A Dissertation submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, to fulfil the requirement to acquire a degree of Master of Science in Medicine Johannesburg 30 September 2014 / Background In South Africa cervical cancer has an age standardised incidence rate of 23 per 100 000 in women below the age of 35 and 76 per 100 000 amongst women over 35. The National Department of Health (NDoH) introduced the national cervical cancer screening policy guidelines in 2000, with the aim to screen 70% of women aged between 30 and 59 over a 10-year period. Health managers at provincial and district level were expected to implement this policy at their respective levels. Research has shown that implementing national health policies is often challenging due to management weaknesses, including the lack of guidelines or tools on how managers should plan and allocate budget for services. Aim The aim of this study is to develop and test an approach to planning and budgeting that would assist health managers to follow a rational process to plan and estimate budget requirements for implementing the cervical cancer screening policy at subnational level. Method This study was conducted in three districts in South Africa. The study was conducted in four phases. A situational analysis of budgeting practices was conducted in the first phase, to describe existing planning and budget allocation practices for cervical cancer screening programmes in the study sites and identify any existing gaps. The process requirements for implementing a cervical cancer screening programme were then identified prospectively in the second phase. Informed by the situation analysis and the process requirements, a computer-based planning and budget estimation program was developed in the third phase and tested through interviews with key informants in the fourth phase of the study. Results The situational analysis revealed a lack of involvement of interviewed programme managers at all the levels, in planning and budgeting for implementing cervical cancer screening programmes. The participants’ descriptions of budget allocation processes indicated that there was no defined process for allocating budget to services and the allocations were not specifically informed by assessed programme needs in their respective areas of jurisdiction. Process requirements for cervical screening were identified and documented for the following aspects of a cervical screening programme: calculating target population to inform planning for service provision, staff and equipment audits, equipment and supplies, material required for systems functioning (e.g., tools, forms, guidelines), transport and communication systems, community information education and communication (IEC) strategies, staff training, laboratory services and services for the treatment of High grade Squamous Intraepithelial Lesions (HSIL). A computerbased planning and budget estimation program, which could enable managers to define and quantify resources needed to implement a cervical screening programme was developed, informed by the documented process requirements. The testing of the computerised planning and budget estimation program indicated that the program could improve planning and help managers to estimate budget requirements for implementing cervical screening. Respondents indicated that the program was relatively easy to use and also felt that it could potentially be useful for programme planning as follows: a) it could serve as a tool for programme needs assessment, b) it could facilitate rational budget estimations, c) managers could use it as a bottom-up tool to motivate for resources, and d) managers could use it to refute inadequate budget allocations where possible. Conclusion The findings of the situational analysis support existing literature in revealing very little if any change in relation to inherent challenges in implementing cervical cancer screening services in South Africa. The findings of this study are relevant for public health programme planning and budgeting beyond cervical screening. Since managers at sub-national level are delegated to implement policy, it is imperative that they are provided with tools that may guide them to plan and budget for services on the basis of needs in their areas of jurisdiction. This study provides one such tool.

Introduction: Ionising radiation can cause DNA double strand breaks (DSB), that result in chromosomal aberrations if un- or mis-repaired. Individuals with compromised DNA damage repair mechanisms display increased chromosomal radiosensitivity. The G0-micronucleus assay (MN assay) and the γ-H2AX assay are two assays used in radiobiology to study DNA DSB and repair. Breast cancer is the leading cancer amongst South African women, with a lifetime risk of 1 in 34. Since most cancer patients in South Africa present with late-stage disease, chemotherapy and radiotherapy are commonly-used treatments. Several international studies have shown breast cancer patients to be more chromosomally radiosensitive than healthy controls. These studies have not been confirmed on a cancer population living in South Africa. Cervical cancer is the second most common cancer in South Africa; however, it is the leading cancer amongst black women with a lifetime risk of 1/35 compared to 1/82 in white women. Studies show a genetic link to cervical cancer susceptibility and DNA damage repair genes. International studies on radiation-induced DNA damage in lymphocytes of cervical cancer patients remain inconclusive and have never been performed on a South African population. Cervical cancer is caused by infection with the Human Papilloma Virus (HPV). Human Immunodeficiency Virus (HIV), HPV and cervical cancer are epidemiologically linked. Due to the high rate of HIV in South Africa, a significant proportion of cervical cancer patients receiving radiotherapy treatment will be HIV-positive. Studies show an effect of HIV on chromosomal radiosensitivity, however this has not been confirmed on a cancer population. The MN assay on the biopsies and exfoliated cervical cells of cervical cancer

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Univ., 2004. / Härtill 4 uppsatser.

Thesis (Ph.D. (Microbiology))--Mahidol University, 1978.

No description available.

Invasive carcinoma of the cervix was compared in women under and over 35 years of age in a 10-year cohort study for the period 1974 - 1983. The aim was to determine if there were any significant differences in disease characteristics and survival. A non-concurrent prospective study design was employed with a follow-up period of at past 5 years. All eligible young patients (n = 82) were studied out of a total patient population of 1522 and compared with a 13% random sample (n = 82) of equally eligible older patients. There were three study losses in each group (3,7%), giving a final comparison number of 79. Patient data included disease stage, treatment type and complications, recurrence time and site and survival time. Tumour pathological characteristics were reviewed and evidence of Human Papillomavirus (HPV) was sought on histology and cytology specimens. Life table analyses were performed on the survival data and compared by the logrank test. The covariates of disease stage, treatment type and tumour type were included in the analysis of the effect of age group on survival. Multivariate analysis with a proportional hazards general linear model was performed for simultaneous control of confounding factors. Other disease characteristics were compared using the Chi-square test. The overall proportion of young women was 11,6%. (This did not change for the period 1984 1988.) Five-year survival was 57% for the young and 46% for the older group (not statistically significant: p = 0,198). There was no statistically significant difference in a number of characteristics, including tumour size, endocervical site, grade or type. There were 8 non-squamous tumours in the young {10%). Residual disease, time to recurrence, rate and site of distant metastasis, and treatment of recurrent tumour did not differ significantly; nor did rate of spread to lymph nodes, adequacy of follow-up or treatment complications. Evidence of HPV was found in 35% of evaluable histology and 21% of malignant cytology. There was no significant excess of HPV in the young group. The same applied to the length of the preinvasive phase and the false negative cytology rate - no significant differences were found. There were significantly more Stage lB tumours in the young group (p = 0,01), surgery was used more often for treatment in young patients (p = 0,027) and the difference in survival between the disease stages was highly significant (p 0,0001). Multivariate analysis showed that the effect of age on survival was non-significant (p = 0,850). The conclusion of the study is that cervical carcinoma in young women is not a different disease with a worse prognosis than in older women. Furthermore, it is not becoming more common in the young locally. Young women tend more often to have early stage disease.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Universidade Federal do Cearà / à fato que a problemÃtica relacionada ao nÃo retorno das mulheres para receber o resultado do exame preventivo tem causas multifatoriais, no entanto, partimos do pressuposto que a educaÃÃo perpassa todas essas Ãreas e que se realizada de forma dialÃgica e reflexiva levarà Ãs mulheres da passividade à criticidade, de forma a serem sujeitos no processo de adoÃÃo de comportamentos saudÃveis e busca pela melhoria dos serviÃos de prevenÃÃo do CCU. Este trabalho trata-se de um estudo experimental randomizado, cujo objetivo foi avaliar os efeitos de uma intervenÃÃo educativa sobre o exame de Papanicolaou em relaÃÃo à adesÃo das mulheres à consulta de retorno para receber o resultado. O local selecionado para realizaÃÃo do estudo foi o Centro de SaÃde da FamÃlia (CESAF) AÃda Santos e Silva, situado no bairro Vicente Pinzon, em uma Ãrea da periferia da cidade de Fortaleza-CE. A populaÃÃo do estudo foi composta pelas mulheres que realizaram o exame de prevenÃÃo do CCU no referido CESAF. A coleta de dados aconteceu no perÃodo de fevereiro a julho de 2008, sendo realizada em trÃs etapas para o grupo de intervenÃÃo (inquÃrito CAP, intervenÃÃo educativa e consulta de retorno), e em duas etapas para o grupo controle (inquÃrito CAP e consulta de retorno). Os dados foram compilados e analisados atravÃs do programa estatÃstico Statistical Package for the Social Sciences (SPSS) versÃo 13.0. Para todas as anÃlises, um valor de p <0,05 foi considerado estatisticamente significativo. Durante a pesquisa foram realizados 261 inquÃritos CAP (150 do grupo intervenÃÃo e 111 do grupo controle). No entanto, foram excluÃdas do estudo, 11 mulheres (09 do grupo intervenÃÃo e 02 do grupo controle) por nÃo terem realizado o exame de Papanicolaou, o que totalizou uma amostra de 250 mulheres (141 do grupo intervenÃÃo e 109 do grupo controle). Quanto ao conhecimento sobre o Papanicolaou, apenas 40,4% foram classificadas com conhecimento adequado. Em relaÃÃo à atitude e prÃtica das mulheres frente ao exame, o percentual de adequaÃÃo foi de 28% e 67,6% respectivamente. Das 230 (92%) mulheres que retornaram para a consulta no presente estudo, 173 (75,2%) compareceram na data aprazada e 57 (24,8%) apÃs a data aprazada. Esses dados sÃo relevantes, na medida em que permitem afirmar que somente o fato de ter consulta de retorno, como no caso do grupo controle (n = 110), a taxa de exames retidos na instituiÃÃo caiu de 23,98% para 10,0%. Quando se associou a consulta de retorno à intervenÃÃo educativa (grupo intervenÃÃo/n = 140), essa taxa baixou para 6,4%. A aplicaÃÃo da estratÃgia elaborada durante esta pesquisa demonstrou sua efetividade, na medida em que despertou o interesse das mulheres, mesmo as que eram do grupo controle, em participar da intervenÃÃo educativa e em debater sobre a problemÃtica em questÃo. A eficÃcia da intervenÃÃo educativa aplicada durante o estudo pode ser comprovada atravÃs da diminuiÃÃo da taxa de nÃo retorno à unidade de aproximadamente 24% para 6%. NÃo houve diferenÃa estatisticamente significativa entre as taxas de nÃo retorno dos grupos controle e intervenÃÃo. O resultado desta pesquisa demonstrou que à primordial a garantia de consulta de retorno Ãs mulheres que realizam o exame de Papanicolaou em um dia normatizado pela instituiÃÃo, com flexibilidade no atendimento Ãs mulheres que nÃo comparecem na data aprazada, para diminuir as taxas de nÃo retorno. AlÃm disso, quando associada a garantia de consulta de retorno à utilizaÃÃo da intervenÃÃo educativa sugerida nesta pesquisa, a taxa de nÃo retorno à bem menor, assim pode-se garantir serviÃo de qualidade na prevenÃÃo e controle do cÃncer cÃrvico-uterino