In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.

Communication between the patient and healthcare professional is pivotal in enabling effective self-care management to occur (Street et al., 2009) which in turn leads to improved health outcomes (Kravitz et al., 1993). However, there is little published data exploring the most effective tools for evaluating whether these communication skills occur and what particular attributes enhance the process (Goodchild, Skinner & Parkin, 2005; Heisler et al., 2003; Parkin & Skinner, 2003). This study aims to identify patient-centred communication skills occurring in consultations and to explore their link with a tool-recording agreement on reported decisions made. Quantitative analysis was conducted on 86 dietetic consultations across four outpatient diabetes services. Audio recordings from 20 of these were qualitatively analysed. Greater agreement on reported decisions correlated significantly with level of empathy demonstrated (t = .283, p = .0005). In consultations featuring agreement, dietitians expressed more empathy (p = .02), used more active listening skills, asked significantly more exploratory questions on self-care practices (U = 18.5, p = .007), provided significantly more supportive/collaborative information-giving exchanges (U = 11, p = .003) and were more likely to set an agreed agenda at the start of consultations. In contrast, consultations featuring disagreement had low levels of empathy, fewer active-listening skills and exploratory questions, significantly greater numbers of persuasive information-giving exchanges (U = 17, p = .007) and more recommending exchanges. Generally, agendas were not set. In conclusion, recording patient/healthcare professional agreement on reported decisions made during a consultation is a simple tool that can indicate the presence of patient-centred communication skills. Active-listening skills allow expressions of empathy that facilitate patient involvement and interactive dialogue. The measure of agreement should be used frequently as a marker of effective dietetic consultations and to provide further data on the relationship between patient-centred communication and implementation of behaviour change for improved health outcomes.

A criminalidade é um problema recorrente de grande relevância, o engajamento delituoso de jovens é um fenômeno preocupante e alarmante, de acentuado impacto na sociedade. A população, em geral, tende a acreditar que os jovens estão cada vez mais perigosos e envolvidos no agir antissocial. Faz-se necessário a realização de pesquisas que desvendem a problemática e busquem alternativas e possíveis soluções. No âmbito internacional, os questionários de delinquência autorrevelada são considerados o método mais seguro para indicar a prevalência e frequência de comportamentos delituosos entre os jovens. O objetivo do presente estudo foi, em termos gerais, conhecer o comportamento divergente e delituoso de adolescentes estudantes de instituições de ensino privadas, investigando a associação do fenômeno a variáveis potencialmente relacionadas e ampliar pesquisa anterior realizada junto a jovens de instituições de ensino públicas. Participaram do estudo 324 adolescentes, do sexo masculino, estudantes de três escolas particulares. Foi aplicado o Questionário sobre Comportamentos Juvenis, um instrumento de autorrelato que aborda questões relativas à família, escola, rotina, pares, local de residência e comportamentos divergentes e delituosos. Os resultados indicaram que 60,80% da amostra relatou já ter praticado algum comportamento delituoso e 68,88% algum comportamento divergente. O comportamento delituoso mais frequente foi a lesão corporal, seguido de dano. Quanto aos comportamentos divergentes 52,5% dos adolescentes declararam já ter consumido bebidas alcoólicas. Os adolescentes foram agrupados em 5 clusters de acordo com o nível de engajamento criminal, concluiu-se que 11,11% dos jovens são responsáveis por 81% dos delitos revelados praticados nos últimos 12 meses. Esses são aqueles de engajamento mais grave e que se diferenciaram dos outros agrupamentos pela idade de primeiro delito, pela diversidade e volume de delitos praticados. / Criminality is a relevant social problem. Juvenile delinquency is a worrying and alarming phenomenon with many impacts on society. The population, in general, Believes that young people are increasingly involved on antisocial behaviours. Studies about this, is necessary to looking for alternatives and possible solutions. In international level. Self-Reported delinquency are considered the best method to indicate the delinquency behaviors prevalence and frequency. The aim of the present study is to know the self-reported delinquency in private schools young boys; investigating the association of the phenomenon with potentially related variables and expanding previous research carried out with youngsters of public educational institutions. Thirty-four adolescents, male, private schoolss students from three participated in the study. The Self Reported Delinquency was applied; its a self-report questionnaire that investigating about family, school, routine, peers, place of residence and divergent and criminal behavior. The results indicated that 60.80% of the sample reported some delinquent behavior and 68.88% some problem behavior. The most frequent criminal behavior was hurt someone, followed by damage. Regarding divergent behaviors, 52.5% of adolescents reported having consumed alcoholic beverages. The adolescents were grouped into 5 clusters according to the level of criminal engagement, it was concluded that 11.11% of young people are responsible for 81% of de delinquency practiced in the last 12 months. These group (5) have more serious engagement and that differ from others, about age, diversity and frequency.

Bakgrund: Integrated Palliative care Outcome Scale (IPOS) syftar till att ge en multidimensionell bild av patienters situation. IPOS används som ett sätt att bedöma patienters upplevelse av sina symtom, sin funktionsförmåga och sitt välbefinnande i relation till svår sjukdom. Få studier har dock utgått från patienternas perspektiv för att undersöka upplevelser av att använda IPOS. Syfte: Att undersöka patienters erfarenheter av att använda Integrated Palliative care Outcome Scale under pågående specialiserad palliativ hemsjukvård. Metod: Studien är genomförd med en kvalitativ ansats och en tolkande beskrivande design. Rekrytering till studien gjordes från tre specialiserade palliativa hemsjukvårdsenheter. Intervjuer genomfördes med 10 patienter, sju män och tre kvinnor med medelåldern 72 år. En majoritet var diagnostiserade med obotlig cancer. Data analyserades genom tolkande beskrivning så som den beskrivs av Sally Thorne. Resultat: Patienterna upplevde att använda IPOS medförde säker vård eftersom att det underlättade för sjuksköterskorna att göra korrekta bedömningar av patienternas behov. Således var IPOS en hjälp att planera vården utifrån patienternas specifika behov. Detta gav patienterna en känsla av att vården de fick var anpassad för dem, vilket gav en känsla av trygghet. De upplevde även att använda IPOS försäkrade att information fördes vidare på ett korrekt sätt från patienterna till vårdpersonalen genom att det minskade risken för missförstånd. De uppgav att IPOS underlättade diskussioner mellan dem och sjuksköterskorna om sådant de upplevde som viktigt. Patienterna upplevde även att använda IPOS möjliggjorde för dem att reflektera över sitt välbefinnande och sin livssituation. Att göra detta tillsammans med en sjuksköterska var berikande eftersom att det kunde ge nya perspektiv. Slutsats: Resultatet indikerar att patienterna i denna studie upplever att använda IPOS var givande för dem. Det kan konstateras att IPOS med fördel kan användas i specialiserad palliativ hemsjukvård. / Background: The Integrated Palliative care Outcome Scale (IPOS) is intended to provide a multidimensional view of patients’ concerns. IPOS can be used with the purpose of assessing patients’ perceptions of their functional status and wellbeing. Few studies have undertaken the patients’ perspective when exploring experiences of using IPOS. Aim: To explore patients’ experiences of using the Integrated Palliative care Outcome Scale during specialized palliative home care. Method: The study adopted a qualitative approach with an interpretive descriptive design. The patients were recruited from three different specialized palliative home care settings. Interviews were performed with 10 patients, seven men and three women, with a mean age of 72 years. A majority of the patients were diagnosed with incurable cancer. Data were analysed using interpretive description, as described by Sally Thorne. Results: Patients experienced that the use of IPOS entailed secure care as it facilitated nurses in making accurate assessments of patient care needs. IPOS helped to plan the care according to patients’ specific needs, making them feel confident that the care provided was tailored to them, giving a sense of security. Patients expressed that IPOS facilitated discussions between them and the nurse about care needs. They believed that using IPOS enabled opportunities for reflection on their wellbeing and life situation. Doing so with a nurse present was enriching, providing new perspectives. Conclusions: Patients experienced that using IPOS was beneficial. It can be concluded that IPOS provide an effective way to enable person-centred care and with advantage could be used in specialized palliative home care.

Submitted by William Justo Figueiro (williamjf) on 2015-07-21T23:42:56Z No. of bitstreams: 1 71c.pdf: 1998686 bytes, checksum: b4bd035a6fcd37ab1ac6a78b99f08184 (MD5) / Made available in DSpace on 2015-07-21T23:42:56Z (GMT). No. of bitstreams: 1 71c.pdf: 1998686 bytes, checksum: b4bd035a6fcd37ab1ac6a78b99f08184 (MD5) Previous issue date: 2013-03-16 / Nenhuma / Este trabalho considera que a popularização da ciência corresponde ao fenômeno social de comunicação dos conhecimentos provenientes da ciência à sociedade em geral (HILGARTNER, 1990; CORNELIS, 1998; MYERS, 2003; CALSAMIGLIA; DIJK, 2004) e assume a existência de graus de popularização da ciência postulada por Hilgartner (1990) e por Jacobi (1999, 1990, 1988, 1985 e 1984), de acordo com os quais a comunicação da ciência ocorre em vários contextos, desde os mais restritos e especializados até os mais amplos e públicos. Ao sustentar que a popularização da ciência é uma troca de linguagem empreendida por sujeitos que, em uma situação de comunicação específica, possuem determinadas finalidades, este trabalho se afilia à concepção charaudiana de contrato de comunicação, que corresponde a um acordo de identificação das condições de realização da troca de linguagem pelos sujeitos. (CHARAUDEAU, 2008a, 2008b, 2007, 2005, 2004 e 2001b). As variações da comunicação pública da ciência (i) decorrem dos componentes dos contratos de comunicação que organizam as trocas de linguagem e (ii) acarretam diferenças na materialidade linguística dos textos, que são o produto dos atos de comunicação. O objetivo desta pesquisa é verificar o indiciamento de graus de popularização da ciência na mídia pelas categorias linguísticas e discursivas correspondentes à referenciação e ao discurso relatado. Ao se afiliar à concepção construtivista da referência, descrita por Mondada e Dubois (2003) e representada também por Apothelóz e Reichler-Béguelin (1995), por Apothelóz (2003) e por Cavalcante (2011), esta pesquisa assume a sistematização de Apothelóz e Reichler-Béguelin (1995) em relação às operações empregadas pelos interlocutores no processo de evolução da referência e as sistematizações relacionadas aos processos de referenciação propostas por Cavalcante (2011) e especialmente por Apothelóz (2003). Além disso, fundamenta-se sobre a definição semiolinguística de que o discurso relatado corresponde ao ato de enunciação mediante o qual um locutor, em determinado espaço e em determinado tempo, relata a um interlocutor o que foi dito por outro locutor a outro interlocutor em espaço e em tempo distintos. (CHARAUDEAU, 2007). O corpus de análise é constituído por vinte notícias de popularização da ciência publicadas nas revistas Ciência Hoje e VEJA entre os meses de janeiro e junho de 2010. O exame dos textos revela o alinhamento dos procedimentos linguísticos e discursivos da referenciação e do discurso relatado à representação dos sujeitos integrantes da instância de recepção midiática, o que evidencia o atendimento à visada de captação do contrato de comunicação da mídia, mediante a qual a instância de produção midiática deve alcançar os sujeitos da instância de recepção. A descrição dos elementos dos contratos de comunicação das duas instâncias de produção possibilita relacionar a configuração linguística dos textos que resultam das trocas de linguagem, a partir da análise dos procedimentos da referenciação e do discurso relatado, aos graus de popularização da ciência representados pelas revistas Ciência Hoje e VEJA. / This paper considers that the popularization of science corresponds to the phenomenon of social communication of knowledge from science to society in general (HILGARTNER, 1990; CORNELIS, 1998; MYERS, 2003; CALSAMIGLIA; DIJK, 2004) and assumes the existence of degrees of popularization of science as postulated by Hilgartner (1990) and by Jacobi (1999, 1990, 1988, 1985 and 1984), for whom the communication of science occurs in various contexts, from the most restricted and specialized to the most general and public. In claiming that the popularization of science is a language exchange undertaken by individuals who, in a specific communicative situation have certain purposes, this paper is affiliated with the Charaudean idea of a communication contract which corresponds to an agreement to identify the conditions for achieving the exchange of language by individuals. (CHARAUDEAU, 2008a, 2008b, 2007, 2005, 2004 and 2001b). The variations in public scientific communication (i) arise from the components of the contracts of communication that govern the exchange of language and (ii) lead to differences in the linguistic materiality of the texts, which are the products of acts of communication. The objective of this research is to verify the effect of degrees of popularization of science in the media by linguistic and discursive categories corresponding to referral and reported speech. In linking to the constructivist conception of reference, described by Mondada and Dubois (2003) and additionally represented by Apothelóz and Reichler-Béguelin (1995), by Apothelóz (2003) and by Cavalcante (2011), this research assumes the systematization of Apothelóz e ReichlerBéguelin (1995) in relation to the operations employed by the interlocutors in the process of reference evolution and the systematization related to the referencing processes proposed by Cavalcante (2011) and in particular by Apothelóz (2003). In addition, this research is based on the semio linguistic definition in which reported speech corresponds to the act of enunciation in which a speaker, at a given location and time, reports to a third party the content of a discussion between one speaker and another in a different location and time. (CHARAUDEAU, 2007). The corpus of analysis consists of twenty popular science news articles published in the journals Ciência Hoje and VEJA between the months of January and June 2010. Examining the texts reveals the alignment of linguistic and discursive referencing procedures and the reported speech related to the representation of individuals that make up the receiving audience of the media in question. This evidences the objective of securing the communication contract of the media whereby the instance of media production should reach the subjects of the media reception. The description of the elements of the communication contracts of the two instances of production permits the relating of the linguistic configuration of the texts, which results in the exchange of language by way of analysis of the referral procedures and the reported speech, to the degree of popularization of science represented by the magazines Ciência Hoje and VEJA.

Base teórica: A doença de Parkinson (DP) é a segunda enfermidade neurodegenerativa mais frequente, crescendo proporcionalmente com o aumento da idade. É uma doença de comprometimento motor e não motor. Levodopa e agonistas dopaminérgicos (AD) são usados no tratamento da DP, permitindo um controle ótimo dos sintomas nos primeiros anos. Entretanto, em 5 anos, metade dos pacientes terão complicações motoras e nãomotoras induzidas pelo uso de antiparkinsonianos. Manifestações neuropsiquiátricas são frequentes, entre elas depressão, ansiedade, prejuízos cognitivos, sintomas psicóticos e transtorno de descontrole dos impulsos(DI). O DI é uma condição caracterizada pela falência em resistir a impulsos ou tentação de executar atos. O DI está associado ao uso de antiparkinsonianos, em especial, os agonistas dopaminérgicos A identificação desta condição é primordial para seu tratamento e estudo adequados. Na literatura atual, o questionário padrão-ouro foi validado na língua inglesa (QUIP), não existindo uma validação para língua portuguesa. Objetivo: Traduzir e validar o questionário QUIP-CS, em sua versão curta e aplicável no momento presente da DP, para lingua Portuguesa do Brasil Métodos: A versão curta da QUIP (QUIP-CS) foi traduzida para o Português por tradutor juramentado. Após, esta foi avaliada por 5 especialistas em DP no Brasil, sendo sugeridas pequenas correções. A versão corrigida em português foi retrotraduzida para o inglês por 2 tradutores juramentados nativos na língua original da escala (inglês), que compararam suas versões posteriormente, chegando-se a uma nova versão final neste idioma. Esta foi enviada ao autor da escala original, que concordou com esta versão, ou seja, foram mantidas as propriedades semânticas do instrumento. Após, a versão final em Português foi auto-aplicada em 65 indivíduos com diagnóstico de DP em tratamento no ambulatório especializado no HCPA, sendo que, de forma aleatória, para 30 foi aplicado um questionário de avaliação sobre o grau de dificuldade de compreensão de suas perguntas. Resultados: Em uma escala de 1 a 5 pontos, onde 1 era nenhuma compreensão das perguntas e 5, clara compreensão, a média de entendimento pelos pacientes foi de 4,06 +/- 0,69 DP. Conclusão: A avaliação desta versão foi considerada de fácil compreensão pelos próprios pacientes. O artigo para validação da tradução do conteúdo da versão em Português da QUIP-CS está em fase de revisão para publicação. / Background: Parkinson’s disease (PD) is the second most often neurodegenerative disease and proportionally growing with people aging. PD is a disease with motor and nonmotor clinical features. Levodopa and dopaminergic agonists (DA) are used for PD treatment, allowing an exquisite control of the motor symptoms during the first years. However, in five years, half patients will present motor or non-motor complications induced by cronic use of these medications. Neuropsychiatric symptoms are often, for example, depression, anxiety, cognitive impairment, psychotic symptoms and impulse control disorders (ICD). The ICD is characterized by failure on resisting an impulse or on performing an specific act. Identification of the PD affected patients is crucial for proper management and study of this condition. There is an already validated self-reported questionnaire for this purpose, the Parkinson's Disease Impulsive-Compulsive Disorders Questionnaire (QUIP), without equivalent in portuguese language. Objective: To translate and to validate the Portuguese short version of the gold-standard questionnaire for identifying ICDs PD affected patients, applicable at the current moment of PD Methods: QUIP-CS was first translated to Portuguese by a professional translator. This translated version was shown to 5 PD neurologist specialists. in Brazil, being suggested minor modifications on it. This new Portuguese revised version was back translated to English by two independent native English speakers. They were both asked to compare the version one another and checked for differences. Then, they contacted each other and got a final back translated version. This one was sent for the original author, that approved its new version comparing to his original and validated one, with no loss of it’s original properties. The Portuguese corrected version was applied to 65 patients in a random way at PD’s ambulatory at HCPA. From these, 30 were asked to answer a number that would represent their level of QUIP-CS questions’ comprehension. Results: In a 1 to 5 point scale, being 1 no comprehension and 5, total comprehension, the average was 4,06 +/- 0,69 DP. Conclusion: Our results on Portuguese version of QUIP-CS show that QUIP-CS translated and corrected version was easily understood and easily self-applied. The article is under revision to be submitted for publication.

Cognitive difficulties can persist for months and years after stroke and adversely impact confidence, mood and functional recovery. Stroke survivors, carers and healthcare professionals collectively agree that improving cognition is the number one research priority for life after stroke. Future research should include measurements of outcome that service users deem important. Patient reported outcome measures (PROMs) are a means of gaining patient perspectives that can be standardised for use in a trial. PROMs should be developed with service users to incorporate their priorities but people with cognitive difficulties are often systematically excluded from the development and use of PROMs. Study 1 used qualitative interviews (N=16) to explore stroke survivor perspectives on the important and measureable impacts of persisting cognitive problems. The results of this study generated requirements for a PROM that related to conceptual underpinning and face validity of a measurement tool. Study 2 was a systematic review of existing PROMs related to cognition. 20 Identified PROMs were critically appraised against the requirements generated in the qualitative study. No existing PROMs were identified that met all of the qualitative study review criteria. The next stage described in chapter 3, was to develop a new PROM that: utilised the strengths of existing tools; met qualitative study requirements; and was refined through consultation with different stakeholders, prioritising feedback of stroke survivors with cognitive difficulties. The result of this work was the Patient Reported Evaluation of Cognitive State (PRECiS) scale. Study 3 was a psychometric study with stroke survivors (N=164) to test PRECiS in a large sample. Quantitative and qualitative data were collected on acceptability, feasibility and other psychometric properties of validity and reliability. PRECiS demonstrated good acceptability to stroke survivors and performed well psychometrically. Future validation work required for PRECiS is described in discussion chapter 4. Subject to further validation work, PRECiS may be particularly useful for pragmatic trials of cognitive rehabilitation after stroke.

Introduction: Achilles tendinopathy can be a chronic disabling condition. Sclerosing injections under ultrasonographic guidance is one method to treat Achilles tendinopathy. Initially good results have later been questioned. Surgery is another treatment option that has been questioned because of varying reported success rate. Aim: We aimed to assess patient- reported outcome in patients suffering from Achilles tendinopathy, treated with sclerosing injections and/or surgery during a 6 ½ year- period. Method: After review of patient records, the Self-reported foot and ankle score (SEFAS) together with an in-house satisfaction questionnaire were mailed to the patients. A SEFAS score of 48 represents normal foot/ankle function. Results: 97 patients (53 women, 44 men, 104 tendons) were included. 69 patients (41 women, 28 men, 75 tendons) returned the questionnaires. The SEFAS values (median and range) were 37.5 (13-48) in patients treated with sclerosing therapy, 42 (15-48) in patients treated surgically and 47 (19-48) in patients that received both treatments. A greater proportion of surgically treated patients were satisfied (90% vs 50%), experienced symptom improvement and were able to return to the previous level of activity. Complications following surgery were wound infections (n=3) and deep vein thrombosis (n=3), two with pulmonary embolism. Following sclerosing injection, there was one complete Achilles tendon rupture. Conclusion: Sclerosing injections seems to be a safe treatment and a positive outcome in 50% of patients might be sufficient to use this therapy in selected patients with Achilles tendinopathy. However, surgical treatments seem more effective but are associated with more severe complications.

A criminalidade é um problema recorrente de grande relevância, o engajamento delituoso de jovens é um fenômeno preocupante e alarmante, de acentuado impacto na sociedade. A população, em geral, tende a acreditar que os jovens estão cada vez mais perigosos e envolvidos no agir antissocial. Faz-se necessário a realização de pesquisas que desvendem a problemática e busquem alternativas e possíveis soluções. No âmbito internacional, os questionários de delinquência autorrevelada são considerados o método mais seguro para indicar a prevalência e frequência de comportamentos delituosos entre os jovens. O objetivo do presente estudo foi, em termos gerais, conhecer o comportamento divergente e delituoso de adolescentes estudantes de instituições de ensino privadas, investigando a associação do fenômeno a variáveis potencialmente relacionadas e ampliar pesquisa anterior realizada junto a jovens de instituições de ensino públicas. Participaram do estudo 324 adolescentes, do sexo masculino, estudantes de três escolas particulares. Foi aplicado o Questionário sobre Comportamentos Juvenis, um instrumento de autorrelato que aborda questões relativas à família, escola, rotina, pares, local de residência e comportamentos divergentes e delituosos. Os resultados indicaram que 60,80% da amostra relatou já ter praticado algum comportamento delituoso e 68,88% algum comportamento divergente. O comportamento delituoso mais frequente foi a lesão corporal, seguido de dano. Quanto aos comportamentos divergentes 52,5% dos adolescentes declararam já ter consumido bebidas alcoólicas. Os adolescentes foram agrupados em 5 clusters de acordo com o nível de engajamento criminal, concluiu-se que 11,11% dos jovens são responsáveis por 81% dos delitos revelados praticados nos últimos 12 meses. Esses são aqueles de engajamento mais grave e que se diferenciaram dos outros agrupamentos pela idade de primeiro delito, pela diversidade e volume de delitos praticados. / Criminality is a relevant social problem. Juvenile delinquency is a worrying and alarming phenomenon with many impacts on society. The population, in general, Believes that young people are increasingly involved on antisocial behaviours. Studies about this, is necessary to looking for alternatives and possible solutions. In international level. Self-Reported delinquency are considered the best method to indicate the delinquency behaviors prevalence and frequency. The aim of the present study is to know the self-reported delinquency in private schools young boys; investigating the association of the phenomenon with potentially related variables and expanding previous research carried out with youngsters of public educational institutions. Thirty-four adolescents, male, private schoolss students from three participated in the study. The Self Reported Delinquency was applied; its a self-report questionnaire that investigating about family, school, routine, peers, place of residence and divergent and criminal behavior. The results indicated that 60.80% of the sample reported some delinquent behavior and 68.88% some problem behavior. The most frequent criminal behavior was hurt someone, followed by damage. Regarding divergent behaviors, 52.5% of adolescents reported having consumed alcoholic beverages. The adolescents were grouped into 5 clusters according to the level of criminal engagement, it was concluded that 11.11% of young people are responsible for 81% of de delinquency practiced in the last 12 months. These group (5) have more serious engagement and that differ from others, about age, diversity and frequency.

Background: Persistent infection with high risk HPV is a necessary but insufficient cause of cervical cancer. Behavioural, viral and host factors modulate the risk of HPV persistence. In this thesis, I explore the role of the vaginal microbiota, a host factor and the presence of multiple HPV infections, a viral factor in HPV persistence. Considering the limited data on the epidemiology of HPV related diseases in low and middle-countries (LMIC), and the limited success of cervical cancer screening strategies in many LMIC, I provide data on the distribution of HPV related diseases in Nigeria and evaluate the acceptability of innovative strategies to increase cervical cancer screening uptake. Methods/Results: To achieve my aims, I implemented a longitudinal cohort study of 1,020 women in Nigeria. I begin my results chapters with two methodological papers. Attrition is an important consideration for every longitudinal cohort, particularly in LMIC, therefore, I present my findings on attrition, determinants of attrition and practical strategies to ensure low attrition in studies conducted in LMIC. Considering that sexual behaviour is an important potential confounder in all HPV studies, and the reliability of self-reported history is often questioned, I present findings on the test-retest reliability of self-reported sexual behaviour history collected in my study. Having found that attrition levels were low and that self-reported sexual behaviour history was generally reliable within my cohort, I present my findings on the association between the vaginal microbiota and persistent hrHPV; and the role of multiple HPV infections in viral persistence. I found that the vaginal microbiota was associated with persistent hrHPV in HIV negative women, but not in HIV positive women; and that multiple HPV infections did not increase the risk of viral persistence when compared to single HPV infections. Next, I present my findings on the prevalence and incidence of anogenital warts in Nigeria, with additional reports on the prevalence of cervical cancer and other HPV associated cancers using data from two population based cancer registries. Finally, I present my findings on the acceptability of innovative strategies to improve cervical cancer screening uptake in Nigeria. I found that Nigerian women had a favorable attitude to the use of HPV DNA based screening as part of routine antenatal care, however attitudes towards the use of self-sampling techniques for HPV based cervical cancer screening varied by religious affiliations. Conclusion: In my thesis, I was able to systematically investigate the epidemiology of HPV infections in a LMIC. I considered the distribution of HPV related diseases, host and viral determinants of HPV persistence and investigated control strategies to reduce the burden of cervical cancer in a LMIC. My results provide useful data for surveillance, monitoring and evaluation of control programs on HPV and cervical cancer in Nigeria and may be useful to cervical cancer control programs in other LMIC.