La Bolivie a des taux d’incidence et de mortalité associés au cancer du col de l’utérus qui setrouvent parmi les plus élevés de l’Amérique. Le programme national de prévention du cancerdu col de l’utérus est basé sur le test Papanicolaou et l’inspection visuelle avec acide acétiquepour la détection de lésions précancéreuses. Cependant, divers types de barrières (économique,socio-culturelle et géographique) empêchent que ce programme ne parvienne à réduireefficacement l’incidence du cancer du col de l’utérus en Bolivie.Le principal facteur étiologique associé au développement du cancer du col de l’utérus estl’infection persistante par les papillomavirus humains à haut-risque (HPV-HR). L’introductionde tests qui permettent la détection du matériel génétique des HPV-HR a donc le potentiel deréduire l’incidence et la mortalité associées à ce cancer dans le monde. De plus, ce test peut êtreréalisé sur des échantillons auto-prélevés. Ceci permettrait une augmentation du taux departicipation des femmes dans les programmes de dépistage primaire.Dans ce travail de thèse, nous proposons une stratégie de faible coût pour la détection des HPVHR.Cette stratégie commence par l’auto-prélèvement de cellules cervico-vaginales avec uncoton-tige et le transport des échantillons à sec sur une lame de verre. Ensuite, l’ADN estrécupéré avec un protocole simple utilisant la résine Chelex-100 et la protéinase K. Un contrôlede qualité de l’extraction d’ADN est réalisé avec une PCR amplifiant un fragment du gène dela b-globine humaine. Finalement, la détection des HPV-HR est faite avec une combinaison dedeux techniques :PCR BSGP-EIA et PCR pU. Toutes les étapes de cette stratégie ont été validéanalytiquement en utilisant des dispositifs et techniques standards comme référence. Dans cetravail nous montrons aussi le bon degré d’acceptabilité envers l’auto-prélèvement par lapopulation féminine locale de Cochabamba. Les différentes études ont été réalisées dans ledépartement de Cochabamba entre août 2014 et mai 2018.Notre stratégie a le potentiel d’améliorer le programme de dépistage du cancer du col de l’utérusen Bolivie étant donné que les femmes préfèrent faire un auto-prélèvement et que nostechniques sont plus sensibles analytiquement pour la détection des HPV-HR. Cependant, il estimpératif que le système de santé public bolivien améliore le suivi clinique des femmes à risqueafin de réduire efficacement l’incidence et la mortalité provoquées par le cancer du col del’utérus. / Doctorat en Sciences biomédicales et pharmaceutiques (Pharmacie) / info:eu-repo/semantics/nonPublished

Excerpt: According to the United States Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are infected with human papillomavirus (HPV), and another 6 million will become infected each year.

Hispanic and African American women are infected with sexually transmitted diseases more often than are Caucasian women. This racial disparity is also seen in the incidence of human papillomavirus (HPV) and cervical cancer. The medical connection between HPV and cervical cancer is often unknown or misunderstood among women. This study addressed the beliefs and subsequent health decisions of minority parents regarding whether to get their daughters vaccinated against HPV. The theoretical framework for this study was Rosenstock's health belief model (HBM). The specific study design used was Husserl and Heidegher's theory on Phenomenology. This qualitative study utilized focus groups containing mothers of young girls ages 9 to 12 years, who were recruited from local churches in San Antonio, TX. Twenty-seven mothers, African American (9), Hispanic (7), and Caucasian (11), participated in one of two focus groups for each racial group. Each focus group session was audiotaped and NVivo for Mac was used to perform a content analysis and to identify the themes present. Minority parents held stronger cultural and spiritual beliefs against vaccinating their daughters for a sexually transmitted disease more so than believing that their daughters were at risk for being exposed to STDs such as HPV. These beliefs presented as barriers to initiating the desired HPV prevention and screening practices. Gaps in the current knowledge of all parents exist and must be thoroughly addressed for all racial/ ethnic groups. Future educational programs need to not only address the gaps in knowledge but also shape and package public health messages with sensitivity to cultural and spiritual concerns.

Sexually active young men are at high risk of contracting HPV and developing genital warts and penile/anal cancers. They contribute significantly to the incidence of HPV in women. The HPV vaccine, Gardasil, was approved in 2009 for use in preventing HPV 6 and 11 in young males ages 9 to 26. Knowledge and awareness of the virus and the vaccine is limited among young men. Promoting education and prevention measures regarding HPV and reducing personal risks to HPV is significant in narrowing the gap between acquisition of the HPV virus and cancer sequelae. A correlational design utilizing cross-sectional survey methodology was used for this study. Seventy participants completed a HPV vaccine survey at a university in Southwestern United States. The survey measured their knowledge and acceptance of the HPV vaccine and their intention to be vaccinated. Male participants were likely to accept or consent to receive the vaccine however they reported low intent to actually get the HPV vaccine. Acceptance of the vaccine was greater among minorities and participants who reported regular doctor visits. Knowledge of HPV and HPV prevention was low. Young men may benefit from HPV vaccine educational marketing strategies that include enhancing their communication skills on HPV, the HPV vaccine and reducing risky sex behaviors.

Human Papillomavirus (HPV) is one of the most common causes of sexually transmitted disease worldwide. Infections by high-risk HPVs, such as HPV-18, have been associated etiologically with cervical cancer. The successful development of HPV vaccines may be beneficial to the HPV-na??ve population, but women that have already been exposed to the virus are still at risk of developing HPV-associated malignancies. A need for a systemic cure for HPV-infection therefore still exists. Gene therapies using tissue-specific promoters have been reported to be a promising tool for treating cancers; however, few studies have explored this possibility for cervical cancer. The aim of this project is to construct a gene expression vector that can specifically target HPV-infected cervical cancer cells, by making use of the activity and selectivity of the P105 promoter which is determined by transcription control elements within the HPV-18 long control region (LCR). The first part of this study involved the construction of LCR deletion plasmids, and examining the subsequent level of gene expression induced within different mammalian cell lines. The results suggest the LCR to be capable in achieving cervical cancer-specific gene expression. The 3′-end of the viral L1 gene upstream of the LCR appeared to have a repressive effect on the promoter and therefore should be excluded for maximum LCR promoter activity. The second part of the project involved site-directed mutagenesis studies performed on selected transcription factor binding sites with an attempt to further increase the level of LCR promoter activity and specificity towards HPV-infected cervical cancer cells. The results suggest that a GRE/YY1 mutation may significantly enhance promoter activity. In terms of promoter regulation, the E2BSs appeared to be responsible for promoter activation in the absence of viral E2 proteins. The findings of this study suggest a possible gene therapy approach towards the treatment of cervical cancer. By making use of the activity and specificity of the HPV-18 P105 promoter to induce cervical carcinoma-specific expression of appropriate therapeutic genes, suicidal phenotypes can be introduced selectively within HPV-positive cervical cancer cells while normal HPV-negative cells are unaffected.

<p>En artikelserie om livmoderhalscancer.</p><p>I Sverige diagnostiseras 30 000 kvinnor varje år med cellförändringar i livmoderhalsen. Av dem utvecklar 450 cancer. Chris Eriksson överlevde livmoderhalscancer med ett ärr som minne. John Karlssons sambo Ylva var en av de som inte överlevde.</p>

Human papillomavirus (HPV) is a double-stranded DNA virus, typically infecting mucosal or cutaneous epithelial keratinocytes. Today, more than 118 different HPV types have been formally described. Sexual transmission of mucosal HPVs is very common and generally asymptomatic, but HPV infection can be associated with benign lesions such as condylomata acuminata or, in rare cases, with malignant lesions such as cervical cancer. Two prophylactic vaccines are currently available in Europe, protecting against HPV-16 and HPV-18 (Cervarix) or against HPV-6, HPV-11, HPV-16 and HPV-18 (Gardasil). In order to assess the impact of the vaccination program, it is mandatory to obtain geographically widespread date on the baseline HPV prevalence and type distribution in cervical samples from women, presenting or not, normal or abnormal cytologic or histologic results. We undertook an epidemiological study in the Capital Region of Brussels to determine the HPV prevalence and type-distribution in 1526 cervical samples of women presenting a cytology within normal limits (WINL), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intra-epithelial lesions (LSIL), high-grade squamous intra-epithelial lesions (HSIL) or invasive cervical cancer (ICC). The HPV prevalence was 10.8% (95%CI: 8.8-12.8) for NILM, 34.5% (95%CI: 28.3-40.8) for ASC-US, 54.0% (95%CI: 47.4-60.6) for LSIL and 100% for HSIL and ICC. With an HPV-16 and HPV-18 prevalence of 63.3% (95%CI: 44.1-67.7) and 73.5% (95%CI: 63.0-84.0) in mono-infected HSIL and ICC, respectively, HPV 16/18 L1 VLP vaccines would be expected to significantly reduce the management and treatment of women suffering from HSIL and ICC in the Capital Region of Brussels. We also detected HPV-30, HPV-53, HPV-66 and HPV-68 in mono-infected HSIL and ICC samples, possibly providing arguments for the reconsideration of the carcinogenicity of these types. Vertical transmission of HPV was also previously reported, but in most cases one could not exclude a placental contamination by HPV positive cells from an infected birth canal. In order to confirm that the placenta can be infected with HPV, we analysed residual cells from 35 transabdominally obtained placental samples from pregnant women undergoing chorionic villous sampling for screening of suspected foetal abnormalities and found that two samples were positive for HPV-16 and HPV-62, respectively. The clinical importance of these results remains to be elucidated, but the previously observed association between placental HPV infection and pregnancy loss might gain further in importance. HPV gene regulation in placental trophoblastic cells has not been studied so far. We studied the HPV-16 early gene expression regulation in transiently transfected monolayer cultured trophoblastic cells with an HPV-16 long control region (LCR) driven reporter plasmid. We observed important differences in constitutive HPV-16 LCR activities between trophoblastic cell lines and could identify progesterone as an important inducer of HPV-16 early gene expression. Steroid hormones are induced during pregnancy and could therefore lead to an enhanced expression of the E5, E6 and E7 proteins upon placental HPV infection. Since these proteins were previously shown to affect trophoblast adhesion, survival, migration and invasion, their enhanced expression might eventually contribute to pregnancy loss. We furthermore found that the transcription of episomally maintained HPV-16 is not regulated by E2 or E1, but by E5, E6 and/or E7.

En artikelserie om livmoderhalscancer. I Sverige diagnostiseras 30 000 kvinnor varje år med cellförändringar i livmoderhalsen. Av dem utvecklar 450 cancer. Chris Eriksson överlevde livmoderhalscancer med ett ärr som minne. John Karlssons sambo Ylva var en av de som inte överlevde.

Undersökningen syftar till att undersöka hur en hälsoinformationskampanj argumenterar för att övertyga målgruppen om att vaccinera sig mot ett virus som kan orsaka livmoderhalscancer. Uppsatsen syftar också till att undersöka hur målgruppen uppfattar kampanjen och om den har någon effekt på den. Målgruppen för hälsoinformationskampanjen är unga tjejer något som är ganska ovanligt för hälsokampanjer. Uppsatsen bygger på både en retorisk analys och en receptionsanalys med hjälp av fokusgruppsintervjuer. Teoretiska utgångspunkter är teorier kring kampanjer. Teorier om risk och skräck, avsändares roll, utvärderingar av kampanjer samt internets roll i hälsokampanjer. Resultaten visar på att målgruppen reagerar på kampanjens argument och uppfattar en risk att drabbas av livmoderhalscancer. Att vaccinationen är kostnadsfri är ett användbart argument och har effekt. Resultaten visar också på alternativa argument som skulle kunna få målgruppen att agera. Vidare konstaterar uppsatsen att kampanjens närvaro, och försök att kommunicera med målgruppen, på nätverket Facebook inte är intressant för målgruppen och därmed verkningslöst.

Bakgrund: Sedan januari 2010 ingår vaccin mot humant papillomvirus i det svenska barnvaccinationsprogrammet. Beslutet att vaccinera eller inte vaccinera sina barn kan vara svårt för föräldrar. Syfte: Var att beskriva föräldrars kunskap om och attityd till vaccin mot humant papillomvirus och hur det inverkar på deras beslut att vaccinera sina barn. Design: Mixed-methods research integrated design. Metod: Beskrivande litteraturstudie. En systematisk sökning gjordes i databaserna CINAHL och PubMed och 12 artiklar identifierades. Artiklarna hade kvantitativ och kvalitativ ansats. Resultat: Föräldrar var positiva till HPV-vaccin. Många föräldrar hade liten kunskap om vaccinet och upplevde att de inte hade tillräckligt med information. Det fanns en oro för vaccinets säkerhet och biverkningar. Många fick information från media men den föredragna informationskällan var vårdgivare. De som fått information från vården var mer positiva till vaccinet. Föräldrar ansåg att den rekommenderade åldern för vaccinet var för låg och det fanns en rädsla att en vaccination skulle påverka dotterns sexuella beteende. Bland de föräldrar som valde att vaccinera var den oron mindre. Sociala normer och religion påverkade föräldrarna i besluten kring vaccination. Lägre utbildning var en prediktor för att välja att vaccinera. Egen eller anhörigas erfarenhet av cellförändringar eller cervixcancer påverkade också intentionen att vaccinera.   Sökord: MeSH-termerna accept*, attitudes, behavior, beliefs, decision, HPV-vaccine, intent*, knowledge, parents. / Background: Since of January 2010 vaccine against human papillomavirus (HPV) is a part of the Swedish child vaccination program. The decision to vaccinate can be difficult for the parents to make. Purpose: The purpose of the study was to describe parental knowledge and attitude towards vaccine against human papillomavirus and how that influenced their decision to vaccinate their children. Design: Mixed methods research with integrated design. Method: A descriptive literature review. A systematic search was performed in the databases PubMed and CINAHL and 12 studies were identified. The studies had quantitative and qualitative design. Results: Parents were positive towards the HPV-vaccine. Many parents lacked knowledge and felt they didn´t have enough information about the vaccine. There was concern about the safety and side effect. Many got their information from media but the preferred source of information was caregivers. Parents who had gotten information from caregivers were more positive towards the vaccine. The recommended age for vaccination was considered too low and there was concern that a vaccination would have an effect on their daughter’s sexual behavior. Among the parents who had made the choice to vaccinate that concern was lower. Social norms and religion affected the parents in their decision to vaccinate. Lower education was a predictor in the decision to vaccinate. Experience of abnormal pap-smears or cervicularcancer also affected the intention to vaccinate.   Search words: MeSH-therms accept*, attitudes, behavior, beliefs, decision, HPV-vaccine, intent*, knowledge, parents.