published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M. Tech.) -- Central University of Technology, Free State, 2007

published_or_final_version / abstract / toc / Obstetrics and Gynaecology / Master / Master of Philosophy

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

A mini-dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Nursing, Technikon Natal, 2002. / Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme. / M

Au Yeung Chi Lam. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 204-221). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Orientador: Christiane Pienna Soares / Coorientador: André Gonzaga dos Santos / Coorientador: Valéria Valente / Banca: Raquel Alves dos Santos / Banca: Marlus Chorilli / Resumo: Atualmente, o câncer cervical é considerado o terceiro tumor mais frequente nas mulheres do Brasil e o seu desenvolvimento, na maioria dos casos, esta relacionado com o Papilomavírus Humano (HPV). Frente ao exposto, tornam-se necessários à busca por tratamentos alternativos no combate do câncer cervical a partir dos produtos naturais, como a cordialina A, isolada da planta Cordia verbenacea DC. A cordialina A possui forte atividade antineoplásica, como também insolubilidade em meio aquoso. Dessa forma, os Sistemas Nanoemulsionados Lipídicos (SNL) têm sido explorados como ferramentas para aumentar a solubilidade de bioativos poucos polares em meio aquoso, como também aumentar a sua eficácia terapêutica. Assim, o presente estudo teve por objetivo avaliar, in vitro, a atividade antineoplásica e os mecanismos de morte celular promovidos pela cordialina A, encapsulada e não encapsulada no SNL, nas linhagens celulares de câncer de colo uterino HPV-16 (SiHa), de HPV negativo (C-33A) e de queratinócitos humanos normais (HaCaT). Para a formulação do SNL foi acrescido de colesterol, tampão fosfato e sistema tensoativo composto por polioxietileno 20-cetil éter e Fosfatidilcolina de Soja (FS). O diâmetro de partícula encontrado nas formulações foi de 159,53 ± 8,0444 nm e 107 ± 0,3333 nm, o índice de polidispersão (PDI) médio foi de 0,38 ± 0,0466 e 0,214 ± 0,0126 e o potencial zeta foi de -16,83 ± 3,15 mV e -20,16 ± 1,68 mV para SNL e cordialina A + SNL, respectivamente. As fotomicrografi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Currently, cervical cancer is considered the third most frequent tumor in Brazilian women and its development, in most cases, is related to Human Papillomavirus (HPV). In view of the above, they are necessary to search for alternative treatments in the fight against cervical cancer from natural products, such as cordialina A, isolated from the Cordia verbenacea DC plant. The cordialina A has strong antineoplastic activity, as well as insolubility in aqueous medium. Thus, Lipid Nanoemulsion Systems (SNL) have been explored as tools to increase the solubility of a few polar bioactive in aqueous medium, as well as to increase its therapeutic efficacy. The aim of the present study was to evaluate in vitro the antineoplastic activity and mechanisms of cell death promoted by cordialin A, encapsulated and non-encapsulated in the SNL, in cervical cancer cell lines HPV-16 (SiHa) of HPV negative (C-33A) and normal human keratinocytes (HaCaT). For the formulation of the SNL was added cholesterol, phosphate buffer and surfactant system composed of polyoxyethylene 20-cetyl ether and Soy Phosphatidylcholine (FS). The particle diameter found in the formulations was 159.53 ± 8.0444 nm and 107 ± 0.3333 nm, the average polydispersion index (PDI) was 0.38 ± 0.0466 and 0.214 ± 0.0126 and the zeta potential was -16.83 ± 3.15 mV and -20.16 ± 1.68 mV for SNL and A + SNL, respectively. The photomicrographs... (Complete abstract click electronic access below) / Mestre

A model was developed in this study to understand women's cervical screening behaviour. It revealed that the interaction among institutional factors, risk appraisal, coping appraisal, and health beliefs and cultural factors contributed to the complex nature of screening behaviour among Chinese women. The institutional component provided the contextual factors within which women perceived the risk of cervical cancer, perceived the practice of cervical screening, and decided to take or not to take cervical screening. Risk appraisal provided the premise factor that induces women to seek coping strategies to reduce or remove the risk. During the process of coping appraisal, women's motivation to have cervical screening could be increased or decreased as the perceived benefits and costs of screening interacted with each other. The importance of the women's health beliefs and cultural factors was reflected in the way that they were affected by their notions of health behaviour and their cultural beliefs about cervical cancer risk and cervical screening participation. Commitment to participate in screening was a reinforcing factor inducing women to take up an offer of cervical screening. / Aim: To explore the knowledge and the perception of the risk of cervical cancer, identify the factors determining cervical screening behaviour, and develop a model to understand cervical screening behaviour among women in mainland China. / Background: Cervical cancer is the most common type of cancer, and is the second most common cause of cancer death in women in mainland China. Cervical screening is the most important intervention for the secondary prevention of cervical cancer. Theories of health behaviour and empirical research highlight risk perception as a significant factor motivating people to opt for cancer screening. However, little is known about the risk perception of cervical cancer and the factors influencing the screening participation of women in mainland China. / Conclusion: This study provides evidence of the complex factors influencing cervical screening behaviour and contributes new knowledge to the understanding of cervical screening behaviour within the Chinese cultural context. It further informs programmes for the promotion of cervical screening among this population. / Methods: A mixed method design consisting of two phases was used, employing both quantitative and qualitative methods of data collection. First, a cross-sectional survey was conducted to collect a baseline assessment of women's knowledge of cervical cancer and screening, their perceptions of the risk of cervical cancer, and the relationship between these factors and their cervical screening behaviour. Findings from this phase also guided the purposive sampling of participants in phase two. / Results: The findings from phase one demonstrated that the availability of an organized screening programme was a major motivator for women to opt for cervical screening. Multivariate analysis shows that having children (OR=2.57, p=0.026), a perception that visiting doctors regularly is important for health (OR-2.66, p=0.025), average (OR-4.84, 1)=0.006) and high levels of knowledge about cervical screening (OR-9.66, p=0.001) were significantly associated with having been screened in the previous three years. / Then in phase two, qualitative research was conducted using semi-structured interviews of 27 women, 16 of whom had been screened and 11 had not. The interview structure was based on an initial analysis of the data from phase one and from a review of the related literature. The data from the interviews were analyzed using latent content analysis, involving an interpretative reading of the symbolism underlying the surface structure in the text. The audio recordings of the interviews were transcribed verbatim in Chinese, and then the key phrases which were important for the objectives of the study were identified. The key phrases and words were grouped according to their commonality of meaning. Then, these groups of data were sorted and classified to create categories and sub-categories, which were mutually exclusive, explicit and accurate without overlapping. / Two themes emerged from the qualitative data from phase two. Theme I was that perceptions of cervical cancer and cervical screening included five categories: the perceived effects of suffering from cervical cancer; the perception of cervical screening; a lack of understanding about cervical cancer and screening; the perceived risk of cervical cancer; and factors related to the cultural beliefs system. Theme II was that the institutional and health care practitioner system included two categories: availability of an organised physical examination programme and the role of the health care practitioner in encouraging cervical screening utilization. / Gu, Can. / Adviser: Chan, Carmen. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 244-267). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Cervical cancer is the third leading cause of cancer death in women worldwide. Although cervical cancer is commonly infected with human papillomavirus (HPV), HPV infection alone is insufficient to induce malignant changes. Many characteristic genetic and epigenetic alterations have been identified in invasive cervical carcinomas but relatively little is known about the specific genetic and molecular alterations that allow pre-invasive epithelial cells to acquire the ability to progress to invasive squamous cell carcinomas. Recently, a family of small non-coding RNAs termed microRNAs (miRNAs) with specific inhibitory functions on target gene expression has been suggested to play an important role in the pathogenesis of human cancers including lung and breast cancer but remain undefined in cervical cancer. / Genome wide chromosomal copy number changes in cervical cancer by Agilent high-density array Comparative Genomic Hybridization demonstrated that only a very limited number of genomic imbalances have an impact on the miRNA profile in cervical cancer cells, although a high proportion of genomic loci containing miRNA genes exhibited DNA copy number alterations in other cancers. The impact of the genomic aberration on their mRNA expression was then confirmed by Aligent Whole Human Genome gene expression array. This suggests that the regulation of miRNA and mRNA expression may be different in cervical cancer. / In conclusion, our global miRNA profiling identified the common differentially expressed and genomic aberration independent miRNAs in cervical cancer. We further revealed the inhibition of hsa-miR-182 reduced tumor cell growth in vitro and in vivo through apoptosis and cell cycle mechanism. This provides new evidence that hsa-miR-182 may contribute to the pathogenesis of cervical cancer. / Keywords. MicroRNA, Cervical Cancer, Tumor Growth / To identify microRNA(s) associated with the tumorigenesis of cervical cancer, we firstly used the TaqMan MicroRNA Assays to survey and quantify a panel of 157 known human miRNAs in cervical cancer cell fines and micro-dissected normal cervical epithelium cells. We identified 2 microRNAs that were differentially up-regulated (fold change > 2, p < 0.05) and 9 differentially down-regulated (fold change > 2, p < 0.05) in cervical cancer cell lines comparing with normal cervical epithelium. Further investigation in tumor samples confirmed these two up-regulated miRNAs (hsa-miR-182 and -183 ) and 3 down-regulated miRNA (hsa-miR-145, 150, 195) from 4 investigated downregulated miRNAs (hsa-miR-145, 150, 195 and 328). / To investigate the biological function of those aberrantly expressed microRNAs, we chose one of the most aberrantly up-regulated microRNA ( hsa-miR-182, fold change > 10) for further investigation. Inhibition of hsa-miR-182 by antisense oligonucleotides inhibited HeLa cervical cancer cell growth in vitro and reduced tumor cell volume in vivo. Gene expression array analysis of HeLa cells with hsa-miR-182 knockdown and over-expression showed specific hsa-miR-182 targeting pathway in apoptosis and cell cycle. It indicated the roles of hsa-miR-182 in cervical cancer growth through apoptosis and cell cycle functions. / Tang, Tao. / Adviser: Richard K W Choy. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3446. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 155-169). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.