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Background: In 2007, the Canadian federal budget provided $300 million over three years to the provinces and territories to implement publicly-funded HPV immunization programs. Current estimates indicate that HPV vaccine uptake varies significantly across Canada and is reported to be lowest in Ontario at 53%. There is a paucity of literature on the determinants of HPV vaccine uptake in the Canadian context, therefore further research is needed. Objectives: To describe the patterns of HPV vaccine non-uptake across health units in Ontario, and identify the individual- and health unit (ecologic)-level factors that influenced HPV immunization decision-making between 2007 and 2011. Methods: The study linked administrative health and immunization databases to identify a retrospective population-based cohort of 144,047 girls eligible for Ontario's school-based HPV immunization program between 2007 and 2011. In this study a girl was considered vaccinated if she received at least 1 dose, otherwise she was considered unvaccinated. Ecologic or health unit-level factors that may have influenced HPV vaccine decision-making were assessed, as well as individual-level predictors including clinical characteristics and sociodemographics. A population-average model based on generalized estimating equations was used to identify determinants associated with non-uptake. Results: In all, 49.3% of girls from 21 public health units refused HPV immunization between 2007 and 2011. Non-uptake varied across health units, from 41.82% to 60.30%. In multivariate analyses, non-uptake was strongly associated with a history of autism (OR=1.60; 95% CI 1.34, 1.90) and Down's syndrome (OR=1.37; 95% CI 1.16, 1.63), refusal of mandatory and optional vaccines (OR=2.23; 95% CI 2.07, 2.4, and OR=3.96; 95% CI 3.87, 4.05, respectively), and infrequent physician visits (OR=1.45; 95% CI 1.35, 1.55). Contextual or health unit-level characteristics appeared to have a weak influence on vaccine decision-making. Conclusions: HPV immunization could lead to a lower risk of developing and dying from HPV-related cancers; however, non-uptake of this vaccine is high. Concerted efforts are needed to reduce missed opportunities during medical consultations, to refine communication strategies and activities to address the information needs of special groups, as well as to develop cross-sectoral collaborations to support the delivery of publicly-funded HPV immunization to schools across Canada. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-02-01 19:49:17.262

Thesis (M Med.(Obstetrics and Gynaecology))--University of Limpopo, 2010. / STUDY RATIONALE: Cervical cancer is the most common cancer of women on the African continent and the second most common cancer of women worldwide and in South Africa ’. It has been estimated in 1997 that, among women who received no cervical screening in South Africa, 1 in 26 women were likely to develop cervical cancer . Screening will probably decrease the incidence of cervical cancer by 60% or more . There is a direct relationship between the number of women screened by Pap smears and the decreased incidence of cervical cancer. In Iceland, where more than 90% of women were screened in that time, the incidence decreased by 80%. In Norway, where only 5% of the women were screened, the incidence only decreased by 10% . In South Africa, it is estimated that Pap smears were taken in 18.8% of white women and only 2.6% of black women in 2002 . Real-world obstacles to successful cervical cancer prevention in develo- ping countries involve people more than technologies 3. This can be ma- naged by focusing on system quality management 3. The root causes of poor quality must be examined. Suba et al 3 found causes such as obso- 7 lete supplies, poorly maintained microscopes, insufficient training and suboptimal working conditions. Successful follow-up for screen-positive women has been achieved through the allocation of budgets for dedicated personnel to recontact women with positive test results 3. Human Papillomavirus (HPV) infection is known to cause cervical can- cer. Human Papillomavirus (HPV) infection is also regarded as the most common sexually transmitted infection worldwide, with an estimated life- time risk of 79% for women to contract at least one infection between the ages of 20 and 79 years . Although some men have anal or genital lesions associated with HPV 16 and 18, most men serve as vectors of oncogenic HPV. Male partners may be important contributors to their female partners’ risk of cervical cancer . The 15 HPV types, which are classified as high risk virus types, cause 95 % of all cervical cancer. The High Risk HPV Genotypes are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. HPV 16 and 18 together cause around 70 % of all cervical cancer ’. Squamous cell cervical cancer constitutes approximately 80% of cervical cancers . Adenocarcinoma is the second most common histological type and shows a rising incidence, even in developed countries . 8 There is geographical variation in type-specific HPV prevalence 9. HPV16 is the most common type associated with adenocarcinomas, except in Southeast-Asia, where the prevalence of HPV 18 exceeds that of HPV 16. HPV 16, 18, 35, 45and 59 are present in 96% of adenocarci- nomas of the cervix 10. A pooled analysis by Clifford et al 9 showed that the prevalence of high risk HPV types is around 18 % in sub-Saharan Africa, with HPV 16 and HPV 35 present in 8% of women. HPV 31 and HPV 33 were present in 7% of women and HPV 18 was present in 4% of women. Sub- Saharan Africa had the highest prevalence of all HPV types and Europe the lowest. The variation in prevalence of HPV 16 across regions was smaller for HPV 16 than for the other high-risk types. The next common high- risk types were HPV 33 and HPV 56 in Asia, HPV 58 in South America and HPV 31 in Europe 9. This study’s rationale was to ascertain the HPV types prevalent in pa- tients with abnormal Pap smears seen at the Gynaecological Outpatients Clinic at Dr. George Mukhari Hospital, the Gynaecological Oncology Clinic at Dr. George Mukhari Hospital, the Tshepang Clinic at Dr. George Mukhari Hospital and the Setshaba Research Centre of the University of Limpopo – Medunsa Campus in Soshanguve. 9 This study can also act as a pilot study for future studies to test the ef- fectiveness of using high risk HPV types screening as a primary screening method, instead of Pap smears, to identify patients who are at a higher risk to develop cervical cancer and who need further investigations such as Colposcopically directed biopsies.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Papillomaviruses (PV) are epithelium specific DNA viruses that can cause health problems ranging from harmless warts to invasive cancer. Papillomavirus induced tumours most often arise in the cervix where human papillomavirus (HPV) infections were shown to cause 99.7 % of all malignancies. This study aims to map binding sites of the multifunctional host protein CCCTC binding factor (CTCF) to the papillomavirus genome, validate them and determine the function of CTCF in the papillomavirus life cycle. Computer predictions of CTCF binding sites in the sequence of 8 different PV revealed a CTCF binding pattern including a conserved high-affinity binding site around nucleotide 3000 in high risk HPV and around nucleotide 5400 in low risk HPV. This binding pattern was experimentally confirmed using electrophoretic mobility shift assays (EMSA). The binding site around nucleotide 3000 in HPV18 was mutated and human foreskin keratinocytes (HFK) were transfected with mutant and wild type HPV18 to analyse the effect of the mutation on viral gene expression and life cycle. Western blotting of methylcellulose differentiated HFK revealed earlier expression of E2 and decreased expression of E1^E4 in the mutant compared to the wild type. Immunostaining of organotypic raft cultures grown from the mutant maintaining cells showed a significant increase in proliferating cells compared to the HFK maintaining the wild type. This was accompanied by pseudo-differentiation of keratinocytes since the cells of the granular layer of the raft expressed the terminal differentiation marker loricrin but maintained the morphology of undifferentiated cells. Thus CTCF was shown to have a major impact on the HPV life cycle and it may play a role in HPV induced carcinogenesis. Furthermore a function of CTCF in long term maintenance of the viral episome was revealed as cells maintaining the CTCF mutant were shown to lose episomes more quickly compared to wild type maintaining cells.

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Thesis advisor: Ann W. Burgess / Background: There is an opportunity for nurses to integrate HPV education and prevention strategies into the routine care for adolescent and young adult sexual assault patients. Study design: An exploratory, cross-sectional, electronic mail survey was conducted to explore forensic nurses' knowledge, beliefs, and attitudes about HPV, the HPV vaccine, and HPV preventative strategies, as well as identify facilitators and barriers that may influence nurses' level of support regarding incorporating HPV preventative strategies into their care. Eligibility criteria for inclusion were: nurse members of the International Association of Forensic Nurses (IAFN) and stakeholders in the care of sexual assault patients. Results: 541 nurses completed the survey; 98% (n= 508) were supportive of at least providing written educational information regarding HPV and the HPV vaccine during post sexual assault care, 86% (n= 446) were supportive of providing written information plus making changes to the written discharge instructions to incorporate HPV vaccination recommendations, and 53% (n= 273) were supportive of providing written information, making changes to the discharge instructions, and initiation of HPV vaccination at point of care. The strongest predictor of level of support was having positive perceived benefits of HPV and vaccination. A one standard deviation increase in perceived benefit was associated with a 50% increased odds of having the highest level of support (support for vaccination initiation) (OR=1.5, CI= 1.1-1.9). Conclusions: Forensic nurses provide care for many adolescents and young adults who are at risk for acquiring HPV and are within the age range for HPV vaccination. There is an opportunity to update current practice guidelines and recommendations. Nurses in this national sample demonstrated a high level of HPV knowledge, as well as positive attitudes and beliefs. The nurses were overwhelmingly supportive of integrating HPV prevention strategies into their care. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Objective: To detect the most prevalent human papillomavirus (HPV) genotypes samples of asymptomatic Peruvian women by analyzing the correlation betwe ienn c Pearvpiacnailc somlaeoaur (PAP)-stained cervical tests and PCR-sequencing. Methods: A total of 254 women attending routine gynecological examinations were included in pthaitsh ostluogdiys.t Tahned scalmaspsliefise dw ebrye tahnea Blyeztehde sbdya PsAysPt etmec.h HnPiqVu ea manpdli feicxaatmioinn ewda su nddoenre au msinicgr othsceo pprei mbeyr as specific for E1 region and positive specimens were confirmed by direct sequencing. Results: The prevalence of HPV was investigated in 254 cervical scrape samples by PCR. PAP smear showed that 94.9% cases had normal morphology and 5.1% had an inflammatory pattern; 2p0r.e5v%a lwenert eg efonuontydp teo ibne c ionrfreeclatetido nw iwthit hH PchVa, ncgoems pinri scienrgv i2c0a dl icfyfetorelongt yg.enotypes. HPV16 was the most Conclusions: Our results suggest the HPV is very frequent even in women with negative PAP, eannddo PceCrRvi csaele smasm tpol ebs.e Itdheen tbifeicsat toiopnt ioofn t htoe HdePtVe rgmeinnoety tphee inc aaussyamtipvteo magateinc tw oofm HePnV m ianyf eaclltoiown t hine nimatpulreaml henisttaotriyo no fo tfh ea pdpisroepasreia aten dp rthope hsyulbascetqicu emnet adseuvreelso pwmheicnht omf acye rhviacvael ma adliirgencatn icmy.pact / jdelvall@upc.edu.pe / This work has been partially supported by Universidad Peruana de Ciencias Aplicadas (UPC), Instituto de Investigación Nutricional and Instituto de Investigación de Efrnomfe rtmheed pardoegsr aImnf ecciosas, Lima, Peru. JR has a fellowship I3, of the ISCIII (Grant No. CES11/012), and LJDV from the Generalitat de Catalunya (2009SGR1208). / Revisión por pares