Le taux de couverture vaccinale contre le papillomavirus humain (HPV) reste faible en France autour de 20%. Ce travail porte sur l’attitude adoptée par la population française afin de comprendre les motivations et les freins à la vaccination HPV.Une série d’études, qualitatives et quantitatives, a été réalisée en 2014-2016 sur deux populations, la première de jeunes filles de 15 à 25 ans et la deuxième de mères ayant des filles âgées de 11 à 16 ans. Notre approche méthodologique est essentiellement basée sur le modèle combiné issu de la théorie du comportement planifié (Theory of Planned Behavior, TPB, Ajzen, 1991) et du modèle des croyances relatives à la santé (Health Beliefs Model, HBM, Rosenstock, 1974). Parmi les modérateurs de la décision les deux systèmes de motivation décrits par Carver et White (1994) ont été retenus. En complément, une étude expérimentale a été conduite basée sur la Théorie des perspectives (Prospect Theory) de Kahneman et Tversky (1979). Les analyses statistiques ont été effectuées avec les logiciels R et SPSS. Plusieurs traitements statistiques ont été opérés sur les données : analyse des comparaisons, analyse en composantes principales (ACP), régressions linéaires multiples, ANCOVA etc.Les résultats apportent de nouveaux éclairages quant au processus de décision d’acceptation ou de refus de vaccination. Le modèle mis en évidence par ces études fait apparaître des facteurs caractéristiques tels que l'attitude favorable à la vaccination, la sécurité du vaccin, le contrôle perçu ainsi que le regret anticipé, qui jouent un rôle déterminant dans le processus de décision. L’environnement médical et familial proche jouent également un rôle essentiel. / The immunization coverage against HPV remains around 20%. The attitude of French girls was studied to understand the motivations and breaks to HPV.Several studies, qualitative and quantitative, were conducted in 2014-2016 on two populations, first sample of young women aged 15 to 25 years and second of mothers of girls aged 11 to 16. Our methodological approach is essentially based on the handset model from The Theory of Planned Behavior (TPB, Ajzen, 1991) and the Health Beliefs Model (HBM, Rosenstock, 1974). To find the moderators of making decision we opted for the two motivational systems described by Carver and White (1994). Finally, the experimental study we were inspired by the Prospect Theory of Kahneman and Tversky (1979). Statistical analyzes were performed using the softwares R and SPSS. Four types of treatment were carried out on the data: Analyze of comparisons (1); Principal Component Analysis (PCA) (2); Linear Regression to explain an intention to be vaccinated by some variables that allows us to make a prediction (3), and ANCOVA (4).The results provide new insights about the process of decision on vaccine acceptance. It appears that the favorable attitude to vaccination, the vaccine safety, the perceived control, and the anticipated regret play an important role in this decision process as well the doctor’s advice and family.

The theme of my thesis is the issue of the new strain of influenza A (H1N1 Pandemic 2009) and the associated awareness of vaccination amongst the elderly. The work is divided into two parts, a theoretical and practical part. In the theoretical part, I tried to comprehensively process the available knowledge on the origins, epidemiology and prevention of influenza with particular emphasis on vaccination, oriented towards the elderly. The practical part is focused on mapping the awareness of the elderly of the issue of vaccination against influenza and analysis of results from a research exploratory investigation. The data acquisition method I used was quantitatively oriented research using anonymus questionnaires. Altogether, I distribued 350 questionnaires; the final number for data processing was 191 questionnaires. In connection with the work I set four hypotheses: 1) More than a third of respondents were vaccinated against the new strain of influenza A (H1N1 Pandemic 2009), 2) The most common reason for not being vaccinated was a lack of information. 3) The size of the place of residence significantly contributes statistically to a sense of awareness of respondents on this issue, 4) More than half of respondents would like to obtain more information on the issue of the new strain of influenza type A (Pandemic H1N1 2009). I confirmed or refuted the formulated the hypotheses based on survey evaluation. The results of the survey showed that most respondents do not feel that they are sufficiently informed about the issue of the new strain of influenza, and therefore discard the use of vaccinations. With this work I would like to stress the importance of information, which can help people consider the risks of influenza and motivate them to be vaccinated. Vaccination is an important means of protection against influenza viruses particulary for high-risk groups including the elderly. For this reason I consider the dissemination of information as very important and I hope that my thesis also serves this purpose.

Area-wide vaccination against pertussis, also known as whooping cough, has been going on since the 40th - 50th of the last century. In our country this vaccination started in 1958. The World Health Organization estimates that worldwide 20 to 30 million people per year contract pertussis. Patients from developing countries account for 90% of cases. Pertussis is the cause of the death of around 200 000 - 300 000 people per year, up to 85% of whom are children under 2 years of age. As the only source of the bacteria Bordetella pertussis are humans, they are also suitable candidate for the elimination. Therefore, the WHO established an ambitious plan to reduce the incidence of pertussis below 0.1 per 100 000 inhabitants by the year 2000. However, no country succeeded in meeting this plan´s objectives on a long-term basis and since the 80th of the 20th century there has been an increasing trend of the disease incidence across all age groups worldwide. As the proof of severity of this issue pertussis was categorized among the so-called "emerging infectious diseases", that is re-emerging diseases. Diseases whose incidence has increased in recent decades and which could become a major health problem in the near future are classified into this category. In the case of pertussis, the most effective prevention is high vaccination rates in the population, especially children. The theoretical part of the thesis summarizes the current knowledge about pertussis. In the practical part I focused on the incidence and development of the disease in the South Bohemian Region in the years 2005 - 2010, with regard to individual age groups. The results show that in the South Bohemian Region the incidence was rising. The highest incidence was in the age group of 10 to 14 years. Another purpose of the research was to compare the incidence of pertussis in the South Bohemian Region with other regions of the CR. The South Bohemian region in the surveyed 6-year-period ranked among the regions with the highest incidence.

Application of the ?vaccination? nursing standard in primary child care Vaccination is a topic having been discussed since the very beginning. It is one of the most important parts of prevention of infectious diseases. Thanks to vaccination we only know some infectious diseases from historical resources nowadays. The vaccination history is not really long, however vaccination has helped save a lot of children lives. Despite undisputable benefit of vaccination there are still more opponents of vaccination, whose arguments are very often groundless or taken out of context. Diseases that had been nearly eradicated thanks to vaccination have spread in countries where some vaccination ended. This is why vaccination is so important. There are a lot of vaccines on the market nowadays, new vaccination substances still appear and compulsory and no-compulsory vaccination is being changed with gradual scientific development. My thesis presents a complex outline of information on children vaccination and vaccination procedures. The aim of the thesis was to explore the present situation and vaccination procedures applied by practitioners for children and adolescents. Another aim was to develop a nursing standard for children vaccination and to check its practical applicability. To meet these goals the thesis is divided into a theoretical part including structured information on children vaccination and vaccination procedures in the past and at present. The practical pat of the thesis is focused on quantitative examination of the present situation, vaccination procedures and collection of information on novelties in vaccination in surgeries of practitioners for children and adolescents. The data were collected by means of a questionnaire, which was distributed to 130 surgeries of practitioners for children and adolescents in Vysočina and South Bohemia regions. 93 of the 130 questionnaires were suitable for processing. The practical part then contains an audit and an inquiry about the elaborated nursing standard performed in 6 surgeries of practitioners for children and adolescents. The questionnaire and the inquiry were anonymous. Both the set goals were met. The results show that there are differences both in vaccination procedures and in approach to children vaccination in the individual surgeries of practitioners for children and adolescents. The research results also point out that information on vaccination is sufficient, however unclear. The result of the audit and the inquiry showed that the elaborated standard is practically applicable and is beneficial for nurses. These result confirm that a nurse always participates in vaccination process, which is why it is important for her to be informed enough on children vaccination and related activities and to be able to perform vaccination as well as related administration. The thesis may be useful in my opinion as it contains complex and structured information on children vaccination. This is why it may be used both in a surgery of a practitioner for children and adolescents and for educational purposes. Of course with consideration to vaccination related amendments of the Ministry of Health Care.

Bakgrund:Vaccinationstätheten har minskat i samhället. Främst omtalat är kombinationsvaccinet mot mässling, påssjuka, röda hund (MPR). Att avböja vaccinationer leder till att mässling åter etableras i samhället. Mässling är en av de mest smittsamma infektionssjukdomar som existerar, där risken för följdsjukdomar är stor och drabbar 20 % av de smittade. Om vaccinationstätheten sjunker under 95 % finns risk att mässling åter får fäste i samhället. Metod:En integrativ litteraturstudie med artikelsökningar utförda i databaserna Academic Search Elite, Cinahl, PubMed och Social Service Abstract som resulterade i 13 relevanta artiklar. Resultat:Studien visar att de flesta föräldrar upplevde att de fick för lite information från hälso- och sjukvården avseende vaccinationer. De sökte sin information via webbsidor eller sökte råd hos andra föräldrar. Därför behöver trovärdig information ges när föräldrar besöker barnhälsovården och informationshäfte delas ut på olika språk för att nå de med olika kulturer. Konklusion och implikation:Studien visar vikten av trovärdig information om vaccinationer för att föräldrar ska kunna ta ställning. Kunskap gör det lättare för hälso- och sjukvårdspersonalen att lägga upp strategier för att undervisa och informera tveksamma föräldrar. Ökad kunskap fås vid fortsatt forskning i ämnet, vilket ökar möjligheterna att WHO når sitt mål om eliminering av mässling. / Background:Vaccination density has decreased in society. The primary concerns are the combination vaccine against measles, mumps and rubella (MMR). To decline vaccination leads to measles being re-established in the society. Measles is one of the most contagious infection diseases that exists, the risk of secondary diseases is substantial which affects 20% of the population. If the vaccination density goes below 95% measles is in the risk of being reaffirm in society. Method:A integrative literature study with article searches conducted in the database Academic Search Elite, Cinahl, PubMed and Social Service Abstract and resulted in 13 relevant articles.  Results:The study shows that most parents experienced that they did not get enough information from the health care sector. They searched for information on websites or through other parents. Therefore, credible information is necessary when visiting the children's health care and to distribute information sheets on different languages to reach those with different cultures. Conclusion and implication:The study shows how important it is with credible information about the vaccines for parents being able to take a stand. Knowledge makes it easier for healthcare personals to set up strategies to teach and inform doubtful parents. Increased knowledge gained from ongoing research in the subject, which increases the opportunities for WHO to reach the goal of eliminating measles.

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

Magister Curationis - Mcur / According to Brown (2010), influenza kills and hospitalises thousands of people every year, about thirty-five thousand and two hundred thousand respectively. Some studies have shown that one of the major reasons that people do not take part in preventative behaviour concerning influenza would be some misconceptions and lack of knowledge. The purpose of this study was to investigate perceptions and attitudes of nursing students at a University in the Western Cape about influenza and their prevention and health seeking behaviour against influenza infection. This topic is important as nursing students are a part of the population group that is frequently exposed to influenza, either at their institutions of learning or in the hospitals and clinics, where they come into contact with patients in their roles as health care workers. A comprehensive review of the literature around perceptions and attitudes and health seeking behaviours regarding influenza was undertaken and considered by the researcher. Most of the literature reviewed came from Western countries as not much research has been done in Africa on the topic. From the literature reviewed, the researcher decided to use the Health Belief Model as a conceptual framework for this study as it has proven to be relatively effective in previous studies of this nature as well as in predicting people's health seeking behaviours.

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.

Magister Scientiae - MSc / We review a number of compartmental models in epidemiology which leads to a nonlinear system of ordinary differential equations. We focus an SIR, SEIR and SIS epidemic models with and without vaccination. A threshold parameter R0 is identified which governs the spread of diseases, and this parameter is known as the basic reproductive number. The models have at least two equilibria, an endemic equilibrium and the disease-free equilibrium. We demonstrate that the disease will die out, if the basic reproductive number R0 < 1. This is the case of a disease-free state, with no infection in the population. Otherwise the disease may become endemic if the basic reproductive number R0 is bigger than unity. Furthermore, stability analysis for both endemic and disease-free steady states are investigated and we also give some numerical simulations. The second part of this dissertation deals with optimal vaccination strategy in epidemiology. We use optimal control technique on vaccination to minimize the impact of the disease. Hereby we mean minimizing the spread of the disease in the population, while also minimizing the effort on vaccination roll-out. We do this optimization for the cases of SIR and SEIR models, and show how optimal strategies can be obtained which minimize the damage caused by the infectious disease. Finally, we describe the numerical simulations using the fourth-order Runge-Kutta method. These are the most useful references: [G. Zaman, Y.H Kang, II. H. Jung. BioSystems 93, (2008), 240 − 249], [K. Hattaf, N. Yousfi. The Journal of Advanced Studies in Biology, Vol. 1(8), (2008), 383 − 390.], [Lenhart, J.T. Workman. Optimal Control and Applied to Biological Models. Chapman and Hall/CRC, (2007).], [P. Van den Driessche, J. Watmough. Math. Biosci., 7, (2005)], and [J. Wu, G. R¨ost. Mathematical Biosciences and Engineering, Vol 5(2), (2008), 389 − 391]. / South Africa

p. 1-71 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-11T18:45:04Z No. of bitstreams: 1 Aide Campagna.pdf: 515544 bytes, checksum: 4f9004238d1224e7ef7a48b5f6182d09 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-04-11T19:12:55Z (GMT) No. of bitstreams: 1 Aide Campagna.pdf: 515544 bytes, checksum: 4f9004238d1224e7ef7a48b5f6182d09 (MD5) / Made available in DSpace on 2013-04-11T19:12:55Z (GMT). No. of bitstreams: 1 Aide Campagna.pdf: 515544 bytes, checksum: 4f9004238d1224e7ef7a48b5f6182d09 (MD5) Previous issue date: 2007 / Os objetivos do presente estudo foram analisar as séries temporais (tendências históricas e sazonalidade) das taxas de mortalidade por doenças respiratórias selecionadas (pneumonias, influenza, bronquites e obstrução das vias respiratórias) em pessoas com 60 anos e mais de idade nas regiões do Brasil no período de 1992 a 2005 e comparar o comportamento dessas séries temporais no período anterior e posterior à intervenção das campanhas de vacinação contra influenza. Trata-se de um estudo ecológico longitudinal misto onde foram utilizados dados secundários do SIM e estimativas da população idosa, por sexo e idade, do IBGE. Os óbitos foram estratificados por ano, mês, sexo, faixa etária, região e capitais agregadas por região, para construção das taxas de mortalidade, posteriormente ajustadas por sexo e/ou idade com a técnica de padronização pelo método direto (população padrão: Brasil - Censo 2000). Para análise do comportamento da mortalidade segundo introdução da campanha de vacinação nos diferentes grupos de idade, foi utilizada a regressão linear ajustando pela tendência histórica e sazonalidade da mortalidade no período de estudo. Observou-se tendência crescente nas taxas de mortalidade pelas causas selecionadas com o aumento da idade da população de estudo. Alem disso, valores mais elevados desses indicadores também foram observados entre os homens e entre os residentes das regiões Sul, Sudeste e Centro Oeste. Identificou-se redução estatisticamente significativa das taxas de mortalidade para todas as faixas etárias no período posterior à introdução das campanhas de vacinação contra a influenza, ainda que controlando a tendência histórica e a sazonalidade das causas de morte estudadas. Os resultados confirmam a importante magnitude das taxas de mortalidade por doenças respiratórias relacionadas à influenza em pessoas idosas no Brasil e qualifica o debate sobre os benefícios da vacinação. Além disso, esse estudo reforça a necessidade de pesquisas que visam avançar nas explicações desses achados. / Salvador