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Coming dissertations at MedFak

  • Self-sampling by elderly women for the detection of HPV and cervical dysplasia Author: Ruth S. Hermansson Link: Publication date: 2021-03-01 13:04

    In Sweden, about 30% of the cervical cancer cases occur in women older than 60 and the mortality rate is as high as about 70% in this age group. There is a lack of knowledge concerning the prevalence of infection with oncogenic types of HPV, and cervical dysplasia in women of 60 years and older. Screening for oncogenic types of HPV is more effective than cytology in reducing the incidence of cervical cancer. It is established that self-collected samples are equally accurate as clinician-taken cervical samples when a validated PCR-based test is used for analysis. 

    Objectives: The overall aim was to gain knowledge about HPV infection and cervical dysplasia prevalence in elderly women and to evaluate the acceptability of repeated self-sampling at home for HPV testing.

    Material and Methods: In Paper I, we investigated the prevalence of HPV and HPV-related cervical dysplasia in 1051 elderly women aged 60 to 89 attending an outpatient gynecology clinic. A gynecologist collected these samples. In Paper II, repeated self-sampling at home for HPV testing was offered to 375 women in each of the four age groups 60, 65, 70, and 75. In Paper III, we carried out a descriptive study with quantitative and qualitative methods to describe older women’s experiences of self-sampling. In Paper IV, we investigated the incidence of oncogenic HPV and HPV-related dysplasia among 632 women aged 65 to 80 years who five years earlier had a negative HPV test.

    Results: The prevalence of HPV was just over 4% both when the samples were collected by a clinician (Paper I) and by self-sampling (Paper II). The majority of women positive in both the first and second HPV tests had dysplasia in histology. Of the women with dysplasia in histology, more than 80% had normal cytology. In Paper II, a self-collected sample was provided by 59.5% of the invited women. In Paper III, 97.2% of eligible women answered the survey, and 13 of 16 invited women participated in the interviews. Most of them reported that they prefer self-sampling because it was easy to perform, less embarrassing, and less time-consuming than a clinic visit. In Paper IV, the incidence of oncogenic HPV was 2.8% in the first test and 1.3% in the second test, and mild cervical dysplasia was found in 50% of women with persistent HPV infection.

    Conclusions: A significant proportion of elderly women were found to have a persistent HPV infection. Among them, there was a high prevalence of dysplasia as diagnosed by histology. Cytology showed extremely low sensitivity. Self-sampling at home combined with repeat HPV testing was well accepted among older women.  

  • The Monoamine Oxidase A Gene and Antisocial Outcomes : An Examination of Genetic, Epigenetic, and Environmental Factors Author: David Checknita Link: Publication date: 2021-02-23 10:04

    Background. Antisocial behaviour involves violation of the basic rights of others or social norms or rules. Such behaviours are indexed in diagnoses such as conduct disorder (CD) in adolescence and antisocial personality disorder (ASPD) in adulthood, which are typified by comorbidity with mood, anxiety, and substance misuse disorders. Alcohol misuse is strongly associated with antisocial behaviour and persistent aggressive behaviours. How environmental and biological factors interface to modulate risk for these outcomes is not yet understood, however, the interaction of adversity with a variable number tandem repeat (uVNTR) polymorphism of the monoamine oxidase gene A (MAOA) gene associates with antisocial behaviour and mental disorders. Further, DNA methylation in a region of interest (ROI) spanning MAOA’s first exonic/intronic junction associates with ASPD in men as well as other mood, anxiety, and substance misuse disorders. 

    Aim and Methods. We characterized methylation of the MAOA ROI by sex and age and examined how negative and positive environmental factors interact with MAOA genotype and methylation on antisocial phenotypes and mental disorders. Participants included men and women from a clinical population of young adults recruited in adolescence at a substance misuse clinic and a community sample of adolescents. 

    Findings. (1) Sex but not age was associated with methylation levels such that high methylation levels among women likely represent X-chromosome inactivation, and sexual abuse was associated with hypermethylation of the MAOA first exon, (2) high methylation levels mediated associations between sexual abuse and current depression diagnosis in women, (3) the highest levels of aggressive behaviour were found among maltreat male carriers of the low-expressing MAOA-uVNTR allele and displayed high levels of exonic methylation, while no interactions were shown in women, and (4) among adolescent girls, but not boys, positive parent-child relationship attenuated the interaction of maltreatment and the high-expressing MAOA-uVNTR allele on alcohol consumption, though the interactions were not robust to adjustments for tobacco use, substance misuse, and delinquent behaviours.

    Conclusion. The findings presented here advance our understanding of how maltreatment interfaces with genotypic and epigenetic factors, in a sex-dependent manner, to promote aggressive behaviour and mental disorders among susceptible individuals.


  • Antibiotic Resistance: A Multimethod Investigation of Individual Responsibility and Behaviour Author: Mirko Ancillotti Link: Publication date: 2021-02-17 09:48

    The rapid development of antibiotic resistance is directly related to how antibiotics are used in society. The international effort to decrease and optimise the use of antibiotics should be sustained by the development of policies that are sensitive to social and cultural contexts.

    The overarching aim of the thesis was to explore and discuss the Swedish public’s beliefs, values and preferences influencing engagement in judicious antibiotic behaviour.

    Study I explored through focus group discussions lay people’s perceptions and beliefs about antibiotics and antibiotic resistance. The Health Belief Model was used to identify factors that could promote or hinder engagement in judicious antibiotic behaviour. Participants found antibiotic resistance to be a serious problem but were not equally worried about being affected by it. There was a tension between individual and collective reasons for engaging in judicious behaviour.

    Study II explored lay people’s views on the moral challenges posed by antibiotic resistance through focus group discussions. Participants identified in the decreasing availability of effective antibiotics a problem of justice, which involves individual as well as collective moral responsibility. Different levels of policy demandingness were discussed in light of these results.

    Study III investigated, through an online Discrete Choice Experiment, public preferences regarding antibiotic treatment and the relative weight of antibiotic resistance in decision-making. Public behaviour may be influenced by concerns over the rise of antibiotic resistance. Therefore, stressing individual responsibility for antibiotic resistance in clinical and societal communication may affect personal decision-making.

    Study IV clarified the notions of collective and individual moral responsibility for antibiotic resistance and suggested a virtue-based account thereof. While everyone is morally responsible for minimising his/her own contribution to antibiotic resistance, individuals do or do not engage in judicious antibiotic behaviour with different degrees of voluntariness.

    The findings suggest that people could change their behaviour due to concerns over their own contribution to antibiotic resistance. Effective health communication should be developed from an appraisal of people’s attitudes, beliefs and social norms that influence antibiotic resistance related behaviours. Policy demandingness should take into account socioeconomic factors characterising local realities.