Orientador: Christiane Pienna Soares / Banca: Luís Octávio Regasini / Banca: Eliana Aparecida Varanda / Resumo: Atualmente, o câncer cervical é considerado a segunda causa mais comum entre as mulheres e encontra-se associado ao Papilomavírus Humano (HPV), que infecta células epiteliais escamosas, dando origem a grandes lesões. Em face da necessidade de se encontrar novos fármacos com atividade antineoplásica, têm-se procurado identificar substâncias isoladas de plantas brasileiras capazes de impedir a proliferação de células neoplásicas infectadas por HPV. A nitensidina B é um alcalóide guanidínico isolado de Pterogyne nitens Tul. (Fabaceae), que possui atividade citotóxica e antifúngica. O presente estudo teve por objetivo, verificar a atividade citotóxica, pró-apoptótica, genotóxica e mutagênica de nitensidina B, por meio de experimentos in vitro, utilizando células de carcinoma cervical infectadas por HPV-16 (SiHa) e não infectadas pelo vírus (C-33A). Para avaliar a citotoxicidade da nitensidina B o teste MTT foi realizado, sendo possível observar um efeito concentração-resposta nas duas linhagens testadas SiHa e C-33A, CI50 = 28,95 µM e 25,78 µM, respectivamente por 24 horas de tratamento e SiHa e C-33A, CI50 = 20,77 µM e 20,96 µM, respectivamente por 48 horas de exposição a nitensidina B. Com o intuito de avaliar a ação pró-apoptótica, foi realizado o ensaio de anexina V por citometria de fluxo e o ensaio do Hoechst-Iodeto de propídio, na qual pode-se verificar que a nitensidina B apresentou morte celular por apoptose tardia na linhagem de células infectadas por HPV-16 (SiHa) e baixa porcentagem de células apoptóticas nas células não infectadas pelo HPV-16 (C-33A), tanto por apoptose precoce, quanto na apoptose tardia/necrose, em todas as concentrações. Para o ensaio de genotoxicidade foi realizado o ensaio do... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Nowadays, cervical cancer is considered the second most common among women, and have been associated with human papillomavirus (HPV), which infects squamous epithelial cells resulting in major injuries. Given the need to find new drugs with antineoplastic activity, have sought to identify compounds antineoplastic from plants, wich are capable of preventing the proliferation of neoplastic cells infected by HPV. Nitensidine B is a guanidine alkaloid isolated from Pterogyne nitens Tul. (Fabaceae), which has cytotoxic and antifungical activies. This study aimed verify by cytotoxic, pro-apoptotic, genotoxic and mutagenic of nitensidine B through in vitro experiments, using cervical carcinoma cells infected by HPV-16 (SiHa) and not infected (C -33A). To evaluate the cytotoxicity of nitensidine B, by MTT assay, it being possible to observe an effect concentration response in both strains tested SiHa and C-33A, IC50 = 28.95 µM and 25.78 µM, respectively, by 24 hours of treatment and SiHa and C-33A, IC50 = 20.77 µM and 20.96 µM, respectively, by 48 hours. In order, to investigate pro-apoptotic activity, it was carried out annexin V flow cytometric and Hoechst-propidium iodide assay, which it could be seen that the nitensidine B showed apoptotic cell death late in the lineage of cells infected by HPV-16 (SiHa) and lower percentages of apoptotic cells in the cells not infected by HPV-16 (C-33A), both early apoptotic, late apoptotic and in necrosis at all concentrations used. For the genotoxicity assay was performed comet assay, where there was a high percentage of DNA in the tail of the cells studied. In SiHa cell line was observed significant genotoxicity at all concentrations tested in treatment for 6 hours and the concentration of DNA in the tail at 5.00 µM to 16.0 µM on exposing cells for 24 hours with nitensidine B. For the line... (Complete abstract click electronic access below) / Mestre

Orientador: Paulo Traiman / Coorientador: Sara de Pinho Cunha Paiva / Banca: Rívia Mara Lamaita / Banca: Ricardo dos Reis / Banca: Luís Otávio Zanatta Sarian / Banca: Anaglória Pontes / Resumo: A vivência da doença onco-ginecológica, proporciona sofrimento, preocupações e perdas tanto na paciente como nos membros da sua família, em particular, naquele que tem a responsabilidade da prestação de cuidados. Clinicamente, tem havido uma tentativa de modificar as respostas de estresse dos indivíduos, com terapias anti-estresse, que focam nas interações entre a mente e o corpo nos fatores mentais, sociais, espirituais e emocionais, afetando diretamente a saúde e a capacidade de auto-cuidado e auto-consciência. O objetivo deste estudo foi avaliar a influência do programa de medicina anti-estresse em mulheres com câncer de colo uterino submetidas à radioterapia e em seu cuidador. A amostra foi constituída de 60 mulheres com câncer de colo uterino, submetidas à radioterapia, acompanhadas pelo Hospital Luxemburgo, em Belo Horizonte, Minas Gerais, e 60 cuidadores, sendo divididos em dois grupos denominados caso e controle. O grupo caso era composto de 30 mulheres e seus respectivos cuidadores, que participaram do programa de medicina anti-estresse (PMAE). O grupo controle não participou da terapêutica (30 mulheres e 30 cuidadores). Os participantes completaram um conjunto instrumentos de medida: o questionário socio-demográfico e clínico, o questionário European Organization for Reseach and Treatment of Cancer Qualityof- Life Questionnaire (EORTC QLQ-C30), a Escala da Qualidade de Vida do Cuidador/Familiar Oncológico e o Termômetro de Distress. Foi coletada uma amostra de saliva para medição do cortisol salivar antes e após a realização das técnicas da medicina anti-estresse. Os grupos foram semelhantes em relação ao estado civil, escolaridade, menopausa, altura e peso. As pacientes que participaram do PMAE apresentaram melhora na qualidade de vida (p=0,0004), diminuição do distresse (p>0,0001) e cortisol salivar (p>0,0001). A qualidade de vida dos cuidadores de mulheres com câncer de colo uterino submetidas ... / Abstract: The experience of onco-gynecological disease, provides distress, worries and losses in both patient and the family members, in particular, in that it has the responsibility of providing care. Clinically, there has been an attempt to modify the stress responses of individuals with anti-stress therapies, which focuses on the interactions between mind and body in the mental, social, spiritual and emotional factors directly affecting the health and capacity for self-care and self -awareness. The aim of this study was to evaluate the influence of the mindy-body medicine (MBM) in women with cervical cancer submitted to radiotherapy and their caregivers. The sample consisted of 60 women with cervical cancer submitted to radiotherapy, followed by Luxembourg Hospital in Belo Horizonte, Minas Gerais, and 60 caregivers were divided into two groups: case and control. The case group consisted of 30 women and their caregivers who participated of MBM. The control group did not participate in therapy (30 women and 30 caregivers). Participants completed a set of measurement instruments: the socio -demographic and clinical questionnaire, the questionnaire European Organization for Research and Treatment of Cancer Quality-of- Life Questionnaire (EORTC QLQ-C30), the Quality of Life Scale Caregiver / Family oncology and Distress Thermometer. A saliva sample for measurement of salivary cortisol before and after performing the techniques of MBM was collected. The groups were similar with respect to marital status, education, menopause, height and weight. The patients who participated MBM showed improved quality of life (p=0.0004), decreased distress (p>0.0001) and salivary cortisol (p>0.0001). The quality of life of caregivers of women with cervical cancer submitted to radiotherapy, which did not participate in MBM decreased (p=0.0475) compared to the group case. Caregivers PMAE participants showed decreased distress (p=0.0013) compared to the control group ... / Doutor

Submitted in fulfillment of the requirements of the degree of the Master of Technology : Radiography, Durban University of Technology, 2014. / Research Aims The purpose of this study is to compare 2D HDR Brachytherapy planning and 3D HDR Brachytherapy planning in terms of dose distribution in order to accurately determine bladder and rectal doses. Further research questions were explored to determine whether relationships existed between Computer Tomography volumes and bladder and rectum dose. Methodology The 30 female patients that volunteered for the study were conveniently selected. Their age and ethnic group did not contribute to their selection. All participants were prepared for cervical HDR Brachytherapy. The Brachytherapy templates were computer generated and treatments were given based on the templates. They then had a Computer Tomography (CT) scan (3D data set) of the pelvis. The computer generated templates for 2D Brachytherapy planning were applied to the CT data set i.e. 2DBP. The plans were optimised to take into consideration the dose to the bladder and the rectum i.e. 3DBP. The 2DBP and the 3DBP were then evaluated in order to determine which method of planning yielded more acceptable dose distributions to the bladder and rectum. Results Significant differences in dose distribution were noted on comparison of 2DBP and 3DBP. A significant relationship was noted in respect of bladder mean dose and rectum mean dose. 3DBP proved to be more efficient in yielding lower mean dose to the bladder and the rectum. Whilst a significant relationship was noted in respect of bladder maximum dose, an insignificant relationship was noted for rectum maximum dose. Therefore, the efficiency of 3DBP to yield lower bladder maximum dose was established but its efficiency to yield lower rectum maximum dose is questionable. This has implications for the management of patients’ with cervical cancer who require cervical Brachytherapy. Recommendations It is imperative that imaging modalities be used for the accurate planning of cervical Brachytherapy. This study recommends that CT be used for HDR Brachytherapy planning by proving its greater efficiency compared to template planning.

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Title: Awareness, knowledge and experiences of women regarding cervical cancer in rural Kwa- Zulu-Natal, South Africa. Background: Cervical cancer has been identified as the second most common cancer in women and contributes to the high mortality rate in women. Among all cancers in women, cervical cancer is rated the second most common cancer in women worldwide. In poorly resourced settings, access to services offering cervical screening is still a challenge and it is estimated that more than 50% of women in developing countries have never had a single screening test for cervical abnormalities. Purpose: The purpose of this study was to assess women’s awareness, attitudes and experiences regarding cervical smear testing and for cervical cancer in rural KwaZulu-Natal and to better understand factors influencing access to and utilization of cervical cancer screening services by rural women. Methods: The method employed was a descriptive study using a questionnaire to collect quantitative data. The sample consisted of 69 women aged 30 years and above, was taken from women who were enrolled in the on-going Microbicide Clinical Trial and attending follow-up clinic visits between July and August 2009. The primary outcome measure for the analyses was who has been screened for cervical cancer and this was assessed from the previous history reports of the women. The secondary outcome measure was to investigate knowledge and perceptions regarding cervical cancer and screening. Socio-demographic factors associated with having been screened were also explored. Results: Out of 69 women, only N=13 (18.8%) reported ever screening for cervical cancer. More than half of women who had never screened reported lack of information as a barrier to screening N=50 (71.4%). Older women aged 35-45, 45 and above were less likely to screen compared to women aged 30 to 34 years of age (OR: 0.06). Having an educational background seemed to increase the likelihood to screen, twice if a woman had primary education (OR 2.0) and almost three times (OR 2.67) if a woman had a secondary or a higher education. More than half of the respondents considered themselves at risk for cervical cancer N=42 (60.8%) and almost all showed a willingness to screen in the future N=64 (93%). Conclusion: Most of the women in this study had never been screened for cervical cancer in their lifetime as reflected by n=55 (82%) while only n=14 (18%) ever screened for cervical cancer. The results of this study cannot be generalised to the population due to the small sample size. However, there is need to facilitate comprehensive health education and the implementation of cervical screening programmes to target women in rural communities to contribute to the success of the cervical screening programme. The results of this study showed that 60% of respondents were informed by health care professionals on cervical cancer screening. Health care workers also should play a vital role in educating communities on cervical cancer and on the benefits for cervical cancer screening, through reaching all patients who utilise health care services with cervical cancer information and also communities through outreach programmes. / AFRIKAANSE OPSOMMING: Titel: Vrouens se bewustheid, houding en ervarings van smeertoetse en servikale karsinoom in die landelike gebiede van KwaZulu-Natal Agtergrond: Servikale kanker is geïdentifiseer as die tweede mees algemene karsinoom in vrouens en dra by tot die hoë sterftesyfer in vrouens. Van al die tipes karsinoom wat by vrouens voorkom, is servikale karsinoom die tweede mees algemene karsinoom onder vrouens wêreldwyd. Die beskikbaarheid van dienste wat servikale smeer toetsing bied, is nog steeds ’n uitdaging in arm gebiede en daar word geskat dat meer as 50 % van vrouens in ontwikkelende lande nog nooit ’n toets vir enige servikale abnormaliteite gehad het nie. Doel: Die doel van hierdie studie was om vrouens se bewustheid, houding en ervarings van servikale smeer toetsing en van servikale karsinoom in die plattelandse gebiede van KwaZulu-Natal te toets en om ’n beter begrip te kry van faktore wat ’n invloed het op toegang tot en gebruik van servikalesmeer toetsing by vrouens in landelike areas. Metode: Die metode wat gebruik is, is ’n beskrywende studie waarin gebruik gemaak is van vraelyste om kwantitatiewe data te versamel. Die monster het bestaand uit 69 vrouens, ouderdom 30 jaar en ouer, wat deelnemers was aan die “Microbicide Kliniese Navorsingsprojek” en wat opvolgbesoeke by klinieke gehad het tussen Julie en Augustus 2008. Die primêre bevinding, wie al ooit vir servikale karsinoom getoets is, is bereik deur die inligting in die laboratorium verslae van die vroue na te gaan. Die sekondêre bevinding was om die deelnemers se kennis en persepsies aangaande servikale karsinoom te toets. Sosio-demografiese faktore wat verband hou met of deelnemers ooit getoets is, is ook ondersoek. Resultate: Van die 69 vrouens, het slegs N=13 (18.8 %) gerapporteer dat hulle ooit getoets is vir servikale kasinoom. Meer as die helfte van die vrouens wat ooit getoets is vir servikale karsinoom het gerapporteer dat ’n gebrek aan inligting ’n weerhoudende faktor was tot die toetse, N=50 (71.4%). Ouer vrouens tussen die ouderdom van 35 – 45, 45 en ouer was minder bereid om te toets in vergelyking met vrouens tussen die ouderdom van 30 tot 34 (OR: 0.06). Dit blyk asof skoolonderrig die kanse op toetsing verhoog, vrouens met primêre skoolopleiding se kanse dat hulle getoets is, is twee keer groter (OR 2.0) en amper drie keer meer (OR 2.67) as ’n vrou sekondêre onderrig of hoër onderrig ontvang het. Meer as die helfte van die respondente dink hulle loop ’n risiko om servikale kanker te kry N=42 (60.8%) en feitlik almal was bereid om hulle te laat toets in die toekoms N=64 (93 %). Bevinding: Die meeste vroue in hierdie studie n=55 (82%) was nog nooit in hul leeftyd getoets vir servikale karsinoom nie terwyl slegs n=14 (18%) ooit getoets was vir servikale karsinoom. Die resultate van hierdie studie kan nie veralgemeen word nie, aangesien die navorsingspopulasie as gevolg van die klein steekproef te klein was. Nietemin is daar ‘n behoefte vir die fasilitering van omvattende gesondheidsopvoeding en die implementering van servikalesmeer toetsing programme. Die resultate van hierdie studie het aangedui dat 60% van die respondente deur professionele gesondheids werkers ingelig is met betrekking tot servikalesmeer toetsing. Gesondheidswerkers behoort ‘n vitale rol te speel in die opvoeding van gemeenskappe in verband met servikale karsinoom en die voordele van hiervan deur alle pasiente wat gesondheidsdienste benut in te lig omtrent servikale karsinoom en ook deur middel van gemeenskaps-uitreikings programme.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Title The Effect of Highly Active Antiretroviral Therapy on Human Papilloma Virus Infection and Cervical Cytological Abnormalities in Women Living With HIV Background Human Papillomavirus (HPV) infection causes cervical cancer. The prevalence of HPV-related dysplastic lesions is significantly higher in patients co-infected with the HI virus and thought to be linked to possible more persistent HPV infection. There is, however, conflicting evidence as to whether treatment of Human Immunodeficiency Virus (HIV) infection with antiretroviral agents may influence cervical HPV infection and the behaviour of Squamous Intraepithelial Lesions (SIL). Aims To examine the effect of the initiation of combination antiretroviral therapy (cART) on: 1) the persistence of cervical Low-grade SIL (LSIL); 2) The progression of cervical LSIL to High-Grade SIL (HSIL); 3) The effectiveness of excision treatment of HSIL 4) HPV genotypes detected, in HIVinfected and uninfected women at the Infectious Diseases Clinic and the Colposcopy Clinic, Tygerberg Teaching Hospital, Cape Town, South Africa. Design and Methods We conducted a retrospective cohort analysis of 1720 women with LSIL of the survival of progression-free-time or time-to-clearance. Time to progression or persistence was compared according to HIV status, antiretroviral treatment and CD4 count. In another retrospective cohort analysis, we investigated the effectiveness of excision treatment in 1848 women who underwent LLETZ or CKC biopsy was used. Logistic regression and survival analysis were used to compare excision treatment failure and recurrence-free time between groups according to HIV status, antiretroviral therapy and CD4 count. To investigate the effect of antiretroviral therapy on the cervical HPV infection, 300 HIV-infected women were prospectively enrolled and followed at 6-monthly interval. Cytological testing and cervical HPV sampling were done at each visit. Biopsy of suspicious lesions and excision treatment were done at colposcopy clinic according to standard a protocol. The Roche Linear array HPV genotyping test was used for HPV detection. Generalized Estimating Equation (GEE) multivariate analysis was applied to investigate the effect of cART on the detection of HPV infection, while adjusting for time-dependent covariates such as CD4 count, sexual activity and excision treatment. The effect on each HPV type was then also compared to the effect on HPV16. Results Overall, we found that there was no difference between the progression of LSIL to HSIL by HIV status. However, among HIV-infected patients, those who started ART before first LSIL had a significantly lower risk for progression (HR 0.66, 95% CI 0.54-0.81). CD4 count did not have an impact on the risk for progression. We also found lower persistence of SIL in the HIV uninfected group (HR 0.69, 95% CI 0.57-0.85) and that cART was independently associated with decreased persistence of LSIL. On the other hand, a higher CD4 count at the time of first LSIL was not associated with lower persistence of the lesion. HIV infected women with HSIL experienced much higher excision treatment failure than uninfected women (53.8% vs. 26.9%, p<0.001). Factors that improved outcome were higher CD4 count and complete excision. cART reduced the risk of detection of any HPV type by 47% (OR 0.53, 95% 0.49-0.58, p<001). When adjusted for covariates, time of exposure to cART and CD4 had a stronger effect. Every month of cART exposure reduced the risk detection of any HPV type with 7%. The effect was also significant on HPV16 alone (OR 0.93, 95% CI 0.90-0.95). All non-oncogenic subtypes were influenced similarly or more strongly than HPV16, as well as oncogenic HPV52. Only one oncogenic subtype HPV subtype, HPV39, was influenced marginally less (ratio of OR 0.95, CI 0.90-0.99, p=0.04). There was an increased risk for any HPV detection at CD4 count<200 (OR 1.63, 95% CI:1.50-1.77), but when adjusted, the time of cART exposure again remained the strongest predictor of risk (OR 0.94, 95% CI:0.93-0.95). Conclusion cART impact the outcome of cervical HPV infection by increasing clearance, decreasing progression of LSIL and recurrence after excision treatment. This effect is time dependent and also associated with CD4 count. Specifically, HPV16 detection risk is also reduced by cART, and all HPV types are influenced at least as much as HPV16, except possibly HPV39. It seems that increased cervical HIVproviral load is associated with HPV detection risk, and both are lowered by cART time. / AFRIKAANSE OPSOMMING: Titel Die Effek van Kombinasie Antiretrovirale Terapie op Menslike Papilloomvirusinfeksie en Servikale Sitologiese Abnormaliteite in Menslike Immuniteitsgebrekvirus-geïnfekteerde Vroue Agtergrond Menslike Papilloomvirusinfeksie (MPV) veroorsaak servikale kanker. Die prevalensie van MPVverwante displastiese letsels is betekenisvol hoër in pasiënte wie ook met Menslike Immuniteitsgebrekvirus (MIV) geïnfekteer is en dit word gereken dat dit te wyte is aan meer persisterende MPV infeksie. Daar is egter teenstrydige bewyse oor of die behandeling van MIV infeksie met antiretrovirale (ART) middels die infeksie met MPV en die gedrag van Plaveisel Intraepiletiële letsels (PIL) kan beïnvloed. Doelwitte Om die effek van die inisiasie van kombinasie ART op: 1) die persistering van Laegraadse PIL (LPIL); 2) die progressie van servikale LPIL na hoëgraadse PIL (HPIL) 3) die sukses van eksisiebehandeling van HPIL; 4) MPV genotypies waarneembaar, in MIV-geïnfekteerde vroue by die Infeksiesiektekliniek en die Kolposkopiekliniek,Tygerberghospitaal, Kaapstad, Suid-Afrika, te ondersoek. Studie-ontwerp en Metodes `n Retrospektiewe kohort-analise op 1720 vroue met LPIL van die oorlewing van progressive-vrye tyd en tyd tot opklaring van PIL is gedoen. Tyd tot progressie of opklaring is vergelyk na aanleiding van die pasiënt se MIV status, behandeling met antiretrovirale terapie en CD4-telling. In nog `n retrospektiewe kohort-analise is die effektiwiteit van eksisiebehandeling in 1848 vroue wie LLETZ or Kouemeskonus eksisie ondergaan het, ondersoek. Logistiese regressie en oorlewingsanalise is toegepas om die voorkoms van onsuksesvolle uitkoms en tyd sonder herhaling van letsels tussen groepe te vergelyk na aanleiding van MIV status, ART en CD4-telling. Om die effek van antiretroviral therapie op servikale MPV infeksie te ondersoek, is 300 MIVgeïnfekteerde vroue opgeneem in `n prospektiewe studie en sesmaandeliks opgevolg. Sitologiese en MPV servikale smere is met elke besoek geneem. Biopsies van verdagte letsels en eksisiebehandeling is by die Kolposkopiekliniek gedoen volgens die standaardpraktyk. Die Roche Linear Array HPV Genotyping toets is gebruik vir MPV deteksie. Algemeen-beraamde vergelyking (GEE) meerveranderlike analise is toegepas om die effek van die anti-MIV terapie op die teenwoordigheid van MPV op die serviks te ondersoek. Die aangepaste effek is ook getoets deur die CD4-telling, die seksuele aktiwiteits- en eksisiebehandelingstatus by elke besoek in ag te neem. Die effek op elke MPV genotipe is laastens dan ook vergelyk met die effek op ‘n spesifieke basislyn genotype; in hierdie geval was MPV16 gekies. Resultate Daar was geen statisties beduidende verskil tussen die progressie van LPIL na HPIL na aanleding van HIV status nie, maar pasiënte wie met ART begin het voordat hulle vir die eerste keer met LPIL gediagnoseer was, het ‘n laer risiko gehad vir progressie (HR 0.66, 95% VI 0.54-0.81). Daar is ook gevind dat dit onafhanklik van die CD4 telling was. Die persistering van PIL was laer in die MIV negatiewe groep (HR 0.69, 95% VI 0.57-0.85), maar ook hier was antiretrovirale behandeling geassosieer met verminderde persistering. Weer eens was daar nie ‘n verband met die CD4 telling nie. MIV-geinfekteerde vroue met HPILwas baie meer geneig tot gefaalde eksisiebehandeling (53.8% teenoor 26.9%, p<0.001). Verbeterde uitkoms was geassosieer met ‘n hoër CD4-telling en ‘n eksisie wat as volledig beskryf was. ART wat reeds voor die eksisiebehandeling begin was, het nie die risiko vir onsuskesvolle uitkoms statisties beduidend verminder nie, maar het egter die risiko vir herhaling van letsels na die eksisie sterk verlaag. ART het die kans dat enige MPV tipe waargeneem sou word, met 47% verlaag (OR 0.53, 95% VI 0.49-0.58, p<001). Wanneer aangepas vir ander faktore, was die tyd wat verloop het sedert ART begin was, sowel as vir die CD4 telling, sterker. Vir elke maand sedert ART begin was, het die kans dat enige MPV tipe waargeneem word, met 7% verminder. `n Soortgelyke effek is op HPV16 alleen gevind (OR 0.93, 95%, VI 0.90-0.95). Die effek was net so sterk of sterker op alle subtipes. Slegs een onkogeniese subtipe, MPV39, was gering minder beïnvloed (ratio van OR 0.95, VI 0.90-0.99, p=0.04). Die kans vir waarneming van enige MPV subtype is hoër wanneer die CD4 telling laer as 200 selle/ɥl is (OR 1.63, 95% VI: 1.50-1.77), maar wanneer aangepas, was die tyd van ART weer eens die sterkste voorspeller van MPV infeksie (OR 0.94, 95% VI:0.93-0.95). Gevolgtrekkings ART verbeter die uitkoms van servikale infeksie met MPV deur progressie en persistering van LPIL en herhaling van PIL na eksisie te verminder. Die effek is tydsafhanklik en word ook deur die CD4 telling beïnvloed. Die kanse dat MPV16 spesifiek waargeneem word, word ook deur ART verminder, en all MPV tipes ondervind dieselfde of groter verlaging van waarnemingsrisiko as MPV16, behalwe miskien MPV39. Ons kon aandui dat verhoogde teenwoordigheid van servikale MIV verband hou met die risiko vir die waarneming van MPV infeksie, en beide word verminer deur die tyd waarmee die pasiënt met ARV terapie behandel is.

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.

M.Cur. (Nursing Management) / Transformational leadership involves the creation of a motivating climate that enhances growth, development, commitment, goal achievement and enjoyment which encourages behaviour based on a set of shared values (Price, 2006:124). In this study transformational leadership referred to concepts of motivation, and change management with regard to the implementation of the Cervical Cancer Screening Programme in a PRe setting. During support visits in Ekurhuleni Health District, the researcher observed a lack of transformational leadership among facility managers in Primary Health Care Clinics to transform the Cervical Cancer Screening Program in line with relevant health care legislation. It was apparent that the problems in implementing the Cervical Cancer Screening Programme were related to poor motivation and lack of implementation of change management principles in the PHC clinics. From the problem statement the following research questions emerged: To what extent is the facility manager perceived as a transformational leader to implement the Cervical Cancer Screening Programme in a PHC clinic? Which actions should the facility manager take to implement the Cervical Cancer Screening Programme in PHe? From the findings guidelines for the facility managers were described to enable them to implement a Cervical Cancer Screening Programme in a Primary Health Care clinic within legal requirements...

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Masters in Science. December 2015 / Cervical cancer remains a global health related issue among females of Sub-Saharan Africa, with over half a million new cases reported each year. Different therapeutic regimens have been suggested in various regions of Africa, however, over a quarter of a million women die of cervical cancer, annually. This makes it the most lethal cancer amongst black women in this area, and makes it important to search for new effective therapeutic drugs through screening of medicinal plant extracts used by many in Sub-Saharan Africa as potential anti-cervical cancer agents. The aim of this study was to evaluate the anti-proliferative effects of Cannabis sativa extracts and its isolate, cannabidiol on cervical cancer cell lines HeLa, SiHa, and ME-180. To achieve our aim, phytochemical screening, MTT assay, cell growth analysis, flow cytometry, morphology analysis, Western blot, caspase 3/7 assay, and ATP measurement assay were conducted were conducted. Results obtained indicate that both plant extracts induced cell death at an IC50 of 50 – 100μg/ml and the Inhibition of cell growth was cell line dependent. Flow cytometry confirmed that, with or without cell cycle arrest, the type of induced cell death was apoptosis. Cannabis sativa extracts led to the up-regulation of apoptosis proteins (p53, Bax, caspase-3, and caspase-9) and the down regulation of anti-apoptosis proteins (Bcl-2 and RBBP6), signalling the execution of apoptosis. Apoptosis induction was further confirmed by morphological changes, an increase in Caspase 3/7 and a decrease in the ATP levels. In conclusion, this data implies Cannabis sativa crude extracts has the potential to inhibit growth and induce apoptosis in cervical cancer cell lines, which may be due to the presence of cannabidiol. Key words: Apoptosis, cervical cancer cells, cannabidiol, and Cannabis sativa extracts

OBJECTIVES To determine if health care workers are aware of the HPV vaccine and its availability, uptake of the vaccine and prescribing practices and reasons for non – uptake of the vaccine . METHODS Health care providers working in the private sector, in the Ethekweni health district in Kwazulu Natal, were interviewed. Health care workers included: 100 general practitioners, 50 gynaecologists, 50 paediatricians, 50 medical staff and 50 nursing staff. A questionnaire was designed for purpose of this study. Visits were be made to health care providers. All heath care providers who were willing to participate were interviewed. STATISTICS Comparisons of awareness among subgroups of health care providers was analysed using Chi-square tests. If significant, pairwise comparisons were made using a Bonferroni adjustment for multiple comparisons. Associations between awareness and other factors, such as demographic, uptake and beliefs were tested using a chi square test. Analysis was done by Stata v11 (StataCorp, 2009) i RESULTS Three hundred health care workers were interviewed - 50 gynecologists (16.7%), 52 pediatricians (17.3%), 99 general practitioners (33%), 49 other medical doctors (16.3%) and 50 (16.7%) nurses. Two hundred and sixty seven health care workers (89%) were aware of the HPV vaccine and one hundred and eighty eight health care workers (70.4%) informed patients of the availability of the HPV vaccine. Most (77.9%) practitioners have only prescribed the vaccine less than ten times. Gardasil® was prescribed by 46%, Cervarix® by 6.5% and prescription of either vaccine of health care workers was 50.2%. Practitioners were generally unaware that Gardasil® could be prescribed to males (62.9%). CONCLUSION Health care workers were aware of the HPV vaccine and prescribed the vaccine on request. However even though practitioners were aware of the vaccine, most have prescribed the vaccine less than ten times since licensing in 2008. Knowledge with regards to the licensed use of the HPV vaccines is deficient. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

Background According to the Programme for Appropriate Technology in Health (PATH), global statistics show that nearly half a million new cases of invasive cervical cancer are diagnosed each year. More than a quarter million women die of this disease annually, with the highest incidence and mortality rates being in developing countries. In South Africa a woman's risk of developing cervical cancer is one in 26. Each year 6 700 women develop cervical cancer while 3 700 die from the disease annually. The overall aim of this research was to determine the patterns of health seeking behaviour of women being treated for cervical cancer. The specific objectives were to: Describe the health service utilization characteristics of patients being treated for cervical cancer. Describe the need factors associated with decision to seek care. Describe the enabling factors associated with decision to seek care. Describe the predisposing factor associated with the decision to seek care. Analysis of factors associated with health seeking behavior in women treated for cervical cancer. Methods An observational study with a descriptive and analytic component was undertaken. The study was conducted in the Oncology Department of Grey‟s Hospital, which is a referral hospital located in Pietermaritzburg from the Umgungundlovu, Umzinyathi, Zululand, Uthukela and Amajuba Health District which has a population of 995 303. All patients treated for cervical cancer within the study period, who provided informed consent for their participation in the study, were enrolled. The total number included in the study was 109. Descriptive statistics were used to explore frequencies emanating from the data. Pearson Chi square tests were used to explore the relationship between two categorical variables and the p-value was used to decide how much evidence there was against the null hypothesis. Odds ratio was also used as a measure of risk to compare whether the probability of a variable is the same for the outcome variables. Regression was performed on the variables that were found to be statistically significant to the outcome variables in the bivariate analyses. Results The variables that most influenced health seeking behaviour and that still remained statistically associated with the outcome variables under the multivariate analysis were found to be age, marital status, employment status, social support for medical treatment, educational level, knowledge of Pap smear screening and recognition of cervical cancer. Conclusion The study achieved its aim of determining the patterns of health seeking behavior of women being treated for cervical cancer at Grey‟s Hospital. It also identified that proper implementation of HPV vaccination and cervical screening programme can be an entry point to address the incidence and presentation of cancer at advance stages, as well the treatment of precancerous lesions of the cervix in the women of reproductive age. An awareness campaign, support for women to undergo screening program and availability of health centers is also recommended. All recommendations need to be considered by the department of health and appropriate authorities in South Africa to minimize the widespread of cervical cancer. / M. Med. Sc. University of KwaZulu-Natal, Durban 2012.