published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background. Cervical cancer is a common female cancer in Hong Kong. Cervical screening has been used in detecting cervical lesions for several decades. Given that human papillomavirus (HPV) infection is the etiological cause of cervical cancer, highly efficacious HPV vaccines are recently developed for preventing against HPV infection. Hong Kong has a well-developed healthcare system but relatively high cervical cancer incidence compared to other developed countries partly due to its suboptimal cervical screening program. This highlights the significance to evaluate the potential of implementing organized HPV vaccination programs for further reducing cervical cancer burden on top of cervical screening in Hong Kong. Methods. Cross-sectional, population-based surveys were conducted to assess the acceptability of female adolescent HPV vaccination among girls from secondary schools in 2008 and among mothers of adolescent daughters in 2008 and 2012. Mathematical model with transmission dynamic and stochastic individual-based components was constructed to model the natural history of HPV infection and cervical cancer and thus to project the public health and economic impacts of organized female adolescent HPV vaccination programs in a societal perspective. The model used Markov Chain Monte Carlo algorithm to estimate natural history parameters of HPV infection and probabilistic sensitivity analysis to consider the uncertainty of costs and health utilities in the economic evaluation of organized HPV vaccination. Results. Reported vaccine uptake among11–18 year-old girls increased from 2.4% among schoolgirls in 2008 to 9.1% among daughters of interviewed mothers in 2012. Among interviewed mothers, 27.5% and 37.6% of them were willing to have their daughters vaccinated at market price in 2008 and 2012, respectively. The mathematical model projected that HPV prevalence decreased soon after mass HPV vaccination and vaccine-induced cervical cancer reduction became obvious after vaccination programs have been launched for 30 years. If HPV vaccinesprovided30-year protection, the median incremental cost-effectiveness ratio (ICER) of routine HPV vaccination programs for 12 year-old girls at 25–75% vaccination coverage was US$26,367–32,527 per quality-adjusted life-year (QALY). The median ICER was above US$48,000/QALY if adding 2-year catch-up program for13–18 year-old girls and above US$58,000/QALY if vaccines protect against HPV infection for only 15 years. Conclusions. This study presented the first evaluation of organized HPV vaccination programs in Hong Kong. If vaccine protection lasted for 30 years or longer, organized routine HPV vaccination for 12 year-old girls would potentially be a cost-effective add-on in substantially reducing cervical cancers and HPV-related diseases on top of cervical screening in Hong Kong at an ICER threshold of US$33,218/QALY. However, the current estimated vaccine uptake was unexpectedly low and vaccine acceptability was only moderate. The findings indicated the importance to devise efficient strategies in achieving high and universal coverage for maximizing the population-level benefits of HPV vaccination. Policymakers should consider integrating the organized HPV vaccination programs with existing infrastructures to promote higher acceptability, to translate willingness to vaccinate to actual uptake, to assess population effectiveness, and to monitor safety issue and potential replacement effect of non-vaccine targeted HPV types following mass vaccination. / published_or_final_version / Public Health / Doctoral / Doctor of Philosophy

Thesis (MFamMed)--Stellenbosch University, 2014. / OBJECTIVE: The purpose of the study was to assess the safety, acceptability and feasibility of Visual Inspection with Acetic Acid and Cervicography (VIAC) followed by Cryotherapy or Loop Electrical Excision Procedure (LEEP) at a single visit for prevention of cancer of the cervix in Bulawayo, Zimbabwe. STUDY DESIGN: The study was descriptive using retrospective data extracted from electronic medical records of women attending the VIAC clinic at United Bulawayo Hospital in the period 1st February2010 to 31st December2012.Over 24 months 4641 women visited the clinic and were screened for cervical cancer using VIAC. If positive and eligible, cryotherapy or LEEP was offered immediately. Treated women were followed up at 3months and 1 year. RESULTS: The VIAC test positive rate was 10.8%.Of those eligible,17.0% received immediate cryotherapy, 44.1%received immediate LEEP, 1.9% delayed treatment and 37.0% were referred to a gynaecologist. No major complications were recorded after cryotherapy or LEEP. Among those treated99.5% expressed satisfaction with their experience. Only 3.2% of those treated at the clinic were VIAC positive one year later. The service was shown to be feasible to sustain over time with the necessary consumables. There were no service-related treatment postponements and the clinic staff and facility were able to meet the demand for the service. CONCLUSION: A single visit approach using VIAC, followed by cryotherapy or LEEP proved to be safe, acceptable and feasible in an urban African setting in Bulawayo, Zimbabwe. / AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.

Background: A global cervical cancer health disparity persists despite the demonstrated success of primary and secondary preventive strategies, such as cervical visual inspection (VI). Cervical cancer is the leading cause of cancer incidence and death for women in many low resource areas. The greatest risk is for those who are unable or unwilling to access screening. Barriers include healthcare personnel shortages, cost, transportation, and mistrust of healthcare providers and systems. Using community health workers (CHWs) may overcome these barriers, increase facilitators, and improve participation in screening for women in remote areas with limited access to clinical resources. Aim: To determine whether the accuracy of VI performed by CHWs was comparable to VI by physicians or nurses and to consider the affect components of provider training had on VI accuracy. Methods: A systematic review and quantitative meta-analysis of published literature reporting on VI accuracy, provider type, and training was conducted. Strict inclusion/exclusion criteria, study quality, and publication bias assessments improved rigor and bivariate linear mixed modeling (BLMM) was used to determine the affect of predictors on accuracy. Unconditional and conditional BLMMs, controlling for VI technique, provider type, community, clinical setting, HIV status, and gynecological symptoms were considered. Results: Provider type was a significant predictor of sensitivity (p=.048) in the unconditional VI model. VI performed by CHWs was 15% more sensitive than physicians (p=.014). Provider type was not a significant predictor of accuracy in any other models. Didactic and mentored hours predicted sensitivity in both BLMMs. Quality assurance and use of a training manual predicted specificity in unconditional BLMMs, but was not significant in conditional models. Number of training days, with ≤5 being optimal, predicted sensitivity in both BLMMs and specificity in the unconditional model. Conclusion: Study results suggest that community based cervical cancer screening with VI conducted by CHWs can be as, if not more, accurate than VI performed by licensed providers. Locally based screening programs could increase access to screening for women in remote areas. Collaborative partnerships in “pragmatic solidarity” between healthcare systems, CHWs, and the community could promote participation in screening resulting in decreased cervical cancer incidence and mortality. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2016. / FAU Electronic Theses and Dissertations Collection

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Cervical cancer is the most common malignancy after breast cancer in women worldwide. It accounts for 83% of all new cases and 85% cancer death in developing countries. In South Africa, cervical cancer is the common cancer in women with an annual crude incidence rate of 30.2 per 100,000 women and the highest rate were found to be in women between the ages of 66-69 years. Approximately 6800 women in S.A face new case of cervical cancer while accounting for 3700 cancer death annually. Because of unequal access to the health facilities, socio-economic differences, HPV and HIV infection, the rate of cervical cancer in black women is higher (42.1%) compared to the low rate in white women. Because of the name “cancer bush’ given to Sutherlandia Frutescence(S.F) plant by the traditional healers as well as Xhosas, Zulu, Sotho and cape Dutch for its anti-cancer activity, the plant was in this study to confirm its cytotoxic effect on the cervical cancer cell lines. Aim of the study: to evaluate the methanolic extracts of Sutherlandia Frutescens on cervical cancer cell lines. Materials and Methods: The MTT assay was performed to evaluate SiHa cell lines treated with methanolic extract of S.F (50μg/ml, 100μg/ml, 150μg/ml and 200μg/ml). The three compounds (Canavanine, GABA and Pinitol) were also evaluated for its anti-tumour activity. The cell growth was then showed in real time using Xcilligence. Flow cytometry was employed to determine the mode of action. Caspase 3/7 assay was performed to confirm if cell death was via caspase-dependent or independent and ATP was done to assess the ATP level in S.F treated cells. Results: MTT shows a significant decline in cells treated with 50μg/ml, 100μg/ml and 200μg/ml of the extract and 50μg/ml was concluded to be the concentration at which 50% of the cells die. The ATP results are inconsistent with MTT result; the ATP level increased in S.F treated cells. Cell index which represents the quantitative measure of cell growth in real time decline upon treatment with 50μg/ml. Flow cytometry showed cells are dying by apoptosis and the cell cycle arrest is mostly in the S phase. The cell death was caspase-dependent as it shows an increased luminescence which is proportional to the number of caspase. The concentrations of the compounds used, Canavanine (1000μM, 1500μM and 2500μM), GABA (100μM, 300μM and 500μM) and Pinitol (30μM, 90μM and 120μM) induce cell death and cell death shows to decrease after the maximum concentration. Conclusion: Sutherlandia Frutescence has proven with number of research that it induces cell death via apoptosis. After evaluating its cytotoxicity, the plant shows to be a promising anti-tumor agent that needs to be clinically proven. / Life Sciences / M. Sc. (Life Science)

published_or_final_version / Public Health / Master / Master of Public Health

First Nations women face nearly three times the risk of cervical cancer and mortality rates of up to six times higher than their non-Aboriginal counterparts. While cervical cancer is almost completely preventable, Southern Alberta First Nations women seldom access cervical screening services. The purpose of this qualitative focused ethnography was to gain an understanding of the cervical screening needs of un- and under-served First Nations women living off-reserve. Thirteen purposefully selected First Nations women participated in three focus groups utilizing semi-structured interviews. Personal self-worth and cervical screening awareness and relevance are essential to the pursuit of cervical screening. Barriers and incentives for screening and opportunities for acceptability and sustainability are explored. A holistic approach, intersectoral collaboration and cultural safety are described by focus group participants as foundational for optimal service delivery. / xii, 223 leaves ; 29 cm.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.