Introdução: A infecção pelo Papilomavirus humano (HPV) enquadra-se como um problema de saúde pública, sendo considerada a infecção sexualmente transmissível (IST) mais comum. Estima-se, mundialmente, que aproximadamente 600 milhões de pessoas possuam o vírus do HPV e que em torno de 75 a 80% das pessoas adquiram- no em algum momento da vida. Objetivo: Analisar os aspectos sociodemográficos e clínicos em mulheres com infecção genital pelo HPV associando-os com o tipo de lesão genital e a sorologia reagente ou não reagente para o HIV e avaliar o seguimento clínico de mulheres com lesão intraepitelial de alto grau (HSIL) causada pelo HPV, que foram submetidas à cirurgia de alta frequência (CAF). Metodologia: Estudo transversal, retrospectivo, com abordagem quantitativa, realizado no Serviço de Moléstias Infecciosas em Ginecologia e Obstetrícia (SEMIGO) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP- USP). Foram estudadas 1027 mulheres com diagnóstico de infecção genital pelo HPV, nas suas expressões lesão intraepitelial de baixo grau (LSIL), HSIL, condilomatoses (vulvar, vaginal, cervical e perianal), ou por identificação de sequências de DNA- HPV por meio de técnicas de biologia molecular. Foram elaborados dois formulários estruturados especificamente para este estudo, um referente às variáveis sociodemográficas e clínicas e outro ao seguimento clínico, ambos validados quanto à forma e conteúdo por três especialistas em infecção por HPV. A coleta de dados foi realizada por meio de consulta ao banco de dados eletrônico do local de estudo, elaborado com o software File Maker Pro 11. A população foi caracterizada por meio de estatística descritiva e os dados foram processados e analisados pelo software Statistical Package for the Social Sciences (SPSS) versão 16.0 for Windows. Para verificar a associação, realizou-se o teste qui-quadrado e análise de regressão logística com cálculo de odds ratio e com intervalo de confiança de 95%. Resultados: A faixa etária predominante foi entre 20 e 29 anos 387 (37,7%), 662 (64,4%) mulheres eram de etnia branca, 597 (58,1%) eram casadas ou viviam como casadas, 438 (42,6%) possuíam de cinco a oito anos de estudo e 529 (51,5%) exerciam atividade não remunerada. Quanto ao tipo de lesão, 237 (23,0%) mulheres possuíam LSIL, 391 (38,1%) HSIL, 349 (34,0%) condiloma e 50 (4,9%) diagnóstico de HPV por meio técnicas de biologia molecular. Observou-se maior probabilidade de soropositividade para o HIV em mulheres não brancas (p<0,01; OR=1,990; IC=1,392-2,843), que estudaram de 0 a 4 anos (OR=4,384; IC=1,706-11,266), viúvas (p<0,01; OR=4,223; IC=1,869-9,542), que fumavam (p<0,01; OR=2,389; IC=1,660-3,437), que tiveram mais de 10 parceiros sexuais (p<0,01, OR=3,487, IC=2,170-5,602) e que se prostituíam (p=0,0039, OR=3,699, IC=1,434-9,540). Em relação ao seguimento clínico de mulheres com HSIL submetidas à CAF, o comparecimento aos retornos pré-estabelecidos diminuiu com o passar do tempo. Conclusão: Faz-se necessário assegurar o acesso das mulheres a um exame preventivo de qualidade, através de programas de rastreamento eficientes, bem como garantir seu seguimento clínico. / Introduction: Human papillomavirus (HPV) infection is considered a public health issue, at it is the most common sexually transmitted infection (STI). Globally, it is estimated that 600,000,000 people carry HPV, and that around 75 to 80% of people will be infected in their lifetime. Objective: To analyze the sociodemographic and clinical aspects of women with genital HPV infection, associate those aspects with the type of genital lesion and a positive or negative test result for HIV, evaluate the clinical follow-up of women with high-grade squamous intraepithelial lesions (HSIL) caused by HPV, who had been submitted to loop electrosurgical excision procedure (LEEP). Methodology: This cross-sectional, retrospective study was performed, using a quantitative approach, at SEMIGO (Portuguese acronyms standing for Gynecology and Obstetrics Infectious Disease Clinic) of the Ribeirão Preto Faculty of Medicine University Hospital (University of São Paulo). The study subjects were 1027 women diagnosed with genital HPV infection, as low-grade squamous epithelial lesions (LSIL), HSIL, condylomatosis (vulvar, vaginal, cervical and perianal), or by identifying DNA-HPV sequences using molecular biology techniques. Two structured questionnaires were designed specifically for this study; one referring to the sociodemographic and clinical variables, and the other to the clinical follow-up, both validated regarding form and content by three HPV infection experts. Data collection was performed through a survey on the electronic database of the study location, using File Maker Pro 11. The population was characterized by descriptive statistics and the data were processed and analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 16.0. The chi-square test and logistic regression analysis were used to verify the association, calculating the odds ration and considering a confidence interval of 95%. Results: Most women (387 or 37.7%) were between 20 and 29 years old, 662 (64.4%) were white, 597 (58.1%) were married or lived in common-law, 438 (42.6%) had one to five years of education, and 529 (51.5%) were unemployed. Regarding the type of lesion, 237 (23.0%) women had LSIL, 391 (38.1%) HSIL, 349 (34.0%) condyloma, and 50 (4.9%) were diagnosed for HPV by molecular biology techniques. It was observed that women were more likely to be infected by HIV if they were not white (p<0.01; OR=1.990; CI=1.392-2.843), had 0 to 4 years of education (OR=4.384; CI=1.706-11.266), were widowed (p<0.01; OR=4.223; CI=1.869-9.542), smoked (p<0.01; OR=2.389; CI=1.660-3.437), had over 10 sexual partners (p<0.01, OR=3.487, CI=2.170-5.602) and were prostitutes (p=0.0039, OR=3.699, CI=1.434-9.540). In terms of the clinical follow-up of women with HSIL submitted to LEEP, their attendance to appointments reduced over time. Conclusion: It is necessary to guarantee women accessibility to high-quality preventive exams through effective screening programs, in addition to ensuring their clinical follow-up.

Introdução: A infecção pelo Papilomavirus humano (HPV) enquadra-se como um problema de saúde pública, sendo considerada a infecção sexualmente transmissível (IST) mais comum. Estima-se, mundialmente, que aproximadamente 600 milhões de pessoas possuam o vírus do HPV e que em torno de 75 a 80% das pessoas adquiram- no em algum momento da vida. Objetivo: Analisar os aspectos sociodemográficos e clínicos em mulheres com infecção genital pelo HPV associando-os com o tipo de lesão genital e a sorologia reagente ou não reagente para o HIV e avaliar o seguimento clínico de mulheres com lesão intraepitelial de alto grau (HSIL) causada pelo HPV, que foram submetidas à cirurgia de alta frequência (CAF). Metodologia: Estudo transversal, retrospectivo, com abordagem quantitativa, realizado no Serviço de Moléstias Infecciosas em Ginecologia e Obstetrícia (SEMIGO) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP- USP). Foram estudadas 1027 mulheres com diagnóstico de infecção genital pelo HPV, nas suas expressões lesão intraepitelial de baixo grau (LSIL), HSIL, condilomatoses (vulvar, vaginal, cervical e perianal), ou por identificação de sequências de DNA- HPV por meio de técnicas de biologia molecular. Foram elaborados dois formulários estruturados especificamente para este estudo, um referente às variáveis sociodemográficas e clínicas e outro ao seguimento clínico, ambos validados quanto à forma e conteúdo por três especialistas em infecção por HPV. A coleta de dados foi realizada por meio de consulta ao banco de dados eletrônico do local de estudo, elaborado com o software File Maker Pro 11. A população foi caracterizada por meio de estatística descritiva e os dados foram processados e analisados pelo software Statistical Package for the Social Sciences (SPSS) versão 16.0 for Windows. Para verificar a associação, realizou-se o teste qui-quadrado e análise de regressão logística com cálculo de odds ratio e com intervalo de confiança de 95%. Resultados: A faixa etária predominante foi entre 20 e 29 anos 387 (37,7%), 662 (64,4%) mulheres eram de etnia branca, 597 (58,1%) eram casadas ou viviam como casadas, 438 (42,6%) possuíam de cinco a oito anos de estudo e 529 (51,5%) exerciam atividade não remunerada. Quanto ao tipo de lesão, 237 (23,0%) mulheres possuíam LSIL, 391 (38,1%) HSIL, 349 (34,0%) condiloma e 50 (4,9%) diagnóstico de HPV por meio técnicas de biologia molecular. Observou-se maior probabilidade de soropositividade para o HIV em mulheres não brancas (p<0,01; OR=1,990; IC=1,392-2,843), que estudaram de 0 a 4 anos (OR=4,384; IC=1,706-11,266), viúvas (p<0,01; OR=4,223; IC=1,869-9,542), que fumavam (p<0,01; OR=2,389; IC=1,660-3,437), que tiveram mais de 10 parceiros sexuais (p<0,01, OR=3,487, IC=2,170-5,602) e que se prostituíam (p=0,0039, OR=3,699, IC=1,434-9,540). Em relação ao seguimento clínico de mulheres com HSIL submetidas à CAF, o comparecimento aos retornos pré-estabelecidos diminuiu com o passar do tempo. Conclusão: Faz-se necessário assegurar o acesso das mulheres a um exame preventivo de qualidade, através de programas de rastreamento eficientes, bem como garantir seu seguimento clínico. / Introduction: Human papillomavirus (HPV) infection is considered a public health issue, at it is the most common sexually transmitted infection (STI). Globally, it is estimated that 600,000,000 people carry HPV, and that around 75 to 80% of people will be infected in their lifetime. Objective: To analyze the sociodemographic and clinical aspects of women with genital HPV infection, associate those aspects with the type of genital lesion and a positive or negative test result for HIV, evaluate the clinical follow-up of women with high-grade squamous intraepithelial lesions (HSIL) caused by HPV, who had been submitted to loop electrosurgical excision procedure (LEEP). Methodology: This cross-sectional, retrospective study was performed, using a quantitative approach, at SEMIGO (Portuguese acronyms standing for Gynecology and Obstetrics Infectious Disease Clinic) of the Ribeirão Preto Faculty of Medicine University Hospital (University of São Paulo). The study subjects were 1027 women diagnosed with genital HPV infection, as low-grade squamous epithelial lesions (LSIL), HSIL, condylomatosis (vulvar, vaginal, cervical and perianal), or by identifying DNA-HPV sequences using molecular biology techniques. Two structured questionnaires were designed specifically for this study; one referring to the sociodemographic and clinical variables, and the other to the clinical follow-up, both validated regarding form and content by three HPV infection experts. Data collection was performed through a survey on the electronic database of the study location, using File Maker Pro 11. The population was characterized by descriptive statistics and the data were processed and analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 16.0. The chi-square test and logistic regression analysis were used to verify the association, calculating the odds ration and considering a confidence interval of 95%. Results: Most women (387 or 37.7%) were between 20 and 29 years old, 662 (64.4%) were white, 597 (58.1%) were married or lived in common-law, 438 (42.6%) had one to five years of education, and 529 (51.5%) were unemployed. Regarding the type of lesion, 237 (23.0%) women had LSIL, 391 (38.1%) HSIL, 349 (34.0%) condyloma, and 50 (4.9%) were diagnosed for HPV by molecular biology techniques. It was observed that women were more likely to be infected by HIV if they were not white (p<0.01; OR=1.990; CI=1.392-2.843), had 0 to 4 years of education (OR=4.384; CI=1.706-11.266), were widowed (p<0.01; OR=4.223; CI=1.869-9.542), smoked (p<0.01; OR=2.389; CI=1.660-3.437), had over 10 sexual partners (p<0.01, OR=3.487, CI=2.170-5.602) and were prostitutes (p=0.0039, OR=3.699, CI=1.434-9.540). In terms of the clinical follow-up of women with HSIL submitted to LEEP, their attendance to appointments reduced over time. Conclusion: It is necessary to guarantee women accessibility to high-quality preventive exams through effective screening programs, in addition to ensuring their clinical follow-up.

Background: Human papillomavirus vaccination is newly developed in this decade. There are 2 types of vaccines. Bivalent vaccine targets on HPV types 16, 18 to prevent cervical cancer. Quadrivalent vaccine target on HPV type 6, 11, 16, 18 to prevent genital warts and cervical cancer. England has adopted a population –based HPV vaccination program. In attempt to find out the worthiness to implement the population-based vaccination program in Hong Kong, this project reviewed 15 cost-effectiveness analyses in Asian countries. Asian countries may have the similar characteristics, such as culture, sex behavior, genome, etc, that makes the result more applicable to Hong Kong. Methodology: Cost-effectiveness analysises of human papillomavirus vaccination were identified by the searching engine MEDLINE (Ovid) by using relevant keywords. All English and Chinese articles relevant to the topic were identified. Articles conducted for the cost-effectiveness of human papillomavirus vaccine in Asian countries were considered as the potential literature for the review. Result and Discussion: The searching engine identified 259 literatures, 16 of them are in Asian countries, 1 of them did not meet the criteria of quality assessment. 15 of them are included in this review. 6 different model approaches were used in the 15 articles. Results from the same countries in 2 separated articles were heterogeneous. That may probably due to the different assumption and perspectives used. Different perspectives would include different costing. Studies only including the direct cost would likely over-estimate the cost-effectiveness of the vaccine. The threshold value adopted would also affect the result. A stricter threshold value would under-estimate the cost-effectiveness. Some low-and-middle income countries has no available data on the vaccination because the vaccine is not available in the market, the data would only rely on the past literature or international data. 12 out of the 15 studies showed that the vaccination is cost-effective in the countries. Conclusion and Implication: the ICER is sensitive to the price of the vaccine, the efficacy, the duration of protection, the discount rate, the screening coverage rate, and the age of receiving vaccination, the vaccination coverage rate and the cervical cancer or genital warts incidence rate. Some studies showed that regular screening combined with vaccination program would be cost-effective. In the studies comparing the 2 types of vaccines, all the results showed that quadrivalent vaccine dominant to the bivalent vaccine. Moreover, the vaccination would decrease the cervical cancer incidence by 20% to 90%. In view of the prevalence of HPV type and the high incidence rate of genital warts. The quadrivalent vaccine is likely beneficial to Hong Kong / published_or_final_version / Public Health / Master / Master of Public Health

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 3 uppsatser.

Thesis (Ph.D.)--University of Western Australia, 2005.

published_or_final_version / Community Medicine / Master / Master of Public Health

No description available.

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