoriamente alocadas para autocoleta da CH (51%) ou para realização da citologia (49%). Nossa amostra foi constituída por 100 mulheres e verificamos que a adesão entre as pacientes que receberam o kit da autocoleta da CH foi significativamente maior do que a adesão entre as pacientes convidadas para realizar a citologia (68,6% e 32,7% respectivamente; p < 0,001). Os dados aqui apresentados apontam a autocoleta da CH como uma possibilidade de atingir mulheres resistentes ou que têm dificuldade de acesso aos programas de rastreio do câncer do colo do útero baseados na citologia. / The Pap smears has major limitations on its sensitivity and coverage, which limits the greatest reduction in mortality rates of cervical cancer. For these reasons, molecular diagnostic methods such as Hybrid Capture have been mentioned as possible substitutes or additions of primary screening of cervical cancer. The aim of the present investigation was to examine the adhesion of a female population, living in the community of the Morro dos Macacos, Vila Isabel, Rio de Janeiro, for self-collection of specimens for Hybrid Capture compared to the Pap smear. We performed a randomized controlled clinical trial in which women were recruited through home visits and randomly allocated to self-collection samples (51%) or for the Pap smear (49%). A hundred women participated and the adhesion between the patients who were allocated to self-collection was significantly higher than among patients invited to be submitted Pap smear (68.8% and 32.7% respectively; p < 0.001). Our findings suggest the self-collection of specimens for Hybrid Capture can be an opportunity to reach women who are resistant or have difficulty of access to cervical cancer prevention programs based on cytology.

Human papilloma virus (HPV) is a ubiquitous virus implicated in a growing list of cancers, particularly cervical cancer‐ the second most common cancer among women worldwide. Although persistent infection with high‐risk oncogenic HPVs such as types ‐16 or ‐18 is necessary, additional factors like co‐infection with other viruses can play a role in cancer progression. Protein‐protein interactions play a central role in the infection, survival and proliferation of the virus in the host. Although some interactions of HPV proteins are well characterised, it is essential to discover other key viral interactions to further improve our understanding of the virus and to use this knowledge for the development of newer biomarkers and therapeutics. The aim of this study was to systematically analyse the interactions of HPV‐16 proteins using yeast two‐hybrid (Y2H). To achieve this, a clone collection of the viral proteome was generated by recombinatorial cloning and three independent Y2H screens were performed: (i) Intra‐viral screen to identify interactions among the HPV‐16 proteins; (ii) Inter‐viral screen to identify interactions with proteins of Herpes Simplex Virus (HSV) which is suggested to be a co‐factor; and (iii) Virus‐host screen to identify novel cellular binding partners. The intra‐viral Y2H screen confirmed some of the previously known interactions and also identified binding of the E1 and E7 proteins. Deletion mutagenesis was performed to map the interaction domains to the amino‐terminal 92 amino acids of E1 and carboxy‐terminal CxxC domain of E7. Replication assays suggest a possible repression of E1‐mediated episomal replication by direct binding of E7. The inter‐viral Y2H screen identified interactions of HPV proteins with seventeen HSV‐1 proteins including transcriptional regulator ICP4 and neurovirulance factor ICP34.5. The biological relevance of these interactions in the context of co‐infection is discussed. The virus‐host screen performed against a human cDNA library identified 54 interactions, a subset of which was validated by biochemical pull‐down assays. The functional relevance of an interaction between E7 and a proto‐oncogene spermatogenic leucine zipper protein (SPZ1) was further investigated suggesting a role of SPZ1 in E7‐mediated cell proliferation. The work presented in this thesis identifies several novel interactions of HPV proteins. Future work will involve the in‐depth elucidation of biological relevance of these interactions. In particular, the interactions of E7 with E1 and SPZ1 are of great interest to improve our understanding of the life cycle and pathogenesis of the virus which can be applied for improved strategies of prevention and treatment of malignancies caused by HPV.

High-risk mucosal human papillomaviruses (HPVs) are major aetiological agents for the development of cervical cancer. Thus, the current goal of cervical cancer treatment is to develop vaccines against HPV s. Such vaccines would either prevent cervical cancer by eliminating HPV infection or be useful for treating established lesions by the destruction of cells displaying HPV proteins. The aim of this thesis was to characterise immune responses to the E5 protein of HPV -16, one of several antigens with possible use in vaccination. To determine whether immune responses to HPV -16 E5 existed and whether they could be correlated with disease severity or with the presence of HPV -16 DNA, both cell mediated (Chapter Two) and humoral (Chapter Three) immunity was investigated in women with and without cervical disease. Cellular responses in a minority of women were inversely correlated with disease severity. However, E5 specific antibodies were negatively correlated with the absence of HPV -16 DNA. Thus, although some immune responses were evident, these were generally limited to a small number of subjects and were not associated with the detection of HPV-16 E5 mRNA or DNA sequence variants. Due to the immune responses in women, E5 was further investigated to determine if the absence of HPV -16 E5 specific immune responses was due to the poor antigenicity of HPV -16. Mice were immunised with synthetic peptides corresponding to full length HPV -16 E5 (Chapter Four). As with the human data, cellular responses and weak antibody responses were detected in mice. Some mice also exhibited cytotoxic T -lymphocyte responses and when E5/major histocompatibility class I (MHC-I) interactions were investigated, a number of peptides showed a high percentage of binding. The E5/MHC-I interactions were further investigated (Chapter Five). The surface expression of MHC-I on cells containing HPV-16 or -18 DNA was found to be lower than on HPV DNA negative cell lines even after stimulation with interferon-gamma. Stimulation with E5 synthetic peptides increased expression of cell surface MHC-I molecules on cell lines negative for HPV DNA. Furthermore, the presence of the E5 gene reduced the expression of the ovalbumin gene in normal human keratinocytes. In conclusion, the data contained within this thesis indicate that HPV-16 E5 CMI is inversely correlated with disease status. It is possible to induce cell mediated responses to HPV -16 E5 and low-titre antibody responses. The presence of HPV16 E5 DNA may impair normal cellular function.

The purpose of this study is to examine the effects and persuasive mechanisms of expository and narrative HPV vaccine messages targeted toward young men. The researcher used the Centers for Disease Control and Prevention’s HPV facts for men as a framework for the expository message condition. He also created two similar but distinct narratives that focused on HPV and men. The first narrative was informed by narrative persuasion studies in the social sciences and was labeled the academic narrative. The second narrative incorporated important elements of storytelling from literary theory and was labeled the classic narrative. A comparison condition, which presented a testimonial from a testicular cancer survivor, was also employed to compare against the effectiveness of the three experimental conditions. In the experiment, 258 men ages 18-26 were assigned randomly to the expository, academic narrative, classic narrative, or comparison conditions. Outcome measures related to the persuasive effects of the messages were attitudes toward talking to healthcare providers about the HPV vaccine and receptiveness to the HPV vaccine. Outcome measures related to the persuasive mechanisms of expository messages were argument strength, source credibility, and emotional arousal. Outcome measures related to the persuasive mechanisms of narrative messages were perceived realism, transportation, identification, and emotional arousal. Hypotheses predicted that argument strength and source credibility would predict changes in knowledge, attitudes, and vaccine receptiveness in the expository condition, whereas perceived realism, transportation, and identification would predict similar changes in the narrative conditions. An additional hypothesis predicted that emotional arousal would affect the persuasion process differently in the expository and narrative conditions. Results indicated that transportation, identification, and emotional arousal were stronger in the narrative conditions, but these variables did not predict persuasive outcomes. Conversely, perceived realism and source credibility had unexpected persuasive effects in both expository and narrative conditions. Implications of the findings and directions for future research are discussed.

Syftet var att undersöka vilket av vaccinen mot Humant papillomvirus-HPV, Gardasil eller Cervarix som är att föredra, med avseende på biverkningsprofilen, det vill säga vilket av vaccinen som är mest skonsamt för kroppen. HPV-vaccinen skyddar mot HPV-typerna 16 och 18 som bland annat orsakar livmoderhalscancer. Viruset smittar via sexuell kontakt och infekterar främst celler i mukosa. Infektionsfrekvensen av HPV är likvärdig mellan män och kvinnor. Det finns högrisktyper av HPV (HPV16/18) som orsakar cancer och det finns lågrisktyper som orsakar genitala vårtor (HPV 6/11). Gardasil innehåller fyra HPV-typer (HPV6/11/16/18) och Cervarix innehåller två HPV-typer (HPV16/18). Mycket vanliga biverkningar (≥1/10) för båda vaccinen är huvudvärk, svullnad, rodnad, och smärta vid injektionsstället. Vanliga biverkningar (≥1/100 eller &lt;1/10) är bland annat feber, illamående och klåda. Fyra artiklar valdes ut med pubmed via sökorden ”Gardasil”, ”Cervarix” och ”safety”. Studie 1 handlar om booster-dosering av bHPV/qHPV till flickor (12-13 år) som tidigare hade fått två doser av qHPV tillsammans med Twinrix (Hepatit A/B). I studie 2 jämfördes två doser bHPV med två respektive tre doser qHPV hos flickor 9-14 år, för att undersöka om vaccinen var likvärdiga eller om två doser bHPV var ett bättre val. Studie 3 och 4 var uppföljningsstudier till samma grundstudie med kvinnor från 18-45 år. Studie 3 pågick fram till månad 48 och studie 4 fram till månad 60. Studie 3 och 4 jämförde tre doser av bHPV med tre doser av qHPV avseende hur seropositiviteten förändrades över tiden. Cervarix fick lägre procentandelar i sin biverkningsprofil, vid jämförelse mot studie 1 och studie 2 (två doser av Cervarix som gavs i Studie 2). Slutsats var att båda vaccinen hade jämförbara biverkningsprofiler och var därför likvärdiga i det avseendet. Om seropositiviteten jämförs så har bHPV längre varaktighet än qHPV eller att qHPV är bättre val eftersom det även skyddar mot HPV 6 och 11. / The purpose of this diploma work project was to determine if one of the HPV-vaccines, Cervarix-bHPV or Gardasil-qHPV, has lower safety adverse events- SAE. There are more than 150 different types of human papillomavirus, which infect mucosal cells, mostly in the genital tract. The virus infects through sexual-contact, there are high-risk HPV-types such as HPV16/18, which are oncogenic and low-risk HPV-types such as HPV6/11, which cause genital warts. The goal for the world health organization-WHO is to get the HPV-vaccines to all women around the globe. Most common age for the vaccinées is 12-years. Headache, pain, erythema and swelling are very common adverse events for both of vaccines. Common adverse events are fever and nausea. In addition, Post Orthostatic Tachycardia Syndrome-POTS and Complex Regional Pain Syndrome-CRPS have been reported, mostly from Japan and Denmark. European medicines agency-EMA made a statement that the HPV-vaccines are not the cause of the POTS or CRPS (2015), because the profile of the symptoms from Japan and Denmark do not correlate with symptom profiles of POTS or CRPS. In Denmark’s case, EMA suggest that some of the cases resembles symptoms of chronic fatigue syndrome-CFS and not POTS. This diploma work project was made with the help of Pubmed, with the words “Gardasil”, “Cervarix” and “safety”. Four articles were chosen from the search.  The authors of the first article examined the effect of booster dose of bHPV or qHPV to girls age 12-13, who already had received two doses of qHPV. In the second article, two doses of bHPV were compared with two or three doses of qHPV in 9-14 year-old girls in order to determine if bHPV were equal or superior to two or three doses of qHPV. The third and fourth articles are follow-up studies of the second one, the third up to 48 months and the fourth up to 60 months. These articles were studying the sero-positivity in the vaccinated subjects over time. When comparing study one and two, the bHPV safety profiles differences were seen in the safety adverse events in both local and general or systemic adverse events. There was a difference of adverse events between (article 2) three doses of qHPV to (article 1) booster dose of qHPV. Sero-positivity showed that bHPV induced high titres of HPV 16 and 18 antibodies while qHPV vaccine also induced high amounts of HPV 16 antibodies but low amounts of HPV 18 antibodies. About 20 % of the women in qHPV-groups lost sero-positivity by month 60. bHPV and qHPV vaccines were similar regarding adverse events. The vaccines had equal types of local and systemic or general adverse events. Sero-positivity was higher in subject vaccinated with bHPV compared to qHPV, with the highest decline in sero-positivity for anti-HPV 18. The conclusions of this literature study is that the qHPV vaccine protects against low-risk and high-risk HPV-types, while the bHPV vaccine has longer duration.

Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, with an estimated incidence rate of 6.2 million new cases each year. Men have higher instances of certain HPV related outcomes (e.g., head/neck cancers) when compared to women, so male vaccination with the HPV vaccine is also paramount to preventing cancer. The present study examined the theory of planned behavior (TPB) as a model for predicting HPV vaccination intentions among men. Results suggest the TPB was a well-fitting model to the data, but not all aspects of the TPB model were predictive of HPV vaccination intentions. Behavioral beliefs (e.g.., the belief that vaccination will provide a beneficial outcome) were the only significant predictor of HPV vaccination intention in the next 6 months. Perceived norms, motivations to comply with norms, attitudes towards the HPV vaccine, and self-efficacy were not significant predictors of HPV vaccination intentions.