Magister Public Health - MPH / The study aimed to describe the knowledge and awareness of HPV infection and vaccine of female university students and to determine the predictors of vaccine acceptability. The study found that 70% of the participants were sexually active. Awareness and knowledge on HPV/vaccine were poor; with only 22% being aware of HPV and that a HPV vaccine was available in South Africa. A greater proportion (80%) reported willingness to be vaccinated. Being aware of the existence of a pap smear, higher knowledge about HPV, higher perceived vaccine effectiveness and higher perceived severity of HPV infection were significantly associated with increased willingness to be vaccinated. / South Africa

This research project aims to examine the idea of stigma attached to cervical cancer in light of its association with HPV, a sexually transmitted infection (STI). The public recognition of this relationship appears to be increasing due to the current media attention surrounding HPV's causative role in the development of cervical cancer, and the newly-released HPV vaccine. Thus, this study explores the experiences and perceptions of cervical cancer patients and survivors living with this disease at a moment in time when it is becoming a very visible manifestation of a sexually transmitted infection, versus one identified historically as a life-threatening cancer. Disease-related stigma has vast individual, community, and societal repercussions: in the context of both cancer and sexually transmitted infections, it is broadly associated in the literature with decreased levels of screening, reluctance to seek treatment, decreased access to social support, economic discrimination, and major difficulties in implementing large-scale prevention efforts, such as contact tracing or name-based reporting. This study is premised on the belief that including the voices of patients and survivors themselves will provide a more holistic and complete understanding of the dimensions of cervical cancer-related stigma, which in turn will help to inform future educational and prevention messages tailored to reduce its impact. Additionally, it will illuminate the complexities and dynamics of how patients/survivors are able or unable to access social support-a first step in designing more effective and relevant support programs.

INTRODUCTION: Since 2006, the Advisory Committee for Immunization Practices (ACIP) has recommended routine vaccination of adolescent girls at ages 11 or 12 years with 3 doses of human papillomavirus (HPV) vaccine to prevent cervical cancer. Cervical cancer disparities exist for several populations in the United States. The topic is scantly documented in scholarly literature with modest knowledge of the uptake of the HPV vaccine in the Delta region. AIM: To examine the HPV vaccination coverage estimates in the counties and parishes that comprise the Delta Regional Authority (DRA) and compare with other non-DRA counties or parishes and the rest of US. This will provide vaccination coverage estimates for adolescent females in the DRA designated Delta region that will provide public health professionals with data for policy and programmatic decision-making. METHODS: We combined data from multiple survey years (2008-2012) from the National Immunization Survey-Teen (NIS-Teen). We conducted bivariate analyses to describe the distribution across selected socio-demographic characteristics and multivariable logistic regression models to produce adjusted prevalence ratios. RESULTS: Teens in the DRA had lower HPV vaccine initiation and completion rates compared to Non- DRA counties or parishes and the Rest of the US. The 3-dose HPV vaccination series completion rate among those who had initiated HPV vaccination and had 24 weeks between their first dose and the NIS interview date was 60.9% (95% CI: 55.8 – 65.8) among adolescent females in the DRA compared to 66.9 (95% CI: 63.7-70.0) of adolescent females in the Non-DRA counties and 67.6% (95% CI: 66.2-69.0) in the rest of the US. CONCLUSION: The low HPV vaccination coverage among adolescents in the DRA showed that it is important to implement additional strategies to increase HPV vaccination coverage that will prevent cancers associated with HPV in the DELTA Region. Stronger provider recommendations and awareness are important for increasing HPV vaccine uptake.

Oral human papillomavirus (HPV) infection and its association with head and neck cancers (HNCs) have been established by many studies. The characteristics of HPV-associated HNCs are distinguishable from those of non HPV-associated HNCs. HPV-associated HNCs are related to sexual behaviour, particularly the lifetime number of oral sex partners. The oral and oropharyngeal HPV epidemiology in South African men has not yet been researched. The objective of this study was to determine the oral and oropharyngeal HPV strain prevalence and associated factors in a selected male population in Pretoria, South Africa. Male factory workers were recruited on a voluntary basis to be part of this study. Oral rinse and gargle samples were tested for 37 HPV types using the HPV linear array genotyping kit (Roche Molecular System). A questionnaire was utilised to obtain information regarding age, medical conditions, substance and alcohol use and sexual behaviour. HIV testing was optional. The HPV prevalence was 5.6% among the men (n=125) aged 17-64 years. High risk HPV (hrHPV) types 16 and 68 were found in two men. Amongst the majority of the participants oral sex seemed to be an uncommon practice however, those participants with hrHPV did practice oral sex. A statistically significant association between HPV infection and an increased number of sexual partners (p=0.027) was seen but not between substance use, HIVstatus or clinical mucosal pathology. Considering the oral and oropharyngeal HPV prevalence found in this study compared to those reported in other countries. It is therefore proposed that a larger nationwide study be conducted to give a more representative view of the burden of oral and oropharyngeal HPV infection in South Africa. / Dissertation (MSc)--University of Pretoria, 2014. / lk2014 / Community Dentistry / MSc / Unrestricted

Thesis (MPH.) -- University of Limpopo, 2020 / The South African government provides human papillomavirus (HPV) vaccination to public school girls for free. The study aimed to investigate knowledge, attitudes and practices towards HPV vaccination, of caregivers of girls aged ≥9 years in grade 4 to 7 attending private schools in South Africa. Objectives included determining levels of knowledge; describing attitudes; describing practices; and investigating levels of knowledge and attitudes of caregivers associated with HPV vaccination coverage in these girls. Turfloop Research Ethics Committee granted ethical clearance. A link to an online survey (Survey Monkey®, USA) was circulated to caregivers via an email to school principals and a Facebook advert. Epi InfoTM was used for data analysis. While 76.5% of caregivers had good knowledge about cervical cancer and HPV vaccination, 45.3% had positive attitudes towards HPV vaccination and 19.4% of the girls were vaccinated. Caregivers with good knowledge were 3.6 (95% CI: 1.6-8.0; p<0.005) times more likely to have vaccinated their daughters/wards, while caregivers with a positive attitude were 5.2 (95% CI: 2.9-9.2; p<0.05) times more likely. The low HPV vaccination uptake is concerning. Results suggest that a positive attitude towards HPV vaccination is a strong predictor of its uptake. / University of Limpopo, Anova Health Institute and National Research Foundation (NRF)

No description available.

Made available in DSpace on 2016-08-10T10:54:58Z (GMT). No. of bitstreams: 1 LUANA CARVALHO DA SILVA.pdf: 1919863 bytes, checksum: 43845eab7ebc38ce4258c581e7475ae9 (MD5) Previous issue date: 2015-05-29 / Cervical cancer is considered an important public health problem, since it affects and kills a large number of women throughout the world. The main risk factor for cervical cancer is the infection by the Human Papillomavirus (HPV), considered to be the most common sexually transmitted disease, in the present days. Despite the high incidence, cervical cancer prevention programs have been implemented worldwide, through the Pap smear and HPV vaccine. Objective: To evaluate the perception and knowledge of nursing students about HPV infection, HPV associated diseases and HPV vaccine, in a private education institution, in Goiânia-GO. METHODS: It comprises a descriptive study with a quantitative approach, carried out through a questionnaire with objective questions that allowed to quantify the knowledge of the participants with regard to HPV infection, diseases associated with the virus and HPV vaccine, ensuring the analysis and interpretation of the results. The research was applied to 361 scholars from both genders. RESULTS: Correct answers related to the knowledge about HPV infection ranged from 40.3% to 99.2%, with an average of 73.8%; about the diseases associated with viruses, the indexes of correct answers ranged from 24.8% to 82.8%, with an average of 61.8%; regarding the HPV vaccine, the indexes of correct answers ranged from 40.8% to 93.0%, averaging 74.6%. CONCLUSION: The results allowed to conclude that academic nursing knowledge was reasonable in relation to HPV infection and HPV vaccine. However, insufficient results were obtained with respect to the knowledge about cancer of the uterine cervix. Thus, we highlight the need for continuing education about the subject, during and after graduation of these professionals, since nursing presents an important role in health teams and in the process of health education of the population. / O câncer do colo do útero é considerado um importante problema de saúde pública, pois ainda acomete e mata um grande número de mulheres em todo mundo. O principal fator de risco para o câncer do colo do útero é a infecção pelo Papilomavírus humano (HPV), considerada a doença sexualmente transmissível mais comum, nos dias atuais. Apesar da alta incidência, o câncer do colo do útero apresenta programa de prevenção, por meio do exame de Papanicolaou e da vacina anti-HPV. OBJETIVO: Avaliar a percepção e o conhecimento dos acadêmicos de enfermagem de uma instituição de ensino superior privada de Goiânia-GO, sobre a infecção pelo HPV, o câncer do colo do útero e a vacina anti-HPV. MÉTODOS: Estudo descritivo com abordagem quantitativa, realizado por meio de questionário com perguntas objetivas que permitiu quantificar o conhecimento dos participantes com relação à infecção pelo HPV, as doenças associadas ao vírus e a vacina anti-HPV, garantindo a análise e interpretação dos resultados. A pesquisa foi aplicada a 361 acadêmicos de ambos os gêneros. RESULTADOS: Os níveis de acertos observados para as questões relacionadas ao conhecimento sobre a infecção pelo HPV variaram de 40,3% a 99,2%, com média de 73,8%; sobre o câncer do colo do útero, os índices de acertos variaram de 24,8% a 82,8%, com média de 61,8%; com relação à vacina anti-HPV, os índices de acertos variaram de 40,8% a 93,0%, com média de 74,6%. CONLUSÃO: Os resultados desse estudo permitiram concluir que o conhecimento dos acadêmicos de enfermagem foi razoável em relação à infecção pelo HPV e à vacina anti-HPV. Entretanto, resultados insuficientes foram obtidos com relação ao conhecimento sobre o câncer do colo do útero. Assim, destacase a necessidade da educação continuada durante e após a graduação desses profissionais, pois a enfermagem apresenta um importante papel em equipes de saúde e no processo de educação em saúde da população.

Seres humanos dependem incessantemente de um sistema de reconhecimento efetivo contra infecções para sobreviver. Dentre as diversas proteínas que compõem a resposta imune inata estão os receptores do tipo Toll (TLR Toll-like Receptors), que possuem a função de reconhecer padrões moleculares associados a patógenos e dar início a uma resposta imune adequada. O carcinoma do colo uterino é uma das principais causas de morte de mulheres por câncer mundialmente, sendo o terceiro tipo de câncer mais comum entre mulheres. Este tipo de neoplasia é vinculada etiologicamente à infecção pelo Papilomavírus humano (HPV). Dentre as principais proteínas virais, E6 e E7 são responsáveis pela manipulação dos processos celulares para promover ciclo viral, sendo essenciais no processo de transformação celular. Nesse contexto, o objetivo deste trabalho foi investigar a importância da via de sinalização de TLRs sobre a infecção por HPV. O polimorfismo rs5743836, na região promotora de TLR9, capaz de alterar a expressão deste receptor, foi estudado quanto à influência sobre a história natural da infecção por HPV em uma coorte de mulheres brasileiras; nenhuma associação relevante foi encontrada, indicando que este polimorfismo não interfere significativamente na resposta à infecção e risco de desenvolvimento de lesões no colo do útero causadas por HPV. Proteínas componentes da via de TLRs demonstraram serem alvos de interação com E6 de HPV16; dentre elas, o notável adaptador MyD88 e IKK&#949;, enzima ativadora de importantes transfatores do sistema imune. Estas interações foram aqui estudadas. A interação de E6 com MyD88 resultou em estabilização da proteína viral, o que parece não depender do sítio LxxLL presente em MyD88, como ocorre com outros parceiros moleculares de E6. O sítio de interação de E6 com IKK&#949; coincide com a região onde se localiza o sítio catalítico desta enzima, sugerindo a ação de E6 na ativação de proteínas alvo de IKK&#949;. Esta interação foi observada em queratinócitos, células alvo das infecções por HPV. A produção de citocinas foi afetada por E6 de HPV16, resultando num aumento da quantidade de IL-8 e IL-6; a indução desta citocina poderia ser explicada pela ativação de IKK&#949;. Estes resultados apontam para a capacidade do HPV16 de interferir com o sistema imune, contribuindo para o processo de carcinogênese. / Humans constantly rely on an effective recognition system against infections in order to survive. Among various proteins that compose the innate immune response, Toll-like Receptors (TLRs) have the role to recognize pathogen associated molecular patterns and initiate a proper immune response. The cervical cancer is one of the main causes of women death worldwide, being the third most common cancer type among women. This type of neoplasia is etiologically associated with the Human papillomavirus (HPV) infection. E6 and E7, two main viral proteins, are responsible for manipulating the cellular processes to promote the virus\' life-cycle, being essential to the cellular transformation process. In the context, the objective of this work was to investigate the relevance of the TLR signaling pathway on the HPV infection. The rs5743836 polymorphism, in the TLR9 promoter region, capable of altering this receptor\'s expression, was studied regarding its influence on the natural history of HPV infection in a Brazilian women cohort; no relevant association was found, indicating that this polymorphism does not interfere significantly in the infection response and risk of developing cervix lesions caused by HPV. Component proteins of TLR pathway were shown to be interaction targets of HPV16 E6; among them, the notable adaptor MyD88 and IKK&#949;, enzyme that activates important immune system transfactors. These interactions were studied in this work. The interaction of E6 with MyD88 resulted in the stabilization of the viral protein, which seems independent of the LxxLL site present on MyD88, as in other E6 molecular partners. The interaction site on IKK with E6 matches with the region containing the enzyme\'s catalytic site, suggesting an influence of E6 in the activation of IKK&#949; target proteins. This interaction was observed in keratinocytes, natural targets of HPV infections. The cytokines production was altered by HPV16 E6, resulting in an increase of IL-8 and IL-6 concentration; the induction of the latter could be explained by the activation of IKK&#949;. These results point to the ability of HPV16 of interfering with the immune system, contributing to the carcinogenesis process.

<p>In this thesis techniques are presented that aim to determine individual DNA signatures by controlled synthesis of nucleic acid multimers. Allele-specific extension reactions with an improved specificity were applied for several genomic purposes. Since DNA polymerases extend some mismatched 3’-end primers, an improved specificity is a concern. This has been possible by exploiting the faster extension of matched primers and applying the enzymes apyrase or Proteinase K. The findings were applied to methods for resequencing and viral and single nucleotide polymorphism (SNP) genotyping.</p><p>P53 mutation is the most frequent event in human cancers. Here, a model system for resequencing of 15 bps in p53 based on apyrase-mediated allele-specific extension (AMASE) is described, investigated and evaluated (Paper I). A microarray format with fluorescence detection was used. On each array, four oligonucleotides were printed for each base to resequence. Target PCR products were hybridized and an AMASE-reaction performed in situ to distinguish which of the printed oligonucleotides matched the target. The results showed that without the inclusion of apyrase, the resulting sequence was unreadable. The results open the possibilities for developing large-scale resequencing tools.</p><p>The presence of certain types of human papillomaviruses (HPV) transforms normal cells into cervical cancer cells. Thus, HPV type determination is clinically important. Also, multiple HPV infections are common but difficult to distinguish. Therefore, a genotyping platform based on competitive hybridization and AMASE is described, used on clinical sample material and evaluated by comparison to Sanger DNA sequencing (Papers II and III). A flexible tag-microarray was used for detection and the two levels of discrimination gave a high level of specificity. Easy identification of multiple infections was possible which provides new opportunities to investigate the importance of multiply infected samples.</p><p>To achieve highly multiplexed allele-specific extension reactions, large numbers of primers will be employed and lead to spurious hybridizations. Papers IV to VI focus on an alternative approach to control oligomerization by using protease mediated allele-specific extension (PrASE). In order to maintain stringency at higher temperatures, Proteinase K, was used instead of apyrase, leading to DNA polymerase degradation and preventing unspecific extensions. An automated assay with tag-array detection for SNP genotyping was established. First PrASE was introduced and characterized (Paper IV), then used for genotyping of 10 SNPs in 442 samples (Paper V). A 99.8 % concordance to pyrosequencing was found. PrASE is a flexible tool for association studies and the results indicate an improved assay conversion rate as compared to plain allele-specific extension.</p><p>The highly polymorphic melanocortin-1 receptor gene (MC1R) is involved in melanogenesis. Twenty-one MC1R variants were genotyped with PrASE since variants in the gene have been associated to an increased risk of developing melanoma. A pilot study was performed to establish the assay (Paper VI) and subsequently a larger study was executed to investigate allele frequencies in the Swedish population (Paper VII). The case and control groups consisted of 1001 and 721 samples respectively. A two to sevenfold increased risk of developing melanoma was observed for carriers of variants.</p>

In this thesis techniques are presented that aim to determine individual DNA signatures by controlled synthesis of nucleic acid multimers. Allele-specific extension reactions with an improved specificity were applied for several genomic purposes. Since DNA polymerases extend some mismatched 3’-end primers, an improved specificity is a concern. This has been possible by exploiting the faster extension of matched primers and applying the enzymes apyrase or Proteinase K. The findings were applied to methods for resequencing and viral and single nucleotide polymorphism (SNP) genotyping. P53 mutation is the most frequent event in human cancers. Here, a model system for resequencing of 15 bps in p53 based on apyrase-mediated allele-specific extension (AMASE) is described, investigated and evaluated (Paper I). A microarray format with fluorescence detection was used. On each array, four oligonucleotides were printed for each base to resequence. Target PCR products were hybridized and an AMASE-reaction performed in situ to distinguish which of the printed oligonucleotides matched the target. The results showed that without the inclusion of apyrase, the resulting sequence was unreadable. The results open the possibilities for developing large-scale resequencing tools. The presence of certain types of human papillomaviruses (HPV) transforms normal cells into cervical cancer cells. Thus, HPV type determination is clinically important. Also, multiple HPV infections are common but difficult to distinguish. Therefore, a genotyping platform based on competitive hybridization and AMASE is described, used on clinical sample material and evaluated by comparison to Sanger DNA sequencing (Papers II and III). A flexible tag-microarray was used for detection and the two levels of discrimination gave a high level of specificity. Easy identification of multiple infections was possible which provides new opportunities to investigate the importance of multiply infected samples. To achieve highly multiplexed allele-specific extension reactions, large numbers of primers will be employed and lead to spurious hybridizations. Papers IV to VI focus on an alternative approach to control oligomerization by using protease mediated allele-specific extension (PrASE). In order to maintain stringency at higher temperatures, Proteinase K, was used instead of apyrase, leading to DNA polymerase degradation and preventing unspecific extensions. An automated assay with tag-array detection for SNP genotyping was established. First PrASE was introduced and characterized (Paper IV), then used for genotyping of 10 SNPs in 442 samples (Paper V). A 99.8 % concordance to pyrosequencing was found. PrASE is a flexible tool for association studies and the results indicate an improved assay conversion rate as compared to plain allele-specific extension. The highly polymorphic melanocortin-1 receptor gene (MC1R) is involved in melanogenesis. Twenty-one MC1R variants were genotyped with PrASE since variants in the gene have been associated to an increased risk of developing melanoma. A pilot study was performed to establish the assay (Paper VI) and subsequently a larger study was executed to investigate allele frequencies in the Swedish population (Paper VII). The case and control groups consisted of 1001 and 721 samples respectively. A two to sevenfold increased risk of developing melanoma was observed for carriers of variants. / QC 20101028