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Background: Cervical cancer is a leading cause of death in Tanzanian women, with annual age-standardized mortality of 38 per 100,000. While organized screening programs have minimized cervical cancer rates in the developed world, a national prevention program has not yet been instituted in Tanzania. Though screening is available at clinics in the Kilimanjaro region, uptake of these services is reported to be low. The objectives of this thesis were: 1) to describe the knowledge, attitudes and practices of cervical cancer screening in rural and urban Kilimanjaro women, 2) to determine the main barriers preventing women from being screened, and 3) to identify important determinants of screening status and screening acceptability in the population. Methods: A cross-sectional survey was administered to 312 rural and 280 urban women in the region over June-July 2012. The sample was obtained through a multistage random sampling strategy. Descriptive statistics were performed to address Objectives 1 and 2, while multivariate logistic regression models were created using generalized estimating equations to address Objective 3. Results: Awareness of cervical cancer in the sample was high, but women had less knowledge of screening tests for the disease. The proportion of ever-screened women was significantly lower in the rural (4%) than in the urban (8%) sample. The most common barrier in never-screened women was not knowing that screening existed, followed by anticipated cost of the procedure. Travel distance was a more frequent concern in rural women. Older age, being married, cervical cancer knowledge and healthcare access factors were significantly associated with screening status in urban women, while only older age and condom use were associated in rural women. Personal beliefs about risk were associated with screening acceptability in never-screened women. Willingness to be screened was low in urban women with high socioeconomic status. Conclusions: Participation in cervical screening is extremely low in the Kilimanjaro region due to both access-related and personal barriers. While Tanzania awaits a national screening program, the identified determinants may inform regional screening and education initiatives aimed at increasing screening coverage in the Kilimanjaro area. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-09-30 14:24:36.139

This investigation is concerned, with the problem of the normative constraints upon scientific research within the broad theoretical framework of the sociology of knowledge, i.e., the contention that knowledge is functionally related to the social system. The concepts "knowledge" and "Social system" are open to wide interpretation; however, in this study knowledge refers to an empirically verifiable variable and the social system is synonomous with the normative system.

MSc(Med), Epidemiology and Biostatistics, Faculty of Health Sciences, 2009 / Background: Soul City Institute for Health and Development Communication (SC IHDC), a Non Governmental Organisation (NGO) set up to promote health through media tackled cervical cancer in 2006. The Soul City cervical cancer educational programme was developed and broadcasted on South African Broadcasting Cooperation (SABC1) television and radio stations across the country. This paper assesses the relationship between exposure to educational programme and knowledge and practise of South African women on cervical cancer. Objective: To investigate if there is an association between exposure to Soul City educational programme on cervical cancer and knowledge and practice of South African women in relation to cervical cancer. Methods: An analytical cross sectional study design was employed. Secondary data from a Soul City study was used and all South African women aged 16 – 65 years who enrolled into the 2006 leg of the study were included. The data was analysed using Stata 9 utilising logistic regression models. Results: There were 1013 women aged between 16 and 65 years in this study and the average age was 35 years. Most women lived in metropolitan areas (53%), were employed (41%), had secondary education (74%) and had knowledge about cervical cancer and Pap smear (>50%). Lack of knowledge about cervical cancer and Pap smear was observed amongst rural residents (>60%), illiterate women (>54%), and Black South African women (>54%). Generally, participation in cervical screening was low among these women. The iv majority of women had never been screened for cervical cancer in the past (49%) as well as in the previous 12 months (79%). However, a higher proportion of women aged 30 years and above had been for cervical screening test in the past (59%). Although many women aged 30 years and above had been screened sometime in the past, more than three quarters of them were not screened in the last 12 months. Low uptake of Pap smear in 2006 was observed amongst rural residents (6%), older women (9%), illiterate (4%), Coloured (20%) and Black (20%) South African women. Overall knowledge about cervical cancer and Pap smear was associated with exposure to Soul City educational programme on cervical cancer through different media more especially television. Women who watched Soul City on television were more likely to have knowledge about cervical cancer (OR = 1.97, and 95% CI = (1.12; 3.47)) and Pap smear (OR = 2.08, and 95% CI = (1.24; 3.47)) than those who did not watch the programme. Participation of women aged 30 years and above in cervical cancer screening in 2006 was not associated with exposure to the Soul City educational programme. Conclusion: The study findings suggest that Soul City educational programme is associated with knowledge about cervical cancer and Pap smear. There was no evidence that exposure to Soul City educational programme was associated with participation in cervical cancer screening in 2006.

Objective: To detect the most prevalent human papillomavirus (HPV) genotypes samples of asymptomatic Peruvian women by analyzing the correlation betwe ienn c Pearvpiacnailc somlaeoaur (PAP)-stained cervical tests and PCR-sequencing. Methods: A total of 254 women attending routine gynecological examinations were included in pthaitsh ostluogdiys.t Tahned scalmaspsliefise dw ebrye tahnea Blyeztehde sbdya PsAysPt etmec.h HnPiqVu ea manpdli feicxaatmioinn ewda su nddoenre au msinicgr othsceo pprei mbeyr as specific for E1 region and positive specimens were confirmed by direct sequencing. Results: The prevalence of HPV was investigated in 254 cervical scrape samples by PCR. PAP smear showed that 94.9% cases had normal morphology and 5.1% had an inflammatory pattern; 2p0r.e5v%a lwenert eg efonuontydp teo ibne c ionrfreeclatetido nw iwthit hH PchVa, ncgoems pinri scienrgv i2c0a dl icfyfetorelongt yg.enotypes. HPV16 was the most Conclusions: Our results suggest the HPV is very frequent even in women with negative PAP, eannddo PceCrRvi csaele smasm tpol ebs.e Itdheen tbifeicsat toiopnt ioofn t htoe HdePtVe rgmeinnoety tphee inc aaussyamtipvteo magateinc tw oofm HePnV m ianyf eaclltoiown t hine nimatpulreaml henisttaotriyo no fo tfh ea pdpisroepasreia aten dp rthope hsyulbascetqicu emnet adseuvreelso pwmheicnht omf acye rhviacvael ma adliirgencatn icmy.pact / jdelvall@upc.edu.pe / This work has been partially supported by Universidad Peruana de Ciencias Aplicadas (UPC), Instituto de Investigación Nutricional and Instituto de Investigación de Efrnomfe rtmheed pardoegsr aImnf ecciosas, Lima, Peru. JR has a fellowship I3, of the ISCIII (Grant No. CES11/012), and LJDV from the Generalitat de Catalunya (2009SGR1208). / Revisión por pares

Thesis(MSc(Med)Pharmacy)) -- University of Limpopo, 2011. / ABSTRACT Introduction: Non-invasive detection of tumour hypoxia theoretically adds value to the. outcome of treatment; however the practical aspect of using 99mTc-EC-MN in cervical cancer remains un-attempted. 99mTc-EC-MN has been used to indirectly detect hypoxia in many tumours (head and neck) and other hypoxic states such as strokes and MI. This study aims to determine the value of using this tracer in early stage cervical cancer. Objectives: This study aimed to investigate the use of 99mTc-EC-MN to determine the degree of hypoxia in cervical cancer. The original study design was to determine whether SPECT with 99mTc-EC-MN would detect ~l'poxi~cervicalc;ancer 'lesions and compare the results with the histological report. The practice of safe handling of radiopharmaceuticals and gaining knowledge in conducting research formed part of the secondary objective of the study. Due to circumstances beyond the control of the researcher, the focus of the study changed from a clinical to a chemistry-based project. Method development: Safety of EC-MN was tested through determination of the labelling efficiency with pertechnetate initially by ITLC-SG. Ethyl acetate, ethanol, saline and ac;etone were selected to develop 99mTc-EC-MN chromatograms to identify the system which best displays separation. Radio-ITLC displayed multiple peaks due to high residual activity in ethyl acetate- and acetone-developed scans. Saline- and ethanol-developed scans showed better separation of 99mTc-EC-MN but separation from free pertechnetate was difficult. Radio HPLC coupled with a diode array detector was used to successfully separate the labelled product, 99mTc-EC-MN from free pertechnetate, thereby achieving good radiolabelling. Clinical application: After the relative safety of the product was established, it was injected IV in the selected patient who had early stage cervical carcinoma. Clinical examinations which included pre-operative WBC, ultrasonography of the kidneys and bladder, and chest x-rays were performed. Histological analysis was performed after surgery and gave results that were insufficient to conclude the absence or the presence of tumour hypoxia. Detection of 99mTc-EC-MN was analysed from blood-flow and -pool images, thyroid and pelvic static, SPECT, and WBS images obtained from a gamma scintillation camera. Faint hot spots consistent with low levels of free pertechnetate were detected in the salivary glands. Hot areas which paralleled the bio-distribution of the 99mTc-EC-MN were also detected in the thyroid, liver, intestines, kidneys, and bladder. There was no tracer detection in the pelvic area. Conclusions: Experience was gained in QC procedures and aseptic preparation of radiopharmaceuticals, and in conducting and co-managing a chemical and clinical based research. Radiochemically related findings demonstrated that tin (II) chloride can be solubilised in water; 99mTc-EC-MN migrates with the solvent front in saline and ethanol developed ITLSG scans; and ITLC cannot sufficiently separate 99mTc-EC-MN from free pertechnetate. Successful labelling of EC-MN was confirmed by scintigraphy and showed tracer distribution that parallels those previously described. Successful labelling of EC-MN with 99mTc can be achieved up to two years after kit manufacture given appropriate storage conditions for the EC-MN. The hypoxic status of the tumour remained inconclusive; therefore the prognostic impact of 99mTc-EC-MN in cervical cancer remains unknown. Recommendations: Product stability and potential expiry should be available for all products, even in the developmental stages and particularly for clinical trials. A simple QC method to separate 99mTc-EC-MN from free pertechnetate should be developed. Further studies are required in order to confirm the efficacy of 99mTc-EC-NM in determining tumour hypoxia in cervical cancer. If a suitable animal model is not available, patients with known cancer tissue hypoxia should be evaluated and compared with those who are non-hypoxic

Cervical cancer is the second most common malignancy worldwide. Infection with HPV is a necessary cause of cervical. Hispanic women in the U.S. experience significantly higher rates of invasive disease than non-Hispanic Whites. In this population, HPV vaccines hold significant potential to eliminate further disparities in cervical cancer morbidity and mortality. The purpose of this study was to examine factors associated with Human Papillomavirus (HPV) vaccine acceptability among a national sample of Spanish speaking callers to the National Cancer Institute's (NCI) Cancer Information Service (CIS). Specifically this research aimed to identify the sociodemographic, sociocultural and attitudinal determinants of HPV vaccine acceptability. This research involved a cross-sectional study with phone-based interviews conducted in Spanish (n = 836). All female Spanish callers to the CIS were asked to respond to a three-part questionnaire that included items relating to ethnic identity and acculturation, knowledge of cervical cancer and related risk factors, and HPV vaccine acceptability. Descriptive, univariate and multivariate logistic regression were used to characterize the study population and to determine the effect of each of the demographic/sociocultural variables on vaccine acceptance. Independent predictors of HPV vaccine acceptability were determined using multivariate linear regression models. Results showed that HPV vaccine acceptance was high among this group of Hispanic women (78%) and that attitudes about vaccines in general and the HPV vaccine specifically were positive. Factors associated with vaccine acceptance included physician recommendation, awareness and accurate knowledge about HPV, and speaking only or mostly Spanish. Other important predictors included influence of peers, positive attitudes about vaccines in general, higher education and being a mother of a female adolescent. The primary reason cited by those who did not favor vaccination was concern over vaccine safety. This research was the first study looking at vaccine acceptability in a large, national sample of Hispanic women. HPV vaccination can lead to important public health benefits for Hispanic women. Targeted educational interventions must take into account the important sociocultural and attitudinal influences on the decision to vaccinate, such as those identified in the present study. Future educational efforts must involve the physician and take into the account the cultural context of attitudes and beliefs regarding vaccine safety and disease susceptibility. Further studies elucidating the interplay between culture specific beliefs and practices regarding vaccination and the decision to participate in HPV vaccination are needed.

Abstract Introduction: "Pap smear" was first proposed in 1928 by Dr. Papanicolaou in USA as a screening test for cervical cancer. In most developed, higher-educated country,the majority of the female population receive regular Pap smear, and hence the incidence of invasive or late stage cervical cancer is relative low. In contrast, in those developing,or under-developed country ,the percentage of women receiving regular Pap smear is lower, and cervical neoplasm is more often diagnosed in the invasive or even later stage.General speaking,the incidence of invasive cervical cancer in a country may be recognized as a relative indicator for the quality of public health care. The higher the percentage of women receiving regular Pap smear is ,the lower the incidence of invasive cervical cancer. In Taiwan, the annual incidence of newly-diagnosed invasive cervical cancer remains high, and cervical cancer stand as the top one of the most lethal female cancer. In theory,since the incubation period from the pre-cancer stage(cervical intraepithelial neoplasm) to frank malignancy in cervix is rather long, allowing adequate opportunity and timing for Pap smear screening, more cervical neoplasm may be diagnosed and treated in the pre-cancer stage, and hence lower the incidence of cancer death from treatment failure. Disappointingly, even being a major program of public health care, and being supported by national institute, the Pap smear rate in Taiwan is far from ideal. We try to find out the causes of low Pap smear rate via analyzing the pattern and availability of health care, medical knowledge, and attitude of those cervical cancer patients. These factors may be of benefit to promote modifying public health program, and thus increase the receptivity and popularity of regular Pap smear in general population. Material and method: This is a retrospective study, focusing on the cervical cancer patients (including carcinoma in situ and invasive cancer of cervix), which were confirmed pathologically and treated successfully in a single hospital in the recent 3 years. Totally, 155 cases were enrolled. All these patients were interviewed face to face, and data were collected (focusing on basic data and the possible factors influencing Pap smear rate) according to a fixed form. SPSS for Windows Ver. 10.0 was used for data analysis. Percentage, distribution was used for descriptive statistics. Cross table analysis, chi-square test, and logistic regression analysis were used for comparing group difference. Results: The data analysis revealed: 1)Most cervical cancer patients didn¡¦t receive regular annual Pap smear 2)Most cervical cancer patients didn¡¦t realize the importance of regular Pap smear before 3)Though some of the cervical cancer patients did have the concept and importance of regular screening, they didn¡¦t receive regular annual Pap smear 4)Invasive cancer rate was higher than CIS rate in this study group 5)The government public health program ¡§¤»¤ÀÄÁÅ@ ¤@¥Í¡¨ (¡§only 6 min, and away from threat of cervical cancer¡¨) seemed to have no major effect in those Taiwanese-speaking, older, and less-educational subpopulation 6)The government public health program ¡§¤»¤ÀÄÁÅ@ ¤@¥Í¡¨ (¡§only 6 min, and away from threat of cervical cancer¡¨) seemed to be insufficient for promoting active participating of the Pap smear program in general population Conclusion: Despite the effort from government health institute, Pap smear rate remained far from ideal in Taiwan, leaving many cases of cervical neoplasm diagnosed and treated in the later and advanced stage. From the result of this study, we can see that some sub-population was prone to be missed in the health care program. The major lithotomy include poor knowledge (¡§language barrier¡¨), naive, wrong attitude (fear and shame of facing health provider under lithotomy position for Pap smear). There¡¦s still much to do to increase the Pap smear rate. The knowledge about cervical cancer and the importance of the Pap smear screening can never be over-emphasized. The education and the resource information should be provided via multiple pathways, including Internet source, regular seminars, or pronouncement in the TV, radio or magazines. The first-line health providers (local doctors, nurses, or even social workers) should be well-trained. The public education should be started right from lithotomy which is the important time point in cervical cancer carcinogen sis (HPV infection and integration). For those with lower socio-economic status, and those in urban area, the Pap smear may be promoted by way of free charge (financial support from national health institute), or packed with other general health examination program. The whole health-care system should be integrated well, and function well, to raise the Pap smear rate in our country. We hope that through the routine screening program, the incidence of invasive cervical cancer can be lowered, shifting most of the cases in the pre-cancer or in situ stage, and can be treated effectively