The incidence of lower genital tract infections in China has been increasing in recent years. The link between high-risk human papillomavirus (HR-HPV) and other sexually transmitted diseases (STDs) remains unclear.Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Ureaplasma urealyticum (UU), yeast, clue cells and HR-HPV.From March to October 2014, gynecological examinations and questionnaires were conducted on 1218 married women. Cervical secretions and vaginal swab specimens were tested for UU was the most common infection (35.5%), followed by bacterial vaginosis (BV) (10.5%), yeast infection (3.7%), CT (2.2%), and Trichomonas vaginalis (1.7%). BV was associated with an increased risk of HR- HPV . There was a strong correlation between abnormal cervical cytology and HR-HPV infection (P < 0.0001).Laboratory results were available for 1195 of 1218 married women. HR-HPV was detected in 7.0% of participants. Forty-seven percent of women had lower genital tract infections (LGTIs). The prevalence of LGTIs in Beijing is at a high level. It is clinically important to screen for the simultaneous presence of pathogens that cause co-infections with HR-HPV. Chlamydia trachomatis (CT) may ascend to the upper genital tract causing pelvic inflammatory disease (PID), which is commonly accompanied by serious reproductive complications including miscarriages, preterm births, ectopic pregnancy and tubal factor infertility ), and our study has been conducted in compliance with the ethical principles for medical research involving human subjects, as stated in the World Medical Association Declaration of Helsinki. Written informed consent was obtained for all eligible participants.A total of 1218 married women who underwent a routine health check for annual gynecologic examinations in Beijing were recruited to the study from March 2014 until October 2014. The inclusion criteria were as follows: the women had to be married, aged 20–70 years and residents of Beijing for at least 6 months. Exclusion criteria, according to our study protocol, were pregnancy, acute and chronic illness, lower genital tract malignancy, previous experience of cervical surgery or had been treated with previous pelvic radiation therapy.Gynecologists conducted regular gynecological examinations and collected vaginal and cervical specimens from all subjects. Each woman was allocated a unique identification number and the laboratory staff were blinded to clinical findings.CT, NG, and UU. The vaginal swab specimens were rolled on to a glass slide for Gram staining. Laboratory tests for genital tract infection including Trichomonas in vaginal secretions were confirmed by wet mount. Gram staining of vaginal secretions for vaginal cleanliness , and a significant association between presence of HR-HPV and concurrent genital BV infection was observed  subjects, and cervical abnormalities were found in 450 (37.7%) subjects . PhysicaP = 0.029, OR = 1.12, 95% CI: 1.01–1.24). Women with coital bleeding had a higher prevalence of HR-HPV infection than those without coital bleeding (14.3% vs. 7.2%), although the difference was not statistically significant , and parturition frequency was significantly higher among CT-infected women than CT-uninfected women . Moreover, there was strong evidence of an association between CT and abnormal vaginal discharge . There was no significant difference in coital bleeding, parturition frequency, cervical hemorrhage or cervical erosion for those who were CT-positive/negative (P > 0.05). Infection with UU was associated with being CT-positive (P = 0.040) but CT-positivity was only weakly associated with HPV infection (P = 0.058).Furthermore, in our study, CT and Trichomonas vaginalis accounted for 2.2% and 1.7% of the sample, respectively. Generally, UU is a common commensal of the female lower genital tract and it seems to be an important opportunistic pathogen when combined with other genital diseases such as cervicitis [Our present population-based study confirmed that disruption of the vaginal microbial community does occur amongst the healthiest women who come forward for physical examination, and that they experience very high rates of LGTI . Of these, the prevalence of sexually transmitted rvicitis . The afoMore than 40 closely related but genetically distinct HPVs that infect the genital tract have been classified as HR or low-risk (LR) according to their oncogenic potential –26. CervAccording to a HPV prevalence survey performed by WHO/IARC  in three areas of China, females without cervical abnormalities had an HPV 16, 52, and 58 infection rate of 10% to 14%, which was second only to that of sub-Saharan Africa . WHO/IARCT infection of the female genital tract can be passed by the mother to her newborn during delivery, and ranks first among all bacterial STDs [CT infection differs throughout countries. The CT prevalence ranges between 0.2% in Spain and 5.6% in Nigeria [CT infection in healthy women in our study was 2.2%, which is comparable to previous studies [CT infection, which suggested that age and parturition were associated with CT infection [CT [Trichomonas vaginalis is not considered to be a co-factor of HPV in lesion progression to CC, which was essentially in agreement with other study [ial STDs . The rep Nigeria . The pre studies . In our nfection . These dtion [CT . MoreoveCT and HR-HPV infection and potential indicators may be partly due to inaccuracies in the self-reported information and absence of some relevant information . However, there have been several studies regarding the role of CT in the development of CC in HPV-infected women. A new meta-analysis study confirmed that individuals who were co-infected with HPV and CT had a higher risk of cervical cancer [CT infection induces a shift from a protective cellular  immune response to the proinflammatory humoral (Th2) immune response, which may adversely influence the clearance of HPV lesions [CT infection may increase susceptibility to HPV causing microabrasions or alterations of epithelial cells thus facilitating the entry of HPV [CT infection is asymptomatic in 70 to 75% of infected women [CT screening must be improved so that CT can be treated promptly. This is especially the case for those who are HR-HPV positive, since it will not only protect against pelvic inflammatory disease and infertility, but may also prevent CC from developing.In this study, the lack of significant association between current l cancer . On one  lesions . Chronic lesions ,37. On ty of HPV . Consideed women , CT screUU is a frequent cause of urethritis, vaginitis, cervicitis, spontaneous abortion, and infertility [UU prevalence rate in healthy women in our study was 35.5%, which is broadly comparable with previous studies [UU infection may be related to HR-HPV status and the pathogenesis of CC [UU may play a role both in initiating cellular anomalies and in viral persistence. However, our study does not support the association that UU infection is positively correlated with HR-HPV status, and further studies with a larger sample size are needed to confirm this issue and the potential mechanisms associated with these pathogens.Vaginal colonization with Ureaplasma spp. occurs in 40–80% of women . UU is aertility . In our  studies ,39. The Lactobacillus spp. with a concomitant increase in the diversity and numbers of anaerobic bacteria, including Gardnerella vaginalis, Prevotella, and Atopobium vaginae, which can delay the clearance of HPV [Our study suggests that HR-HPV infection was significantly associated with BV, indicating that BV may serve as a cofactor in the development of CIN. BV is a condition characterized by a decrease in e of HPV ,42. Furte of HPV . The vage of HPV , which cThe prevalence of co-infections in our study population was of a magnitude that warrants attention by public health services. Our results reinforce the hypothesis that some non-HPV STDs might play a role as cofactors in HPV-mediated cervical carcinogenesis. It may be important to screen for the simultaneous presence of different co-infections with HPV in married women, especially young women. Futher studies could reveal the mechanisms by which the vaginal microbiota, as a community or through the actions of specific bacteria, provides protection against HR-HPV infection.


The objectives were to measure uptake of and factors associated with human papillomavirus (HPV) vaccination initiation and to determine whether HPV vaccination reduced the uptake of cervical cancer screening.N = 3588).We conducted a cross-sectional survey in a random sample of Swiss women aged 18–49 years in 2014 (Vaccination initiation was 69.3% and full coverage (three doses) 54.1% for 18–20-year olds, respectively, 42.4% and 33.9% for 21–24-year olds. Women with ≥ 10 lifetime sexual partners were less likely to have received any HPV vaccination than women with ≤ 2 partners . Amongst 1000 unvaccinated women (18–24 years), reasons for not having initiated vaccination were lack of information (22.5%) and fear of vaccine side effects (18.1%). Vaccination status was not associated with adherence to cervical cancer screening recommendations (OR 1.3). 95.4% of all vaccinated participants knew about the continued need for screening.Our data suggest that HPV vaccination is not associated with reduced uptake of cervical cancer screening. This study provides information that can be used to improve HPV vaccination uptake in Switzerland.The online version of this article (doi:10.1007/s00038-017-1050-x) contains supplementary material, which is available to authorized users. The aim of human papillomavirus (HPV) vaccination programs is to reduce the incidence of cervical cancer and other HPV-associated cancers ; numbers are the unweighted totals and percentages are those after applying the survey weights. Of the 3622 completed interviews we excluded 34 with impossible values for age at vaccination and vaccine type. We did not impute any missing values. We used weighted logistic regression to investigate factors associated with HPV vaccination and cervical cancer screening behaviors. We stratified analyses for vaccination initiation by age class 18–20 years and 21–24 years (and report results for completed vaccination in Supplementary Table 5). In the models about adherence to cervical cancer screening recommendations by the Swiss Gynecological Society, we focused on sexually active women aged 20–49 years only; adherence to guidelines was considered to be present if 20- to 29-year-old women had a Pap test every 2 years or more often; 30- to 49-year-old women every 3 years or more often  were fear of vaccine side effects  and being opposed to HPV vaccination . In the age group 21–24 years (N = 679), the two major reasons were lack of information  and having had already sexual partners . In Table Table N = 1385) stated that cervical cancer screening should be continued at the same frequency; 20.3% (95% CI 14.2–28.1%) thought that screening is still needed after HPV vaccination but less often; 0.8% (95% CI 0.5–1.4%) considered screening unnecessary after HPV vaccination; and 3.8% (95% CI 2.6–5.5%) did not know. Among unvaccinated women (N = 2111), the values were 56.2% (95% CI 52.1–60.0%), 30.2% (95% CI 27.3–34.5%), 1.5% (95% CI 0.8–2.9%) and 12.0% (95% CI 9.4–14.4%), respectively.When asked about the necessity for cervical cancer screening after HPV vaccination, 75.2% (95% CI 67.6–81.4%) of all vaccinated women (N = 2345), 71.7% had had at least one Pap test; the value was 72.7% (95% CI 65.2–79.1) for women not having initiated HPV vaccination and 69.9% (95% CI 62.7–76.2%) for vaccinated women. 98.1% of women aged 25–49 years (N = 1141) had had at least one Pap test (Supplementary Table 3). Amongst women having initiated Pap testing, 77.7% (95% CI 73.2–81.7%) of 18–24-year olds and 65.0% (95% CI 60.8–68.9%) of 25–49-year olds had Pap tests annually, which is more often than recommended by the expert guidelines.In the age group 18–24 years (N = 725) who had never had a Pap test, only 0.5% (95% CI 0.1–2.1%) reported being vaccinated against HPV as a reason for not having initiated Pap testing.In multivariable analysis, which focused on sexually active women aged 20–49 years, we found that having been vaccinated against HPV was not associated with adherence to cervical cancer screening recommendations . Besides age, household income and use of hormonal contraception affected adherence to cervical cancer screening recommendations. Women with high income had an OR of 2.3 (95% CI 1.2–4.6) to adhere to screening recommendations compared with women with low income. Women using hormonal contraception were more likely to adhere to screening recommendations than those not using hormonal contraception . We provide complete results of multivariable analysis of cervical cancer screening and additional information on mean age at first Pap test, timing of first Pap test in relation to first sexual intercourse, results of cervical cancer screening and frequency of operations at the cervix in Supplementary Tables 3 and 4. Of the 18–24-year olds , which record national coverage by age 16 years of 51% for completion (three doses) during the survey period 2011–2013  at the time they were interviewed were those who were least likely to have received HPV vaccination when they were younger (47%). A survey in Australia found a similar association; women aged 20–29 years with 10 or more lifetime partners were less likely than those with fewer than two partners to have received any HPV vaccine  Below is the link to the electronic supplementary material.


In the present study, we examined the antecedents and processes that impact job interviewees’ decisions to engage in deceptive impression management . Willingness and capacity to engage in faking were found to be the processes underlying the decision to use deceptive impression management in the interview. We also examined a personality antecedent to this behavior, Honesty-Humility, which was negatively related to the use of deceptive impression management through increased willingness to engage in these behaviors. We also tested a possible intervention to reduce IM. In particular, we found that warnings against faking – specifically, an identification warning - reduced both the perceived capacity to engage in interview faking, and subsequent use of several faking behaviors. Moreover, this warning reduced faking without adversely impacting applicant reactions. Within organizations, personnel selection is a critical human resource function. The aims of selection are to increase the probability of hiring the best candidates (those with the skills to perform the job well) while decreasing the probability of hiring undesirable candidates (those with low job fit with the organization and job). The One potential obstacle to the success of the interview is impression management (IM). IM tactics are specific strategies used by interviewees to manipulate the image they project to others. For instance, applicants might exaggerate or completely fabricate their job qualifications, flatter or compliment an interviewer or organization, or distance themselves from or lie about past negative events in their job history . Researcinterview faking . do possess. 1, as certain elements of the structured interview may create additional opportunities to use faking behaviors  slight image creation, which refers to minor attempts at faking to create an image of a good candidate , (b) extensive image creation, which refers to more extreme faking behaviors  (c) image protection, which refers to defensive tactics  and (d) deceptive ingratiation, which refers to tactics aimed at increasing likability . This taxonomy was used in this current study.Research on deceptive IM has been growing steadily over the past decade. One prominent advancement sparking research in this area was the development of a taxonomy and a measurement scale through which to understand interview faking. More specifically, over the course of several studies, Interview faking has been found to inflate interviewer evaluations of the candidate . As not Taken together, recent research conducted on IM use suggests that many applicants are able and willing to use deceptive IM in interviews, and that such behavior may impact interview performance, as interviewers struggle to accurately detect such behavior. However, a number of questions remain unanswered regarding interview faking, including the processes underlying, the people most likely to engage in it, and potential ways to reduce it.capacity – one’s perceived ability to engage in response distortion; (b) willingness – one’s motivation or inclination to engage in response distortion, and (c) opportunity – situational variables that influence response distortion. These mechanisms can guide the search for antecedents of interview faking, as well as ways to reduce interview faking. For instance, a recruitment-focused interview is proposed to increase one’s perceived opportunity to fake, whereas general mental ability is proposed to increase the perceived capacity to fake  as this tends to be a function of the situational context such as number or type of questions, which is something that was held constant across participants in our experimental design.Hypothesis 1: Willingness will be positively related to the usage of deceptive IM tactics.Hypothesis 2: Capacity will be positively related to the usage of deceptive IM tactics.Personality has been found to be particularly important in understanding IM in the interview and the workplace . Within r = -0.57), Narcissism (r = -0.53), and Psychopathy (r = -0.72). Furthermore past research has demonstrated that those low in Honesty-Humility tend to be more manipulative and willing to take advantage of other individuals. For example, Individuals high in Honesty-Humility tend to be more sincere, fair-minded, and humble, whereas those low in Honesty-Humility are more manipulative, self-serving, and believe they are superior to others . MoreoveIt seems plausible that this manipulative, self-serving behavior would generalize to the interview context. Those low on Honesty-Humility may see interview faking as having instrumental value in the interview, and perceive that applicants are expected to portray themselves in a positive light. Consistent with trait activation theory , the intwhy Honesty-Humility relates to use of faking is that individuals low in Honesty-Humility have an increased willingness to use deceptive IM. For example, those low in Honesty-Humility have been found to increase willingness to engage in unethical business practices . Specifically, the warned group had a significantly lower mean score than the unwarned group, suggesting that the warning instructions reduced the score inflation in the warned group.Of the many different types of warnings, Beyond these extrinsic considerations around being identified and experiencing negative consequences, there may be a more internal approach that warnings can take. Researchers have suggested that values and morals largely influence one’s beliefs toward faking, and subsequent engagement in faking behavior . DespiteMore specifically, a moral warning involves appealing to the ethical values of an individual by highlighting the moral norm around faking. Research demonstrates that in order for people to engage in unethical behavior, they often engage in a socio-cognitive mechanism called moral disengagement . In otheIn the present study we focused on three types of warnings and compared these to an unwarned (control) condition: (a) identification warning, (b) moral warning, and (c) combination warning. Although we believe all three types of warnings will reduce faking, due to a paucity of research in this area, we do not have enough information to propose which will have the strongest effect on faking reduction. As such, we merely hypothesize that each type of warning will reduce faking compared to the unwarned condition.In addition to a main effect on faking, we also proposed that the reduction in faking behavior would operate through the two interview faking processes of capacity and willingness. Specifically, warnings should reduce applicant’s perceived capacity and willingness to engage in deceptive IM. For instance, an identification warning could reduce an individual’s belief that they have the capacity to successfully fake, whereas a moral warning could reduce an individual’s willingness to fake.Hypothesis 5: Those who received any of the three warning instructions will have lower mean levels of deceptive IM tactic usage than those who did not receive warning instructions.Hypothesis 6: Those who received warning instructions will have reduced (a) capacity and (b) willingness to fake.A supplementary focus of this study was to examine applicant reactions to warnings. As interviews often have the dual function to both select and recruit candidates , organizPerformance anxiety has been studied extensively in evaluation and appraisal contexts. Specifically, a negative relationship between performance anxiety and test performance was found . This maHypothesis 7: Those who received the warning instructions will experience more performance anxiety.Procedural justice refers to whether the actual format and content (interview) was perceived as fair. Candidates who experience injustice during the interview process may not recommend the company to other potential applicants . TherefoThe specific manner in which interview warnings could impact procedural justice perceptions is unclear. On the one hand, because warning instructions may involve informing the applicant that he or she may be identified and disqualified if dishonesty is detected, this may cause applicants to view the process as less fair, as they feel that the interviewer is distrusting them and lead to lowered perceptions of procedural justice. In contrast, warnings may elicit elevated perceptions of procedural justice, as individuals may perceive warnings as an intervention that can allow for everyone to receive fair and equal consideration in the interview. Research Question 1: How will the warning instructions affect procedural justice perceptions?2. The age of the participants ranged from 17 to 53, with a mean age of 21.6 years (SD = 4.35). The sample was predominately female (75.5%) and 77% of participants had experienced at least 3–4 interviews prior to this study.Participants were 173 undergraduate students enrolled in psychology courses at a university in Western CanadaEach interview was conducted by one of two interviewers. Due to logistical considerations, we could not have all interviews conducted by a single interviewer, and so split the work between two. Interviewers were recruited and selected from the business program at the university, and were both female and had similar appearance, ethnicity, and mannerisms . Both of the interviewers also had prior interviewing experience (1–2 years). Interviewers also wore similar professional clothing to each interview. The interviewers underwent three rounds of practice interviews, in which they were both familiarized with the warning instructions and interview script. A 20 minute semi-structured scripted interview was used in order to keep the number of opportunities available for the applicant to use deceptive IM tactics consistent. Specifically, the interview consisted of both unstructured , and structured behavioral questions , to better mirror real employment interviews. Jokes were also scripted into the interview for interviewees to have an opportunity to decide whether or not to use ingratiation .Interview training was also used in order to standardize the way interviews were conducted. Each interviewer conducted three interviews with graduate students acting as the interviewee. The interviewers discussed any point of the interview that they had dissimilarity in conducting, and agreed upon similar tonal and verbal delivery of each element of the interview. After six interviews, the interviewers had reasonably similar delivery of the scripted interview.Participants were informed in advance that their participation would involve a job interview. Once they arrived, they were given a job description for an insurance sales associate. They were also given role-play instructions, which asked them to imagine themselves as applicants applying for a position , and infDeceptive IM tactics were collected through self-report on the Interview Faking Behavior Scale IFB; . The fouFive items were created deductively to measure these two elements of response distortion. Three items assessed the capability or confidence one felt in using deceptive IM tactics in the interview (α = 0.78). The three items were “I felt confident in my ability to deceive the interviewer,” “I could have provided inaccurate information about myself without the interviewer knowing it,” and “I could have mislead the interviewer if I wanted to.” Two items assessed the willingness that one had in engaging in deceptive IM tactics (α = 0.65). The two items were “I was more than willing to deceive the interviewer” and “I felt motivated to mislead the interviewer”.Strongly Disagree) to 5 (Strongly Agree).The personality dimension of Honesty-Humility was measured with 16 Honesty-Humility items from HEXACO . CronbacFour items as used and adapted by Three out of six items used by Four motivational items as adapted by Table 2. Table 3 contains the means and standard deviations of motivation for each respective condition. There were no significant differences between the conditions in motivation  of the participant. In addition, the overall motivation of interviewees was high (M = 4.17 out of 5) indicating that despite being students in an experiment, they took the interview seriously. We also created a dummy coded variable for the two interviewers to test for interviewer effects. There was also no effect of interviewer found on any of the dependent variables, and as such we collapsed across the two interviewers.Means, standard deviations and correlations are displayed in r = 0.12 to 0.49 (see Table 2). The sole exception is that the correlation between capacity and image protection . On the whole, the average correlation between willingness and deceptive IM is 0.35, and the average correlation between capacity and deceptive IM is 0.17. Furthermore, hierarchical regression analyses were conducted on each deceptive IM tactic (see Table 4). When willingness and capacity were simultaneously entered as predictors, willingness remained statistically significant, whereas capacity did not, suggesting willingness provided incremental prediction beyond capacity. Therefore, Hypothesis 1 was supported, whereas Hypothesis 2 was only partially supported.Hypothesis 1 and 2, which posited that willingness and capacity would be related positively to deceptive IM, were tested through correlational and regression analyses. Seven out of the eight correlations between willingness and capacity and the four deceptive IM tactics were significant, ranging from r = -0.17, p < 0.05), extensive image creation , image protection , and ingratiation . To test the mediation advanced in Hypothesis 4, we used the PROCESS add on to SPSS , extensive image creation , and image protection  through willingness . Thus, it appears that those who are high in Honesty-Humility were less likely to engage in deceptive IM tactics through decreased willingness. This supports Hypothesis 4.Hypothesis 3 received support, as Honesty-Humility was negatively correlated with the use of all four deceptive IM tactics, including slight image creation  = 1.77, p = 0.040], and extensive image creation  than those who did not receive any warning instructions. However, there was no significant reduction in deceptive IM behavior found between those who received the combination or moral warning instructions and the unwarned condition. Therefore, Hypothesis 5 was partially supported, as only the identification warning reduced deceptive IM usage.To test Hypothesis 5, which stated that those who receive warnings would engage in less deceptive IM, independent sample Table 5. Two Analyses of Variance (ANOVAs) were conducted with willingness and capacity as the dependent variable, and condition as the independent variable. There was a significant effect of condition on capacity , but no significant effect of condition on willingness . As such, follow up t-tests were used to examine the effect. Hypothesis 6 was partially supported, as the identification warning was found to significantly reduce the capacity to fake  below the unwarned condition. However, there was no significant impact on willingness .Hypothesis 6 posited that warnings would impact willingness and capacity. The means of willingness, capacity, and each deceptive IM tactic for each condition are displayed in F(3) = 1.56, n.s.] or performance anxiety . Table 6 contains the mean applicant reactions experienced by the participants in the four warning conditions. Therefore, Hypothesis 7 was not supported.To investigate Hypothesis 7 and research question 1, which involved examining the effects of the warning instructions on applicant reactions, two ANOVAs were conducted on procedural justice and performance anxiety. There was no significant effect of condition found on procedural justice [Finally, one interesting set of correlations is between the use of deceptive IM and applicant reactions. It appears that those who used deceptive IM reported significantly higher performance anxiety, with an average correlation of 0.35. On the other hand, deceptive IM was not associated with how individuals perceived procedural justice.The present study contributes to our understanding of interview faking in a number of ways. First, we tested two components (willingness and capacity) of the model of faking proposed by capacity to fake, the findings of this study suggest that those who are low in Honesty-Humility tend to have higher willingness to engage in deceptive IM tactics. In turn, they tend to engage in more slight, extensive image creation, and image protection behaviors in the interview. Together, this seems to indicate that personality variables and situational interventions likely operate through different mechanisms.Though Honesty-Humility has been found to be related to unethical behavior such as lying, cheating on exams, and counterproductive work behaviors in the workplace , 2013, tInterestingly, although those low in Honesty-Humility were significantly more confident in their ability to engage in faking behaviors, there was no mediating effect of capacity on actual deceptive IM behavior. Therefore, it appears that Honesty-Humility is a trait related to engagement in dishonest behaviors through motivation, and not the perceived ability to engage in these behaviors. Whereas some may posit that the interview is a strong situation that promotes faking to the extent that “everyone does it,” this research adds to a body of literature indicating that some are more likely than others to do so e.g., , and speFrom a practical perspective, these findings indicate that because interviewers are poor at detecting deceptive IM , organizPerhaps the most impactful and novel finding of the present study is that the identification warning was able to reduce faking among interviewees. More specifically, those who received the identification warning reported engaging in less slight and extensive image creation than those in the unwarned condition. When considering the nature of the various faking behaviors, reducing these two classes of behaviors may be particularly important for interview validity, as they involve exaggerating or even completely fabricating experience, qualifications, and characteristics.why warnings would or would not work. Our findings indicate that only identification warnings reduced the applicant’s perceived capacity to fake, and a subsequent reduction in faking behavior. The prominent role of the identification warning in reducing perceived capacity to fake makes particular sense, given that capacity taps into whether the applicant believes they can fool the interviewer without them knowing it. In addition, expectancy theory . This could be due to the fact that moral warnings emphasize the social norm of honesty, but do not include tangible consequences or risk of being identified as dishonest. Despite reinforcing a negative social norm toward faking in the interview  with a consideration of how applicants will react to the process . Given this, one potential concern about warnings was that they could adversely impact applicant reactions. We found that there was no detrimental impact of any of the three warning types on either of the applicant reactions we investigated – performance anxiety and procedural justice. This is important for several reasons. From a procedural justice perspective, research shows that lower perceptions of procedural justice lead to negative applicant reactions . The facOn the other hand, there was a concern that warnings might impact performance anxiety. Given that performance anxiety has been found to negatively impact interview performance , this isPractically, organizations may want to consider adding warning instructions to their interview process. As that there are no detrimental effects on applicant reactions, warnings may serve as an effective low cost addition to reducing deceptive IM in the interview.SD = 0.57) for slight image creation, 1.46 (SD = 0.50) for extensive image creation, 1.87 (SD = 0.57) for image protection, and 1.67 (SD = 0.59) for ingratiation. These results are highly comparable to the findings of SD = 0.69) for slight image creation, 1.38 (SD = 0.56) for extensive image creation, 1.78 (SD = 0.72) for image protection, and 1.90 (SD = 0.90) for ingratiation. Third, the interviewers were selected carefully based on their appearances and mannerisms in order to maximize their similarity, and they were thoroughly trained in the interview protocol. Furthermore, statistical tests of interviewer effects on the dependent variables were carried out, and no significant differences were found. In sum, we took several steps to ensure that the interview closely mirrored real interviews, with the added benefit of allowing inference of causal relationships.One strength of this study was the experimental design, in that random assignment was used to place participants into four different conditions . Though field studies may provide more generalizability, it would not be possible to randomly assign candidates to conditions and infer cause and affect relationships. Second, this study employed the use of a semi-structured scripted interview in order to keep the number of opportunities available to fake consistent, while mimicking a real employment interview. Jokes and unstructured questions  were scripted into the interview to enhance the realism. The base rates of deceptive IM tactics overall found for this study were 1.82 , which may have resulted in a more modest estimation of the actual effect warnings may have on reducing IM behavior. Though This study examined the antecedents of interview faking behavior, the application of a novel method to reducing IM tactic usage in the interview, and the processes through which personality and warnings impact deceptive IM. Willingness and capacity were found to be the processes underlying the decision to use deceptive IM in the interview. Moreover, Honesty-Humility was related to increased use of slight and extensive image creation, and image protection tactics, and it appears that this occurs through the mechanism of willingness. Finally, identification warnings were found to reduce the mean level of some deceptive IM behaviors (slight and extensive image creation), and to reduce perceived capacity to engage in IM successfully. Future research should further examine the use of warning instructions on IM tactic usage, as it appears to be a promising method to reducing faking behavior in the interview.SL conducted the research, analyzed the data, and wrote up the preliminary document. JB contributed by providing edits on various versions of the document, and advice on the data analysis. TO contributed through providing edits on various versions of the document.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Human immunodeficiency virus (HIV)-positive women have a high prevalence of human papillomavirus (HPV), and are infected with a broader range of HPV types than HIV-negative women. We aimed to determine the prevalence of cervical cytologic abnormalities, high-risk (HR)-HPV prevalence, type distribution according to the severity of cervical lesions and CD4 cell count and identify factors associated with HR-HPV infection among women living with HIV in Manaus, Amazonas.We enrolled 325 women living with HIV that attended an infectious diseases referral hospital. Each woman underwent a gynecological exam, cervical cytology, HR-HPV detection by Polymerase chain Reaction (PCR) using the BD Onclarity™ HPV Assay, colposcopy and biopsy, when necessary. We assessed the associations between potential risk factors and HR-HPV infection.n = 93), 43.0% had multiple infections. Women with HPV infection showed higher prevalence of cervical abnormalities than that HPV-negative . The prevalence of HR-HPV among women with cytological abnormalities was 87.5% for LSIL and 100.0% for HSIL. Women with CD4 < 200 cell/mm3 showed the highest HR-HPV prevalence (59.3%) although this trend was not statistically significant . The mean CD4 cell count decreased with increasing severity of cervical lesions . The multivariable analysis showed that increasing age was associated with a decreased risk of HR-HPV infection with an adjusted prevalence odds ratio of 0.9  for each additional year. The only factor statistically significant associated with HR-HPV infection was CD4 cell count.Overall, 299 (92.0%) women had a PCR result. The prevalence of HR-HPV- infection was 31.1%. The most prevalent HR-HPV types were: 56/59/66 (32.2%), 35/39/68 (28.0%), 52 (21.5%), 16 (19.4%), and 45 (12.9%). Among the women with HR-HPV infection  contains supplementary material, which is available to authorized users. Infection with human papilloma virus (HPV) is the main cause of cervical cancer . In BrazYoung women are the most affected by HPV and by multiple infections. The prevalence tends to decrease with increasing age . A high Women living with HIV have a higher prevalence of HPV infection with high-risk oncogenic (HR-HPV) multiple infections. Immunosuppression resulting from HIV increases the risk of developing squamous intraepithelial lesions when compared with the general population –10. PatiIt is also possible that adherence to highly active antiretroviral therapy (HAART) is associated with decreased development of precursor lesions of cervical cancer and improved clearance of HPV infection, increasing survival of women living with HIV with a consequent decrease in cases of cervical cancer .In Amazonas, Brazil, there are few data on the epidemiology of HPV and related cancers and the impact of HIV on these conditions. The objective of this study was to estimate the prevalence of cervical HPV infection and the frequency of genotypes, according to the severity of cervical lesions and CD4 cell counts and identify factors associated with HPV infection in women living with HIV/AIDS that attended a reference hospital for HIV/AIDS in Manaus, Amazonas.A cross-sectional study was conducted for HR-HPV screening in women living with HIV/AIDS that attended an outpatient HIV reference service within a tertiary care hospital (FMT-HVD). This teaching hospital attends most of the HIV/AIDS cases in the Amazon state (95.0%). This reference hospital is the unique ART provider in the Amazonas state. The study was performed from May 2014 to February 2015.Women who had a confirmed HIV diagnosis and consecutively sought a gynecological visit to perform routine cytology in the HIV outpatient service of the FMT-HVD hospital were eligible for the study. Women were included if older than 18 years of age, agreed to sign the consent form, were not pregnant and did not have a contraindication for Pap smear examination  and detectable viral load (copies/mL), and nadir CD4 cell count (cells/mm3) were obtained from electronical medical records of the hospital. However, when the last determination had been undertaken more than three months before enrolment, a blood sample was collected.After signing the consent form, a nurse interviewed women using a structured questionnaire. The questionnaire included items on sociodemographic, clinical, behavioural, reproductive health and HIV history, including current antiretroviral therapy (ART) use and previous change in ART regimen, and current STI signs and symptoms. Data on CD4 cell counts  and introduced into SUREPATH® Preservative Fluid . Samples were transported on the same day at room temperature to the Fundação Centro de Controle de Oncologia (FCECON) laboratory, where 1 mL of each sample was stored at − 80 °C until they were shipped for HPV determination.The participants underwent a gynecological evaluation and two samples of cervical cells were collected. The first sample was taken for conventional cytology using a long Ayres’s spatula for subsequent processing at the hospital. The second sample was collected with a cervical brush . They were processed using the BD Onclarity™ HPV Assay , which can detect 14 HR-HPV genotypes by simultaneous identification of the HR types 16, 18, 31, 45, 51, 52, and due to the limits of this test, other HR genotypes reported by genotype group . The BD Onclarity™ HPV Assay has shown good performance when compared with Hybrid Capture 2, with specificity ranging from 50.3 to 95.2% and sensitivity from 95.2 to 98.0% . Molecul3). Comparisons between HR-HPV infected and non-infected women were formally carried out using for categorical variables the X2 test, and for continuous variables, the student-t test or the Fisher exact test (when expected frequencies were less than 5), or the U-Mann Whitney test (for non-parametric variables). To ascertain associations between potential risk factors and HR-HPV infection, prevalence odds ratios (pOR) were calculated with their corresponding 95.0% CI. For the multivariate analysis, pOR were calculated by multiple logistic regression modelling that included covariates for potential confounders, and for factors that were statistically significant (p < 0.1) at univariate analysis. All tests were two-tailed and the p-value less than 0.05 was considered statistically significant.Data were analyzed using Stata 10.0 . Data were described using percentages and medians with interquartile ranges (IQR), as appropriate. Prevalence and 95.0% confidence interval (CI) were calculated. The results were categorized according to CD4 cell counts -kappa coefficient, by lesion severity.The study was approved by the Ethical Institutional Review Board of FMT-HVD (number: 466/2012). Patients gave their signed consent to participate. All women were informed about conventional cytology and HR-HPV detection results. Colposcopy and biopsy were performed following recommendations of the Brazilian Ministry of Health . The stuA total of 331 women were pre-screened and all agreed to participate in the study. Among these, six were excluded because no HIV positive result could be documented in the medical record. Thus, the total number of participants available for analysis was 325. Their median age was 40.7 years (IQR: 33.1–46.2). A total of 299 women living with HIV had a valid PCR result and 324 a valid result in conventional cytology. The median CD4 cell count with IQR among ART users and ART-naïve when HIV was diagnosed was 321 (173–487) and 620 (422–739). The median (IQR) CD4+ cell count among ART users and patients not on ART was 257 (133–283) and 197.5 (88–314.5), respectively.p-value= 0.3). A higher proportion of those with an HR-HPV-positive result had not performed previously cervical cytologies than those with an HR-HPV-negative result , and most frequently had CD4 cells with counts< 200 cells/mm3 than women with HP-HPV-negative result . In general, in each age group, women with a CD4 cell count < 200 cells/mm3 had a higher HR-HPV prevalence than women with higher CD4 cell counts, although 95.0% CI was large, suggesting a small number In the CD4 cell count < 200 cells/mm3 category.Table p-value = 0.07). HR-HPV prevalence by CD4 cell group was 23.8% in those with CD4 > 500 cell/mm3, 34.2% in 200–499 cell/mm3 and 59.3% in < 200 cell/mm3. The proportion increased with decreasing CD4 cell count, although this pattern was not statistically significant .The results of the PCR screening showed that 93 out of 299 women were infected with HR-HPV, resulting in a prevalence of 31.1% (95.0% CI: 25.8–36.4). The distribution of age specific HR-HPV prevalence ranged from 25.4% in the age group 31–35 years to 43.5% in those aged > 50 years. The proportion seemed to increase from 36 years onwards, peaking at older women , the prevalence of HPV-16 was 27.5% (n = 11), of HPV-18 was 5.0% (n = 2) and of HPV-52 was 35.0% (n = 14). Multiple infections had a higher HR-HPV prevalence in older age groups  than in younger age groups  but no trend with age was found .The most prevalent HR-HPV types among 93 HR-HPV-positive and HIV positive women were HPV pool-56/59/66 32.3%), HPV-35/39/68 (28.0%) and isolated HPV-52 (21.5%), HPV-58 (20.4%), HPV-16 (19.4%), HPV-45 (12.9%), HPV-31 (11.8%), and HPV-18 (2.2%)  for each additional year. The only factor statistically significant associated with HR-HPV infection was CD4 cell count: women with CD4 cell count < 200 cell/mm3 had an pOR of having HR-HPV that was 4.7  times greater than that of women with CD4 cell count ≥500 cells/mm3.When compared with HR-HPV-negative women, those with a HR-HPV-positive result were younger, a lower proportion had undertaken a cervical cytology ever, had a lower median CD4 cell count at last determination, and a higher proportion had CD4 cell count < 200 cell/mm3 Table . ResultsOverall, 84.2% (275) of women had a normal cytology, 2.7% (9) ASCUS, 1.7% (5) ASC-H, 8.1% (25) LSIL, 3.4% (10) HSIL, and no cancer cases. The proportion of cytological abnormalities was higher in women with HR-HPV-positive than in women with a negative HR-HPV-result. . The same pattern was observed by decreasing CD4 cell count groups , and in HPV-52 .HPV- 56/59/66  was the most prevalent genotype 52.3%) among 21 HR-HPV-positive women with LSIL and the most prevalent one (60.0%) among 10 HR-HPV-positive women with HSIL in a total of 93 women coinfected with HR-HPV and HIV (Table % among 2p < 0.001) and HSIL . In women with multiple HR-HPV infections, the degree of severity of cytological lesions was strongly correlated with a decreased CD4 cell count  than those with CD4 200–499 cell/mm3 (80.0%) and those with CD4 < 200 cell/mm3 (100.0%).Figure The overall agreement for conventional cytology observed between the blinded first and second evaluators was 89.0%. By type of lesion, it was > 90.0% and the PABA-kappa statistic ranged from 0.82–0.97 , which can limit the clearance of the virus, and 16.0% of women were commercial sex workers, which is a highly HPV exposed population [The prevalence of HR-HPV infection found, 31.1%, is approximately half of that found in another study in HIV positive women in Amazonas (61.6%) . This dipulation . Other spulation , 21–24. We found that 43.0% of HR-HPV-infected women had multiple infections, which is in agreement with other Brazilian, ranging from 32.2% to 64.8% –27 and rIn the present study, we found a wide diversity regarding HR-HPV types and their distribution, with HPV-52, HPV-16 and HPV-45 being the most frequent individual types. However, this needs to be taken with caution because the PCR method used did not allow the measurement for all individual genotypes and the various groupings of HPV types difficult the interpretation. As an example, the high prevalence of HPV-35/39/68 might be driven by HPV-35 alone and this type has been implicated in HSIL and invasive cervical cancer in women living with HIV . Women lA low number of cases of HPV-18 were detected although it ranks amongst the top positions in most regions , 39. In Age-specific HR-HPV distribution presented as a unimodal distribution skewed to the left although this pattern was not statistically significant. Although there are studies that indicate a higher prevalence of HPV in younger women,, 52–55 wIn multivariable analysis, increasing age presented only borderline association with an increasing risk of presenting HR-HPV. We did not observe a peak of prevalence among young women (< 26 years) which might be explained because only 13.0% in our sample were < 26 years and among them, only 11 (27.0%) were infected with HR-HPV.In the present study we found a clear association between weakened immune status and infection by HR-HPV. In most studies of HIV and HPV, the magnitude of increased HPV prevalence was proportional to the severity of immunosuppression , 63–65. We found high diversity of HR-HPV types in women with abnormal cytology results. In our study, most cytological alterations were related to types 16, 31 and 45. HPV-16 was the most common type in HSIL, which has been reported in a meta-analysis of HIV positive women with HSIL,  and in w3), and median age was 40.7 years. These women could have a higher self-care standard, higher accessibility to health care and better health, which would result in underestimating the true HR-HPV prevalence in the population. In addition, we did not measure variables such as nutrition and behaviour of male partners that can influence HPV DNA detection [This study has some limitations. It did not include a truly population-based design, as study participants were recruited from a reference hospital. However, this hospital attends to 95.0% of HIV patients from the Amazonas. Our sample included women who had a prolonged history of HIV infection (median 6 years), most were taking HAART (87.9%), had previously cytology (97.2%), had a relatively immune competence status  contribute to high-grade lesions. Newer vaccines such as the nonavalent HPV vaccine –72 preseAdditional file 1:Table S1. Prevalence of conventional cytology results according to HPV status and CD4 counts among 298 women living with HIV in Manaus, Amazonas. Table S2 Association between cytological lesions and CD4 cell counts among women living with HIV in Manaus, Amazonas. Table S3 Agreement between blinded observers in the independent reading of conventional cytology by type of lesion (DOCX 19 kb)


Head and neck squamous cell carcinomas (HNSCC) are often divided by their aetiology. Noxae associated collectives are compared with the human papilloma virus (HPV)-associated group, whereas different localisations of oral (OSCC) and oropharyngeal (OPSCC) squamous cell carcinomas are mostly discussed as one single group. Our aim was to show that classification by aetiology is not appropriate for OSCC.INK4a immunostaining. Only 4 (1.98%) of the p16INK4a+ cases were + for HPV using PCR. Our homogenous collective of OSCC allowed us to compare HPV+ and HPV negative (−) patients without creating bias for tumour localisation, age, gender or tumour stage.HPV DNA was detected by PCR in 7 (3.47%) patients, and we identified 12 (5.94%) positive (+) cases by p16INK4a immunostaining and HPV DNA-related PCR, on 202 OSCC patients. HPV subtypes were determined with an HPV LCD Array Kit. Clinicopathological features of the patients were analysed, and the disease specific survival rates (DSS) for HPV+ and HPV− patients were obtained.After testing OSCC samples for HPV positivity, we compared the results of two commonly used HPV detection methods, p16INK4a immunostaining is a not a reliable HPV detection method for OSCC. Positive p16INK4a immunostaining did not agree with + results from PCR of HPV DNA. Furthermore, the influence of HPV-related oncogenic transformation in OSCC is overestimated. The significance of HPV infection remains clinically unclear, and its influence on survival rates is not relevant to OSCC cases.p16 Head and neck squamous cell carcinomas (HNSCC) are one of the most common cancers in the world and are ranked sixth for men and eleventh for women in cancer frequency . AlthougINK4a positivity is more often seen in OPSCC [INK4a. HPV associated oncoproteins as E7 are influencing the expression of p16INK4a  to compare a completely homogenous group and assess two of the most commonly used HPV detection methods with respect to HPV expression rates and II) to evaluate HPV status for relevance to patient survival and clinical outcome.INK4a  patients tested positive for p164a Table , and cel4a Table . No inteINK4a staining. In 8 (3.96%) cases, p16INK4a staining was positive, but the PCR result was negative. In 3 (1.49%) cases, p16INK4a staining was negative but the PCR for HPV was positive. In conclusion, p16INK4a staining for the detection of HPV is insufficiently sensitive and specific.7 3.47%) patients were scored as HPV+ based on the PCR results . Furthermore, it served as proof of the reliability of the PCR method, as there were no discordant results between the PCR compared to the HPV LCD Array Kit, indicating that every OSCC identified as HPV+ by PCR was also positive with the LCD kit. In 5 OSCC cases, HPV subtype 16 was present, in one case HPV subtypes 16 and 52 were present, and in one case HPV subtypes 16 and 53 were present.Relevant clinical data from the 202 included patients with an OSCC diagnosis are listed in Table p > 0.05). HPV+ patients with OSCC had an average overall survival (OS) of 33.17 months : 22.96−43.38), and HPV− patients showed an average OS of 78.34 months .The survival rates from both groups were not significantly different according to univariate and multivariate analyses  and p16 INK4a− cases . HPV+ / p16INK4a+ cases had also no better survival rates .Survival rates were also not significantly different between p16p = 0.001) and was evaluated to the same degree in 52 patients. Three of these patients were HPV+, four were positive for p16INK4a, and two of the p16INK4a+ patients were also HPV+.Both local recurrence and lymph node recurrence played a major role in survival  of HPV+ patients was an average of 8.56 months ; HPV− patients showed an average RFS of 18.66 months .INK4a+ patients was an average of 22.05 months , and p16INK4a- patients had an average RFS of 17.70 months .Recurrence free survival (RFS) of p16p = 0.031), patients' ages (p = 0.012) and lymph node metastasis (p = 0.003) at the time of primary diagnosis had a significant influence on overall survival rates independent of HPV status or p16INK4a.The UICC stage (p > 0.05) independent of HPV or p16INK4a status. Resection margins were assessed and were R0, tumour free, in every case.In contrast, patient gender, T category, extra capsular spread and tumour grading were not significantly associated with overall tumour related survival or DSS  and are in accordance with the Declaration of Helsinki. All patients gave their consent.Two independent pathologists defined the centre of the tumour and the invasion front and the lymph nodes of every study patient. The tissue was formalin fixed and paraffin embedded in blocks. The pathologists then marked the areas to be represented in the tissue microarray (TMA). A minimum of two tumour cores from the centre of the tumour, the invasion front and the corresponding lymph nodes with a 6 mm core size were assembled into the TMA using a Tissue Microarrayer  as described before .INK4a antibody  according to the manufacturer's recommendations. Visualisation of staining was performed with the chromogenic substrate 3.3′-diaminobenzidine . Finally, nuclei were counterstained with Mayer's acid haematoxylin, and the slides were covered with Pertex mounting medium  as described previously [INK4a was evaluated as described before with a methodological standardization to ensure result reproducibility [Four-micron TMA sections were stained with p16eviously . Positivcibility .FFPE full-face slides of the central tumour area from every patient were cut in 15-micron sections to extract DNA , 30. ExtAfter exhibiting a positive HPV signal by PCR, the HPV 3.5 LCD Array Kit  was used to distinguish which of the 32 HPV subtypes were present, including high and low risk types, as described previously . After aU-test was used. Probabilities of less than 0.05 were considered significant.Data and figures were analysed with the ‘Statistical Package for the Social Sciences’ . Cox regression was used for survival analysis. Categories were tested for associations using cross tabs (Chi-squared-test). To compare groups, the non-parametric Mann Whitney INK4a immunostaining should not be used for HPV detection in OSCC. Furthermore, OSCC as a distinct localisation with principally squamous cell tissue should be clearly differentiated from OPSCC, which mainly contains lymphoid tissue. Considering the reliability of current data from the literature and the results presented here, there is no justification to promote therapy de-escalation in OSCC cases based on an HPV infection. HPV infection in OSCC is of low incidence and does not seem to be a predictive biomarker.p16


Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women.L1 viral capsid gene.Cross-sectional study was performed on 494 Tunisian women visiting Women’s Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of The overall HPV prevalence was 34% (95% CI: 30–38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76–92%) and 24.5% (95% CI: 20–29%) respectively. The distribution of HPV prevalence according to women’s age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest  and the oldest women  among women with SIL and 9.2% (95% CI: 6–12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0–5%) among women with SIL and 0.3% (95% CI: 0–1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant . The frequency of E variant was lower among SIL than among NIL women . Conversely, the African-2 variant frequency was higher among SIL than among NIL women . In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL.HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia. Papillomaviridae family with approximately 8 Kbp circular double-stranded DNA. The genome encodes for 6 early proteins responsible for virus replication and 2 late proteins L1 and L2, which are the viral structural proteins [According to the International Agency for Research on Cancer (IARC) 528,000 new cases of cervical cancer were estimated worldwide in 2012 . Papilloproteins , 5. Accoproteins , of whicproteins . The mosproteins . HPV-16 proteins . Severalproteins .The age specific HPV prevalence has varied widely across different population and showed a bimodal distribution with two peaks of HPV positivity in younger and older women, respectively –16. In aSo far, few molecular epidemiological studies on HPV infections have been conducted in North-African countries, which is a region located at a crossroad of Southern Europe, Sub-Saharan Africa and the broader Middle East –22. ThisThe present study aimed to investigate HPV prevalence, HPV genotype and HPV-16 variants distribution among women attending Women’s Healthcare Centers in the central region of Tunisia. This study would provide background information to improve cervical cancer screening and to predict the impact of HPV vaccination program in an Arab Muslim country.The National Ethical Committee approves this cross-sectional study. Prior to their participation, written informed consent was obtained from all enrolled women. Participants were collected from Public  and Private Women’s Healthcare Centers located at Monastir and Sousse. These locations are two neighboring coastal towns known for their touristic activity that share similar lifestyle habits and sociological level. Inclusion criteria include sexually active (≥1 year) and non-pregnant women. Exclusion criteria included immunocompromised patients, patients under corticosteroid therapy, hysterectomized women and previous surgical procedures on the cervix. The cervical sampling was performed according to routine clinical methods and standards. Trained gynecologist or midwife collected samples using sterile speculum. A first sample for cytological screening was collected by the Ayer spatula. Cytological smears were reported by cytopathologists according to the 2001 Bethesda system. A second sample for molecular HPV screening was collected by a cytobrush and placed in 5 mL of phosphate buffered saline (PBS).All subjects were interviewed, during gynecologic visit, using a questionnaire to collect demographic characteristics, medical history, contraceptive methods, sexual and reproductive behavior information and women’s lifestyle  and knowledge about HPV screening and vaccine.L1 gene. To ensure the DNA quality of the samples, a second primer pair of PCO3/PCO4 that provides amplification of 100 bp sequence of the β-globin gene was used simultaneously as an internal control for each PCR reaction. One hundred nanograms of the extracted cervical DNA was added to a mixture containing 12.5 μL of iQ™ SYBR®Green Supermix , 0.64 μM of each primer MY09/MY11, 0.08 μM of each primer PCO3/PCO4 and nuclease free water yielding a final volume of 25 μL. The reaction was carried out on an iQ5 thermocycler  using the following conditions: initial denaturation at 94 °C for 5 min followed by 30 cycles of denaturation at 94 °C for 30 s, annealing primers at 55 °C for 1 min and primers extension at 72 °C for 90s. A positive control (cloned HPV-DNA) and a negative control (nuclease free water) were included in each amplification reaction. HPV positive samples were detected using dissociation curve, which gave melting peaks at 81 ± 0.5 °C. For confirmation, PCR products were run on a 2% agarose gel stained with ethidium bromide and visualized with UV light.Cervical cells were recovered from the cervical cytobrush specimen by centrifugation and viral DNA was extracted using QIAamp MinElute virus spin kit  according to the manufacturer’s instructions. Concentration and purity of the extracted DNA were evaluated using a NanoDrop spectrophotometer, according to the manufacture’s instructions . To detect HPV-DNA, real-time polymerase chain reaction (RT-PCR) assay was performed using MY09/MY11 primers and SYBR Green I chemistry . Theses www.ncbi.nlm.nih.gov/BLAST, June 2015) , complete genome, GenBank: AF472508.1; Human papillomavirus type 16 variant (African type 2), complete genome, GenBank: AF472509.1; Human papillomavirus type 16 Asian-American variant, complete genome, GenBank: AF402678.1).HPV-DNA positive samples were subjected to DNA sequencing to identify HPV types and HPV-16 variants. The gel purified L1-PCR products were sequenced using BigDyeDeoxy terminator cycle sequencing kit  according to the manufacturer’s instructions. The products were then purified on a separation column , and the templates were sequenced on an automated ABI-PRISM 310 Genetic Analyzer (Applied Biosystems). Sequence analysis was performed using nucleotide-nucleotide BLAST analysis (blastn) against known HPV genotype and HPV-16 reference variants sequences stored in the GenBank database . The distribution of age, age at first intercourse and years of sexual activity, according to the different study population subgroups were analyzed and a t-test was used to compare these quantitative variables. The Chi-square test was used to estimate the differences in HPV prevalence between the groups of studied women. The Spearman’s Rank correlation test was used to test the relationship between age and age at first intercourse.p-value less than 0.05 in the univariate analysis were included in the multivariate analysis. A p-value of less than 0.05 was considered significant.A descriptive analysis and frequency distributions were conducted for all studied risk factors associated with HPV infection and squamous intraepithelial lesion (SIL) occurrence  in order to calculate sample size and percentages. Possible associations between HPV positivity or SIL and all the above-cited factors were determined by logistic regression to estimate Odds ratios (ORs) and 95%-confidence intervals (95%-CIs). Variables with a R = 0.356; p < 10-6). While, among more aged women (>40 years) a negative correlation was observed . The majority of women have primary or secondary education (80%); 10% have received higher education; and 10% were illiterate. The participating women are mainly non menopausal (90.9%); 16.8% of them use hormonal contraception and only 1% use condom as a contraceptive method. Most of the women are married (76.2%) and 22.3% declared that they have more than one sexual partner. Vaginal bacterial infections were observed among 10% . Based on women’s medical files, data about viral sexually transmitted infections  were available only for 152 participants and no positive results were reported. None of the enrolled women have ever been screened for HPV infection or received HPV vaccine or heard about the HPV vaccine. Pap smear cytology results show that 15.9% (n = 75) of women have HPV associated lesions (SIL) and 84.1% (n = 396) of them have no intraepithelial lesion (NIL). Women with SIL are classified into 41.3% with low-grade SIL (LSIL) (n = 31) and 58.7% with high-grade SIL (HSIL) (n = 44).In this study, no significant difference was observed when demographic data and distribution of lifestyle factors of the included women from the different locations were compared (Monastir and Sousse). Among the 494 eligible women, 23 DNA samples were negative for β-globin amplification and were consequently excluded from further analysis. Data were thus evaluated for 471 cases. Demographic, lifestyle and clinical characteristics of these women were summarized in Table n = 160, 95% CI: 30–38%) with significantly higher prevalence among women with SIL than those with NIL 84%  and 24.5%  respectively, p < 10-6) (Table p = 0. 025). Moreover, as expected, NIL women having multiple sexual partners had a significantly higher HPV prevalence than NIL women having one sexual partner  and 18.5%  respectively, p = 3.10-5). The HR-HPV prevalence rate was about three times higher among women who have multiple sexual partners than those who have one sexual partner .The overall HPV prevalence assessed by real-time PCR amplification and melting curve analysis was 34%  followed by HPV-6 , HPV-11 , HPV-31 , HPV-58  and HPV-66 . However, HPV-18 prevalence rate was less than 2% (95% CI: 0–4%). Among the nine HR-HPV types detected, HPV-45 was the least frequent type, which was detected in only one case of HSIL. HR HPV types were more prevalent among HPV positive women having multiple sexual partners and HSIL . HPV-16 was the most prevalent HR type among women with NIL and SIL , it was also frequent among women having multiple sexual partners and HSIL . Concerning LR-HPV types, they were more frequent among LSIL women  , African-2 (Af-2) and Asian-American (AA), were detected in our population study. None of the HPV-16 positive cases belongs to African-1 variant. HPV-16 E variant was the most frequent . The prevalence of the HPV-16 E variant was highest in HSIL , followed by LSIL , NIL . The majority of HPV-16 Af-2 variant was found in HSIL than NIL , 0.5%, 95% CI: 0–1%, respectively). The HPV-16 AA variant was detected only among women with NIL .p-value less than 0.05 from univariate analysis were further included in multivariate analysis . In addition, when we compared characteristics of LSIL women with HSIL women, we found that those with HSIL had a significantly higher HR-HPV prevalence, were older and had a longer period of sexual activity . No more significant differences were found between women with NIL and SIL or between HSIL and LSIL.When we compared epidemiological, demographic, and lifestyle habits of women with NIL and SIL, we found that women with SIL had a higher HPV prevalence, a younger age at first intercourse and a longer period of sexual activity  compared to those having one sexual partner (18.5%) or married (19.2%). Previously, Hassen et al., published HPV prevalence in women with normal cervical cytology from the central region of Tunisia (Sousse and Monastir) . They obIn our study, eighteen different HPV types were detected. Out of the eleven oncogenic types, HPV-16 was the most common in our population and six  were found among NIL, which was consistent with global studies in women with normal cervical cytology . Among wWe also explored risk factors influencing HPV infection and squamous intraepithelial lesions occurrence. Previous studies have shown that young age, age at the first sexual intercourse, multiple sexual partners, oral contraceptive use, smoking, number of pregnancies and menopause are the specific risk factors for cervical HPV infection –46. In oEvaluation of prevalence and genotype distribution of HPV infection in the general population is very important to estimate the potential impact of current HPV vaccines. Currently, three vaccines against HPV infection are available and distributed in more than 100 countries . However, HPV type classification shows a great difference between geographic regions worldwide . HPV bivThis cross-sectional study contributes to the knowledge of HPV epidemiology in Tunisian women with and without cervical lesions. We found that infected menopausal women were at higher risk to develop cervical lesions. We also found that the HPV-16 was dominant and that the HPV-18 was not very common, suggesting that the currently available bivalent vaccine may have lower efficiency with Tunisian women. Altogether, these results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.


To provide a scientific basis for the prevention and treatment of cervical intraepithelial neoplasia grade 1 (CIN1). This study evaluated the impact of human papillomavirus (HPV) infection on the natural history of CIN1. Electronic databases of Cochrane Library, EMBASE, PubMed, CNKI, CBM, and Wanfang were searched in April 2016. The eligibility criteria were documented by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We used the Newcastle-Ottawa scale (NOS) to assess study quality.P < 0.00001) and persistence  was higher in the HPV-positive group than HPV-negative group. Specifically, the risk of CIN1 progression  was higher among persistent high-risk HPV-positive patients and the ratio of CIN1 regression  was lower in the HPV-positive group than HPV-negative group. Thirty-eight studies out of 3,246 identified papers were eligible for inclusion. The risk of CIN1 progression (relative risk [RR]: 3.04; 95% confidence interval [CI]: 2.41–3.83;  HPV infection resulted in an increased risk of CIN1 progression and decreased disease reversibility. Persistent high-risk HPV infection resulted in a further increased risk of CIN1 progression. Cervical intraepithelial neoplasia grade 1 (CIN1) is a precancerous lesion closely related to cervical cancer and characterized by a shorter and less observable clinical course. There is no consensus for intervention and treatment of CIN1, and there are currently no clear markers to predict disease progression and regression ; therefohttps://doi.org/10.1155/2017/8971059) in this study as follows: P, cervical intraepithelial neoplasia grade 1 (CIN1); I, HPV positivity; C, HPV negative; O, the relative risk (RR) of progression, persistence, and regression of CIN1 in HPV-positive and HPV-negative patients being compared; S, retrospective studies and prospective studies. The search strategies were determined (the specific search strategy is described in Appendix 2) before the study. The MESH search terms for PubMed included the following:  AND (“Human Papillomavirus DNA Tests”[MeSH] OR human papillomavirus detected OR human papillomavirus test OR human papillomavirus infection) AND (Cohort Study OR follow up).A systematic search was conducted using the Cochrane Library, Excerpta Medica database (EMBASE), PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and the Wan fang Data. The literature search was performed on April 20, 2016. The PICOS items were identified  and the carcinoma in situ (CIS) classification system; patients diagnosed with CIN1 who did not undergo interventions including cryosurgery, electrocoagulation therapy, laser therapy, microwave therapy, cold knife conization, loop electrosurgical excision procedure, and trachelectomy; follow-up observation for at least 6 months; complete information so that each document contained sufficient information to calculate statistical indicators of relative risk (RR) or 95% confidence intervals (CIs). The exclusion criteria were as follows: studies that did not meet the inclusion criteria, literature reviews, the absence of a control group, and duplicate publications. We also excluded papers with incomplete initial data.The Newcastle-Ottawa scale (NOS), recognized as a good study quality assessment tool, was used to assess the quality of the studies identified in our literature search (see Appendix 3). The evaluation system included eight literature evaluation entries for a total of nine possible points , includiTwo authors (Mingzhu Liu and Xiaolong Yan) independently extracted data and crosschecked their data after aggregating the results. Disagreements were resolved by discussion with Professor Mingxia Jing. Data were collected at the start of the study, including basic information, background and characteristics of the research object, and disease diagnosis and evolution. This information is presented in I2 index. Low and high levels of heterogeneity were considered as I2 ≤ 50% and >50%, respectively. We use a fixed model on the conditions of P > 0.05 and I2 ≤ 50%. We use a randomized model on the conditions of P < 0.05 or I2 > 50%. Combined effects were estimated as relative risk (RR) values with 95% confidence intervals (CIs). All reported P values were two-sided, and a significance level of 0.05 was used. Subgroup analyses were also performed by HPV type (high-risk HPV and low-risk HPV), study design (retrospective and prospective studies), regional population distribution , sample size , and follow-up time . Sensitivity analyses were performed using Stata 12.0.Thirty-eight articles were analyzed using RevMan 5.0 (Cochrane systems IMS) and Stata 12.0 . To assess the heterogeneity among studies, we calculated the The basic features of the 38 studies included in this meta-analysis are listed in Z = 6.28; P < 0.00001), with low heterogeneity , with significant heterogeneity , with high heterogeneity . The ratio of regression of CIN1 was higher in patients followed up for 18–24 months than in those followed up for 6–18 months or >24 months . Significant differences in HPV type, study design, and sample size were not detected (see Appendix 4).In subgroup analyses, the risk of the persistence of CIN1 was higher in American than European or Asian populations (RRP = 0.000); the ratio of CIN1 disease regression was 0.61-fold lower in the persistent HR-HPV infection group than in the HPV-negative group . The impact of transient HR-HPV infection on CIN1 disease progression and regression was not statistically significant. Furthermore, persistent and transient HPV infection did not have a significant impact on CIN1 persistence . All of the included studies were distributed evenly from the central line, with no significant deviation. Therefore, no individual study affected the pooled effect results.A total of 38 studies were included in the current study. Of these, 23 studies examined HR-HPV infections and three of these also considered LR-HPV infection. Three studies assessed HPV infection times. Studies have shown that HPV infections are associated with an extended disease course in CIN1, increasing the risk of disease progression and hampering the reversal of CIN1. Persistent HR-HPV infection was a major factor associated with CIN1 progression. This finding provides important data for the clinical management of CIN1 disease, in order to avoid excessive or inadequate treatment. Regional population distribution and follow-up time were also associated with CIN1 disease outcome.In the HPV-positive group, the risks of CIN1 progression, persistence, and regression, respectively, were 3.02, 1.45, and 0.65, compared to the HPV-negative group. A randomized controlled study from the atypical squamous cells of undetermined significance-low-grade squamous intraepithelial lesion (ASCUS-LSIL) (ALTS) group [Our research on the impact of HPV type and infection duration on CIN1 disease history found that persistent HR-HPV infection was a major risk factor for CIN1 progression to CIN2+, while LR-HPV and transient infections were not significantly associated with increased risk of CIN1 progression. The results are corroborated in a large prospective study by Dalstein et al. . FurtherAsian = 3.94; RREuropean = 3.10; RRAmerican = 2.31; P = 0.380), and the ratios of disease regression  and persistence  were higher than those in Asia and European countries. In these Americas countries, 87.5% are North Americas countries (seven US and one Brazilian states). Previous studies have shown that a screening strategy of ThinPrep cytologic tests (TCTs) combined with HPV tests has gained popularity [Regional population distribution and follow-up time were the two main factors influencing CIN1 disease history. The risk of disease progression in HPV-positive CIN1 patients in the Americas was lower than that of patients in Asian and European countries (RRpularity . CIN1 hapularity . Therefopularity –50.This study has the following advantages. First, the well-designed studies provided strong evidence for the analysis of the influence of HPV infection on CIN1 disease history. Furthermore, the full search was relatively comprehensive and included a large number of studies, significantly increasing the sample size compared with using the single original research study criteria; therefore, the combined effect size was more accurate. Second, subgroup analyses were performed according to HPV type, study design, regional population distribution, sample size, and follow-up time, in order to explore potential confounders. Some limitations should be considered when interpreting the results of this study. First, CIN1 is affected by many factors and we were unable to control for parameters such as age at first sexual intercourse, number of pregnancies and delivery times, and individual immune status. Second, most studies included a larger age range; therefore, we did not conduct subgroup analysis by patient age. Third, more papers from China were included in the present study, which would limit the significance. This conclusion needs to be further testified in the people from other countries. Finally, there are few studies on low-risk HPV infection potentially affecting the results of subgroup analysis of HPV type. Therefore, we will research low-risk HPV infection in future studies to improve the accuracy of these results.HPV infection resulted in an increased risk of CIN1 progression and reducing disease reversibility. Persistent high-risk HPV infection resulted in a further increased risk of CIN1 progression. Furthermore, regional population distribution and follow-up times influenced CIN1 disease history.Appendix 1: The PICOS Principles in the PRISMA Statement. Appendix 2: Full Search strategy. Appendix 3: Newcastle-Ottawa Quality Assessment Scale: Cohort Studied. Appendix 4: Subgroup Analyses. Appendix 5: Sensitivity Analysis.


Unfortunately, a number of corrections had not been carried out during the production of the original version of this article .Within the paragraph headed ‘Chemotaxonomy and physiological characteristics’ the reference to Fig. 2b has been corrected to Fig. 1b.Streptomyces flavolimosus has been italicised.The sentence ‘As observed from Box–Cox plot , the blue line indicates the current transformation (=0.77)’ has been changed to ‘As observed from Box–Cox plot , the blue line indicates the current transformation (Lambda = 1)’.Table 7 has been clearly formatted to include lines.Numbers in the equation for Y (Cholesterol oxidase activity) have been corrected to subscript:1), cholesterol (X2) and ammonium sulphate (X3) on the cholesterol oxidase activity’.The caption for Fig. 6 has been amended to ‘Three-dimensional response surface plots for the effect of initial pH (X


Human papillomavirus (HPV) vaccine coverage rates remain low. This is believed to reflect parental hesitancy, but few studies have examined how changes in parents’ attitudes impact HPV vaccine uptake. This study examined the association between changes in parents’ vaccine attitudes and HPV vaccine receipt in their adolescent children.A baseline and 1-year follow-up survey of HPV vaccine attitudes was administered to parents of 11–17 year olds who had not completed the HPV vaccine series. Changes in attitudinal scores  from the Carolina HPV Immunization Attitudes and Beliefs Scale were assessed. Two outcomes were measured (in parents’ adolescent children) over an 18-month period and analyzed using multivariable regression; receipt of next scheduled HPV vaccine dose and 3-dose series completion.There were 221 parents who completed the baseline survey (11% response rate) and 164 with available follow-up data; 60% of their adolescent children received a next HPV vaccine dose and 38% completed the vaccine series at follow-up. Decrease in parents’ uncertainties was a significant predictor of vaccine receipt, with each 1-point reduction in uncertainties score associated with 4.9 higher odds of receipt of the next vaccine dose. Higher baseline harms score was the only significant predictor of lower series completion.Reductions in parents’ uncertainties appeared to result in greater likelihood of their children receiving the HPV vaccine. Only baseline concerns about vaccine harms were associated with lower series completion rate. Education for parents should emphasize the HPV vaccine’s safety profile. The human papillomavirus (HPV) vaccine was introduced in 2006, but coverage has remained lower than for other recommended adolescent vaccines for tetanus, diphtheria, pertussis (Tdap), and meningococcal disease . HPV vacThe degree to which parents’ HPV vaccine attitudes influence their decisions to have their adolescent children get the HPV vaccine series has been examined in prior studies –13. MostThis was a cohort analysis of survey data, conducted in parallel with a medical care quality improvement project designed to increase HPV vaccine coverage in adolescent patients from seven Wisconsin communities who receive care from Marshfield Clinic Health System  . BrieflySurvey-eligible parents were selected using stratified random sampling by community. Baseline surveys were distributed over three months in Spring 2015, with the follow-up survey administered one year later. Contact information for eligible adolescents was extracted from MCHS administrative records and an invitation was mailed to the “Parents of” each enumerated adolescent. The mailing contained a cover letter describing the study and an invitation to participate, as well as the survey instrument and a postage-paid return mailer. A reminder letter was sent to non-respondents about one month after the initial mailing, and a phone outreach was also made to remaining non-respondents. A passive consent procedure was utilized whereby participants were informed that completed surveys would be linked to their EHR data. A $2 cash incentive was enclosed in all mailed follow-up survey invitations. Study procedures were approved by the Marshfield Clinic Institutional Review Board.The primary predictor was change between baseline and 1-year follow-up in the sub-factor scores from the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) . AttitudTwo HPV vaccine outcomes were examined in separate analyses, and these variables again pertained to each parent’s youngest HPV vaccine eligible adolescent child. These HPV vaccine outcomes were assessed over 18 months of follow-up after each participant completed their baseline survey. The first outcome was receipt of the next (scheduled) HPV vaccine dose, which captured those who received their first (i.e. initiation), second, or third  dose (depending on how many HPV vaccine doses were received before baseline). The second outcome was receipt of all three doses of HPV vaccine . Data on vaccinations were collected from a regional population-based immunization registry , which iSeveral covariates were also analyzed that were suspected of possibly modifying or confounding the association between changes in parents’ HPV attitudes and adolescent HPV vaccine receipt. From the baseline survey, this included each parent’s age, gender, education level , health insurance coverage , and baseline CHIAS scores. From the follow-up survey, this included report of a physician’s recommendation to get the HPV vaccine in the prior year. In addition, EHR data on each parent’s youngest adolescent child’s prior HPV, Tdap, and meningococcal vaccination history, number of ambulatory care visits over three years (prior to baseline), gender, and age were also examined as covariates.p < 0.05) association with HPV vaccine receipt were retained in subsequent models. Finally, a reduced multivariable model was fit by adding each covariate separately and applying forward selection to exclude any covariates that were not significant independent predictors of HPV vaccine receipt. The two HPV vaccine receipt outcomes were tested separately using this same analytical approach. All analytical procedures were conducted using SAS Version 9.4 .Sociodemographic characteristics were reported descriptively. Logistic regression was used to examine the association between changes in parents’ HPV vaccine attitudes and receipt of the HPV vaccine in their adolescent child. Basic models were first created to examine the crude associations between each CHIAS sub-factor change score (follow-up score minus baseline score) and HPV vaccine receipt. Next, given the well documented influence of physician advice on HPV vaccination –19, a teAt baseline, 1998 surveys were mailed to eligible parents, with 221 (11%) respondents. Among those, 187 returned responses at the 1-year follow-up, with 175 confirmed as the same parent who responded at baseline (cohort retention 79%). Eleven respondents were excluded from analyses due to missing covariate data, yielding a final analytical sample of 164 parents. Parent respondents were primarily Non-Hispanic White females (Table p’s < 0.001) over one year. At the 1-year follow-up survey, 77% of parents reported having received a physician’s recommendation for their adolescent child to get the HPV vaccine in the prior year.At baseline, 32% of parents’ adolescent children had initiated the HPV vaccine, having received 1–2 prior HPV vaccine doses . Sixty percent of parents’ adolescent children  had received at least one HPV vaccine dose and 38%  had completed the 3-dose series by the end of the 18-month follow-up period. As outlined in Table The basic models revealed that changes between baseline and follow-up in CHIAS sub-factor scores for harms, uncertainties, and ineffectiveness were significantly associated with receipt of next HPV vaccine dose. Parents whose attitudes became more favorable over time had a higher likelihood of vaccine receipt. Specifically, each 1-point decrease in the harms, uncertainties, or ineffectiveness score was associated with 5.4 , 3.8 , and 2.3  higher odds of having received the next HPV vaccine dose, respectively. After covariate adjustment, most associations with attitudinal change scores were attenuated, leaving only the CHIAS uncertainties change score, baseline CHIAS uncertainties score, and baseline CHIAS harms score as significant predictors of receipt of next HPV vaccine dose  and 2.3  higher odds of their adolescent’s series completion, respectively. And again, associations with attitudinal change scores were attenuated after covariate adjustment, with only baseline CHIAS harms score and receipt of prior HPV vaccine being significantly associated with HPV vaccine series completion during the follow-up period (Table Prior research has shown that parents’ CHIAS scores are significant predictors of their intent to get their child vaccinated against HPV, as well as their self-reported history of HPV vaccine receipt , 20, 21.Though the baseline survey response rate was low and somewhat skewed toward parents of younger adolescents who were more apt to have received Tdap/meningococcal vaccines, parental concerns about the safety of the HPV vaccine seemed to be the most influential attitudinal barrier. On average, the CHIAS harms score remained stable between baseline and follow-up. But even among parents whose CHIAS harms score shifted favorably, their adolescents were not more likely to get the HPV vaccine after covariate adjustment. In contrast, the baseline CHIAS harms score was strongly associated with receipt of the next HPV vaccine dose and was the only significant attitudinal predictor of HPV vaccine series completion. Thus it seemed parents with high harms scores were not apt to change their minds, and even if they did, it had no impact on HPV vaccine receipt. This finding was consistent with some prior studies. Notably, the CHIAS harms score was also among the strongest predictors of HPV vaccine initiation after one year among parents of adolescent girls in North Carolina . Also, fSeveral covariates were also significantly associated with HPV vaccine receipt. As expected, a prior HPV vaccine dose was the strongest predictor of both receipt of next dose and series completion. A reported physician’s recommendation to get the HPV vaccine in the prior year was also associated with receiving the next HPV vaccine dose, but adolescents’ age and gender were not associated with receipt of next dose or series completion. Interestingly, parents with publicly-assisted health insurance had six times greater odds of their adolescent child initiating or getting their next HPV vaccine dose during the follow-up period relative to parents with private health insurance. Reasons for this are obviously speculative, but it may be related to some Medicaid pay-for-performance initiatives targeting childhood immunizations , recogniThis study was strengthened by the systematic sampling of parents of adolescents who receive primary care within an integrated regional healthcare system, a level at which clinical care quality improvement initiatives are apt to occur. Also, adolescents’ clinical data on HPV vaccine coverage was linked to their parents’ CHIAS scores. In terms of limitations, the baseline survey response rate was of particular concern because it was very low, which might reflect sensitivities about the general topic of HPV or the lack of a baseline response incentive. Low baseline response does not negate the associations observed within the cohort and is not by itself indicative of nonresponse bias , 31, butHPV vaccine coverage remains low in the U.S. , but imp


The two right-sided difference topography visualizations (upper and lower) of the grand average of the N400 effect (incongruent minus congruent condition) for the two turn-taking modes were exchanged. The shown N400 effect plot for Listening is the N400 effect plot for Reading aloud, whereas the N400 effect plot shown for Reading aloud is the N400 effect plot for Listening. This only affects the visualization of the two difference topographies. The corrected Figure In the original article, there was a mistake in Figure The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


EBioMedicine (Hu and colleagues in their recently published paper in Medicine  regardinThis study has a strong methodology, since it employed the FIESTA study , initiatAlso, for statistical analysis, multivariate Weibull proportional hazards regression model before and after adjusting for confounding factors, were used.Gastric cancer is one of the most common cancers in the world. It is rarely detected early, and the prognosis remains poor  and receThe authors declared no conflicts of interest.