A presente dissertação propõe métodos para mineração de dados para diagnóstico de câncer de mama (CM) baseado na seleção de variáveis. Partindo-se de uma revisão sistemática, sugere-se um método para a seleção de variáveis para classificação das observações (pacientes) em duas classes de resultado, benigno ou maligno, baseado na análise citopatológica de amostras de célula da mama de pacientes. O método de seleção de variáveis para categorização das observações baseia-se em 4 passos operacionais: (i) dividir o banco de dados original em porções de treino e de teste, e aplicar a ACP (Análise de Componentes Principais) na porção de treino; (ii) gerar índices de importância das variáveis baseados nos pesos da ACP e na percentagem da variância explicada pelos componentes retidos; (iii) classificar a porção de treino utilizando as técnicas KVP (k-vizinhos mais próximos) ou AD (Análise Discriminante). Em seguida eliminar a variável com o menor índice de importância, classificar o banco de dados novamente e calcular a acurácia de classificação; continuar tal processo iterativo até restar uma variável; e (iv) selecionar o subgrupo de variáveis responsável pela máxima acurácia de classificação e classificar a porção de teste utilizando tais variáveis. Quando aplicado ao WBCD (Wisconsin Breast Cancer Database), o método proposto apresentou acurácia média de 97,77%, retendo uma média de 5,8 variáveis. Uma variação do método é proposta, utilizando quatro diferentes tipos de kernels polinomiais para remapear o banco de dados original; os passos (i) a (iv) acima descritos são então aplicados aos kernels propostos. Ao aplicar-se a variação do método ao WBCD, obteve-se acurácia média de 98,09%, retendo uma média de 17,24 variáveis de um total de 54 variáveis geradas pelo kernel polinomial recomendado. O método proposto pode auxiliar o médico na elaboração do diagnóstico, selecionando um menor número de variáveis (envolvidas na tomada de decisão) com a maior acurácia, obtendo assim o maior acerto possível. / This dissertation presents a data mining method for breast cancer (BC) diagnosis based on selected features. We first carried out a systematic literature review, and then suggested a method for feature selection and classification of observations, i.e., patients, into benign or malignant classes based on patients’ breast tissue measures. The proposed method relies on four operational steps: (i) split the original dataset into training and testing sets and apply PCA (Principal Component Analysis) on the training set; (ii) generate attribute importance indices based on PCA weights and percent of variance explained by the retained components; (iii) classify the training set using KNN (k-Nearest Neighbor) or DA (Discriminant Analysis) techniques, eliminate irrelevant features and compute the classification accuracy. Next, eliminate the feature with the lowest importance index, classify the dataset, and re-compute the accuracy. Continue such iterative process until one feature is left; and (iv) choose the subset of features yielding the maximum classification accuracy, and classify the testing set based on those features. When applied to the WBCD (Wisconsin Breast Cancer Database), the proposed method led to average 97.77% accurate classifications while retaining average 5.8 features. One variation of the proposed method is presented based on four different types of polynomial kernels aimed at remapping the original database; steps (i) to (iv) are then applied to such kernels. When applied to the WBCD, the proposed modification increased average accuracy to 98.09% while retaining average of 17.24 features from the 54 variables generated by the recommended kernel. The proposed method can assist the physician in making the diagnosis, selecting a smaller number of variables (involved in the decision-making) with greater accuracy, thereby obtaining the highest possible accuracy.

Objetivo: Avaliar a acurácia da colposcopia utilizando a Classificação Colposcópica Internacional de 2002. Métodos: 3040 pacientes de população geral foram rastreadas para patologia cervical através de exame citopatológico, captura híbrida para HPV de alto risco e inspeção cervical. As colposcopias que resultaram em biópsia (n=468) executadas no rastreamento e acompanhamento destas pacientes foram gravadas, revistas por dois colposcopistas cegados e incluídas para análise. Resultados: Os observadores apresentaram excelente concordância (Kappa=0.843) no relato dos achados pela nova nomenclatura. A colposcopia apresentou sensibilidade de 86% e especificidade de 30.3% em diferenciar colo normal de colo anormal (LSIL, HSIL ou carcinoma); quando a colposcopia objetivava diferenciar colo normal ou LSIL de HSIL ou carcinoma, apresentou sensibilidade de 61.1% e especificidade de 94.4%. Os achados colposcópicos classificados como “maiores” pela nova classificação apresentaram valores preditivos positivos elevados para HSIL. Presença do achado colposcópico na zona de transformação e tamanho da lesão estavam associados a HSIL. Bordas externas definidas, associação de múltiplos achados distintos e presença de zona iodo negativa não estavam relacionados à gravidade das lesões. Conclusão: A colposcopia utilizando a Classificação Internacional de 2002 mostra-se um bom método de rastreamento, mas como método diagnóstico apresenta falhas, não podendo substituir a avaliação histológica. A categorização em achados colposcópicos “maiores” e “menores” apresentada pela nova classificação é adequada. Na realização da colposcopia, é importante também que a lesão seja situada em relação à zona de transformação e que seu tamanho seja indicado, já que estes foram fatores associados a lesões de alto grau. / Objectives: To evaluate the colposcopic accuracy according to 2002 International Colposcopic Classification. Methods: 3,040 women from the general population were screened for cervical pathology by Pap smear, high risk HPV Hybrid Capture and naked eye visual inspection. All colposcopic exams that needed biopsy (n=468) performed during screening or follow-up were recorded, reviewed by two blinded colposcopists and included for analysis. Results: The two observers showed excellent agreement (Kappa=0.843) on reporting colposcopic findings according to the new classification. Colposcopy had sensitivity of 86% and specificity of 30.3% when the objective was to distinguish normal cervix from abnormal (LSIL, HSIL or carcinoma); for distinguishing normal cervix or LSIL from HSIL or carcinoma, colposcopy had sensitivity of 61.1% and specificity of 94.4%. Colposcopic findings graded as “major changes” had the highest predictive positive values for detecting HSIL or carcinoma. Colposcopic findings at transformation zone and size of lesion were related to HSIL. Sharp outer border, multiple colposcopic findings and iodine negativity were not statically related to severe lesions. Conclusion: Colposcopy using the new International Classification is a considerable screening method, but its value for diagnoses is restricted and it is not possible to substitute histological sampling. Categorization in “major changes” and “minor changes” according to the new classification is appropriate. When performing colposcopy, it is important to describe where is the colposcopic finding, in or outside the transformation zone, and its size, whereas these characteristics were related to high grade lesions.

A presente dissertação propõe métodos para mineração de dados para diagnóstico de câncer de mama (CM) baseado na seleção de variáveis. Partindo-se de uma revisão sistemática, sugere-se um método para a seleção de variáveis para classificação das observações (pacientes) em duas classes de resultado, benigno ou maligno, baseado na análise citopatológica de amostras de célula da mama de pacientes. O método de seleção de variáveis para categorização das observações baseia-se em 4 passos operacionais: (i) dividir o banco de dados original em porções de treino e de teste, e aplicar a ACP (Análise de Componentes Principais) na porção de treino; (ii) gerar índices de importância das variáveis baseados nos pesos da ACP e na percentagem da variância explicada pelos componentes retidos; (iii) classificar a porção de treino utilizando as técnicas KVP (k-vizinhos mais próximos) ou AD (Análise Discriminante). Em seguida eliminar a variável com o menor índice de importância, classificar o banco de dados novamente e calcular a acurácia de classificação; continuar tal processo iterativo até restar uma variável; e (iv) selecionar o subgrupo de variáveis responsável pela máxima acurácia de classificação e classificar a porção de teste utilizando tais variáveis. Quando aplicado ao WBCD (Wisconsin Breast Cancer Database), o método proposto apresentou acurácia média de 97,77%, retendo uma média de 5,8 variáveis. Uma variação do método é proposta, utilizando quatro diferentes tipos de kernels polinomiais para remapear o banco de dados original; os passos (i) a (iv) acima descritos são então aplicados aos kernels propostos. Ao aplicar-se a variação do método ao WBCD, obteve-se acurácia média de 98,09%, retendo uma média de 17,24 variáveis de um total de 54 variáveis geradas pelo kernel polinomial recomendado. O método proposto pode auxiliar o médico na elaboração do diagnóstico, selecionando um menor número de variáveis (envolvidas na tomada de decisão) com a maior acurácia, obtendo assim o maior acerto possível. / This dissertation presents a data mining method for breast cancer (BC) diagnosis based on selected features. We first carried out a systematic literature review, and then suggested a method for feature selection and classification of observations, i.e., patients, into benign or malignant classes based on patients’ breast tissue measures. The proposed method relies on four operational steps: (i) split the original dataset into training and testing sets and apply PCA (Principal Component Analysis) on the training set; (ii) generate attribute importance indices based on PCA weights and percent of variance explained by the retained components; (iii) classify the training set using KNN (k-Nearest Neighbor) or DA (Discriminant Analysis) techniques, eliminate irrelevant features and compute the classification accuracy. Next, eliminate the feature with the lowest importance index, classify the dataset, and re-compute the accuracy. Continue such iterative process until one feature is left; and (iv) choose the subset of features yielding the maximum classification accuracy, and classify the testing set based on those features. When applied to the WBCD (Wisconsin Breast Cancer Database), the proposed method led to average 97.77% accurate classifications while retaining average 5.8 features. One variation of the proposed method is presented based on four different types of polynomial kernels aimed at remapping the original database; steps (i) to (iv) are then applied to such kernels. When applied to the WBCD, the proposed modification increased average accuracy to 98.09% while retaining average of 17.24 features from the 54 variables generated by the recommended kernel. The proposed method can assist the physician in making the diagnosis, selecting a smaller number of variables (involved in the decision-making) with greater accuracy, thereby obtaining the highest possible accuracy.

Le cancer du sein demeure un problème de santé publique majeure dans le monde. Afin d'améliorer les chances de survie et la qualité de vie des femmes, il est nécessaire d’effectuer le diagnostic à un stade précoce et d’appliquer le traitement. Dans ce contexte, un des objectifs de cette thèse est de développer des puces à protéines pour le diagnostic et le pronostic du cancer du sein. Parmi les nombreux marqueurs biologiques potentiels, des recherches récentes ont montré que des anticorps anti-heat shock proteins (anti-HSPs) sont associés à la genèse tumorale. Ces anticorps seraient donc de bons biomarqueurs diagnostiques et pronostiques pour le cancer du sein. Par conséquent, nous avons élaboré une puce à antigènes afin de détecter les anticorps anti-HSP dans le sérum de 50 patients atteints de cancer du sein et de 26 témoins sains. Nos résultats indiquent clairement que la la détection multiplex d’une combinaison d'anticorps anti-HSP permet de discriminer les patients atteints de cancer du sein des témoins sains avec une sensibilité de 86% et une spécificité de 100%. Ensuite, nous avons élaboré une puce à anticorps pour doser la concentration de l'activateur du plasminogène de type urokinase (uPA) et de son inhibiteur principal (PAI-1) dans 16 extraits cytosoliques de tissus tumoraux. uPA et PAI-1 sont décrits comme étant de bons biomarqueurs pronostiques et prédictifs du cancer du sein. De faibles taux de uPA (≤3 ng / mg de protéine) et PAI-1 (≤14 ng / mg de protéine) sont associés à un faible risque de récidive et pas de bénéfice d’une chimiothérapie pour les patients atteints de cancer du sein. Les résultats obtenus à partir de puces à anticorps étaient surface dépendante par rapport aux résultats obtenus sous forme ELISA. En outre, l'utilisation de nos puces à anticorps nécessite 25 fois moins de volume d'échantillon par rapport à un dosage ELISA, résolvant ainsi les principales limites de la méthode ELISA. Enfin, nous avons déterminé et optimisé les paramètres influençant les performances des puces à protéines, comme par exemple la chimie de surface, la durée expérimentale, la concentration des solutions, etc. Nous avons également étudié les conditions de stockage à la fois pour des surfaces chimiquement fonctionnalisées et pour les puces à protéines. Les résultats ont montré que les puces à protéines conservent leur activité biologique jusqu’à trois mois de stockage. / Breast cancer becomes the most common cancer among women. In order to improve women's chances of survival and life quality, to be diagnosed at an early stage and to receive correct treatment are the most promising ways. In this context, we aim at developing an antigen microarray for screening serological biomarkers to diagnose breast cancer patients as early as possible. Among numerous potential biomarkers, recent researches showed that antibodies against heat shock proteins (HSPs) are associated with tumor genesis and would be good diagnostic and prognostic biomarkers for breast cancer. Therefore, we used customized antigen microarray to screen anti-HSP antibodies in 50 breast cancer patients and 26 healthy controls. Our results indicated clearly that combining multiplex detection of anti-HSPs antibodies could discriminate breast cancer patients from healthy controls with sensitivity 86% and specificity 100%. Then, we elaborated an antibody microarray to detect the concentration of urokinase type plasminogen activator (uPA) in 16 cytosolic extracts of breast tummor tissue. uPA is good prognostic and predictive biomarker for breast cancer, low levels of uPA (≤3 ng/mg of protein) is associated with low risk of recurrence and no benefit of chemotherapy for breast cancer patients, and vice versa. Our results showed that the results obtained from our antibody microarray were surface dependent compared with the results obtained from ELISA. Furthermore, the use of our antibody microarray requires 25 times less sample volume compared with ELISA kit, thus solving the main limitations of ELISA. Finally, we determined and optimized the parameters which affected the performances of protein microarray, e.g. microarray surface chemistry, experimental duration, the concentration of solutions, etc. Furthermore, we studied the storage conditions for both chemically functionalized microarray surface as well as printed protein microarray. Results showed that our protein microarrays retain efficient biological activity for at least 3 month of storage.

Please read the abstract in the section 00front of this document Please cite as follows: Opperman JA, 2002, Die emosionele belewenis van 'n beenmurgoorplanting : 'n Maatskaplike Werk perspektief, MA dissertation, University of Pretoria, Pretoria, viewed yymmdd < http://upetd.up.ac.za/thesis/available/etd- 07252005-110248/ > / Dissertation (MA (Social Work))--University of Pretoria, 2002. / Social Work and Criminology / MA (Social Work) / unrestricted

Karlsson, E &amp; Liljesson, M. Kvinnors upplevelse av att få en bröstcancerdiagnos. Examensarbete i omvårdnad 15 högskolepoäng. Malmö universitet: Fakulteten för Hälsa och samhälle, Institutionen för vårdvetenskap, 2022.   Bakgrund: Bröstcancer är den vanligaste cancerformen för kvinnor världen över. I Sverige diagnostiserades 7570 kvinnor med bröstcancer år 2020. Bröstcancern upptäcks vanligtvis av kvinnan själv eller genom mammografi. Diagnostiken består av trippeldiagnostik, som kan fastställa diagnosen. Den generella behandlingen av bröstcancer är cytostatika, kirurgiskt ingrepp och/eller strålning. Att genomgå en behandling är fysiskt, psykiskt och socialt utmanande. Att diagnostiseras med en sjukdom kan innefatta en kris eftersom det utgör ett hot mot individens existens. Syfte: Litteraturstudiens syfte var att belysa biologiska kvinnors upplevelse av att få en bröstcancerdiagnos. Metod: En kvalitativ litteraturstudie har utförts med inriktning mot omvårdnad. Litteratursökningar har genomförts i databaserna Cinahl och PubMed där 15 kvalitativa artiklar påträffades. Kvalitetsgranskning av artiklarna utfördes enligt SBU:s (2014) mall. En analys av artiklarna har utformats enligt Friberg (2017). Resultat: Att få en bröstcancerdiagnos upplevs av majoriteten av kvinnorna som en chock och livet förändrades. Kvinnorna uttryckte olika existentiella tankar och känslor som gav påverkan på det fysiska, psykiska och sociala. Resultatet identifierade följande kategorier känslomässiga reaktioner, tankar kring döden, socialt stöd, religionens betydelse kopplat till diagnosen och förlust av identitet. Konklusion; Att få en bröstcancerdiagnos upplevdes av majoriteten av kvinnorna som en chock medan tankar och känslor utspelade sig olika för varje individ. Genom kvinnornas upplevelse kan krisreaktionens två första faser identifieras, vilket gör att sjuksköterskan behöver vara medveten och kunnig om krisreaktionens olika faser för att kunna utföra en god omvårdnad. / Karlsson, E &amp; Liljesson, M. Women's experience of being diagnosed with breast cancer. Degree Project in nursing 15 credit points. Malmö University: Faculty of Health and Society, Department of Care Science, 2022.  Background: Breast cancer is the most common form of cancer worldwide among women. In 2020, 7570 women were diagnosed with breast cancer. Breast cancer is usually detected by the woman herself or by mammography. By preforming a triple diagnosis, the diagnosis will establish. The general treatment of breast cancer is chemotherapy, surgery, and radiation. Undergoing treatment is physically, psychological, and socially challenging. Being diagnosed with a disease can create a crisis as the disease poses a threat to the individual's existence. Aim: The purpose of the literature review is to illustrate biological women's experience of being diagnosed with breast cancer. Method: A qualitative literature review has been conducted with a focus on nursing. Literature searches have been performed in the databases Cinahl and PubMed, where 15 qualitative articles were found. Qualitative review of the articles was performed following SBU:s (2014) template. An analysis of the articles has been designed according to Friberg (2017). Results: Getting a breast cancer diagnosis is perceived by most women as a shock and their lives changed. The women expressed various existential thoughts and feelings that gave physically, psychological, and socially impact. The result identified following categories emotional reactions, thoughts about death, social support, the religious meaning connected to the diagnosis and loss of identity. Conclusion: The women's experience of receiving the diagnosis for breast cancer was experienced by the majority as a shock, while thoughts and feelings unfolded differently for each individual. Through the women´s experience, the first two phases of crisis can be identified. Which means that the nurses need to be aware and knowledgeable about the different phases of the crisis to be able to perform good nursing.

Indiana University-Purdue University Indianapolis (IUPUI) / Men’s adherence to masculinity norms has been implicated as a risk factor for unhealthy behaviors (e.g., drinking to intoxication, having unprotected sex with multiple, simultaneous partners) and lack of engagement in healthy behaviors (e.g., blood pressure screening, cholesterol screening, wearing protective clothing while in the sun, receipt of annual medical and dental exams) (Boman & Walker, 2010; Courtenay, 2000a, 2000b, 2011; Hammond, Matthews, & Corbie-Smith, 2010; Iwamoto, Cheng, Lee, Takamatsu, & Gordon, 2011; Locke & Mahalik, 2005; Mahalik, Lagan, & Morrison, 2006; Mahalik et al., 2003; Nicholas, 2000; Pachankis, Westmaas, & Dougherty, 2011; Pleck, Sonenstein, & Ku, 1993; Wade, 2009). Masculinity has been defined as behaviors, beliefs, and personality characteristics associated more often with men than women as well as characteristics and behaviors that society prescribes and reinforces in men (Thompson, Pleck, & Ferrera, 1992). Rooted in geographical, cultural, and temporal environments, diverse masculinities have emerged throughout the United States and the world (Connell, 1995; Courtenay, 2011). Traditional masculinity beliefs and behaviors in the United States include the sturdy oak (men should be tough, self-reliant, stoic, and confident), no sissy stuff (men should avoid feminine characteristics and behaviors), the big wheel (men should strive for success and status), and give ‘em hell (men should embrace aggressiveness, daring, and violence) (Brannon, 1976). Numerous qualitative studies have suggested that some men find cancer screening examinations involving the rectum (i.e., endoscopy for colorectal cancer [CRC] screening or digital rectal examination [DRE] for prostate cancer screening) an affront to their masculinity (see Table 1 for quotations from these studies) (Bass et al., 2011; Beeker, Kraft, Southwell, & Jorgensen, 2000; Getrich et al., 2012; Goldman, Diaz, & Kim, 2009; Harvey & Alston, 2011; Holt et al., 2009; Jilcott Pitts et al., 2013; Jones, Devers, Kuzel, & Woolf, 2010; Rivera-Ramos & Buki, 2011; Thompson, Reeder, & Abel, 2011; Wackerbarth, Peters, & Haist, 2005; Winterich et al., 2009). However, to the author’s knowledge, no quantitative studies have considered the role of masculinity in CRC screening adherence. Unfortunately, current CRC screening rates fall below the 70.5% Healthy People 2020 screening objective (U.S. Department of Health and Human Services, 2012).Research is needed to better understand relationships between men’s masculinity norms and CRC screening adherence so that interventions may be developed to reduce barriers to screening, improve screening rates, and, ultimately, decrease men’s mortality from CRC. The present study will address this gap in the literature by examining the masculinity norms and CRC screening adherence of male veterans aged 51-75 years who are at average CRC risk (Levin et al., 2008). First, the prevalence of CRC, its risk factors and warning signs as well as CRC screening techniques, screening rates, and characteristics of individuals who are adherent and non-adherent to CRC screening guidelines are summarized. Next, the concept of masculinity, theoretical and empirical support for studying masculinity norms within the context of CRC screening, and potential relationships between masculinity norms and colorectal cancer screening behaviors are described. Finally, the study methods, results, and future directions and limitations of this research are described.

The introduction of new, innovative technologies within cancer diagnosis is needed, however, the barriers to entering the healthcare market are high, with various regulations and stakeholders to consider. The purpose of this thesis is to research doctors’ attitudes toward the current and emerging methods within cancer diagnosis, with the ultimate objective of providing insights into how companies can affect doctors’ technology acceptance behavior. Understanding of the end-user can facilitate the early involvement of doctors in a company's development process, which can contribute to a successful introduction of a new technology to the healthcare market. This thesis adopts a qualitative single case study approach, where the empirical data was collected through semi-structured interviews. The interviews were conducted with doctors specialized in General Medicine and Obstetrics and Gynecology. The findings reveal that doctors are cautiously positive towards new technologies, but require them to deliver greater benefits compared to their costs, have high performance, and have good usability. In addition, they demand them to be supported by research studies that substantiate their efficacy. Furthermore, a company must build trust by means such as establishing credibility and demonstrating a clear clinical purpose. The thesis also concludes that doctors’ attitudes are influenced by their belief systems and social factors, including the opinions of colleagues or hospital leaders. Finally, the findings suggest that companies should conduct research studies, create resource-sharing collaborations, involve doctors early in the development process, and establish effective communication strategies to influence doctors’ technology acceptance behaviors. / Det finns ett uttalat behov av att introducera innovativa teknologier inom cancerdiagnostik till marknaden, men hälso- och sjukvårdsmarknaden har höga inträdesbarriärer men många regulationer och aktörer att ta hänsyn till. Syftet med denna studie är att fördjupa förståelsen av läkares inställning till existerande och nya teknologier inom cancerdiagnostik. Det yttersta målet är att bidra med insikter rörande hur företag kanpåverka läkares acceptans av nya teknologier. Genom förbättrad förståelse och tidig involvering av slutanvändaren, i detta fall läkarna, kan en introduktion av nya teknologier simplifieras. Denna studie innefattar en kvalitativ, enkel fallstudie, där datainsamlingen skett genom semistrukturerade intervjuer. Dessa intervjuer hölls med läkare med specialisering inom allmänmedicin samt obstetrik och gynekologi. Resultatet visar att läkarna har en försiktigt positiv attityd till nya teknologier, men har höga krav på prestation, användbarhet och nytta-kostnad förhållandet. De kräver även att teknologin stöds av noga utförda forskningsstudier som kan påvisa dess effektivitet och nytta. Studien visar även att företag måste bygga förtroende hos läkarna, genom att exempelvis visa på ett tydligt kliniskt syfte. Vidare visar resultatet att läkarnas attityder influeras av deras trossystem samt sociala faktorer, däribland kollegors och sjukhusledares åsikter och rekommendationer. Slutligen uppmanas företag att genomföra forskningsstudier, etablera samarbeten mellan berörda grupper, involvera läkare tidigt i utvecklingsprocessen, och etablera effektiva kommunikationsstrategier för att påverka läkares acceptans av ny teknologi.

No description available.

This study is a secondary analysis of survey data collected in fall 2000 from patients of a safety-net hospital and its eight community health outreach clinics in Fort Worth, Texas. The study examined three objectives. These include explaining the utilization of Pap smear tests among the sample who were low-income women, by ascertaining the determinants of using these services. Using binary logistic regressions analyses primarily, the study tested 10 hypotheses. The main hypothesis tested the race/ethnicity/immigration status effect on Pap smear screening. The remaining hypotheses examined the effects of other independent/control variables on having a Pap smear. Results from the data provide support for the existence of a race/ethnicity/immigration status effect. Anglos were more likely to have had a Pap smear, followed by African Americans, Hispanic immigrants, and finally, by Hispanic Americans. The persistence of the race/ethnicity/immigration status effect, even when the effects of other independent/control variables are taken into account, may be explained by several factors. These include cultural differences between the different groups studied. The race/ethnicity/immigration status effect on Pap smear screening changed with the introduction of age, usual source of care, check-up for current pregnancy, and having multiple competing needs for food, clothing and housing into the models studied. Other variables, such as marital status, employment status and health insurance coverage had no statistically significant effects on Pap smear screening. The findings of this study are unique, probably due to the hospital-based sample who has regular access to subsidized health insurance from a publicly funded safety-net healthcare network and its healthcare providers. Given the importance of race/ethnicity/immigration status for preventive Pap smear screening, public education efforts to promote appropriate Pap smear tests among vulnerable populations should target specific race/ethnicity/immigration status groups in the U.S. within the cultural context of each group. Furthermore, publicly funded health programs for underserved populations such as the John Peter Smith Connections and Medicaid should be maintained and strengthened.