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1
Squarzon, Laura. « Evaluation of HPV type-specific antibody response induced by the prophylactic quadrivalent vaccine ». Doctoral thesis, Università degli studi di Padova, 2013. http://hdl.handle.net/11577/3422903.
Texte intégralRésumé :
Human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide and affects approximately 300 million new individuals each year. HPV is considered the primary etiological agent involved in the development of cervical cancer and causes half a million cases per year worldwide. Prevention of genital HPV infection through immunization has led investigators to employ a number of strategies to develop candidate HPV vaccines. Until today, two different vaccines are available on the market: a quadrivalent vaccine that protects against HPV types 16, 18, 6, and 11 (Gardasil®, Merck Sharp and Dohme), and a bivalent vaccine that protects against HPV types 16 and 18 (Cervarix™, Glaxo SmithKline). Current data regarding the efficacy of these vaccines derive mainly from studies performed by the manufacturers and standardized assays are not commercially available to measure HPV immunity.
In this context, the aim of this PhD research project is to set up and standardize HPV pseudovirion-based neutralization (PBNA) and enzyme-linked immunosorbent (ELISA) assays and to use these tests to evaluate and compare the immunogenicity and cross-reactivity levels of the two prophylactic HPV vaccines, which are offered free in Italy to 12-year old girls and are recommended to women aged 12-45 years, according to World Health Organization (WHO) guidelines.
First, pseudovirions of HPV types 6, 11, 16, 18, 31, 45, 52, 58 were obtained with a titer of 109 transducing units/ml and neutralization and ELISA assays standardized. Subsequently, a cross sectional study to evaluate the humoral immune response against HPV-volunteers, adolescents, and healthy vaccinated adults with Gardasil® or Cervarix™ was approved by ethics committee of University Hospital of Padua. Comprehensive results were obtained from a group of 100 subjects from Veneto Region, where the quadrivalent Gardasil® vaccine was offered. The study group included 81 subjects investigated within 1-6 months after the completion of the three doses of vaccine and 7, 7, and 5 subjects investigated at 2, 3, and 4 years after vaccination, respectively.
At 1-6 months after the completion of the vaccination cycle, 100% vaccinees had neutralizing antibodies (NAbs) against HPV16, 98,8% had NAbs against HPV18, while 91% had NAbs against HPV6 and 50% had NAbs against HPV11. The NAbs titer ranged widely from 1:40 to over 1:10,240 and was lower for NAbs against HPV6 and HPV11 as compared with NAbs titers against HPV16 and HPV18. A progressive reduction of NAbs titer was observed over time and, at 4 years from vaccination, 80% of subjects had NAbs against HPV16, HPV18 and HPV6, and 60% against HPV11. Low level cross-NAbs titer against HPV31 (1:40) was detected in 50% (3/6) of subjects at 1-6 months after vaccination, while no cross-NAbs were detected against HPV45, HPV52 and HPV58.
We also evaluated the presence of HPV type-specific NAbs in a group of 6 young girls vaccinated with CervarixTM at 1-6 months after the completion of the vaccination cycle. All subjects presented specific NAbs against HPV16 and HPV18. Titers were higher as compared with titers observed in Gardasil® vaccinated subjects. 100% of subjects presented also cross-NAbs against HPV31, whereas 16,6% presented cross-NAbs against HPV45 and HPV58. None presented cross-NAbs against HPV52.
Thanks to these results we can conclude that high-level NAbs were induced with both Gardasil® and CervarixTM vaccines. For the first vaccine, we observed the decline of NAbs titers and the limited cross-neutralization against HPV31. For the second one, cross-neutralizing NAbs were observed against HPV31 in all subjects, together with the presence of NAbs against HPV45 and HPV58 in some subjects.L'infezione da papilloma virus umano (HPV) è una delle più comuni infezioni trasmesse per via sessuale in tutto il mondo e colpisce circa 300 milioni di nuovi individui ogni anno. L’infezione persistente da tipi di HPV definiti ad alto rischio è la causa necessaria per lo sviluppo del cancro del collo dell’utero. Annualmente, vengono registrati circa 500.000 casi di carcinomi del collo dell’utero in tutto il mondo. La necessità di prevenire questo tipo di infezione ha portato nel corso degli ultimi anni allo sviluppo di diverse strategie vaccinali. Ad oggi, sono disponibili due diversi vaccini profilattici: un vaccino quadrivalente che protegge contro HPV16, 18, 6, e 11 (Gardasil®, Merck Sharp & Dohme), e un vaccino bivalente che protegge contro HPV 16 e 18 (Cervarix™, Glaxo SmithKline). I dati riguardanti l'efficacia e l’immunogenicità di questi due vaccini derivano principalmente da studi effettuati dalle ditte produttrici. Non sono disponibili inoltre test standardizzati commerciali in grado di valutare l'immunità nei confronti dei diversi tipi di HPV. Obiettivo di questo progetto di ricerca di dottorato è quello di sviluppare e standardizzare un test specifico per la ricerca di anticorpi anti-HPV basato sulla neutralizzazione di diversi tipi di HPV mediante pseudovirioni (PBNA) e un test immunoenzimatico (ELISA), e di utilizzare questi test per valutare e confrontare i livelli di immunogenicità e cross-reattività dei due vaccini profilattici anti-HPV che sono offerti gratuitamente in Italia alle ragazze nel loro dodicesimo anno di età e che vengono raccomandati per le donne di età compresa tra i 12 e i 45 anni, secondo le linee guida dell'Organizzazione Mondiale della Sanità (OMS). A tal fine, sono stati prodotti diversi lotti di pseudovirioni corrispondenti ai tipi HPV6, 11, 16, 18, 31, 45, 52, 58 con un titolo pari a 109 unità trasducenti/ml e sono stati standardizzati i saggi di neutralizzazione tipo-specifica e il saggio ELISA. E’ stato disegnato uno studio cross-sectional per valutare la risposta immunitaria umorale contro i diversi tipi di HPV in soggetti sani, adolescenti e adulti, vaccinati con Gardasil® o Cervarix™. I risultati sono stati ottenuti analizzando un gruppo di 100 soggetti della Regione Veneto, dove era offerta la vaccinazione con Gardasil®. In particolare, sono stati esaminati 81 soggetti a distanza di 1-6 mesi dal completamento del ciclo vaccinale, 7 soggetti valutati a 2 anni dalla vaccinazione, 7 soggetti a 3 anni dalla vaccinazione, e 5 a 4 anni dalla vaccinazione. A distanza di 1-6 mesi dal completamento della vaccinazione con Gardasil®, il 100% dei soggetti presentava anticorpi neutralizzanti contro HPV16, il 98,8% contro HPV18, il 91% contro HPV6 e il 50% contro HPV11. Sono stati ottenuti titoli di anticorpi neutralizzanti compresi tra 1:40 e 1:10,240. I titoli osservati nei confronti di HPV6 e HPV11 sono risultati inferiori rispetto a quelli osservati nei confronti di HPV16 e HPV18. E’ stata, inoltre, osservata una riduzione progressiva nel titolo in base al tempo intercorso dall’ultima dose vaccinale. A 4 anni dalla vaccinazione, l'80% dei soggetti presentava anticorpi neutralizzanti contro HPV16, HPV18 e HPV6, mentre il 60% nei confronti di HPV11. Per quanto riguarda la presenza di anticorpi cross-neutralizzanti, è stato osservato un titolo pari a 1:40 nei confronti di HPV31 nel 50% (3/6) dei soggetti entro i primi 6 mesi dalla vaccinazione, mentre non sono stati rilevati anticorpi cross-neutralizzanti nei confronti di HPV45, HPV52 e HPV58. E' stata valutata, inoltre, la presenza di anticorpi neutralizzanti nei confronti dei diversi tipi di HPV in un gruppo di 6 ragazze vaccinate con CervarixTM a distanza di 1-6 mesi dal completamento della vaccinazione. Tutti i soggetti presentavano anticorpi neutralizzanti nei confronti di HPV16 e HPV18, a titoli più elevati rispetto ai titoli osservati nei soggetti vaccinati con Gardasil®. Il 100% dei soggetti presentava, inoltre, anticorpi cross-neutralizzanti contro HPV31, mentre il 16,6% aveva anticorpi cross-neutralizzanti contro HPV45 e HPV58. Nessun soggetto ha presentato anticorpi cross-neutralizzanti contro HPV52. In conclusione, entrambi i vaccini sono in grado di indurre elevati livelli di specifici anticorpi neutralizzanti i tipi di HPV vaccinali. Per quanto riguarda il vaccino Gardasil® è stata osservata una diminuzione dei titoli anticorpali nel tempo e una limitata cross-neutralizzazione nei confronti di HPV31. Per quanto riguarda il vaccino CervarixTM, invece, è stata osservata la presenza di anticorpi cross-neutralizzanti contro HPV31 in tutti i soggetti, unitamente alla presenza degli anticorpi neutralizzanti contro HPV45 e HPV58 in alcuni soggetti.
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Fontes, Adriele Souza. « Resposta específica aos antígenos da vacina anti-HPV em homens infectados pelo HIV-1 ». Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/99/99131/tde-03082015-103315/.
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Introdução: A infecção pelo Papiloma Virus Humano (HPV) vem sendo reportada como uma das doenças sexualmente transmissíveis com maior incidência na atualidade, porém a sua prevalência não é bem esclarecida em homens, principalmente devido a baixa presença de sintomas. Além disso, poucos estudos foram realizados nesta população até o momento para verificar a resposta imune pós-vacinação. As hipóteses testadas serão fundamentais para aprofundar o conhecimento da imunopatogênese, da resposta vacinal em pacientes infectados pelo HIV e colaborar no desenho e estratégias de vacinação anti-HPV na população infectada pelo HIV Objetivos: Analisar a resposta específica aos antígenos da vacina anti-HPV em homens infectados pelo HIV. Métodos: Um total de 24 pacientes infectados pelo HIV que preencheram os critérios de inclusão durante o período de coleta foram vacinados pela vacina anti-HPV bivalente em três doses nos períodos: zero, dois e seis meses. Os grupos foram divididos em: Grupo Controle (Cinco indivíduos sadios, com sorologia negativa para HIV); Grupo A (Nove pacientes com CD4 <500 celulas mm³); Grupo B (10 pacientes com CD4 >=500 celulas mm³). Foram realizados ELISA para a detecção de anticorpos Anti-HPV nos momentos pré e pós-vacinação nos grupos estudados; posteriormente realizamos nos mesmos o ensaio de cultura celular para detecção de citocinas (IFN?, IL17, TNF, IL6 e IL10) pela técnica de CBA . Resultados: Obtivemos soroconversão da primeira dose da vacina para o grupo A 55,6%, grupo B 30%, grupo controle 60%; na segunda dose obtivemos para o grupo A 88,8%, grupo B 80%, grupo controle 80%, e por final a terceira dose no grupo A 88,8%, grupo B 90%, grupo controle 100%. A citocina IL 6 (perfil TH2) demonstrou níveis mais elevados, comparados entre os grupos A, B e grupo controle (p<0.001). A partir da 3° dose da vacinação observamos baixos níveis de INF-? (perfil TH1) A e B (p<0.0006). O grupo controle apresentou produção de INF- ? quando comparado com grupos A e B (p<0.001). Conclusão: Os pacientes soropositivos e grupo controle foram respondedores a vacinação anti-HPV. Foi demonstrada uma elevada produção das citocinas entre os grupos sugerindo uma imunomodulação do grupo HIV+. Esse trabalho apresenta informações relevantes que estimulam a realização de novos estudos nessa população, avaliações de reações cruzada da vacina que pode resultar em proteção a outros tipos de HPV não presentes na vacina, além de analisar por mais tempo as titulações no soro desses pacientes. Os dados do nosso estudo podem corroborar para a vacinação nessa população, diminuindo assim o risco de uma infecção, mortalidade e morbidade das doenças causadas pelo HPV em homens.Introduction: Infection with Human Papilloma Virus (HPV) has been reported as one of the sexually transmitted diseases with a higher incidence nowadys, but its prevalence must be clarified in men, mainly due to low presence of symptoms. Moreover, few studies have been performed in this population until now to verify the immune response post-vaccination. The hypothesis here suggested will be the key for better understanding of the immunopathogenesis, the vaccine´s response in HIV-infected patients and collaborate in the design and strategies of vaccination against HPV in HIV-infected population. Objectives: Analyze the specific response to antigens of HPV vaccine in HIV-infected men. Methods: A total of 24 HIV-infected patients who were in accordance with the inclusion criteria during the data collection period were vaccinated with anti-HPV bivalent vaccine in three period doses: zero, two and six months. The groups were distributed in: Control group (five healthy subjects with negative serology against HIV); Group A (nine subjects with CD4 <500 cells/mm³; Group B (10 subjects with CD4 >500 cells/mm³). ELISA was performed to detect the level of antibodies anti-HPV before and after vaccination in the studied cohort. Postenarly, cells of these groups were submitted in culture to verify citokynes production (IFN?, IL17, TNF, IL6 and IL10) using CBA methodology. Results: We obtained seroconversion after the first dose of anti-HPV vaccine: control group 60%, group A 55,6% and group B 30%. In the second dose: control group 80%, group A 88,8% and Group B 80%. And at last, the third dose: Control Group 100%, Group A 88,8% and group B 90%. IL 6 citokyne (TH2 response) was detected in higher level when compared Control, A and B groups (p<0.001). IFN? citokyne (TH1 response) was detect in low level only after the third dose of vaccination, showing relevance between A and B groups (p<0.0006). Additionally, higher IFN? production was detected when compared the control with A and B groups (p<0.001). Conclusion: HIV patients and controls (HIV-) were responders to anti-HPV vaccination. It was clear that an elevated cytokine production was detected between groups, suggesting immunomodulation of HIV + group. This work suggests relevant information that challenge: new studies in this population, verification of cross-reactions of the vaccine resulting in protection of other HPV types not present in this vaccine, and analyze for longer period the titers of anti-HPV antibodies in these patients. All together, our data can corroborate for vaccination in this population, thus decreasing the risk of infection, mortality and morbidity of the disease caused by HPV in men.
3
Bergstrand, Anna-Sara, et Pettersson Siri Cordes. « ”Kan man skydda sig mot någon form av cancer så ska man väl det.-” : Unga vaccinerade kvinnors kunskap om Humant Papillomvirus samt kunskap om och inställning till vaccination mot Humant Papillomvirus ». Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-271343.
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Bakgrund Humant papillomvirus (HPV) orsakar vårtor och är en vanligt förekommande könssjukdom världen över. Vaccination mot de vanligaste HPV-typerna som kan orsaka kondylom och leda till cancer ingår sedan 2012 i det allmänna vaccinationsprogrammet för flickor och unga kvinnor. Tidigare forskning visar att unga kvinnor trots låg kunskap om viruset, har en positiv inställning till vaccination. Syfte Att undersöka unga vaccinerade kvinnors kunskap om HPV samt deras kunskap om och inställning till HPV-vaccination. Metod En kvalitativ explorativ studie. The Health Belief Model användes som teoretisk modell. Individuella intervjuer med åtta unga kvinnor som vaccinerats mot HPV. Data analyserades med innehållsanalys. Resultat Totalt genomfördes åtta intervjuer med unga kvinnor födda 1993-1998. Tre kategorier skapades: 1) Bristande kunskap om HPV 2) Tillförlitligt skydd mot cancer samt 3) Vaccinet är tillgängligt. Kunskapen om HPV och HPV-vaccin var låg hos de unga kvinnorna. Den främsta anledningen till att de valde att vaccinera sig var rädsla för cancer, andras inflytande till vaccinering, främst från mödrar, en tilltro till hälso- och sjukvården och till vaccinet samt att vaccinet är tillgängligt. Slutsats Det är tydligt att kunskapen om HPV och vaccinet är låg bland de deltagande unga kvinnorna. Inför framtiden behövs anpassad information till unga kvinnor om viruset och vaccinet för att tillgodose behovet av information. Det är viktigt att unga kvinnor som vaccineras mot HPV har kunskap om vaccinet för att veta hur de skyddar sig mot HPV och att de även ska förstå vikten av att gå på gynekologisk cellprovskontroll som en del av prevention av HPV.Background Human papillomavirus (HPV) cause warts and is a common sexually transmitted infection worldwide. Vaccination against the most common HPV types that can cause genital warts and cancer is implemented in the national vaccination programme for girls and young women since 2012. Previous research shows that young women, despite low knowledge about the virus, are in favour of the vaccine. Objective To explore young vaccinated women’s knowledge about HPV and knowledge and attitudes towards HPV-vaccination. Method An qualitative explorative study. The Health Belief Model was the theoretical framework. Individual interviews were conducted with young women vaccinated against HPV. Data were analyzed with content analyses. Results In total eight interviews were undertaken with young women born in 1993-1998. Three categories were revealed through the interviews: 1) Lack of knowledge about HPV 2) Reliable protection against cancer and 3) The vaccine is available. The young women had low knowledge about HPV and HPV vaccine. The main reasons for vaccination were; fear of cancer, influence from others, especially the mothers, trust in the healthcare and the vaccine and the vaccine is available. Conclusion The knowledge of HPV and the vaccine was low among the included women. In the future the iformation about the virus and the vaccine needs to be adapted to the young women to provide the need of information. It is important that young women who are vaccinated against HPV have knowledge about the vaccine to be able to protect themselves against HPV and that they are aware of the importance of attending future cervical cancer screening controls as a part of the prevention against HPV.
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Farfan, Arribas Diego Jose. « DNA Vaccines Against HIV-1 : Augmenting Immunogenicity of gp120 ». Link to electronic thesis, 2002. http://www.wpi.edu/Pubs/ETD/Available/etd-0107102-160706/.
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Olivera-Botello, Gustavo. « Modélisation numérique des aspects immunologiques de la réaction à l’infection à HPV et de la vaccination anti-HPV par Gardasil® ». Thesis, Lyon 1, 2011. http://www.theses.fr/2011LYO10038/document.
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L’infection au papillomavirus humain (HPV) est connue pour être le principal facteur causal d’une série de maladies aussi bien bénignes (condylomatose ano-génitale, papillomatose lyringée, et autres) que malignes (cancer du col de l’utérus, certains cancers ORL, et autres). Deux vaccins prophylactiques (Gardasil® et Cervarix®) sont sur la marché depuis à peu près quatre ans pour prévenir cette infection. Le présent travail de thèse comportait trois objectifs principaux : i) étudier in-silico l’immunogénicité du vaccin Gardasil® ; ii) étudier in-silico l’histoire naturelle d’une infection à HPV et iii) évaluer in-silico le potentiel de l’hypothèse thérapeutique suivante : l’administration intramusculaire du vaccin Gardasil® chez des patients atteints d’une papillomatose laryngée induirait un effet bénéfique car l’arrivée des immunoglobulines au tissu affecté empêcherait l’HPV de compléter son cycle de vie et, par conséquent, la maladie de se propager. Les principales conclusions sont : i) pour qu’une papillomatose laryngée ne s’étende pas il faudrait, d’après nos simulations, que le taux d’IgGs sériques soit maintenu au-dessus de 200 mMU/mL ; ii) pour rester, sur une période de 10 ans, le plus longtemps possible au-dessus de ce seuil (d´effet thérapeutique), en administrant la quantité minimale de vaccin, il faudrait, d’après nos simulations, suivre le protocole suivant : l’immunisation de base (à 0, 2 et 6 mois), suivie de trois rappels successifs tous les six mois jusqu’au 24ème mois, suivis d’un rappel 18 mois plus tard ; iii) par ailleurs, il semble inutile (voire contreproductif), d’après nos simulations, de modifier le schéma traditionnel de base (0-2-6 mois)Two prophylactic vaccines have demonstrated to prevent infections with the human papillomavirus (HPV). Thus, they have been in the market for the last four years, or so. The three main objectives of the present project were: i) to study in-silico the immunogenicity of one of these vaccines (Gardasil®); ii) to study in-silico the natural history of an HPV infection, and iii) to assess in-silico the potential of the following therapeutic hypothesis : the intramuscular administration of Gardasil® to patients already suffering from a recurrent respiratory papillomatosis would result in a better prognosis thanks to the fact that the HPV-specific immunoglobulins that would bathe the affected tissue would impede the virus to complete its life cycle and, therefore, the disease to progress. The main conclusions are: i) according to our simulations, the minimum serum IgG titer required for hampering the progression of a recurrent respiratory papillomatosis would be 200 mMU/mL ; ii) in order to keep, within a time window of ten years, the anti-HPV IgG titer over the just-mentioned therapeutic-effect threshold, the biggest possible fraction of time and through the administration of the smallest possible number of booster doses, it would be necessary, according to our simulations, to adopt the following vaccination schedule: the basic three doses (at months 0, 2 and 6), followed by three successive booster doses, every six months, until reaching the 24th month, followed by a late final booster dose, 18 months later. iii) incidentally, it would seem to be inappropriate, according to our simulations, to modify the original initial vaccination schedule (at months 0, 2 and 6)
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Ebertz, Barika. « Factors influencing women's intentions to obtain the Human Papillomavirus (HPV) vaccine ». Thesis, Högskolan Kristianstad, Sektionen för hälsa och samhälle, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-10745.
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Background: Cervical cancer is second most common cancer in women. The 15% incidence of cervical cancer in women worldwide can potentially be reduced by the vaccine against human papillomavirus (HPV). It is therefore important for all healthcare professionals including registered nurses to understand what affects women’s intentions and willingness to receive HPV vaccination so that they can overcome any inappropriate barriers and promote public health. Aim: The aim of this article was to describe factors influencing women’s intentions to obtain the HPV vaccine. Method: The following databases Cinahl, Medline, PsycINFO, Summon @ HKR and Pubmed were searched for articles that studied factors influencing women’s intention to obtain the HPV vaccine. Ten studies met the inclusion criteria, five qualitative and five quantitative. Results: Four main categories were identified that influenced women’s intention to obtain the HPV vaccine: knowledge, attitudes, the influence of other people and the safety of the vaccine. Discussion: Better access for women to accurate information is the key to increase women’s intention to obtain the HPV vaccine and improving public health. Conclusion: Correct information about HPV and HPV virus is needed to increase women’s intention to obtain the vaccine.Bakgrund: Cervixcancer är den näst vanligaste cancern hos kvinnor med en global incidens på15 %. Cervixcancer leder till hög mortalitet. Genom Humant Papillomvirus (HPV)-vaccinering kan incidensen minskas kraftigt. Vaccintäckningen är suboptimal på många plaster i världen. Det är viktigt att vårdpersonal, inklusive sjuksköterskor, förstår vilka faktorer som påverkar viljan och beslutet att vaccinera sig. På så sätt kan sjukvårdspersonal påverka dessa beslut och faktorer och därigenom öka vaccinationstäckningen i befolkningen. Syfte: Syftet var att beskriva faktorer som påverkar kvinnors avsikt till att vaccinera sig mot HPV. Metod: I denna allmänna litteraturstudie användes databaserna Cinahl, Medline, PsycINFO, Summon @ HKR and Pubmed för att söka efter artiklar som studerade faktorer som påverkar kvinnor att vaccinera sig mot HPV. Totalt tio artiklar inkluderades, fem kvalitativa och fem kvantitativa studier. Resultat: Fyra huvudkategorier identifierades som påverkade kvinnor att vaccinera sig mot HPV: Kunskap, attityder, andras inflytande och vaccinets säkerhet. Diskussion: Bättre tillgång till korrekt information för kvinnor om HPV-vaccinet är nyckeln till att öka kvinnors avsikt att vaccinera sig och på så sätt förbättra folkhälsan. Slutsats: Det krävs korrekt information om HPV virus och vaccin för att öka kvinnors avsikt till att vaccinera sig.
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Barley, Jessica. « Promoting HPV vaccine acceptability in men ». Tallahassee, Fla. : Florida State University, 2008. http://purl.fcla.edu/fsu/lib/digcoll/undergraduate/honors-theses/341812.
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Thesis (Honors paper)--Florida State University, 2008.Advisor: Dr. Mary A. Gerend, Florida State University, College of Arts and Sciences, Dept. of Psychology. Includes bibliographical references.
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Busch, Marc Gregory. « Evaluation of different SIV plasmid DNA vaccines : a model for HIV vaccine development / ». For electronic version search Digital dissertations database. Restricted to UC campuses. Access is free to UC campus dissertations, 2004. http://uclibs.org/PID/11984.
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Lundberg, Maria, et Martin Färdig. « Gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin ». Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-234188.
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Bakgrund: Humant papillomvirus (HPV) är ett sexuellt överförbart vårtvirus, som kan orsaka cellförändringar och livmoderhalscancer. Tidigare forskning har visat att kunskap om HPV och HPV-vaccin generellt är låg och att vaccinationstäckningen bland unga kvinnor i många länder varit suboptimal. Syfte: Syftet med föreliggande studie var att kartlägga gymnasieelevers kunskap om och inställning till HPV och HPV-vaccin, samt undersöka om det föreligger skillnader mellan elever på praktiska och teoretiska gymnasieprogram. Metod: Studien var en deskriptiv komparativ tvärsnittsstudie med kvantitativ ansats. Orems egenvårdsteori användes som teoretisk referensram. De 230 deltagarna från fyra gymnasieskolor i Uppsala besvarade ett enkätformulär. Resultat: Majoriteten av eleverna hade generellt låg kunskap om HPV och HPV-vaccinet, hade låg tilltro till vaccinet och var osäkra på huruvida de i framtiden ville vaccineras, dock hade elever på teoretiska program bättre kunskap och mer positiv inställning än elever på praktiska program. Flickor hade bättre kunskap och om HPV och HPV-vaccin än pojkar. De flesta hade inte hört talas om vaccin mot HPV, men de allra flesta hade kännedom om vaccin mot livmoderhalscancer. Slutsats: Den låga kunskapen om HPV och HPV-vaccin kan påverka elevernas inställning samt deras intentioner att i framtiden vaccineras. Resultatet indikerar på ett behov av mer information om HPV och HPV-vaccin. Skolsköterskans hälsosamtal med gymnasieelever bör inkludera information och diskussion om HPV och HPV-vaccin anpassad för ungdomar, för att ge dem möjlighet att förstå sambandet mellan kondylom, HPV och livmoderhalscancer, och därmed lättare kunna ta ställning till vaccination.
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Frylemo, Angelica, et Emelie Karlsson. « Aspekter som påverkar vårdnadshavares beslut om HPV-vaccination : En litteraturstudie ». Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-16289.
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Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the world and there are over 100 different varieties. Several of the varieties can lead to cancer. Although there are vaccines available, the vaccine coverage varies in the providing countries. Aim: The aim of this study was to describe aspects that make guardians choose to refrain from giving their children HPV-vaccines. Method: This Literature study is based on nine qualitative articles published between 2010 and 2020 and the articles were found in Cinahl and PubMed. Results: Guardians who refrained from the HPV-vaccine to their adolescents mentioned varied aspects. Some guardians were concerned about side effects of the vaccine and others mention a lack of knowledge and information about HPV and the vaccine. Guardians expressed concerns about vaccinating against sexually transmitted infections with their adolescents. A varied confidence in health care staff was mentioned by the guardians and they sought information from more unreliable sources such as stories from friends and family or the internet. The fact that HPV-vaccine only was provided to girls, in many of the countries, was a reason for the guardian’s skepticism. Conclusion: The result showed that there are various aspects that make guardians refrain from HPV-vaccine. Some reasons are more common in certain countries. Today's society is multicultural, which leads to a need for more studies to be done from an international perspective. Being able to meet the guardian’s various needs for information about HPV-vaccine is essential to get a higher HPV-vaccine coverage in the world.
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Öberg, Conny, et Sofia Josefsson. « Knowledge and beliefs about HPV and HPV vaccine among young Thai females ». Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-295648.
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Background: Human Papilloma Virus (HPV) is the recognized main reason for developing cervical cancer. HPV vaccine given to females is the most effective prevention. Purpose: To investigate knowledge and beliefs about HPV, cervical cancer and HPV vaccine among young Thai females in north-eastern part of Thailand. Further, to discover potential differences between those stating having knowledge about HPV and cervical cancer (group SHK), and those stating not having knowledge about HPV and cervical cancer (group SNHK). Method: A cross-sectional survey using a questionnaire about knowledge and beliefs of HPV where 221 young Thai females, aged 18-21, participated. Orem’s self-care theory was used as theoretical framework. Result: Less than 50 % of the participants knew about visible signs and symptoms of HPV infection. However, over 70 % had knowledge regarding HPV´s relation to sexual activity. Internet was the greatest source of information about HPV. Participants had positive belief towards the vaccine and more than 95% wished to get vaccinated. Group SHK had more knowledge then group SNHK with significant difference in seven out of fourteen knowledge items, and showed more positive beliefs with significant difference in six out of sixteen belief statements. Conclusion: The overall level of knowledge about HPV and cervical cancer was insufficient. However, this did not affect the participant’s beliefs in the subject negatively. Health care should provide viable internet sites with information about HPV to ensure that young Thai females get requisites, enabling self-care on preventing HPV infections by vaccination.Bakgrund: Humant Papillom Virus (HPV) är den erkänt främsta orsaken till livmoderhalscancer. Vaccinering av unga kvinnor är den erkänt mest effektiva preventionen. Syfte: Att undersöka kunskap och åsikter om HPV, livmoderhalscancer och HPV vaccin bland unga thailändska kvinnor i nordöstra Thailand. Vidare, att undersöka om det fanns några skillnader mellan dem som säger sig ha kunskap om HPV och livmoderhalscancer (grupp SHK) och de som säger sig inte ha någon kunskap om HPV och livmoderhalscancer (grupp SNHK). Metod: En tvärsnittsstudie med ett frågeformulär om kunskap och åsikter om HPV som 221 unga thailändska kvinnor, i åldern 18-21, besvarade. Dorotea Orems omvårdnadsteori användes som teoretisk ram. Resultat: Mindre än 50 % av deltagarna hade kunskap om symtom av en HPV infektion. Över 70 % hade kunskap om HPV och dess relation till sexuell aktivitet. Största källan för information om HPV var internet. Deltagarna hade positiva åsikter inför vaccinet, mer än 95 % skulle vilja vaccinera sig. Grupp SHK hade mer kunskap än grupp SNHK med signifikant skillnad i sju av fjorton kunskapsämnen, och visade mer positiva åsikter med signifikant skillnad i sex av sexton påståenden rörande åsikter. Slutsats: Nivån av kunskap rörande HPV och livmoderhalscancer är otillräcklig, men det påverkar inte unga thailändska kvinnors åsikter om HPV vaccin i negativ riktning. Hälso- och sjukvården bör erbjuda korrekta och trovärdiga websidor med information om HPV för att ge unga thailändska kvinnor de förutsättningar som krävs för egenvård i prevention av HPV infektion genom vaccinering.
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Gutjahr, Alice. « Évaluation de combinaisons de ligands de PRR et de particules biodégradables pour la vaccination muqueuse ». Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1325.
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De nombreux obstacles freinent le développement d'un vaccin efficace contre le VIH. Pour franchir ces barrières, le recours aux adjuvants est une option prometteuse. Dans ce contexte, l'objectif de ce doctorat est l'évaluation de combinaisons de ligands de PRR et de particules biodégradables pour la vaccination muqueuse. La première partie de l'étude vise à analyser la valeur ajoutée de molécules hybrides composée de deux ligands de PRR comparée à la co-administration des deux agonistes. Des molécules stimulant TLR7 et TLR2 puis TLR7 et NOD2 ont été évaluées. Nous avons démontré l'intérêt de l'association de ligands de PRR au sein d'une même molécule, pour l'induction de réponses immunitaires systémiques et muqueuses. Des études récentes ont montré l'intérêt d'agonistes de STING comme adjuvant vaccinaux. Nous avons étudié l'induction de réponses immunitaires par les agonistes de STING, administrés par voie parentérale ou muqueuse. Nous avons démontré le fort potentiel de ligands de STING pour l'induction de réponses cellulaires et muqueuses. Lors de ces études, nous avons démontré que l'intérêt de la vectorisation d'agonistes de PRR dépend de la molécule. En effet, bien que la vectorisation d'une molécule hybride TLR7/TLR2 n'ait pas d'impact sur la réponse immunitaire induite, la vectorisation d'agonistes de STING potentialise leur effet immunostimulant. Pour finir, nous avons montré que la voie d'administration a un impact sur la réponse immunitaire induite. Afin de mieux comprendre les mécanismes mis en jeu, une étude de biodistribution des formulations de NP de PLA après administration par voie systémique ou muqueuse a été réaliséeThere are many barriers to the development an effective HIV vaccine. The use of adjuvants is a promising option to overcome these obstacles. In this context, the objective of this PhD is the evaluation of combinations of PRR ligands and biodegradable particles for mucosal vaccination.The first part of this study aimed at assessing the added value of hybrid molecules composed of two PRR ligands compared to the co-administration of the two agonists. TLR7 and TLR2 stimulating molecules followed by TLR7 and NOD2 were evaluated. We demonstrated the interest of the association of PRR ligands within the same molecule for the induction of systemic and mucosal immune responses.Recent studies showed the interest of STING agonists as a vaccine adjuvant. We investigated the induction of immune responses by STING agonists administered parenterally or mucosally. We confirmed the strong potential of STING ligands for the induction of cellular and mucosal responses.In these studies, we demonstrated that the interest of vectorization of PRR agonists depends on the molecule. Indeed, although the encapsulation of a TLR7/TLR2 hybrid molecule has no impact on the induced immune response, the vectorization of STING agonists potentiates their immunostimulatory effect.Finally, we showed that the route of administration has an impact on the immune response induced. In order to better understand the mechanisms involved, a biodistribution study of PLA NP formulations after systemic or mucosal administration was performed
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Cheung, Oi-ying Creamy, et 張靄凝. « Literature review of parental acceptability about HPV vaccine ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42994615.
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Cheung, Oi-ying Creamy. « Literature review of parental acceptability about HPV vaccine ». Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42994615.
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LeÌtourneau, Sven C. « HIV-1 vaccine development ». Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442825.
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Ward, Scott Matthew. « Towards an HCV vaccine / ». St. Lucia, Qld, 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16402.pdf.
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Lhomme, Édouard. « Analyse des déterminants et modélisation de la réponse immunitaire post-vaccination dans des stratégies vaccinales expérimentales ». Thesis, Bordeaux, 2019. http://www.theses.fr/2019BORD0271.
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Les essais cliniques de vaccins posent des défis méthodologiques particuliers, principalement liés à la spécificité du développement des vaccins, les schémas des essais cliniques, de l'absence d'un corrélat de protection validé et de la complexité des techniques immunologiques évaluant l'immunogénicité des candidats vaccins. Celles-ci nécessitent des recherches méthodologiques pour définir les méthodes les plus appropriées. Cette thèse porte sur la recherche méthodologique visant à optimiser les méthodes utilisées dans le développement clinique des vaccins, notamment pour proposer et développer des méthodes statistiques de modélisation de l'immunogénicité, en prenant comme exemple les essais cliniques des vaccins contre le VIH et le virus Ebola.Nous avons d'abord étudié la dynamique des réponses immunitaires après la vaccination et montré qu'il faudrait tenir compte des temps de mesure précoce dans les futurs essais cliniques pour mieux comprendre le rôle des lymphocytes T CD4 auxiliaires et évaluer leur rôle prédictif dans la réponse immunitaire aux vaccins. Ensuite, nous avons développé une nouvelle approche de modélisation bivariée pour l'analyse de la réponse cellulaire mesurée par la technique de cytométrie en flux de marquage des cytokines intracellulaires (ICS). Cette nouvelle méthode a montré de très bonnes performances statistiques et devrait devenir la nouvelle méthode statistique standard pour les analyses ICS dans les essais vaccinaux. Ce travail aura un impact direct sur l'évaluation de la réponse du ICS dans les essais cliniques de vaccins.En ce qui concerne la réponse humorale, nous avons montré qu'il subsiste des incertitudes importantes sur les déterminants de la réponse anticorps après une vaccination préventive contre le virus Ebola. Cela met l'accent sur l'intérêt d'harmoniser les méthodes de mesure et les schémas d'étude. De plus, il indique le besoin de mettre en place des essais cliniques randomisés à bras multiples sur le vaccin contre le virus Ebola pour une comparaison précise de l'immunogénicité entre les différentes stratégies vaccinales.Nous avons présenté enfin la méthodologie d’un essai randomisé de phase 2 contre le virus Ebola évaluant trois stratégies vaccinales dans quatre pays d’Afrique de l’Ouest, et plus particulièrement pour finir une réflexion méthodologique et éthique sur la question de l’inclusion des personnels de l’essai dans un essai clinique vaccinale contre le virus Ebola en période non-épidémique.Les méthodes développées dans le cadre de cette thèse contribueront à améliorer la conception et l'analyse des futurs essais vaccinaux, et pourraient également être transposées plus largement à d'autres domaines de rechercheSpecific methodological challenges exist in vaccine clinical trials, due principally to specificities of vaccine development, clinical trial design, absence of validate correlate of protection, and complexities of new immunological assays for evaluating immunogenicity of vaccine candidates. These require methodological research to define the most appropriate methods. This thesis focuses on methodological research to optimize methods used in the clinical development of vaccines, especially to propose and develop statistical methods to model immunogenicity, using HIV and Ebola vaccine clinical trials as an example.We first investigated the dynamics of the immune responses post-vaccination and showed that early sampling time points should be considered in future clinical trials to better understand the role of the early CD4 helper T cells and to evaluate their predictive role in the immune response to vaccines. Then, we developed a new bivariate modelling approach for the analysis of the cellular immune response (assessed by intracellular cytokine staining, ICS) that showed good statistical performances and should become the new statistical standard method for ICS analyses in vaccine trials. This work will have a direct impact on the assessment on the ICS response in vaccine clinical trials.Regarding the humoral response, we showed that there are still significant uncertainties in the determinants of the antibody response after preventive vaccination against Ebola virus disease. This emphasizes the interest of harmonizing measurement methods and study designs. Furthermore, it indicates the need of randomized multi arm Ebola vaccine trials for accurate comparison of immunogenicity between different vaccine strategies.Finally, we presented the methodology of an international randomized phase 2 trial against Ebola, and in particular a methodological and ethical reflection related to the enrollment of study personnel in Ebola vaccine trial in a non-epidemic context.Methods developed in this thesis will contribute to improve the design and analysis of future vaccine trials, and also could be transposable more widely to other research domains
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Angiola, Julie E. « HPV vaccine acceptance among rural, Rocky Mountain region women ». Laramie, Wyo. : University of Wyoming, 2009. http://proquest.umi.com/pqdweb?did=1980572871&sid=1&Fmt=2&clientId=18949&RQT=309&VName=PQD.
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Sandoval, Federico. « Optimisation d’un vaccin thérapeutique contre les tumeurs des voies aérodigestives supérieures associées au virus de papilloma humain (HPV) : Mise en évidence du rôle de la compartimentalisation de la réponse immunitaire antitumorale ». Thesis, Paris 5, 2012. http://www.theses.fr/2012PA05T012.
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De récents essais cliniques ont montré les bénéfices thérapeutiques des nouvelles immunothérapies (Sipoleucel T pour le cancer de la prostate…). Mais jusqu’ici la majorité des essais cliniques de vaccins contre le cancer n’ont montré que de faibles effets sur les patients, ce qui contraste avec les résultats obtenus dans les modèles pré cliniques. Ceux-ci, comprennent la greffe sous cutanée de cellules tumorales ce qui ne mime pas la vrai localisation anatomique de la lésion tumorale. De plus, dans la plupart des cas les vaccins anti-cancéreux sont administrés par voie systémique et induisent une réponse antitumorale avec un effet thérapeutique au niveau du compartiment systémique. La réponse antitumorale induite par ces vaccins au niveau du microenvironnement tumoral et ses effets antitumoraux sur des modèles orthotopiques n’ont jamais été décrits sur des modèles pré cliniques. Comme la majorité des tumeurs humaines se développe dans des localisations muqueuses, nous avons étudié l’effet de la voie d’immunisation dans l’induction des réponses antitumorales au niveau du site anatomique de la tumeur en comparant l’induction de LT CD8+ spécifiques de l’antigène tumoral après une vaccination par voie systémique (intramusculaire) ou muqueuse (intranasale). Cette stratégie de vaccination repose sur l’utilisation d’un vecteur non réplicatif qui cible les antigènes in vivo aux cellules dendritiques et qui a été développé au sein de notre unité. Il s’agit de la sous unité B de la toxine de Shiga (STxB) associée à un antigène tumoral (protéine E7 de l’HPV16) nous avons également analysé l’effet antitumoral de cette vaccination sur deux modèles de tumeurs orthotopiques à localisations ORL et pulmonaires exprimant l’antigène E7. Nous avons montré que la vaccination i.n. induisait une plus forte réponse LT-CD8+ spécifique et des effets antitumoraux au niveau des localisations muqueuses que la vaccination par voie systémique, et que cette immunisation par voie i.n. induisait un phénotype particulier sur ces LT-CD8+ spécifiques et en particulier une augmentation de l’expression des intégrines CD103 et CD49a en opposition à la voie systémique. L’inhibition de CD49a réduit l’effet thérapeutique de la vaccination par voie i.n. et le nombre de LT-CD8+ infiltrant les tumeurs orthotopiques. Nos résultats montrent que la réponse LT-CD8+ systémique ne sert pas comme marqueur prédictif de la qualité de la réponse immunitaire antitumorale au niveau local. Nos observations mettent en évidence l’existence d’une compartimentalisation de la réponse muqueuse antitumorale, une découverte capitale pour le développement rationnel des vaccins anti cancerRecent clinical trials have shown the therapeutic benefits of new promising immunotherapies (Sipoleucel T for prostate cancer, Ipilimumab in melanoma…). But by far, the majority of cancer vaccine clinical trials have shown modest clinical effects on cancer patients, contrasting with results found in preclinical models. Those preclinical models of cancer rely on subcutaneous grafts of tumor cells which do not mimic the true anatomic location of tumor lesions. In addition, in most cases cancer vaccines are administrated by systemic route, eliciting systemic antitumor responses and therapeutic effects. The antitumor response elicited by those vaccine strategies at the local environment of tumor location and their antitumor effect on orthotopic tumor models has not yet been addressed in preclinical cancer models. Since the majority of human tumors develop at mucosal surfaces, we addressed the question of the effect of the immunization route in the induction of local mucosal antitumor CD8+T cell responses by comparing a systemic intramuscular (i.m.) and intranasal (i.n.) route of administration of cancer vaccine. This vaccine consists of a non-replicative vaccine strategy that targets tumor antigen in vivo to dendritic cells developed at our laboratory and composed of the B subunit of the Shiga toxin (STxB) associated to a tumor antigen (E7 protein of HPV16). We also analyzed the antitumor effect of these vaccinations on two mucosal orthotopic tumor models of head and neck and lung cancer expressing the E7 antigen. We found that intranasal vaccination induced stronger specific CD8+T cell responses and antitumor effects at mucosal sites than systemic immunization, and, that mucosal vaccination induced a mucosal imprinting phenotype on mucosal derived antigen specific T cells as they expressed the mucosal integrins CD103 and CD49a, as opposed to systemic specific CD8+T cells or tumor infiltrating T cells in subcutaneous tumors. Inhibition of CD49a reduced the antitumor efficacy of the nasal vaccine and the number of tumor infiltrating CD8+T cells on orthotopic mucosal tumors. Our results showed that systemic antigen-specific T cell responses as typically assessed did not predict the quality of local mucosal immune response. Our observations provide direct evidence for the compartmentalization of mucosal tumor immunity, a critical finding for the rational design of better cancer vaccines
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Wheldon, Christopher W. « HPV Vaccine Decision-Making among Male Sexual Minorities : An Integrative Theoretical Framework for Vaccine Promotion ». Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5877.
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Men who have sex with men (MSM) are at increased risk of anal cancer as a result of anal HPV infection. Routine HPV vaccination is recommended for all MSM up through age 26; however, vaccine uptake among this population is low. The Integrative Model of Behavioral Prediction (IM) was used to identify, describe, and explain psychosocial factors related to HPV vaccine decision-making for young MSM. A sequential mixed-methods approach consisting of semi-structured interviews, a quantitative survey, and a qualitative open-ended survey was used to address the following aims: (1) Determine salient outcome, normative, efficacy, and control beliefs related to HPV-vaccination among young MSM; (2) Identify information needs and trusted sources of information regarding HPV vaccination among young MSM; and (3) Develop and test a structural equation model guided by the Integrated Model of Behavioral Prediction. The purpose and objectives of this research address priorities outlined in the Institute of Medicine's report on health disparities among lesbian, gay, bisexual, and transgender (LGBT) populations. Results highlight the lack of information and knowledge regarding HPV prevention in this population. The majority of respondents had heard of the HPV vaccine but generally perceived it as a women's health issue. Attitudes toward vaccination were generally positive, as was behavioral intention to get vaccinated within the next 12 moths. Salient behavioral beliefs described physical benefits such as lowering risk and promoting overall health. Psychological benefits were described as protecting sex partners and providing peace of mind. There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and potential side effects. Normative influences on decision-making were minimal. Availability, cost, and convenience were among the most salient external control factors. Issues surrounding disclosure of sexual minority status influenced control factors including self-efficacy. Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination. Empirical findings support the proposed behavioral model of vaccine decision-making.
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Nilsson, Jenny, et Elisabeth Hävermark. « Humant papillomvirus : Gymnasieelevers kunskaper om och attityder till HPV, HPV-vaccin, kondomanvändning och cellprovtagning ». Thesis, Uppsala University, Department of Public Health and Caring Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-105454.
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Purpose: To assess awareness and attitudes regarding HPV, HPV-vaccines, use of condom and participation in pap-smear screening among high-school students in Uppsala County. The intention was also to investigate if there were any differences between students at theoretical programmes and vocational programmes.
Methods: 608 students from seven high-schools in Uppsala County answered a questionnaire covering demographics, awareness and attitudes regarding HPV, HPV-vaccine, use of condoms and pap-smear tests.
Results: A majority of the students had never heard of HPV (86 %, n=521), HPV-vaccine (94 %, n=537) or the link between HPV and cervical cancer (88 %, n=563). Most respondents had a positive attitude towards HPV-vaccine (84 %, n=508), but the biggest obstacle was the high cost (37 %, n=227). The students believed that it was less likely that they would use a condom with a new partner if vaccinated (mean=78, SD=26, p<0.001), or if they or their partner used contraceptive pills (mean=62, SD=32, p<0.001) compared to how likely it was that they would use a condom in general with a new partner. The girls rated the probability that they would participate in a pap-smear screening as relatively low if vaccinated (mean=59 SD=27). Students at theoretical programmes had better knowledge about HPV and HPV-vaccines. They were also more positive to the use of condoms and participation in pap-smear screening. Furthermore, more students at theoretical programmes (11%, n=46) than at vocational programmes (9%, n=16) planned to be vaccinated (p=0.048).
Conclusion: The awareness regarding HPV and HPV-vaccine was low among high school students in Uppsala County, especially among students at vocational programmes. More information is required to increase the awareness and motivation to use condoms and participate in pap-smear screening.
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Boros, Monika. « Medias vinkling av HPV-vaccinet : En kritisk diskursanalys ». Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-28460.
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Syfte och frågeställningar: Syftet med studien är att undersöka på vilka sätt och vilka metoder två olika mediekanaler använder sig av för att övertyga och skapa trovärdighet om HPV-vaccinet. Metod och material: Kritisk diskursanalys på ett avsnitt ur samhällsprogrammet TV4 Kalla Fakta och tidningsartiklar rörande HPV-vaccinet. Huvudresultat: Framställning av HPV-vaccinet skiljer sig väsentligt åt vid granskning av Kalla Fakta och tidningsartiklarna. Metoderna som används i texterna för att skapa trovärdighet är expertutlåtanden och skapa förtroende med tittarna och läsarna.
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Stridh, Sandra, et Solvind Hammar. « Knowledge of Human papillomavirus (HPV) and attitudes towards HPV-vaccine among Thai female university students ». Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-214748.
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Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection and causes 529.000 cases of cervical cancer every year. Nowadays, there are vaccines available to prevent infection. Knowledge of HPV influence the attitude towards the vaccine and is therefore a factor of accepting the vaccine. Aim: The aim of this study was to examine the knowledge of HPV and attitudes towards HPV-vaccine among Thai female university students. Method: Descriptive and cross-sectional study with quantitative method using a questionnaire. Purposive sampling was used. The sample consisted of students from two different universities in Bangkok, Thailand and out of the 201 students whom filled in the questionnaire, 192 questionnaires were used. Result: There were 64.6% of the participants that had heard of HPV previously. Of these, the most common source of information was health professionals. The HPV-vaccine was known by 42.6% of the participants and 17.4% had taken the vaccination. Over 90% of the participants had a poor or moderate knowledge of HPV. In total, most of the participants in the sample were found to have a positive level of attitude towards the vaccine (72.4%). Almost all participants wanted to know more about HPV and the HPV-vaccine and 88.5% thought it was necessary for them to get the vaccination. Conclusion: As some gaps in knowledge among the participants were shown, the information to young women should be improved and aim to increase the motivation towards the use of preventive methods, such as taking the HPV-vaccine.
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Leung, Tiem-yee, et 梁湉兒. « Literature review on parental acceptability of human papillomavirus (HPV) vaccine ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46939003.
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Dailey, Phokeng M. « Communication, Somali Culture and Decision-making about the HPV Vaccine ». The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366284195.
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Reveal, Jacqueline Marie, et Jacqueline Marie Reveal. « Increasing HPV Vaccine Provider Recommendations in a Rural Southwest Clinic ». Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/622928.
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Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States, however vaccination uptake remains low. One of the known barriers of low vaccination rates is lack of a health care provider recommendation. The purpose of this project was to implement a practice change to increase the number of HPV vaccine recommendations provided by primary care providers (PCPs) to patients aged 9-26 years. The setting for this project was the Little Colorado Physician’s Office, a primary care clinic in rural northern Arizona. Four PCPs, including three family physicians and one family nurse practitioner, and members of the QI team participated in the project. The project was designed as a quality improvement project, guided by the Model for Improvement framework. The needs of the individual practice and their population were assessed by a quality improvement (QI) team using a fishbone diagram for root-cause analysis. A practice change was then implemented by the QI team and evaluated for its effectiveness in improving HPV vaccination recommendations. Outcome measures included the number of HPV vaccine recommendations made by a primary care provider to eligible patients and the number of HPV vaccines administered to patients. In a four-week period of practice change implementation, eight patients were considered eligible for the HPV vaccine. Of these patients, 100% were offered the HPV vaccine by their healthcare provider. The practice change was successful in promoting HPV vaccination recommendations by PCPs, and the QI team reported the change was beneficial to their practice.
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Ariyo, Oluwatosin. « Correlates of Human Papillomavirus (HPV) Vaccine Acceptance in Appalachian Tennessee ». Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etd/3238.
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Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the U.S., where one HPV-related cancer is diagnosed every 20 minutes. The most common HPV-related cancer is cervical cancer, with an estimated incidence of 12,000 cases annually, a third of which lead to death. Cervical cancer disparately affects women of ethnic minority groups and geographically isolated regions, such as Appalachia. Tennessee ranks third highest in cervical cancer incidence in the country. Many cases of cervical cancer could be prevented through vaccination against HPV, however, vaccination rates for females in Tennessee are among the lowest in the country. This mixed-methods study included an in-depth exploration of the factors that influence HPV vaccine acceptance in Appalachian Tennessee.
Healthcare providers, mothers of adolescent girls, and college-aged women were recruited to participate in the study. From October 2016 to January 2017, interviews were conducted with healthcare providers (n=12), focus groups were conducted with mothers (n=13), and a survey was administered to college women (n=479). Interview and focus group sessions were recorded, transcribed and analyzed using a thematic framework. Survey responses were analyzed using descriptive tests, comparison of means, and regression analyses.
The predominant barriers to vaccine acceptance identified in the study were: cost and novelty of the vaccine, vaccine safety, lack of school-entry requirement, and the implication of vaccine acceptance on adolescents’ sexual activity. Most negative perceptions towards the vaccine appeared to be propagated by the sociocultural influence on sex and reproductive health communication within the community. Perceived benefits for cancer prevention and receipt of strong and personal provider recommendations facilitated vaccine acceptance. Additionally, college students who reported vaccine acceptance reported discussing sexual health topics with their mothers more often than those who had not been vaccinated.
The findings from this study provide foundational insights about the facilitators and barriers of HPV vaccine acceptance in Appalachian Tennessee. Identifying and understanding these factors is crucial to improving HPV vaccination rates and essential to maximizing the primary benefit of the vaccine in addressing the existing cervical cancer disparity in the region.
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Odunsi, Adekunle Omatayo. « Immunogenetic analysis of HLA Class II in premalignant disease of the cervix and correlation with HPV status ». Thesis, Open University, 1999. http://oro.open.ac.uk/54556/.
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The human papilloma virus (HPY) infection has a causal association with cervical intraepithelial neoplasia (CIN) and cervical cancer. However, pre-malignant or malignant transformation is not always observed with HPY infection. lILA molecules are important in the regulation of the immune response to foreign antigens. The role of genetic variation at the HLA class II loci (DR and DQ) in CIN was investigated in 176 British Caucasian patients and 420 controls (normal cervical cytology and negative for HPY 16, 18, 31 and 33). HLA DQB 1 *03 typing was performed by a novel polymerase chain reactionrestriction fragment length polymorphism method (A-RFLP). The technique uses PCR to mutate the first base of codon 40 (DQ alleles) from T to G to create an artificial restriction site for an enzyme, MluI, which distinguishes DQB 1 *03 from other alleles and is confirmed by digestion of amplified DNA with Mlul. Further HLA DR-DQ typing was performed by PCR DNA amplification and oligonucleotide probe typing. HPY types (16, 18, 31 & 33) were detected by using type-specific oligonucleotide primers and PCR. The alleles of the DQB 1 *03, DRB 1 *04 and DRB 1 * 11 groups were strongly associated with susceptibility to CIN. Specifically the haplotypes DRB 1 *040 I-DQB 1 *0301 and DRBl*1101-DQB1*0301 were significant and indicated susceptibility. The DQBl*03 locus was more contributory to this association than the DRB 1 loci. A weak protective effect was shown for the haplotype DRB 1 *0 10 I-DQB 1 *0501. Positive correlation was also observed for HPY-positive CIN, suggesting that specific HLA alleles may be important in determining the immune response to HPY antigens and the risk for CIN after HPY infection. Immunoaffinity purification of the susceptibility and protective HLA ~ molecules was performed and the naturally processed peptides were eluted and sequenced by Edman degradation. The data obtained was used for motif prediction of HPY 16 E6, E7, Ll and L2 sequences that may be capable of binding to these HLA molecules. Motif prediction as well as the binding affinity of predicted peptide motifs for HLA D RB 1 *0401 and DRB 1 *0 10 1 was accomplished using the published data' on the naturally bound peptide sequences bound to these HLA molecules. The results revealed significant differences in both the number and binding affinity of the HPV 16 derived peptides to the protective and susceptibility HLA molecules. These results should help in the rational design of vaccines against HPV.
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Parker, Fatima Bibi. « Willingness to participate (WTP) in a future HIV vaccine trial in a high risk sample : perceived barriers and facilitators to participation ». Thesis, Link to the online version, 2006. http://hdl.handle.net/10019/1151.
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Muusha, Prudence. « Prevalence of Human papillomavirus among women following HPV vaccine introduction ; a systematic review ». Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29833.
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Background: Worldwide efforts have been made by some countries to offer HPV vaccination since its introduction in 2006. Population effectiveness of HPV vaccines is presently an active area of research. We review available evidence on the effectiveness of HPV vaccine uptake among female adolescents to prevent HPV infection. Methods: A comprehensive search of published and grey literature was conducted in several electronic databases using a pre-defined search strategy related to HPV prevalence following vaccination. The database searches were complemented by hand-searches of reference lists of eligible studies. Data were extracted onto a purpose-designed data extraction form, pooled in a meta-analysis and stratified by continent considering vaccine type, cross protective and (high/low) risk HPV types as subgroups. Results: Our search yielded 1680 studies, of which thirteen met with our inclusion criteria (8332 vaccinated women aged 12 to 34 years from across the world). The pooled HPV (comprising types 6, 11, 16 and 18) prevalence among vaccinated female adolescents was 7% (95% Confidence Interval (CI): 5% to 9%, 13 studies, n=8,332). The 13 studies were conducted across 3 continents: HPV prevalence for North America was 5% (95% CI: 3% to 7%, 9 studies, n=5781, age range =13 to 34); Europe, 14% (95% CI: 9% to 18%, 3 studies, n=2213, age range =13 to 29) and Australia 5% (95% CI: 3% to 8%, 1 study, n=5781, age range=13 to 34). Of the studies which reported the effect of vaccination on other non-vaccine HPV type prevalence (known as cross protective types) HPV (31, 33, 45, 51 & 58), the overall pooled cross protective HPV prevalence was 9% (95% CI: 6% to 12%, 4 studies, n=3081 age range=13 to 29), by continent North America had 14% (95% CI: 12 to 17%, 1 study, n=753 age range=14 to 24), Europe 7% (95% CI: 6 to 8%, 2 studies, n=1990, age range=13 to 29) and Australia with 8% (95% CI: 5% to 11%, 1 study, n=338 age range=18 to 26). Conclusion: This study showed an HPV prevalence of 7% in women vaccinated against HPV types 6,11,16 and 18, which represents a substantial difference to the 22% HPV prevalence in non-vaccinated women. There was no statistically significant difference between HPV prevalence across the continents. There is however, still a dearth of information on vaccinated women and HPV prevalence, highlighting the need for further studies in this area. Strengths and limitation of this review • The review comprehensively searched multiple databases and bibliographies. We had no language restrictions. • We were stringent in the selection of studies as far as vaccination status was concerned. Studies considering HPV prevalence in unvaccinated women were excluded. • A variety of methods was utilised in collecting data across the studies. However, some of the study participants were not representative of the general population. Caution therefore, needs to be considered when using these results to make inferences or conclusions about prevalence of certain populations.
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Chivu, Corina M. « Factors affecting exposure to health promotion about HPV vaccine in England and variations in uptake of HPV vaccine in secondary schools in the West Midlands ». Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/71047/.
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Background: In 2008, the health departments of the United Kingdom implemented a routine and catch-up HPV immunization programme in schools to reduce the incidence of cervical cancer. European studies conducted from 2007 to 2012 showed inconsistent results on HPV vaccine uptake in relation to ethnicity and girls’ age. Aim: To examine the relationship between area deprivation and the take-up of informative materials related to HPV vaccination in secondary schools in England. Another aim was to investigate the association between uptake of HPV vaccine and area deprivation, ethnicity and religion and to explore the views and experiences of girls, teachers and health providers on the HPV vaccine to understand how mechanisms of programme delivery, strategies and practices contributed to HPV vaccine uptake in a city in the West Midlands. Methods: Secondary data about uptake of professionally developed teaching materials by 4,750 schools in England was employed to explain the relationship between the takeup of the materials and the level of social deprivation of the area within which the school was located using logistic regression. Other secondary data about uptake of the third dose of HPV vaccine by year 8 girls in a city in the West Midlands was used to explain the variability of uptake across 20 schools between 2008 and 2012. Analytic statistics included simple and multivariate linear regressions. Qualitative data was collected through 47 semi-structured individual interviews with nine nurses, four school staff and 34 year 8 girls as well as through non-participant observations in 12 secondary schools between February and September 2013. Thematic analysis identified major themes related to the school context of implementation of the HPV vaccine programme as well as facilitators and barriers to uptake of HPV vaccine in the city of the study. Results: Of all secondary schools in England invited to receive the HPV educational materials, 1,395 schools (30.17%) responded. These schools were in the largest quintile of school size as well as maintained schools. After controlling for other covariates, it was found that schools in the least deprived quintile had 1.31 the odds of requesting materials compared with the schools in the most deprived areas (95% CI=1.05-2.53). Deprivation of school address postcode remained statistically significantly associated with uptake of HPV vaccine after controlling for ethnicity, school type and academic year. Similarly, the academic year 2009/10 remained statistically significantly associated with uptake of HPV vaccine adjusting for geographic and school factors. Deprivation of school catchment area was no longer statistically significantly associated with uptake of HPV vaccine when the other variables were held constant and the same was true for the association between ethnicity and uptake. Thematic analysis showed that school based HPV vaccination programme was accepted by most of the schools in the city of study and was delivered by a mobile clinic aiming to vaccinate all eligible girls. Chasing up the consent forms and communication with the parents were the most challenging activities in the HPV vaccination administration. However, they were essential for a high HPV vaccine uptake. The manner in which the school staff and nurses sought parents’ and girls’ consent before and on the day of vaccination was often very persuasive and not entirely ethically justified. The HPV vaccine was poorly promoted in the school environment because of tight curriculum for compulsory subjects and the lack of adequate staff. A number of other influences affected girls’ choices about receiving the vaccine. The family played the most important role for daughters’ emotional support as also did the provision of information to help girls understand and make their own decision about the vaccine. The interactions with friends and nurses were beneficial for girls’ confidence and feelings on the day of vaccination. Girls’ fear of injection caused by their poor knowledge, rumors spread by peers and parental negative attitudes about HPV vaccine were major obstacles to uptake before and on the day of vaccination. The main parental reasons for vaccine refusal were lack of understanding of the information about HPV vaccine, which they received from the school, their inadequate information, obtained from sources other than health professionals, their misconceptions about the safety of the vaccine and their religious beliefs related to their daughters’ sexual activity in the future. Conclusion: The impact of the HPV vaccination education campaign suggests differential level of exposure due to unevenly distributed requests for the materials across England. At local level, the HPV programme was not equally well implemented across the schools in the city. This was mainly due to school factors, including the location as well as the organization of delivery. The findings highlight the need for further investigation of factors associated with uptake of HPV vaccine to guide health policy and public health interventions for effective implementation of the HPV vaccination programme in all schools.
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Rambout, Lisa. « A Novel Approach to Guide Health Promotion Planning for Preventive Human Papillomavirus (HPV) Vaccination Among Adolescent Girls in an Ontario Public Health Unit ». Thèse, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/23477.
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Human papillomavirus (HPV) is widespread in the population and an important concern for public health. HPV-associated benign and cancerous disease is vaccine preventable yet vaccine uptake has been suboptimal. Adolescents are the primary target for vaccination yet their perspective has been inadequately examined. Ontario provides population-based preventive HPV vaccination to adolescent girls yet in the program’s first 2 years only approximately half of eligible girls received it. Effective strategies to improve vaccine uptake are needed. This thesis proposes a theory and ethics-based model to guide health promotion planning for HPV vaccination. Adopting an adolescent perspective, the model is applied and comprises: 1) a systematic review to identify barriers and facilitators to HPV vaccination from the viewpoint of young females; 2) GIS uses for communicating geospatial health information regarding vaccination; and 3) a roadmap for the future including recommendations for guiding principles, research, intervention development, and health policy.
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Gamboa, Socorro Herrera. « HPV vaccines| Disparities in their acceptance and use ». Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527373.
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The purpose of this study is to determine whether there is a disparity in the receipt or uptake of the HPV vaccine by race/ethnicity in young females, and whether the sources of information about HPV and the HPV vaccine affects the receipt of the HPV vaccine by race/ethnicity. Data from the California Health Interview Survey was utilized in analyzing these factors related to females who received the HPV vaccine. Although there were significant differences between receipt of the vaccine by race/ethnicity, overall vaccine receipt was low for all groups, which is consistent with other findings. Vaccination rates also varied by age, which likely was the result of better access to the HPV vaccine for younger females and by source of information.
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Ryan, Chelsea N., Kathryn L. Duvall, Emily C. Weyant, Kiana R. Johnson et David L. Wood. « Human Papillomavirus Vaccine Uptake, Knowledge, and Acceptance for Youth : A Systematic Review of Appalachia ». Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/15.
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Though vaccine uptake and public support have risen since the release of the first HPV vaccines, the United States has far lower initiation and completion rates for the HPV vaccine series in comparison to other vaccines indicated for youth. Disparities are even greater in the Appalachian regions. Understanding factors contributing to these discrepancies is vital to improving raise vaccine rates in Appalachia. A comprehensive literature search identified all articles pertaining to HPV vaccination in children and adolescents living in Appalachia. The final 15 articles were included in a systematic review of the topic. Findings: HPV disease and HPV vaccine-related knowledge and communication were low in Appalachian communities, and vaccine uptake was lower in all areas of Appalachia as compared to non-Appalachian U.S. Moreover, large variations in uptake existed among Appalachian subregions. Many variables appear to contribute to this variation, including vaccine acceptance for younger adolescents, local and press-driven critical reports of the vaccine, physician communication, and views of the family matriarchs. Targeting the Appalachian subregions, specific campaigns or intervention may be more impactful than viewing the region as a homogenous whole.
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Kutscher, Sarah. « Immunomonitoring technologies for the evaluation of Modified Vaccinia Virus Ankara expressing HIV-1 nef as a vaccine against AIDS ». Diss., lmu, 2010. http://nbn-resolving.de/urn:nbn:de:bvb:19-117303.
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Carvalho, Ieda Silva. « Custo-utilidade da vacinação contra Papilomavírus humano no Brasil ». Dissertação apresentada ao Programa de Pós-Graduação do Instituto de Saúde Coletiva, como requisito parcial para a obtenção do título de mestre em Saúde Coletiva, 2013. http://www.repositorio.ufba.br/ri/handle/ri/13110.
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O câncer de colo de útero (CCU) é um importante problema de saúde em todo o mundo. O HPV é o principal fator associado a esta doença. Para a prevenção primária da infecção foi desenvolvido a vacina quadrivalente que protege contra os tipos HPV 16, 18, 11 e 6. Objetivo: este estudo analisou a relação custo-efetividade e custo-utilidade da adição da vacina contra HPV para Sistema Único de Saúde brasileiro, em comparação ao rastreamento pelo exame citopatológico, programa existente. Método: foi adaptado um modelo de Markov da história natural da infecção por HPV para estimar custo e qualidade de vida para uma coorte hipotética de meninas de 10 anos de idade acompanhadas por 70 anos. Duas estratégias foram comparadas: vacinar e rastrear (estratégia alternativa) em relação ao rastreamento (estratégia base). No modelo a cobertura para o rastreamento foi de 77,1% e para a vacina 95%. A taxa de desconto aplicada para calcular custos e efeitos futuros de saúde foi de 5%. A análise de sensibilidade foi realizada para avaliar as incertezas quanto à cobertura vacinal, a sensibilidade do exame citopatológico e o valor da vacinação. Resultados: o modelo simulou que a adição da vacina poderia reduzir em 76,18% o risco de morrer por CCU, evitando 12.072 óbitos por esta doença a um custo médio de US$ 633.559,32/óbitos evitados, com um ganho de 1.389.478 anos de vida ajustado por qualidade. Quanto aos anos de vida ganhos ajustado por qualidade (AVAQ), a estratégia base (rastreamento) representaria um custo médio de US$ 11,62/AVAQ enquanto a estratégia teste (vacina e rastreamento) teria um custo médio de 241,66 US$/ AVAQ. A razão de custo-efetividade incremental (RCEI) desta estimativa foi de US$ 5.504,46/AVAQ. Conclusão: Esta análise, apesar das limitações metodológicas, demonstra que a incorporação, pelo SUS, da vacina quadrivalente ao programa de rastreamento pode ser uma alternativa custo-efetiva para reduzir a mortalidade por CCU.
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MacArthur, Kelly Rhea. « The HPV Vaccine Decision-Making Process : Inequality, Perceived Risk, and Trust ». Kent State University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=kent1405546716.
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Venkat, Pavithra. « Use of media to improve human papilloma virus (HPV) vaccine acceptability ». [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-165204/.
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Cleveland, S. Matthew. « HIV-1-specific antibody responses to a plant virus-HIV chimera ». Thesis, University of Warwick, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340090.
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Liu, Hao, et 刘昊. « Herd immunity of large scale HPV vaccination : a systematic review ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206935.
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Human papillomavirus (HPV) has a high prevalence among the population, and brings an enormous health impact and burden to the public. Vaccines have been developed in recent years, and their efficacy has been noted in many studies. Although there is much theoretical research conducted worldwide on the indirect protective effect of HPV vaccines to the unvaccinated population, convincing evidence on real world settings is still to be found. This systematic review recruits studies from two databases, PubMed and MEDLINE ovidSP and is intended to examine herd protection on community levels. 5 studies are included and the conclusion suggests that the herd protection is most significant among the sexually active young population, whereas it doesn’t seem to benefit people of older age. Therefore, follow up studies in the future are still needed to evaluate the herd immunity among the old age groups.published_or_final_version
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Kornfeld, Julie. « Factors Associated with Acceptance of Human Papillomavirus Vaccine : A Study of Spanish Information Seekers ». Scholarly Repository, 2009. http://scholarlyrepository.miami.edu/oa_dissertations/346.
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Cervical cancer is the second most common malignancy worldwide. Infection with HPV is a necessary cause of cervical. Hispanic women in the U.S. experience significantly higher rates of invasive disease than non-Hispanic Whites. In this population, HPV vaccines hold significant potential to eliminate further disparities in cervical cancer morbidity and mortality. The purpose of this study was to examine factors associated with Human Papillomavirus (HPV) vaccine acceptability among a national sample of Spanish speaking callers to the National Cancer Institute's (NCI) Cancer Information Service (CIS). Specifically this research aimed to identify the sociodemographic, sociocultural and attitudinal determinants of HPV vaccine acceptability. This research involved a cross-sectional study with phone-based interviews conducted in Spanish (n = 836). All female Spanish callers to the CIS were asked to respond to a three-part questionnaire that included items relating to ethnic identity and acculturation, knowledge of cervical cancer and related risk factors, and HPV vaccine acceptability. Descriptive, univariate and multivariate logistic regression were used to characterize the study population and to determine the effect of each of the demographic/sociocultural variables on vaccine acceptance. Independent predictors of HPV vaccine acceptability were determined using multivariate linear regression models. Results showed that HPV vaccine acceptance was high among this group of Hispanic women (78%) and that attitudes about vaccines in general and the HPV vaccine specifically were positive. Factors associated with vaccine acceptance included physician recommendation, awareness and accurate knowledge about HPV, and speaking only or mostly Spanish. Other important predictors included influence of peers, positive attitudes about vaccines in general, higher education and being a mother of a female adolescent. The primary reason cited by those who did not favor vaccination was concern over vaccine safety. This research was the first study looking at vaccine acceptability in a large, national sample of Hispanic women. HPV vaccination can lead to important public health benefits for Hispanic women. Targeted educational interventions must take into account the important sociocultural and attitudinal influences on the decision to vaccinate, such as those identified in the present study. Future educational efforts must involve the physician and take into the account the cultural context of attitudes and beliefs regarding vaccine safety and disease susceptibility. Further studies elucidating the interplay between culture specific beliefs and practices regarding vaccination and the decision to participate in HPV vaccination are needed.
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Jasper, Brenda Renee. « Knowledge and Acceptance of HPV and the HPV Vaccine in Young Men and Their Intention to be Vaccinated ». Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5505.
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Sexually active young men are at high risk of contracting HPV and developing genital warts and penile/anal cancers. They contribute significantly to the incidence of HPV in women. The HPV vaccine, Gardasil, was approved in 2009 for use in preventing HPV 6 and 11 in young males ages 9 to 26. Knowledge and awareness of the virus and the vaccine is limited among young men. Promoting education and prevention measures regarding HPV and reducing personal risks to HPV is significant in narrowing the gap between acquisition of the HPV virus and cancer sequelae. A correlational design utilizing cross-sectional survey methodology was used for this study. Seventy participants completed a HPV vaccine survey at a university in Southwestern United States. The survey measured their knowledge and acceptance of the HPV vaccine and their intention to be vaccinated. Male participants were likely to accept or consent to receive the vaccine however they reported low intent to actually get the HPV vaccine. Acceptance of the vaccine was greater among minorities and participants who reported regular doctor visits. Knowledge of HPV and HPV prevention was low. Young men may benefit from HPV vaccine educational marketing strategies that include enhancing their communication skills on HPV, the HPV vaccine and reducing risky sex behaviors.
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Xu, Lin. « HIV-1 mucosal immunity : from infection to prevention : HIV-1 envelope gp41 conserved region P1 modulates the mucosal innate immune response and acts as a potential mucosal adjuvant The HIV-1 viral synapse signals human foreskin keratinocytes to secrete thymic stromal lymphopoietin facilitating HIV-1 foreskin entry By shaping the antigen binding site in IgA, the CH1α domain is crucial for HIV-1 protection in highly exposed sero-negative individuals The antigen HIV-1 envelope gp41 conserved region P1 can act as mucosal adjuvant by modulating the innate immune response ». Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCB071.
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La vaccination muqueuse, notamment celle administrée par voie nasale, est considérée comme la méthode optimale permettant de protéger les sites muqueux de l'infection par des pathogènes. Cependant, le manque d'adjuvants muqueux spécifiques ainsi qu'une prise en compte insuffisante du système immun nasal limite le développement des vaccins muqueux. P1, un domaine conservé de gp41, la glycoprotéine d'enveloppe du VIH-1, a été récemment utilisé par le laboratoire d'acceuil pour développer un vaccin prophylactique muqueux après immunisation combinée par voie nasale et intra-musculaire. Ce vaccin s'est montré efficace lors études pré-cliniques et clinique de Phase I chez l'Homme, grâce à sa capacité d'induire des IgA muqueux contre P1 bloquant la pénétration muqueuse du VIH-1 par transcytose et de stimuler la production d'IgG spécifiques de gp41 induisant la lyse des cellules infectées par le VIH-1 par cytotoxicité cellulaire médiée par anticorps (ADCC). Dans le travail présenté ici, nous avons caractérisé les mécanismes immuns induits par ce vaccin basé sur P1 au niveau de la muqueuse nasale humaine. Tout d'abord, nous avons démontré que P1 initie une réponse immune en induisant la sécrétion de la cytokine TH2, la Thymic Stromal LymphoPoietin (TSLP), par les cellules épithéliales nasales. TSLP est connyu pour ses propriétés d'adjuvant muqueux puissant et son récepteur, le TSLP-R, joue un rôle déterminant dans la réponse muqueuse à IgA. Nous avons montré que P1 induit l'expression de TSLP via l'interaction de P1 avec le galactosyl céramide, un récepteur du VIH-1 permettant l'entrée muqueuse du virus. De plus, nous avons identifié la voie de signalisation Calcineurin/NFATet le microRNA- comme partenaire décisifs dans la régulation de la production de TSLP induite par P1. Dans un second temps, nous avons montré que le peptide P1 module la réponse innée en activant les cellules dendritiques (DCs). Cette stimulation par P1 induit l'augmentation de l'expression des molécules de co-stimulation par les DCs. La sécrétion de l'IL-6 et de l'IL-10 par les DCs est aussi augmentée par P1 alors que celle de l'interféron gamma, IFN-', est réduite, démontrant ainsi que les DCs activée par P1 se polarisent en une phénotype facilitant une réponse Th2 et IgA. De plus, l'IL-8 et les chimiokines CCL20 et CCL22 sont secrétées indiquant que les DCs ont acquis la capacité de recruter des cellules immunes dans la muqueuse pour initier une réponse muqueuse adaptative. La métalloprotéinase MMP-9 permettant la dégradation de la matrice extracellulaire et facilitant la migration des cellules hors de la muqueuse, est aussi produite. Une boucle positive autocrine de TSLP est observée, puisque P1 induit la sécrétion par les DCs de TSLP en conséquence l'augmentation de l'expression du TSLP-R par les DCs induite par P1. Finalement, P1 active la prolifération des lymphocytes TCD4+ médiée par les DCs. En conclusion, nous avons démontré que P1 est un peptide multifonctionnel avec un grand potentiel dans le développement de vaccin, non seulement comme antigène vaccinal candidat mais aussi comme potentiel adjuvant qui pourrait être combinés à d'autres vaccins muqueuxMucosal vaccination, especially intranasal administrated ones, has been considered to be ideal for protection from pathogens invading through mucosal sites. However, the lack of specific adjuvant and insufficient acknowledgement of nasal immune system limits the development of vaccine. P1, a conserved region of gp41 envelope glycoprotein, was recently developed into a prophylactic HIV-1 vaccine immunized via both the intramuscular and intranasal routes. It showed high efficiency in pre-clinical and phase I clinical trial due to induction of P1 specific mucosal IgA with transcytosis blocking activity and IgG inducing antibody dependent cell cytotoxicity. In this study, we characterized the immunological mechanism underneath P1-vaccine in nasal mucosa. Firstly, we demonstrated that P1 initiate immune responses by inducing nasal epithelial cells to secret the Th2 cytokine Thymic Stromal LymphoPoietin (TSLP). TSLP has been reported to be a strong mucosal adjuvant, and its receptor TSLP-R plays a critical role in IgA response. We showed that P1 induce TSLP expression via the interaction with galactosyl ceramide, the receptor of HIV-1 mucosal entry. Furthermore, we identified Calcineurin/NFAT signaling pathway and microRNA-4485 as important players in the regulation of TSLP production induced by P1. Secondly, we showed that P1 modulates innate immune responses by activate dendritic cells (DCs). P1 stimulation results in enhanced expression of costimulatory molecules on DCs. Furthermore, the secretion of IL-6, IL-10 were increased, while IFN-γ was reduced, indicating that P1 activated DCs polarize into a Th2 and IgA prone phenotype. In addition, IL-8, CCL20, CCL22 were produced indicating a capacity at recruiting immune cells to mucosal surface for initiation of an adaptive immune response. MMP-9 was also produced allowing degradation of the extracellular matrix and facilitating the migration of immune cells out of the mucosa. Stricingly, a TSLP autocrine loop was observed as P1 induced DCs to secret TSLP and meanwhile, enhanced DC expression of TSLP-R. Finally, P1 activated DCs enhanced the proliferation of CD4+ T cells. In conclusion, we demonstrated that P1 is a multi-functional protein with a great interest for vaccine development, not only as an antigen for vaccine candidate, but also as a potential adjuvant that can be combined to other mucosal vaccines
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Woodberry, Tonia. « Development of a mucosal HIV polytope vaccine / ». [St. Lucia, Qld.], 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16255.pdf.
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Islam, Amina Mahmood. « A qualitative study of women's attitudes towards the introduction of the HPV vaccination in Singapore ». Thesis, Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41710034.
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Tam, Ka-lai, et 譚嘉麗. « A systematic review of knowledge and attitudes towards HPV vaccinationamong Chinese women ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48425527.
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Introduction: Cervical cancer is the second most prevalent cancer among female and one of the top causes of cancer death worldwide. Human Papillomavirus (HPV) infection is the primary factor of cervical cancer. HPV vaccine has potential to contribute greatly by curbing the development of cervical disease and to optimize public health outcomes. Chinese populations were disproportionally affected by cervical cancer and the cultural backgrounds of Chinese are distinctively different from other races. In near future, there is possibility that China may introduce the vaccine. Little is known about Chinese’s perceptions on HPV vaccine and the situation in Chinese community may be different. To achieve an effective prevention of cervical cancer in China, a comprehensive understanding of Chinese women’s knowledge, attitudes and practices on HPV vaccination is crucial before introduction of HPV vaccine to ensure high uptake and coverage among Chinese women.
Objectives: To investigate the knowledge, attitudes and the associated factors on HPV vaccination among Chinese women.
Methods: Published studies on knowledge and attitudes of HPV vaccination in preventing cervical cancer in Chinese population were identified by using the major databases: Global Health, Medline, Pubmed, CINAHL, PsycINFO and CKNI from 2005 to 2012. 15 articles were included after reviewing for eligibility.
Results: The overall awareness of HPV and HPV vaccine among Chinese women was low. Chinese women generally showed knowledge deficit about HPV and HPV vaccine. Despite inadequate knowledge, level of acceptance of HPV vaccination among Chinese women was high. Several major reasons influencing the attitudes of HPV vaccination among Chinese were cost, concerns on efficacy and safety of HPV vaccine, social influences, perceived likelihood of being infected with HPV, and recommendations and endorsements from others. Different level of parental acceptance was resulted in different studies. They concerned the safety of HPV vaccine and worried that HPV vaccination may promote unsafe sex of daughters.
Discussion: Policy makers should seriously consider implementation of HPV program for low-resource setting after balancing the cost and benefit of HPV vaccine program. Raising the awareness and knowledge level concerning HPV vaccine among Chinese population should be set as the urgent priority. To improve the public awareness and acceptance of HPV vaccination, education interventions should be targeted at both recipients and parents. Factors influencing the acceptability of HPV vaccination must be considered in constructing public health strategies for advocating HPV vaccination. Vaccination promotion campaign should be carefully framed for culturally sensitive setting. Healthcare professionals have important roles in recommending vaccination. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination.published_or_final_version
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Master of Public Health
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Humby, Samantha A. « An investigation of the effects of helminth worm infection on the capacity of HIV vaccines to boost vaccine-generated immune responses ». Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24896.
Texte intégralRésumé :
To protect against sexual transmission, successful future HIV vaccines will likely be given to adolescents as a booster subsequent to primary immunization during infancy. In sub-Saharan Africa (SSA), a large proportion of children are chronically infected with a variety of helminths. These infections may suppress the ability of a host to elicit vaccine-induced Th1 responses that are considered important for a successful HIV vaccine. This study investigated the effect of chronic helminthic infection on the boosting capacity of a poxvirus-protein HIV vaccine regimen (SAAVI MVA-C and Env gp140 protein) in a mouse model. Groups of mice were prime-vaccinated with SAAVI MVA-C through an intramuscular injection, and Env gp140 protein formulated in Alum adjuvant which was administered via an intraperitoneal injection. These vaccinations were given concurrently, 2 weeks prior to infection with Schistosoma mansoni (Sm) through a percutaneous route. Control mice were either left uninfected (Naïve) or infected in the same manner (Sm) without vaccination. A booster vaccination was given 8 weeks post helminth infection. HIV-specific immune responses were analysed in the blood and spleens two weeks after booster vaccination. The magnitudes of cumulative IFN-γ ELISPOT responses to HIV Gag, RT and Env peptides were significantly (p<0.05) lower in the vaccinated and Sm-infected (Vaccine+Sm) mice (948 sfu/106) than vaccinated and uninfected (Vaccine) mice (1733 sfu/106), with IFN-γ responses to RT (CD8) being the most dominant for both mouse groups (Vaccine+Sm: 734 ± 221 sfu/106, Vaccine: 521 ± 116 sfu/106). No significant difference was observed in the magnitudes of cumulative IL-2 ELISPOT responses to the vaccine peptides between the Vaccine+Sm and Vaccine groups, however IL-2-producing T cell responses to Env (CD4) dominated in both mouse groups. Vaccine+Sm and Sm groups had similar IFN-γ- and IL-2-producing T cell responses to SEA. Splenocytes from Vaccine+Sm mice secreted less Th1 (IFN-γ, IL-2, TNF- α) and Th2 (IL-4, IL-6, IL-10) cytokines than those from uninfected vaccinated mice in response to HIV vaccine peptides. The total number of activated CD4+ T cells responding to vaccine peptides was greater for Vaccine+ Sm mice than Vaccine mice (p<0.05), however, no such statistical significance was observed in the differences seen between these vaccinated mouse groups for the number of activated CD8+ T cells. The frequencies of central memory activated CD4+ T cells were seen to be greater in Vaccine group (Gag; 34.28 ± 8.35%, Pol; 33.53 ± 6.34%, Env(CD4); 33.92 ± 3.87%, Env (CD8); 38.76 ± 10.52%) as opposed to the Vaccine+Sm group (Gag; 28.09 ± 3.95%, Pol; 26.45 ± 4.66%, Env (CD4); 28.79 ± 6.95%, Env (CD8); 28.65 ± 3.29%). Furthermore, Vaccine+Sm mice had higher titres of HIV-1 gp140- specific IgG1 antibodies (p<0.0001) (a Th2 antibody marker) but significantly less gp140- specific IgG2a (p<0.0001) and IgG2b (p<0.001) (Th1 antibody markers) antibodies. This trend was also observed with total non-Env-specific antibody titres. This study demonstrates that chronic helminthic infection is associated with an attenuated boosting capacity of a poxvirus-protein HIV vaccine in a mouse model, suppressing both T cell cytokine production and Th1-type antibody responses. Since HIV vaccine-induced Th1 responses are considered important for a successful HIV vaccine, these data suggest that chronic helminthiasis may impact negatively on future HIV vaccination outcomes in adolescents living in SSA where helminthic parasites are endemic.
48
Alarcón, Soto Yovaninna. « Data science in HIV : statistical approaches for therapeutic HIV vaccine data ». Doctoral thesis, Universitat Politècnica de Catalunya, 2021. http://hdl.handle.net/10803/672179.
Texte intégralRésumé :
The present dissertation contributes to Data Science in the Human lmmunodeficiency Virus (HIV) field, addressing specific issues related to the modelling of data coming from three different clinical trials based on the development of HIV therapeutic vaccines. The biological questions that these studies raise are identify biomarkers that predict HIV viral rebound; explain the time to viral rebound as a consequence of antiretroviral therapy (cART) stop considering the variability of data sources; and find the relationship between spot size and spot count from Enzyme-Linked lmmunosorbent spot (ELISpot) assays data. To handle these problems from a statistical perspective, in this thesis we: adapt the elastic net penalization to the accelerated failure time model with interval-censored data, fit a mixed effects Cox model with interval-censored data, and improve statistical methodologies to deal with ELISpot assays data and a binary response, respectively.
In order to address the variable selection among a vast number of predictors to explain the time to viral rebound, we consideran elastic-net penalization approach within the accelerated failure time model. Elastic-net regularization considers a possible correlation structure among covariates, which is the case of messenger RNA (mRNA) data. For this purpose, we derive the expression of the penalized log-likelihood function for the special case of the interval-censored response (time to viral rebound).
Following, we maximize this function using distinct approaches and optimization methods. Finally, we apply these approaches to the Dendritic Cell-Based Vaccine clinical trial, and we discuss different numerical methods for the maximization of the log-likelihood.
To explain the time to viral rebound in the context of another study with data from several clinical trials, we use a mixed effects Cox model to account for the data heterogeneity. This model allows us to handle the heterogeneity between the Analytical Treatment lnterruption (ATI) studies and the fact that the patients had different number of ATI episodes. Our method proposes the use of a multiple imputation approach based on a truncated Weibull distribution to replace the interval-censored by imputed survival times. Our simulation studies show that our method has desirable properties in terms of accuracy and precision of the estimators of the fixed effects parameters. Concerning the clinical results, the higher the pre-cART VL, the larger the instantaneous risk of a viral rebound. Our method could be applied to any data set that presents both interval-censored survival times and a grouped data structure that could be treated as a random effect.
We finally address two different issues that have arisen when analyzing the BCN02 clinical trial. On one hand, we fit univariate log-binomial models as an alternative to the usual logistic regression. On the other hand, we use one/two- way unbalanced ANOVA to analyze the variability of the main outcomes from the ELISpot assays across time. Although these assays are widely used in the context of the HIV study, the relationship between spot size or spot count and other variables has not been studied until now.
In this thesis, we propose, develop, and apply different statistical approaches that contributes to answer diverse clinical questions that are relevant in several clinical trials. We have tried to highlight that to be able to choose the appropriate methodology, make correct clinical interpretations and contribute to a meaningful scientific progress, a narrow collaboration with scientists is necessary. We expect that the original results from this thesis will contribute to the path of development and evaluation of a therapeutic HIV vaccine, helping to improve the way of living of HIV-infected people.La presente tesis contribuye a la ciencia de datos abordando problemas biológicos relevantes en el desarrollo de vacunas terapéuticas para el Virus de Inmunodeficiencia Humana (VIH) mediante la modelización de datos procedentes de tres ensayos clínicos diferentes. Algunas de las cuestiones suscitadas en estos estudios y que esta tesis aborda son: identificar biomarcadores para estudiar los factores de riesgo del rebote viral del VIH, explicar el tiempo transcurrido hasta el rebote viral como consecuencia del cese de la terapia antirretroviral (cART) considerando la variabilidad de las fuentes de datos y estudiar la relación entre las variables spot size y spot count en ensayos inmunoabsorbentes (ELISpot). Para abordar cada uno de estos interrogantes desde una perspectiva estadística, en esta tesis hemos adaptado una penalización de red elástica para el modelo de vida acelerada (AFT) con datos censurados en un intervalo, ajustado un modelo de Cox de efectos mixtos con datos censurados en un intervalo y mejorado las metodologías estadísticas existentes para tratar los datos de los ensayos ELISpot y de respuesta binaria, respectivamente. En primer lugar, hemos abordado el problema de tener más de cinco mil ARN mensajeros (ARNm) para explicar el tiempo hasta el rebote viral. Para ello, hemos considerado un enfoque de penalización de red elástica para el modelo de vida acelerada. Esta regularización considera una posible estructura de correlación entre las covariables, como sucede con los ARNm. Para este objetivo, primero derivamos la expresión de la función de verosimilitud penalizada considerando una respuesta censurada en un intervalo (tiempo hasta el rebote viral). A continuación, maximizamos esta función utilizando distintos enfoques y métodos de optimización. Finalmente, aplicamos estos métodos al ensayo clínico DCV2 y discutimos sobre diferentes enfoques numéricos para la maximización de la verosimilitud. En segundo lugar, para explicar el tiempo hasta el rebote viral proponemos ajustar un modelo de Cox de efectos mixtos. Dado que el tiempo hasta el rebote viral está censurado en un intervalo utilizamos imputación múltiple basada en una distribución de Weibull truncada. Este modelo nos permite controlar la heterogeneidad entre los estudios de interrupción analítica del tratamiento (ATI) y el hecho de que los pacientes tengan diferente número de episodios ATI. Según el estudio de simulación que realizamos, nuestro método tiene propiedades deseables en términos de exactitud y precisión de los estimadores de los parámetros de efectos fijos. Finalmente abordamos dos problemas diferentes dentro del ensayo clínico BCN02. Por un lado, ajustamos modelos log-binomiales univariados como alternativa a la clásica regresión logística. Por otro lado, utilizamos un modelo ANOVA no balanceado para analizar la variabilidad de los resultados principales de los ensayos ELISpot a lo largo del tiempo. Aunque los ensayos ELISpot se usan a menudo en el estudio del VIH, la relación entre variables como el spot size, spot count y otras no se había estudiado hasta ahora. En esta tesis hemos propuesto y desarrollado diferentes enfoques estadísticos que han dado respuesta a preguntas biológicas planteadas en tres ensayos clínicos. En este trabajo se destaca la importancia de que los distintos miembros de un equipo científico-multidisciplinar colaboren estrechamente, para así poder determinar la metodología apropiada, hacer correctas interpretaciones clínicas de los resultados de éste y, de esta forma, contribuir a un progreso científico significativo. Esperamos que los resultados originales de esta tesis contribuyan al desarrollo y la evaluación de una vacuna terapéutica del VIH, lo cual ayudaría notablemente a mejorar la calidad de vida de las personas infectadas por VIH.
49
Guo, Jiayun, et 郭嘉韵. « A systematic review on the effects of message framing on HPV vaccine acceptability ». Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193783.
Texte intégralRésumé :
Introductions: Cervical cancer has been the second most frequent cancer among females worldwide. Over 85% of women’s deaths from the disease are living in developing countries in 2008. Human papillomavirus (HPV) vaccination may provide a feasible strategy for cervical cancer prevention so as to reduce the disease burden. However the uptake of HPV vaccination is low. To promote HPV vaccination, the design of message frame, may be important. However, little research has been conducted to provide a clear interpretation of the effectiveness of health message frame on uptake of HPV vaccination.
Objectives: To evaluate the effects of gain- and loss-framing message on HPV vaccination acceptability and explore the factors that might influence the acceptability of HPV vaccination.
Methods: Literature search on the studies investigating gain- and loss-framed message on HPV vaccination. PubMed and Google Scholar during 2006 to 2013.
Results: Ten articles, seven from U.S.A, two from Canada, and one from Ireland, were included in the systematic review. The effectiveness between message framing and the context of HPV vaccination were different by studies; the different effect of message framing may be due to in the studies population. Age, sex, culture and individuals’ risk perceiving level might have influence on the effect of gain- and loss-message framing. Four of five articles, which targeted at young population, showed that loss-farmed message is more effective to increase individual’s positive attitude and response to HPV vaccination.
Participants with a greater number of sexual partner with higher avoidance-oriented attitudes, or are less likely to use protection; loss-framed message is more effective. In turn, when young people, particularly female with a lower number of sexual partner, with approach-oriented attitudes, or are more likely to use protection, both gain-and loss-framed message have no effect on their intention to vaccinate. However, another five articles in this review targeted at parents with young children found inconsistent results of framing effects on HPV vaccine acceptability.
Discussion: The effect of gain- or loss-framed tends to be different, depending on types of health behavior promoted. Loss- and gain-framed messages might have different effect to different audience. Framing message selection is matching on individuals’ motivational orientation may help in prompting HPV vaccine acceptability. However, there is a lack of studies on the association between message framing effects and HPV vaccine acceptability, especially for Chinese population. Further investigations of message framing effects on acceptance of HPV vaccination in Chines population are necessary.published_or_final_version
Medicine
Master
Master of Public Health
50
Richert, Laura. « Trial design and analysis of endpoints in HIV vaccine trials ». Thesis, Bordeaux 2, 2013. http://www.theses.fr/2013BOR22048/document.
Texte intégralRésumé :
Des données complexes sont fréquentes dans les essais cliniques récents et nécessitent des méthodes statistiques adaptées. La recherche vaccinale du VIH est un exemple d’un domaine avec des données complexes et une absence de critères de jugement validés dans les essais précoces. Cette thèse d’Université concerne des recherches méthodologiques sur la conception et les aspects statistiques des essais cliniques vaccinaux du VIH, en particulier sur les critères de jugement d’immunogénicité et les schémas d’essai de phase I-II. A l’aide des données cytokiniques multiplex, nous illustrons les aspects méthodologiques spécifiques à une technique de mesure. Nous proposons ensuite des définitions de critères de jugement et des méthodes statistiques adéquates pour l'analyse des données d'immunogénicité multidimensionnelles. En particulier, nous montrons l’intérêt des scores multivariés non-paramétriques, permettant de résumer l’information à travers différents marqueurs d’immunogénicité et de faire des comparaisons inter- et intra-groupe. Dans l’objectif de contribuer à la conception méthodologique des nouveaux essais vaccinaux, nous présentons la construction d’un schéma d’essai optimisé pour le développement clinique précoce. En imbriquant les phases I et II d’évaluation clinique, ce schéma permet d’accélerer le développement de plusieurs stratégies vaccinales en parallèle. L’intégration d’une règle d’arrêt est proposée dans des perspectives fréquentistes et Bayesiennes. Les méthodes mises en avant dans cette thèse sont transposables à d’autres domaines d’application avec des données complexes, telle que les données d’imagerie ou les essais d’autres immunothérapiesComplex data are frequently recored in recent clinical trials and require the use of appropriate statistical methods. HIV vaccine research is an example of a domaine with complex data and a lack of validated endpoints for early-stage clinical trials. This thesis concerns methodological research with regards to the design and analysis aspects of HIV vaccine trials, in particular the definition of immunogenicity endpoints and phase I-II trial designs. Using cytokine multiplex data, we illustrate the methodological aspects specific to a given assay technique. We then propose endpoint definitions and statistical methods appropriate for the analysis of multidimensional immunogenicity data. We show in particular the value of non-parametric multivariate scores, which allow for summarizing information across different immunogenicity markers and for making statistical comparisons between and within groups. In the aim of contributing to the design of new vaccine trials, we present the construction of an optimized early-stage HIV vaccine design. Combining phase I and II assessments, the proposed design allows for accelerating the clinical development of several vaccine strategies in parallel. The integration of a stopping rule is proposed from both a frequentist and a Bayesian perspective. The methods advocated in this thesis are transposable to other research domains with complex data, such as imaging data or trials of other immune therapies