Introduction Cervical cancer is the fourth most common cancer in women worldwide. An estimated 62,000 cases of cervical cancer occur annually in China, accounting for 12% of global incidence. Virtually all cervical cancers are related to infection by Human Papilloma Virus (HPV): effective HPV vaccines have been developed and vaccination programmes introduced in many countries over the last decade. Given the burden of cervical cancer in China, it is imperative that effective primary and secondary prevention strategies are introduced. Effective introduction of HPV vaccination programmes will require education and information strategies that are informed by a comprehensive understanding of the knowledge, attitudes and beliefs about HPV infection and its relationship to cervical cancer in the Chinese population. Aims and objectives The aims of my thesis are: 1) to systematically review the evidence from the Chineselanguage literature in relation to knowledge of and attitude towards HPV infection and HPV vaccination, and 2) to explore knowledge and attitudes about HPV infection, HPV vaccination and cervical screening amongst teenagers in Heilongjiang province in China. Methods I undertook a systematic literature review using two electronic Chinese databases – the ‘Chinese National Knowledge Infrastructure’ (CNKI) database and the ‘Wanfang’ database. These were searched from inception through November 30th 2012: MeSH terms were applied to both Chinese databases. Manual searching of relevant online journals was also undertaken. Following selection of papers based on pre-determined inclusion and exclusion criteria, quality assessment was carried out using a modified quality assessment checklist, and included studies were classified as good, fair or poor quality. Due to heterogeneity of populations and survey instruments a narrative approach was adopted for data synthesis. I also undertook a questionnaire survey of high-school students in China. Questions were designed based on the Health Belief Model, informed by findings from my systematic review, and refined through cognitive interviews prior to field work in early 2014. The survey targeted students in five public high schools in one middle-income city (Mudanjiang city) and two small counties (Ning’an and Hailin) of Heilongjiang province; 3788 young people aged 14-22 years participated. Descriptive statistical analysis was used to summarise demographic characteristics; initially differences were identified using the chi-square test. Factor analysis was applied to identify attitude patterns and logistic regression analysis models were applied to determine the association between attitude (potential predictors) and acceptability, attitude and levels of knowledge. Results Forty seven articles met my inclusion criteria and were included in the systematic review. All included studies were published between 2006 and 2011; all were cross-sectional questionnaire surveys with sample sizes ranging from 100 – 9,865. The quality of included studies varied considerably. Included populations ranged from the general public, to young people, and health professionals. Awareness of HPV and knowledge of the relationship between HPV and cervical cancer, and of the sexually transmitted nature of HPV, were the main issues examined. Awareness of HPV was low among all non-health professionals groups. Similarly, understanding of the relationship between HPV infection and cervical cancer and of the sexually transmitted nature of HPV was low. However, significant differences in awareness and knowledge were found, based on urban/rural status, ethnicity and age. Uighur women had the lowest awareness and knowledge levels, followed by rural women adults, and teenagers. Acceptability of HPV vaccination varied in terms of the vaccine target recipients (whether adult women, or for their daughters), and between health professionals and the general public). Reported levels of HPV vaccine acceptability (for women adults themselves and for their daughters) were higher in North China compared to South China. Health professionals were less willing to accept the vaccine for their daughters than they were to receiving it themselves. The cost, source and appropriate age for HPV vaccination were also frequently examined issues. Importantly, a high proportion of the health professionals believed that the appropriate age for vaccine was over 18 years old for girls. 3788 participants aged 14-22 years were included in the questionnaire survey, with 54% females and 20% urban students. Overall awareness of HPV was 13.2% and acceptability of the HPV vaccine was 68%. Knowledge levels varied in different content areas; for example 74% of respondents knew that HPV vaccination is not 100% effective against cervical cancer while only 6% knew that poor personal hygiene did not increase the risk of contracting HPV infection. Attitudes towards HPV infection and vaccination were also interesting and novel; the greatest concern about HPV vaccination was minor side effects (72%). The highest-rated source of recommendations about HPV vaccination was parents (66%), while there were concerns expressed about ‘gossip’ in relation to HPV vaccination (51%). No urban/rural differences were found in knowledge and attitudes - gender differences existed, but depended on specific circumstances. Participants who were willing to accept HPV vaccination were more likely to be influenced by others, to report high perceived severity of HPV and cervical cancer, to perceive benefits of HPV vaccination and to score well on knowledge questions. Participants with high knowledge scores for HPV infection and vaccination were more likely to consider HPV infection and cervical cancer to be serious, and were less likely to associate HPV infection with stigma. Participants who had high levels of awareness of HPV infection were more likely to be influenced by others in relation to accepting HPV vaccination. Discussion My thesis has produced new and novel findings in relation to HPV vaccination knowledge, attitudes and beliefs in China. Low levels of awareness and knowledge amongst Chinese people may be influenced by traditional Chinese culture, which perhaps makes people more reluctant to consider issues related to sexual practices. Another possible explanation is that people tended to under-report knowledge of HPV when answering the questions in the survey in order to conform to social norms in China - these topics are highly sensitive in China. High levels of acceptability of HPV vaccines may have also been influenced by ‘ways of thinking’ among Chinese people; their natural inclination is to accept all recommendations for vaccination from government agencies – so they may not have thought hard about this choice. There is optimism in the Chinese population that cancer can be prevented by vaccination – indeed, they are inclined to believe it will prevent disease that can generate serious health impacts in the future. Nevertheless, some Chinese people have conservative attitudes towards the effectiveness of HPV vaccination and some suspicion of the drug companies which produce these vaccines. There were significant methodological issues in my comparisons of Western and Chinese literature. Western literature is more likely to comprise good quality studies – typically there are better-defined sampling frames, more valid and reliable instruments and robust theoretical frameworks. The difference in quality between Chinese and Western literature arises from the stricter rules for reporting and evaluation in western publications and the relatively low publishing standards in Chinese literature. / My thesis also details a number of methodological issues which arose in conducting my questionnaire survey – ideally, I would like to follow up the work I have done with a multi-centre population-based study among teenagers in China (an idea which I will pursue once I return to China). This would hopefully provide better quality information on the influences of factors such as socio-economic status and family background in determining acceptability of HPV vaccination. Nevertheless, my relatively modest, school-based study has, I believe, produced results which add to the information available to health care planners and policy makers in the field of HPV vaccination in China. Conclusion My systematic review is, to my knowledge, the first to identify and synthesise findings about knowledge of and attitude towards HPV infection and vaccination in the Chinese literature – as such, it addresses a gap in currently available evidence. Although there are methodological limitations in Chinese literature (with more poor quality studies), the results still have implications for further health education intervention programmes and health policy. My questionnaire survey was also a ‘first’ in many ways – it explored attitudes towards HPV vaccines based on Health Belief Model among Chinese teenagers and examined HPV related stigma among mainland Chinese teenagers. Low levels of awareness and knowledge and conservative attitudes towards sexually related infections suggest the impact of Chinese traditional culture and a range of other social and financial constraints in China. Hence, there is a great deal to be done before HPV vaccination can be implemented in China – there are educational needs, and in many areas societal and cultural attitudes need to be challenged. Significant changes are also need in government policy and investment – these are major challenges for health care in China, and I sincerely hope my thesis will contribute to these important debates.

Background: The HPV vaccine has been introduced to the public and the medical community since June 2006 for the vaccination of females and since November 2009 for the vaccination of males ages 9-26 years old. The purposes of this research were to explore multiple factors and relationships among Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived barriers, and perceived benefits) and mediating factors (self-efficacy and cues to action) related to HPV, HPV-associated diseases, and HPV vaccine among Russian college students and to determine which factors were most important when considering who would/would not seek HPV vaccination. Methods: A quantitative, cross-sectional, descriptive, and correlational survey design was used in this study. An existing self-report questionnaire HPV Study Survey was adapted with the permission from the author. One thousand two hundred participants were contacted by Yaroslav-the-Wise Novgorod State University, Veliky Novgorod, Russia registrar's office through e-mails and messaging using two social networks through simple random sampling method using the SQL statement "ORDER BY NEWID" propriety of Microsoft algorithm out of the total student population (9,923 students). The survey was distributed through SurveyMonkeyTM survey software that was activated December 2011 - April 2012. Results: Two hundred seventy students replied to the survey (22.5% response rate) and 117 participants fully completed it out of 270 who responded to the survey (43.33% completion rate). The initial response rate increased 4.4 times using social networks messaging compared to e-mailing invitations. Overall, average knowledge levels were moderate. Participants' behaviors regarding their sexual activity showed that the majority of participants were sexually active. Participants' perceptions (susceptibility, severity, barriers, and benefits) and mediating factors (cues to action and self-efficacy) were moderate. Participants' behavioral intention to get HPV vaccination was moderate. There were statistically significant differences between males and females in perceived susceptibility, perceived barriers, self-efficacy, behavioral intention, and in three behavioral items (having had sexual contact; age of having had sexual contact and sex for the first time). Sixty percent of the variance in behavioral intention getting HPV vaccination could be explained by two HBM constructs (perceived benefits and self-efficacy). Self-efficacy was the number one predictor of behavioral intention (p < 0.001) and perceived benefits were the number two predictor of behavioral intention (p < 0.01).

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-07-19T17:43:23Z No. of bitstreams: 1 Geise Paiva. Carcinoma de pênis.pdf: 1212270 bytes, checksum: f6aea41a94c500d0761c9c32a738597a (MD5) / Made available in DSpace on 2012-07-19T17:43:23Z (GMT). No. of bitstreams: 1 Geise Paiva. Carcinoma de pênis.pdf: 1212270 bytes, checksum: f6aea41a94c500d0761c9c32a738597a (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / O câncer de pênis é um problema de saúde pública principalmente em países em desenvolvimento. No Brasil, a incidência é alta e as regiões Nordeste e Sudeste são as mais afetadas, concentrando, respectivamente, 41,9% e 40,4% dos casos, segundo dados da Sociedade Brasileira de Urologia. Com o objetivo de conhecer melhor as características da doença no Estado, procedemos a revisão de prontuários e lâminas histológicas dos pacientes com a doença, atendidos do Hospital Aristides Maltez, Bahia, entre janeiro de 1997 a dezembro de 2007. Foram estudados 314 pacientes, a média de idade foi de 57 anos, 45% dos pacientes eram analfabetos e pacientes pardos representaram 83,8% da amostra. Amputação foi o procedimento mais comum, realizado em 288 casos (74,1%), linfadenectomias foram realizadas em 77 pacientes. Alterações histológicas sugestivas de infecção por HPV foram observadas em 239 (75,9%) pacientes. Segundo a classificação da OMS de 2004, o carcinoma usual foi o mais freqüente, com 241 (76,8%) casos e os subtipos representaram 23,2% da amostra. Dentre os subtipos, o misto e o Warty foram os mais observados, 29 (9,2%) e 26 (8,2%) e sarcomatóides e verrucosos foram os menos freqüentes, 1 (0,3%) e 2 (0,6%) dos casos, respectivamente. Observamos características clínicas semelhantes: baixo nível econômico e social, baixíssimo nível de instrução, predominância de pardos e negros, dificuldade de acesso aos serviços de saúde, tempo arrastado de sintomatologia, média de idade de 57 anos, além de altas taxas de infecção por HPV. Aspectos clínico-patológicos de mais de 300 pacientes foram apresentados e revistos segundo nova classificação da OMS de 2004. Nossa série é uma das primeiras a rever os casos segundo esta nova classificação, importante para prever a evolução destes tumores e auxiliar a clínicos e cirurgiões a estabelecer a melhor estratégia no tratamento. Conhecer o perfil da doença no Estado possibilita a criação de medidas voltadas à prevenção, diagnóstico e tratamento precoce para diminuir a incidência e morbidade desta triste realidade da doença em nosso país. Assim como permite a longo prazo a continuidade de um trabalho de investigação que possa responder a questões ainda não entendidas sobre a doença. / Penile Cancer is a public health problem mainly in developing countries. In Brazil, the incidence is higher in the Northeast and Southeast regions, respectively responsible for 41.9% and 40.4% of the cases, according to the Sociedade Brasileira de Urologia. Aiming to better understand the characteristics of this disease in our state, we proceeded reviewing medical records and histological slides of patients with the disease who were treated at the Hospital Aristides Maltez, Bahia, between January 1997 and December 2007. We studied 314 patients, with average age of 57 years, 45% were illiterate and mulatto patients accounted for 83.8% of the sample. Amputation was the most commonly procedure performed in 288 cases (74.1%), lymphadenectomy was performed in 77 patients. Histological changes suggestive of HPV infection were observed in 239 (75,9%) patients. According to the WHO classification of 2004, the usual carcinoma was the most frequent, with 241 (76.8%) cases and the other subtypes accounted for 23.2% of the sample. Among the subtypes, warty and mixed were the most frequently observed, 29 (9.2%) and 26 (8.2%) and sarcomatoid and verrucous were the least frequent, 1 (0.3%) and 2 (0.6%) of the cases, respectively. We observed similar characteristics: low economic and social, very low level of education, a predominance of brown and black skin, limited access to health services, time dragged symptoms, average age of 57 years and high rates of HPV infection. Clinical and pathological aspects of more than 300 patients were presented and reviewed following the new WHO classification of 2004. Our series is one of the first to review the cases under this new classification, important to predict the evolution of these tumors and help clinicians and surgeons to establish the best strategy for treatment. Knowing the profile of the disease in the state allows the creation of measures aiming prevention, early diagnosis and treatment to reduce the incidence and morbidity of this sad reality in our country. Allowing also long-term continuation

The theoretical part summarizes information about cervical cancer, which is caused by the human papilloma virus. Cervical cancer is ranked on the second place in the incidence of cancers world wide. Virus HPV affects both men and women. For men, it results in the emergence of genital warts or cancer of the penis. Although there are existing opportunites for effective prevention for men, the focus is more on the female population.This thesis looks at the current problems in the prevention of cervical cancer, which affects an ever growing number of women and men. In this work, we find out how informed are the young people about cervical cancer, their knowledge about possibilities of prevention, and experience of vaccinated respondents in the age in which this vaccination is recommended, that is, before the start of an active sexual life. In the research part, is a summary of a questionnaire, which was done among pupils of a primary school in Plzen. The age range of respondents was 13- 16 years. The research included both girls and boys. The assumption that girls are more informed and are more interested in information regarding cervical cancer and boys on the contrary don?t search for this information because they think that this problem does not concern them , was largely confirmed by this research.

Orientador: Paulo Cesar Giraldo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T21:42:54Z (GMT). No. of bitstreams: 1 EleuterioJunior_Jose_D.pdf: 17867889 bytes, checksum: 0d9e1c3f2399c5be86d6fbf719dc98c4 (MD5) Previous issue date: 2007 / Resumo: Objetivos: Estudar a importância de determinados marcadores de diagnóstico e prognóstico de lesões escamosas genitais, com ênfase nos estudos de p16INK4a e HPV de alto risco. Material e Métodos: Marcadores tumorais foram revisados em 21 estudos publicados entre 1994 e 2005, no sentido de identificar aqueles que teriam melhor valor diagnóstico e/ou prognóstico das lesões intra-epiteliais escamosas. Revisão mais apurada avaliou os marcadores p16INK4a e HPV de alto risco em lesões do colo uterino (36 publicações entre 1994 e 2006). Estudou-se a associação do p16INK4a e HPV de alto risco em 96 amostras de colo utenno (13 casos de lesão intra-epitelial escamosa de alto grau (HSIL), 26 casos de lesão intra-epitelial escamosa de baixo grau (LSIL) e 57 biópsias normais. O p16INK4a foi identificado por imuno-histoquímica, usando-se o p16INK4a kit (E6H4 clone, DakoCytomation, Carpinteria, CA) e o DNA-HPV foi classificado por captura híbrida (Digene®). Associações foram avaliadas pelo índice KAPPA. No artigo foram envolvidos 54 homens, parceiros sexuais assintomáticos de mulheres com lesão intra-epitelial escamosa de baixo grau associada com HPV de alto risco, com a finalidade de verificar se a presença do HPV de alto risco poderia ajudar a identificar os casos com maior risco de ter lesões intra-epiteliais penianas, devendo submeter-se à biópsia. O DNA-HPV foi testado por captura híbrida (Digene®) em raspados do pênis. Peniscopia identificou lesões suspeitas que resultaram em biópsias. Resultados: As revisões demonstraram uma clara potencialidade clínica no uso da associação do p16INK4a e do HPV de alto risco no diagnóstico das SIL do colo uterino, e um possível uso como fator prognóstico. O p16INK4a foi detectado em 92,3% das HSIL, em 15,4% das LSIL e em nenhum caso de histologia normal. Encontrou-se respectivamente sensibilidade, especificadade, valor preditivo positivo e valor preditivo negativo de 92,3%, 100%, 100% e 98,3%, de p16INK4a para HSIL e 100%, 70,42%, 43,3% e 100% do HPV de alto risco para HSIL. No segundo estudo o HPV de alto risco estava presente em 25,9% dos parceiros. A peniscopia levou a 13 biópsias (24,07%) com os seguintes diagnósticos: condiloma (2 casos), PIN I (2 casos), PIN II (1 caso) e histologia normal (8 casos). O teste de HPV de alto risco revelou 80% de sensibilidade, 100% de especificidade, 100% de valor preditivo positivo e 88,9% de valor preditivo negativo para identificação de lesões penianas, mostrando que homens com HPV de alto risco positivo têm maior chancer de ter lesões escamosas penianas em biópsias guiadas pela peniscopia que aqueles com lesões aceto-brancas com teste de HPV negativo, (p = 0.007); OR = 51 (Cl 1.7-1527.1). Conclusões: Marcadores como o HPV de alto risco têm um potencial muito grande para aumentar o poder diagnóstico das HSIL e, principalmente, supor o prognóstico da evolução destas lesões, principalmente quando associado ao p16INK4a / Abstract: Objectives: To study the importance of the diagnostic and prognostic markers of genital squamous lesions, meanly p16INK4a and high risk HPV. Material And Methods: Squamous intra-epithelial lesion tumoral markers were revised in 21 publications between 1994 and 2005 to identify those with diagnostic and prognostic value. More accurate revision assessed the markers p16INK4a and high risk HPV (36 publications between 1994 and 2006). The p16INK4a and high-risk Human papillomavirus were investigated in 96 samples of the cervix (13 cases of high grade squamous intraepithelial lesions, 26 cases of low grade intraepithelial lesions and 57 normal tissues). The p16INK4a was identified by immunohistochemistry using the p16INK4a kit (E6H4 clone, DakoCytomation, Carpinteria, CA). and Human papillomavirus DNA was classified by hybrid capture (Digene®). Associations were evaluated by the KAPPA index. In the other report fifty four asymptomatic male sexual partners of women with low grade squamous intraepithelial lesions (LSIL) associated to high risk HPV were examined, between April 2003 and June 2005, to verify if the high risk HPV could help to identify those with more risk to have a squamous penile lesion. The DNA-HPV was tested by second generation Hybrid Capture (Digene ®) in penile scraped samples. Peniscopy identified suspicious lesions leading to biopsy. Results: The revisions showed the clinical potentiality of the concomitant use of high risk HPV and p16INK4a in diagnosis of cervical SIL and a possible utility in prognosis of genital squamous intra-epithelial. In 96 cervical biopsies, p16INK4a was detected in 92.3% of the high-grade squamous intraepithelial lesions, in 15.4% of the low-grade and in none of the normal tissues. The sensitivity, specificity, positive predictive value and negative predictive value for high-grade lesion were 92.3%, 100%, 100%, and 98.3%, respectively when considering p16INK4a expression, and 100%, 70.2%, 43.3% and 100%, respectively when considering high-risk HPV. In the male partner study high risk HPV was present in 25.9% (14/54) of the cases. Peniscopy led to 13 biopsies (24.07%). Condyloma (2 cases), PIN I (2 cases), PIN II (1 case) and normal tissue (8 cases) were found. The high risk HPV test presented 80% sensitivity, 100% specificity, 100% positive predictive value and 88.9% negative predictive value for the identification of penile lesions. So, there was a greater chance in finding HPV lesions in the biopsy in the positive cases for high risk HPV with abnormal peniscopy than in the negative cases for high risk HPV with anormal peniscopy (p = 0.007); OR = 51 (CI 1.7-1527.1). Conclusions: Markers as high risk HPV have a potential to increase the diagnostic of HPV induced lesions and maybe indicate the evolution, meanly associated with p16INK4a / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Thesis (M.A.) / INTRODUCTION: Cervical cancer exists as the second most common cancer among women world wide, and in numerous countries is the leading type of female cancer. Specifically, Zambia has one of the highest mortality rates and cervical cancer incidence rates. The goal of this study is to analyze the published literature on preventative techniques for cervical cancer in resource-deprived areas of sub-Saharan Africa by focusing on the correlation between the Human Papilloma Virus (HPV), Acquired Immunodeficiency Syndrome (AIDS), and cervical cancer; the accuracy and feasibility of “screen and treat” clinics; and socio-economic and geographical barriers. RESULTS: Correlations exists between the prevalence of HIV, HPV, and cervical cancer in sub-Saharan Africa, and a clear association exists between HPV and cervical cancer. The deliverance of HPV vaccines as well as educational programs has helped to improve this medical problem. Main screening methods for cervical cancer include the Pap smear, naked eye visual inspection of the cervix after the application of either diluted acetic acid (VIA), Lugol’s iodine (VILI), or with a magnifying device (VIAM), colposcopy, and tests for HPV markers. Studies indicate that the VILI screening test has the highest level of sensitivity with the LEEP method also of importance. The procedure is relatively low cost and is easy to implement when excising lesions. Major risk factors and determinants of cervical cancer can help to explain the underlying barriers of access to care. Women’s misconceptions regarding cervical cancer, gender inequality in African nations, socio-economic status, and foreign aid all play major roles the cervical cancer screening process. A lack of proper education, especially among women in sub-Sahara Africa, has led to misconceptions about the causes of cervical cancer. Studies have found that some women associated cervical cancer with prostitution, a Satanic curse, and other bad behavior. Gender inequality also plays a significant role since the Zambia government had reported that a husband would have absolute rights over children and reproductive rights over his wife once he had made payments for a bride. Geographical barriers also exist as the terrain in Zambia is swamp-like and heavy flooding throughout the year is common. After flooding occurs, communities become physically separated. Furthermore, there are correlations between high incidence rates of cervical cancer and high poverty as it has been shown that the largest number of people living on less than $1.25 dollars per day is that of sub-Saharan Africa. DISCUSSION: Studies have indicated that virtually all of cases of cervical cancer are caused by HPV, implying that HPV testing and detection would largely prevent the progression of lesions. Ultimately, this would reduce the high incidence rate of cervical cancer in Zambia and in other Sub-Saharan African countries. In areas where cytology programs are either non-existent or not efficient, HPV testing approaches should be evaluated and implemented, and they should be based off of the HIV/AIDS infrastructure that has already been established. In regards to the screening approaches, VIAM and VIA are the only two tests that are also practical, affordable, and available. Affordability is the major concern when implementing screening programs in sub-Saharan Africa; for this reason, either VIAM and VIA would arguably be the best options as long as they were effective. VIA would be considered the most appropriate method in terms of screening procedures as the method has the advantage of giving immediate results that can be applied to large populations. Lastly, the lack of proper education, including sex education, has in part led to drastic misconceptions about the causes of cervical cancer. Women hold negative beliefs about cervical cancer since they associate it with being unclean and view it as a reflection of bad behavior. Geographical barriers also play a role; the physical inaccessibility of the clinic discourages women to come to the clinic for screenings. Home visits by physicians and/or the utilization of community health workers may help to eliminate this particular barrier of access. This strategy would be especially beneficial to residents of rural areas since they are more likely to live farther away from institutionalized clinics and screen and treat facilities and are also more likely to be in a state of extreme poverty.

Purpose of Review: Interactions between microorganisms can alter subsequent disease outcomes. Human papilloma virus (HPV) and Chlamydia trachomatis (CT) establish human genital co-infections, and CT infection is a co-factor for HPV-induced cervical cancer. This review focuses upon (i) data indicating that clinically significant interactions occur and (ii) proposed mechanisms underlying these outcomes. Recent Findings: Epidemiological surveys indicate that (i) simultaneous HPV/CT genital co-infections are common; (ii) CT co-infection accelerates HPV-induced cytopathology; and (iii) HPV infection facilitates CT infection. Single-infection studies suggest specific molecular mechanisms by which co-infection alters clinical outcomes, including (i) HPV E6/E7 protein modification of host cell pathways enhances CT replication or immune evasion and (ii) CT-mediated host cell or neutrophil dysfunctions promote HPV-mediated neoplasia. Summary: There are multiple avenues for future dissection of HPV/CT interactions. Moreover, the known and potential health consequences of co-infection highlight the need for improving current HPV vaccines and developing an effective CT vaccine.

This study examined parental acceptability of the Human Papilloma Virus (HPV) vaccination among Latino parents. The role that acculturation may play in Latino parents' acceptability of the vaccine was also examined. A survey conceptualized using the Health Belief Model and two acculturation measures were administered to participants (N = 130). Approximately 70% of parents endorsed that they would vaccinate their daughters with the HPV vaccine. A regression analysis revealed that perception of susceptibility, perception of seriousness, perception of benefit, and cues to action significantly predicted parental acceptability, with 57% of the variance accounted by these variables. Acculturation was not a significant predictor of parental acceptability. These results indicate that a large proportion of Latino parents are likely to accept the HPV vaccine and that certain Health Belief Model constructs may predict acceptability in this population. It is important for healthcare providers to understand what factors may predict Latino parents' acceptability to the HPV vaccine given the high rates of cervical cancer among Latina women. Recommendations for future research in this area are provided.

Healthy People 2020 was launched in December 2010 with a target human papilloma virus (HPV) vaccination rate of 80%. As of 2014, we were well short of this goal, especially among males, for whom the HPV vaccine became recommended in 2011. An estimated 14-20% of adolescent-aged males had completed the vaccine schedule as of 2015. This is particularly problematic in northeast Tennessee, as multiple risk factors for lower vaccination rates are characteristic of the population, including being white and living in the South. Reasons to decline vaccination vary, and usually involve concerns about safety, efficacy, and necessity. Worries about sexual disinhibition from being vaccinated are often cited by opponents. Parents also perceive a lack of benefit from getting the vaccination starting at age 11 before their sons are sexually active. The media and internet are also barriers to appropriate vaccination in males, as previous research has demonstrated that media coverage is more likely to focus on political controversies instead of benefits, and is more likely to emphasize the benefits to females. Research on improving vaccine uptake on males is currently limited. Doctors who appear knowledgeable and are willing to spend time talking about the HPV vaccine for male patients may increase vaccination rates. Other interventions that may also be effective include vaccinating as part of nurse visits or through school programs. Early studies have been mixed on the effect of patient and parent education on vaccine uptake, although a 2015 review demonstrated that most practice- and community-based educational interventions have some positive effect on uptake. The purpose of this project was to improve HPV vaccine uptake among male patients in a family practice residency program through patient and parent education. After informed consent was obtained, the patients and/or their parents were given a handout produced by the CDC highlighting the benefits of vaccination for males. A chart review was done to determine vaccine coverage among males before the intervention instituted in November of 2016. The intervention was completed in August 2017, and a repeat chart review is currently ongoing to determine vaccine coverage in the post-intervention period. Data collection and analysis is ongoing at the time of abstract submission. We expect a statistically significant increase in the number of male patients who have received any doses of vaccine, and in the number who have completed the vaccine series. Future research should involve broadening the intervention to include local family medicine and pediatrician’s offices to increase vaccine uptake in these populations as well.

Syfte: Syftet med denna studie är att belysa hur sjuksköterskor/barnmorskor upplever möjligheter och svårigheter att arbeta förebyggande med livmoderhalscancer i Uganda.Bakgrund: Livmoderhalscancer är den andra vanligaste cancerformen hos kvinnor världen över. Livmoderhalscancer är mest förekommande i Afrika söder om Sahara. I Uganda finns det få sjuksköterskor och barnmorskor som kan utföra hälsosamtal och screening av cellförändringar. Med rätt förebyggande insatser kan incidensen av livmoderhalscancer minska.Metod: En kvalitativ intervjustudie baserad på åtta semistrukturerade intervjuer. Intervjumaterialet analyserades med hjälp av innehållsanalys.Resultat: Sjuksköterskorna och barnmorskorna upplevde att förebyggande insatser möjliggjordes genom screening, behandlingar och outreaches, hälsosamtal och utbildning av hälso- och sjukvårdspersonal samt finansiering. Svårigheterna med att arbeta förebyggande med livmoderhalscancer var bristande stöd från regeringen, svåråtkomlig omgivning, attityder i samhället och brist på kunskap. Slutsats: Uganda behöver bättre finansiering, mer utbildad personal samt tillgång till vaccin och behandlingar för att förbättra förebyggandet av livmoderhalscancer. Ett nationellt screening-program som infattar hela befolkningen skulle påverka det förebyggande arbetet positivt. / Aim: The aim of this study was to elucidate how nurses/midwives perceive thepossibilities and obstacles to practice preventive nursing regarding cervical cancer in Uganda.Background: Cervical cancer is the second most common cancer form amongst women worldwide. The highest incidence of cervical cancer is found in sub- Saharan Africa. In Uganda there are few nurses and midwives to support cervical cancer screening and health talks. With the right preventive measures the incidence rate could be decreased.Method: A qualitative study design based on eight semi-structured interviews. The data was analysed using content analysis.Results: The perceived possibilities to practise preventive nursing were prevention through screening, outreaches and treatments, prevention through health education and practical training plus financing. Obstacles elucidated during the interviews were lack of support from the government, remote places hard to reach, attitudes in the community and lack of knowledge.Conclusion: In order to enhance the preventive measures regarding cervical cancer, Uganda is in need of better funding, more trained staff, access to vaccine and adequate treatments. It would also be beneficial with a nation wide screening program.