The human papilloma virus (HPY) infection has a causal association with cervical intraepithelial neoplasia (CIN) and cervical cancer. However, pre-malignant or malignant transformation is not always observed with HPY infection. lILA molecules are important in the regulation of the immune response to foreign antigens. The role of genetic variation at the HLA class II loci (DR and DQ) in CIN was investigated in 176 British Caucasian patients and 420 controls (normal cervical cytology and negative for HPY 16, 18, 31 and 33). HLA DQB 1 *03 typing was performed by a novel polymerase chain reactionrestriction fragment length polymorphism method (A-RFLP). The technique uses PCR to mutate the first base of codon 40 (DQ alleles) from T to G to create an artificial restriction site for an enzyme, MluI, which distinguishes DQB 1 *03 from other alleles and is confirmed by digestion of amplified DNA with Mlul. Further HLA DR-DQ typing was performed by PCR DNA amplification and oligonucleotide probe typing. HPY types (16, 18, 31 & 33) were detected by using type-specific oligonucleotide primers and PCR. The alleles of the DQB 1 *03, DRB 1 *04 and DRB 1 * 11 groups were strongly associated with susceptibility to CIN. Specifically the haplotypes DRB 1 *040 I-DQB 1 *0301 and DRBl*1101-DQB1*0301 were significant and indicated susceptibility. The DQBl*03 locus was more contributory to this association than the DRB 1 loci. A weak protective effect was shown for the haplotype DRB 1 *0 10 I-DQB 1 *0501. Positive correlation was also observed for HPY-positive CIN, suggesting that specific HLA alleles may be important in determining the immune response to HPY antigens and the risk for CIN after HPY infection. Immunoaffinity purification of the susceptibility and protective HLA ~ molecules was performed and the naturally processed peptides were eluted and sequenced by Edman degradation. The data obtained was used for motif prediction of HPY 16 E6, E7, Ll and L2 sequences that may be capable of binding to these HLA molecules. Motif prediction as well as the binding affinity of predicted peptide motifs for HLA D RB 1 *0401 and DRB 1 *0 10 1 was accomplished using the published data' on the naturally bound peptide sequences bound to these HLA molecules. The results revealed significant differences in both the number and binding affinity of the HPV 16 derived peptides to the protective and susceptibility HLA molecules. These results should help in the rational design of vaccines against HPV.

Cervical cancer is the second most common malignancy worldwide. Infection with HPV is a necessary cause of cervical. Hispanic women in the U.S. experience significantly higher rates of invasive disease than non-Hispanic Whites. In this population, HPV vaccines hold significant potential to eliminate further disparities in cervical cancer morbidity and mortality. The purpose of this study was to examine factors associated with Human Papillomavirus (HPV) vaccine acceptability among a national sample of Spanish speaking callers to the National Cancer Institute's (NCI) Cancer Information Service (CIS). Specifically this research aimed to identify the sociodemographic, sociocultural and attitudinal determinants of HPV vaccine acceptability. This research involved a cross-sectional study with phone-based interviews conducted in Spanish (n = 836). All female Spanish callers to the CIS were asked to respond to a three-part questionnaire that included items relating to ethnic identity and acculturation, knowledge of cervical cancer and related risk factors, and HPV vaccine acceptability. Descriptive, univariate and multivariate logistic regression were used to characterize the study population and to determine the effect of each of the demographic/sociocultural variables on vaccine acceptance. Independent predictors of HPV vaccine acceptability were determined using multivariate linear regression models. Results showed that HPV vaccine acceptance was high among this group of Hispanic women (78%) and that attitudes about vaccines in general and the HPV vaccine specifically were positive. Factors associated with vaccine acceptance included physician recommendation, awareness and accurate knowledge about HPV, and speaking only or mostly Spanish. Other important predictors included influence of peers, positive attitudes about vaccines in general, higher education and being a mother of a female adolescent. The primary reason cited by those who did not favor vaccination was concern over vaccine safety. This research was the first study looking at vaccine acceptability in a large, national sample of Hispanic women. HPV vaccination can lead to important public health benefits for Hispanic women. Targeted educational interventions must take into account the important sociocultural and attitudinal influences on the decision to vaccinate, such as those identified in the present study. Future educational efforts must involve the physician and take into the account the cultural context of attitudes and beliefs regarding vaccine safety and disease susceptibility. Further studies elucidating the interplay between culture specific beliefs and practices regarding vaccination and the decision to participate in HPV vaccination are needed.

Background: Vaccines have been hypothesized in the etiology of autoimmune diseases including type 1 diabetes. There are cases of diabetes reported in the Vaccine Adverse Event Reporting System (VAERS) following the administration of the human papillomavirus (HPV) vaccine, however this potential association has yet to be investigated. The objective of this thesis was to determine whether there is an association between immunization against HPV and the development of type 1 diabetes mellitus in grade 8 girls eligible for Ontario’s vaccination program. Methods: A retrospective, population-based, cohort study of girls residing within an Ontario health unit and eligible for the province’s publicly funded school-based HPV vaccination program between 2007 and 2010 was executed using provincial administrative health databases and the Immunization Recording Information System (IRIS) database. To control for known, unknown and unmeasured time-independent confounders, a self-controlled case series analysis was conducted. The relative incidence and 95% confidence interval were estimated using conditional Poisson regression. Results: The study cohort was comprised of 3465 girls with a mean age of 13.2 years at cohort entry (range 12.7 to 13.6 years). The mean duration of follow up was 2.7 years and ranged from 1.6 to 3.6 years. The proportion of girls who received at least one dose of the qHPV vaccine during the observation period was 58.3% (n=2020). During the study follow-up 15 cases of new onset type 1 diabetes were observed, six of which were classified as etiologically exposed to the qHPV vaccine. Using an indefinite risk window, immunization with the qHPV vaccine was not associated with an increased risk of developing type 1 diabetes (age and season-adjusted RI 0.15; 95% CI 0.02-1.32). Conclusions: The results of this thesis regarding the risk of type 1 diabetes following immunization with the qHPV vaccine are inconclusive as a consequence of the small number of cases identified. However, the random distribution of cases across time and across exposure status suggests that there is no association. Before a definitive conclusion is reached the analysis must be re-conducted on a larger cohort. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-05-28 10:39:00.73

No description available.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.

BACKGROUND: Now considered a cornerstone of healthcare, patient-provider communication has long been studied and analyzed. Medical associations such as the Joint Commission and the American Association of Orthopaedic Surgeons (AAOS) have strongly endorsed for physicians to exercise patient-focused communication, a practice that involves showing empathy, involving patients in medical care decisions, eliciting concerns, and educating patients on treatment options (Joint Commission, 2016; AAOS, 2017). A lack of patient-provider communication has previously been identified as a significant factor in adverse medical outcomes occurring within hospitals (Khan et al., 2017). Bridging the communication disparity between patients and providers is crucial to improving overall patient outcome. Primary care providers are especially essential to improving overall patient outcome because they serve as the first point of contact for many patients accessing the healthcare system. While there is much literature on the importance of effective patient-provider communication, few studies provide technology-based tools that can enhance this establishment of communication. Human Papillomavirus is presently the most common sexually transmitted infection (STI) nationwide with 79 million Americans currently infected (CDC, 2017). Approximately 42,700 HPV-attributable cancers are diagnosed in the United States annually, and HPV is believed to be responsible for over 90% of cervical cancer cases (CDC, 2018). The Advisory Committee on Immunization Practices (ACIP) currently recommends three preventative HPV vaccines. Despite high rates of infection, HPV vaccination rates nationwide remain low as coverage of the HPV vaccine falls behind that of coverage for required vaccines like the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) (Reagan-Steiner, 2016). Previous studies have sought to address factors that affect decisions to vaccinate children. An analyzation of the National Immunization Survey of Teens has identified that parents’ belief that the HPV was not necessary as a main factor (Darden et al., 2013). As a result, there is a gap needed to be filled by providers to educate parents on the importance of the HPV vaccine. PURPOSE: The current study sought to determine the effectiveness of a web-based mobile health education program called Wheel of Wellness (WoW) on patient-provider communication, to assess the viability and impact of WoW to increase HPV vaccination rates in age eligible children (boys and girls aged 9-17) and to augment awareness about the benefits of HPV vaccination in both these children and their guardians. RESEARCH METHOD AND DESIGN: As of August 2018, twenty-seven parents of children between the ages of 9 and 17 years of age within the Pediatrics and Adolescent departments of Boston Medical Center (BMC) have been recruited. Parents enrolled in the WoW program to compile a list of concerns to be shown to a provider during their child’s appointment. Participants were asked questions to determine initial knowledge on the HPV vaccine, and their opinions on the HPV vaccine. Following their appointment, participants completed a questionnaire to assess opinions on the WoW program in facilitating communication with their provider on the HPV vaccine and related cancers. Seven physicians were interviewed to assess their views on the WoW program in facilitating communication with their patients on the HPV vaccine and related cancers. RESULTS: Initial stages of this study found that views on the effectiveness of the WoW program in facilitating patient and provider communication on the different aspects of HPV vaccination and affecting parents’ decisions to vaccinate their children were mixed by both patients and their providers. Based on the WoW feedback collected from parents, the system was widely acceptable in terms of ease in usage and with the majority of parents (92%) reporting that the WoW website is helpful for communicating their health concerns with their provider. However, the majority of providers reported having never been presented the WoW system and expressed views that WoW was inefficient as it was a parallel system to existing workflow. This study determined that of the 12 participants who had one dose of the vaccine prior to enrollment, 75% of these participants completed the HPV vaccine series during the study. CONCLUSION: Based on the initiation and completion statistics reported, this shows great potential for the use of the BNI coupled with the WoW system to help improve rates of initiation and completion of HPV vaccination going forward as the intervention may have helped encourage parents to either initiate vaccination or complete their child’s previously started series. Further studies should explore ways of empowering patients to facilitate more communication with their providers and improvements to technology to enhance provider recommendation in order to promote an increase in HPV vaccine completion. / 2021-06-17T00:00:00Z

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.

How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.