The purpose of the study was to learn more about the use or non use of the Papanicolaou Test (referred to hereafter as the Pap test) among a selected population of women on the Ball State University Campus.The author was concerned with the fact that, according to projections of the American Cancer Society, 12,000 women die each year of uterine cancer. Many of these deaths could have been avoided if women would have availed themselves yearly of a simple testing device known as the Pap test.After considerable research and discussions with Ball State University women of all ages, it was obvious that many women do not take advantage of this cancer detection device. It became this author's desire to discover why the Pap test is overlooked by so many women. Research pointed out several reasons for this phenomenon, namely: 1) length of time required for the test, 2) inability to afford the Pap test, 3) fear of the results and 4) lack of prior experience with the Pap test combined with a feeling of wellness. latter reason was summarized in the general statement: "Have never had the Pap test and I am fine, so why bother?".Also appearing in this research was the subtle hint that perhaps the medical profession itself was partly to blame for the nonuse of the test. Overworked physicians and understaffed laboratories were cited as possible reasons why doctors were not encouraging their patients to avail themselves of the Pap test.Previous studies on this subject have been conducted in lower socioeconomic populations in San Diego, California, and Baltimore, Maryland. The above named reasons for not having the yearly Pap test were the conclusions of these studies also. The author felt that a study of women representing a different segment of society possibly would be of help in this area of cancer research and control.A questionnaire was developed and distributed to the female residents in all the Ball State University married students' housing units. This selected group of women represented a fairly homogeneous population with an assumed similar type of background and education.A total of 670 questionnaires were distributed and 535 were completed and returned for an 80 per cent rate of response.Following are some of the significant results of the survey:83 per cent of the women had a complete physical examination within the last year.96 percent of the women had a Pap test within the last year.74 per cent of the women indicated their desire for a "clean bill of health" which prompted yearly Pap tests.89.9 per cent stated they were not afraid to learn the results of the Pap test.41 per cent of the women revealed that their first knowledge of the Pap test came through the news media.92 per cent of the women felt their husbands were more aware of the benefits of the Pap test than they themselves. The results of this study indicated that these women, as a group, were concerned about their health and were eager to seek out proper medical care in order to safeguard themselves.

Background Colorectal cancer (CRC) is one of the most common cancers with high morbidity and mortality among both genders and yet it carries a better prognosis when detected early. Colorectal cancer screening using faecal occult blood test (FOBT) is proven to be cost-effective, however worldwide FOBT uptake rate is suboptimal which directly affects the cost-effectiveness of the screening program. Identifying those factors that influence the uptake of colorectal cancer screening using FOBT will allow implementation of relevant measures when planning a population based screening program. Methods A structured electronic search using PubMed and Medline was conducted in order to identify studies that included factors influencing the uptake of CRC screening by using FOBT. Qualities of included studies were assessed by quality assessment checklist STROBE. Results Factors that contributed to the low uptake rate of CRC screening by FOBT were identified and summarized. They were broadly divided into 3 groups. Demographic factors: age, gender, social economic status, insurance status and education, for ethnicity, employment status and obesity further studies in the future may be needed. Subject factors: subject’s attitudes and knowledge towards CRC screening, type of FOBT screening, health concerned behavior, frequency of clinical visit and physiciancomment. Provider factors: health care system factor and physicians’ factors. Conclusion Different factors, in particular those factors that were associated with low FOBT uptake rate in CRC screening, were reviewed and summarized in this paper. With the continuous effort from worldwide as well as local investigators, timely measures can be implemented to tackle this deathly disease and to ensure cost effectiveness of a screening program. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

No description available.

published_or_final_version / Public Health / Master / Master of Public Health

Cervical cancer is the ninth leading cause of female cancer deaths in Hong Kong. In 2011, 391 new cases of cervical cancer were diagnosed and the age-standardized incidence rate was 7.2 per 100,000 standard populations. In 2012, 133 women died from this cancer, accounting for 2.5% of female cancer deaths. The age-standardized death rate of cervical cancer was 2.1 per 100,000 standard populations. Human papillomavirus (HPV) infection is an established cause of cervical cancer. HPV vaccines offer more than 70% protection for women against HPV types 16 and 18 infections and their related cervical precancerous lesions and cervical cancer. As there are usually no symptoms in high-risk HPV infection, it is often diagnosed at a late stage. Regular cervical smears can offer early detection of pathological changes and pre-cancerous stage for a timely medical treatment to prevent progression to cervical cancer. The Cervical Screening Programme (CSP) of Department of Health (DH) was launched on 8 March 2004. It is a voluntary program with the objectives to increase the population coverage of cervical screening among women and to reduce the incidence and mortality of cervical cancer in Hong Kong. Women participating in the programme are encouraged to have cervical smears in the medical centres of their own choices and to provide their cervical smear information through their health care providers to the central registry of the CSP - The Cervical Screening Information System (CSIS). As at 31 December 2013, 491,674 women have registered with CSP. When DH implemented CSP in March 2004, a report was published in the same year showing evidence that an organized screening compared with the opportunistic screening could substantially increase benefits and reduce costs. Another local study conducted early this year supported by the Health Services Research Fund also highlighted the importance and urgency in enhancing the current screening protocol. It is of public health interests to study and compare the programme outcomes with countries like Finland, Australia, UK and Japan where different policy was adopted for the prevention of cervical cancer. Information gathered from research papers on epidemiological studies has been collected and analyzed on population benefit (outcome, access, disparities), cost (cost benefit, efficiency, cost containment), equity, feasibility and constituency perspectives in formulation of the policy alternatives. In conclusion, strengthening what is already in place with better allocative efficiency could protect the female population against cervical cancer. From the education perspective, emphasis on the risk of HPV infection in the sex education curriculum would raise the awareness on the precaution of HPV infections amongst young females. Additionally, vaccination at the age of 12 can provide protection against most types of HPV. It is strongly recommended that a cervical screening and HPV co-testing strategy at a triennial interval could provide the best cost and benefit effectiveness. Together they can enhance protection coverage of women at 12 through immunization and from 25 - 64 through active population screening. The ultimate objectives to reduce incidence, mortality and increase coverage could be achieved. / published_or_final_version / Public Health / Master / Master of Public Health

This dissertation explores a diagnostic image analysis framework using multispectral digital colposcopy for real-time in vivo detection of cervical cancer. In the first part of the dissertation, the clinical feasibility of a previously developed multispectral digital colposcope (MDC) is demonstrated using a hamster cheek pouch model of carcinogenesis. Various studies on MDC applications to cervical cancer detection in human subjects are then presented. First, an automated diagnostic image analysis algorithm for cervical cancer using white light reflectance images is presented. The algorithm can identify pre-neoplastic tissue areas from an entire cervix based on intensity changes feature in the reflectance images induced by acetic acid treatment. Then, the information about tissue type is incorporated into the diagnostic image analysis framework. For this purpose, a Markov Random Field (MRF) model is adopted and the results are discussed. One of the practical difficulties of utilizing a MRF model in unpolarized white light reflectance imaging is the specular reflection problem since the effect of specular reflection extends into surrounding tissue areas. Through the use of cross polarized imaging, the effects of specular reflection reduced and the ability to segment images based on tissue types is enhanced, leading to better diagnostic performance. The diagnostic performance of polarized imaging is compared to that of unpolarized imaging. In order to assess the performance of the proposed approach, a gold standard for the entire cervical image is constructed using histopathology results from a whole cervix specimen. The results presented in this dissertation indicate that an automated diagnostic image analysis framework for early detection of cervical cancer has the potential to be clinically applied as a low cost alternative screening technique in developing countries. Advances in imaging technology as well as in image analysis algorithms will continue to reduce the cost of diagnostic imaging systems and improve the imaging and diagnostic capability, leading to an inexpensive, real-time, minimally-invasive alternative to conventional screening techniques for early detection of cervical cancer in developing countries. / text

No description available.

The short-lived PET radionuclide (^134)La(t(_1/2)=6.7 minutes) is well suited to the repeated evaluation of blood perfusion, thus providing a method of following changes in tumour behaviour, in response to therapy. Ligands, both acyclic and macrocyclic, have been synthesised, and the complexes formed with (^134)La(^3+) evaluated in vitro and in vivo. Other lanthanide complexes have also been evaluated for potential use in magnetic resonance imaging and photoimmunoassay studies. A preliminary crystal structure determination of a lanthanum tetrabenzylphosphinate complex reveals the presence of one water molecule in the inner co-ordination sphere. The development of monoclonal antibodies with a specificity for the surface features of tumour cells presents a method for the localisation of a radionuclide at the tumour. Copper-64 (t(_1/2)=12.7 hours) uniquely combines the decay properties required for imaging and therapy. Ligands have been developed for derivatising antibody molecules with radioactive copper, whilst retaining specificity for the target antigen. Three modified proteins have been evaluated in vivo, and show a high tumour uptake compared with blood, but modest uptake compared with the liver, suggestive of some degree of protein denaturation during labelling. A more subtle approach has been developed, exploiting the affinity of biotin for avidin. Higher selectivity at much shorter post-administration time is potentially attainable by the use of a multi-step procedure. A copper binding ligand incorporating biotin has been synthesised. The (^64)Cu complex of the conjugate shows specificity for the protein avidin both in vitro and in vivo. The prognosis of patients with hepatoma or liver metastases is poor. A lipophilic copper complex has been synthesised and retention in the liver demonstrated in vivo. Measurements with three cell lines in vitro suggest that the complex is more readily taken up by tumour cells (and cells from metastases) compared to normal cells.