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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

Background: Screening for breast and cervical cancers is important because early detection increases cancer survival. Since 1991, the U.S. government has helped finance a national early detection program for breast and cervical cancer among uninsured low-income women, known in Virginia (VA) as Every Woman's Life (EWL).Objectives: This study aims to determine whether there are differences in the prevalence of breast and cervical cancer screening based on insurance coverage, assess the prevalence of screening by health district, and evaluate the ability of EWL to effectively reach its target population.Methods: Cross-sectional data from the 2005 Behavioral Risk Factor Surveillance System survey were analyzed. Using population weights, descriptive statistics were generated and multiple regression was performed to assess the association between insurance coverage and screening prevalence among VA women 40 to 64 years of age (n=1,627). Adjusted screening prevalence by health district was also calculated. EWL client (n=4,959) and provider data from the VA Department of Health was obtained to create screening density maps with Geographic Information Systems.Results: After adjustment, women with insurance were significantly more likely to have a mammogram within the last two years compared to those without insurance (78% vs. 50%, pConclusion: The results of this study will be used to assist EWL in recruitment of additional screening and/or diagnostic sites in underserved areas of Virginia.

Orientador: Maria de Lourdes da Silva Marques Ferreira / Banca: Maria José Sanches Marin / Banca: Silvia Franco da R. Tonhom / Resumo: Introdução: O câncer de colo do útero é a terceira neoplasia maligna mais comum entre as mulheres no Brasil. Uma das formas de prevenção, assim como da detecção precoce da doença é iniciada na rede de atenção básica com a realização do exame Papanicolaou. Objetivo: Apreender a percepção de mulheres sobre a prevenção do câncer de colo uterino por meio da citologia oncótica, visando a elaboração de material educativo. Método: Trata se de um estudo com abordagem qualiquantitativo, realizada com vinte mulheres que procuraram uma Unidade Básica de Saúde de um município do interior paulista para realização do exame Papanicolaou. Para a coleta de dados foi utilizada a entrevista áudio gravada e a análise foi feito por meio do método do discurso do sujeito coletivo (DSC) e sustentado pela representação social. Resultados: Os DSCs foram construídos por meio das falas expressadas pelas participantes e agrupados em três temas, o tema um contemplou a percepção das mulheres em relação ao exame de Papanicolaou que relataram os sentimentos e a vulnerabilidade envolvida no exame, os significados, a falta de conhecimento e as dúvidas em relação ao exame. O tema dois compreendeu a participação e as experiências das mulheres na prevenção do câncer de colo de útero que narraram ter participação ativa em relação a prevenção e a periodicidade do exame. O tema três revela que a participação do serviço público na realização do exame é boa e posto como obrigatória, o desejo da consulta medica com o ginecologista e da ampliação dos dias e horários da coleta foram relatados pelas participantes. Conclusão: Observou-se que as ideias e os pensamentos das mulheres envolvidas neste estudo valorizam e se preocupam com a realização do exame, mais ainda existe falta de conhecimento e dúvidas em relação a prevenção... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Cervical cancer is the third most common malignant neoplasm among women in Brazil. One of the forms of prevention, as well as the early detection of the disease are initiated in the primary care network with the Papanicolaou examination. Purpose: To understand the perception of women about the prevention of cervical cancer through oncotic cytology, aiming at the elaboration of educational material. Method: This was a study with a qualitative approach, performed with twenty women who sought a Basic Health Unit in a city in the interior of São Paulo to perform the Pap smear test. For the data collection the recorded audio interview was used and the analysis was done through the collective subject discourse (DSC) method and sustained by social representation. Results: The CSDs were constructed using the speeches expressed by the participants and grouped into three themes, the theme one considered the perception of women in relation to the Pap smear, which reported the feelings and vulnerability involved in the examination, the meanings, the lack of Knowledge and doubts regarding the examination. Topic two comprised the participation and experiences of women in cervical cancer prevention who reported having an active participation in the prevention and periodicity of the examination. Topic three reveals that the participation of the public service in the accomplishment of the examination is good and it becomes mandatory, the desire of the medical consultation with the gynecologist and the extension of the days and times of the collection were reported by the participants. Conclusion: It was observed that the ideas and thoughts of the women involved in this study value and care about the test, but there is still a lack of knowledge and doubts regarding the prevention of cervical cancer. Product: Understanding the need for educational strategies with the... (Complete abstract electronic access below) / Mestre

Thesis advisor: James Lubben / In 2011, an estimated 12,710 women suffered from cervical cancer and 4,290 died from it in the U.S. HPV vaccination (HPV-V) and PAP screening (PAP-S) could reduce this burden. Using 2010 National Health Interview Survey data, current disparities in the use of PAP-S and HPV-V in U.S. women aged 18-30 years were investigated. An adapted Behavioral Model of Health Care Utilization guided the study. Main outcomes were PAP-S in prior year and ever-HPV-V, both initiation and completion. Adjusted predictor estimates were obtained through multivariate logistic regressions with appropriate statistical procedures and weights for complex survey design. A sub-analysis focused on unvaccinated women. The sample had 3,129 women aged 18-30 years, representing about 27 million women of similar age in the U.S. PAP-S, HPV-V initiation and completion rates were 53.5%, 17.9%, and 10.3%, respectively. Hispanics were 33% less likely than Non-Hispanic-Whites to initiate HPV-V. Non-Hispanic-Blacks were 55% more likely and 57% less likely than Non-Hispanic-Whites to receive PAP-S and complete HPV-V, respectively. Non-Hispanic Asians were 36% less likely than Non-Hispanic-Whites to receive PAP-S, but this result was borderline significant. Younger age and being unmarried were predictors of lower PAP-S but higher HPV-V. Ever gave birth was a predictor of higher PAP-S but lower HPV-V. Preventative behaviors (PAP-S and flu vaccination) were predictors of higher HPV-V. STI-history was a predictor of higher HPV-V and PAP-S. Not having health insurance for over one year or recent health provider visit were predictors of lower PAP-S and HPV-V. Living in the South was a predictor of lower HPV-V. Household income was not a predictor of any outcomes. Most common reported reason for no HPV-V was "no need." Study findings indicate interventions to mitigate disparities in cervical cancer prevention are needed. Tailored education interventions for both women and health care providers along with opportunities associated with the 2010 Affordable Care Act, such as broader access to health care, emphasis on health information technology, and initiatives with PAP screening and adult vaccination as potential quality indicators for performance/payment, can reduce these disparities. Future research should focus on the feasibility of alternative venues for receiving HPV-V and PAP-S. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

African American women tend to have lower attendance rates at cervical cancer screenings compared to the attendance rates of women from other ethnic groups. The purpose of this research project was to understand how perceptions of African American women affects attendance of future cervical cancer screenings. The goal was to understand what contributes to low attendance. Previous research did not focus on factors contributing or interfering with appointment attendance among African American women, aged 30-65. The conceptual framework was based on individual health behavior. The research questions examined lived experiences affecting attendance of cervical cancer screenings, attendance of future screenings, and perceptions of experiences. Data collection was based on a phenomenological approach. Open-ended questions were used to gather descriptions of 5 participants' experiences via telephone interviews. These interviews were recorded, transcribed, and coded for recurring themes and patterns. Findings revealed 3 emergent themes related to the attendance of screenings: being knowledgeable of the purpose of cervical cancer screening, a female examiner performing the screening, and the encouragement of family and friends. The implications for social change would be increased knowledge among African American women aged 30-65 and the medical community.

By 1970, Singapore’s urban landscape was dominated by high-rise blocks of planned public housing built by the People’s Action Party government, signifying the establishment of a high modernist nation-state. A decade earlier, the margins of the City had been dominated by kampongs, home to semi-autonomous communities of low-income Chinese families which freely built, and rebuilt, unauthorised wooden houses. This change was not merely one of housing but belied a more fundamental realignment of state-society relations in the 1960s. Relocated in Housing and Development Board flats, urban kampong families were progressively integrated into the social fabric of the emergent nation-state. This study examines the pivotal role of an event, the great Kampong Bukit Ho Swee fire of 1961, in bringing about this transformation. The redevelopment of the fire site in the aftermath of the calamity brought to completion the British colonial regime’s ‘emergency’ programmes of resettling urban kampong dwellers in planned accommodation, in particular, of building emergency public housing on the sites of major fires in the 1950s. The PAP’s far greater political resolve, and the timing of and state of emergency occasioned by the scale of the 1961 disaster, enabled the government to rehouse the Bukit Ho Swee fire victims in emergency housing in record time. This in turn provided the HDB with a strategic platform for clearing other kampongs and for transforming their residents into model citizens of the nation-state. The 1961 fire’s symbolic usefulness extended into the 1980s and beyond, in sanctioning the PAP’s new housing redevelopment schemes. The official account of the inferno has also become politically useful for the government of today for disciplining a new generation of Singaporeans against taking the nation’s progress for granted. Against these exalted claims of the fire’s role in the Singapore Story, this study also examines the degree of actual change and continuity in the social and economic lives of the people of Bukit Ho Swee after the inferno. In some crucial ways, the residents continued to occupy a marginal place in society while pondering, too, over the unresolved question of the cause of the fire. These continuities of everyday life reflect the ambivalence with which the citizenry regarded the high modernist state in contemporary Singapore.

<p>Poly(A) polymerase (PAP) is the enzyme catalyzing the synthesis of the adenine tail to the 3’-end of mRNA. This A-tail is present on the majority of the primary RNA transcripts of protein-coding genes, and is important for mRNA stability, export to the cytoplasm and translation. Therefore, PAP is a key regulator of eukaryotic gene expression. This thesis describes the heterogeneity of PAP and the functional significance of multiple isoforms of PAP. </p><p>PAP exists in many different isoforms generated by three different mechanisms, gene duplication, alternative mRNA processing and post-translational modification. In HeLa cell extracts three different forms of PAP being 90, 100 and 106 kDa in size have been detected, where the 106 kDa isoform is a phosphorylated version of the 100 kDa species. It is shown that the N-terminal region of PAP contains a region required for catalysis, while the C-terminal end is important for the interaction with the cleavage and polyadenylation specificity factor (CPSF). Interestingly, it was found that also the extreme N-terminal end is important for the interaction with CPSF. This region is post-translationally modified by phosphorylation. Five alternatively spliced forms of PAP mRNAs are encoded by the PAPOLA gene while one unique species is encoded by the PAPOLG gene. The analysis showed that the exact structure of the alternatively spliced C-terminal end of PAP played an important role for catalytic efficiency. Thus, the C-terminal end contains a region important for modulating the catalytic efficiency of PAP.</p><p>Aminoglycoside antibiotics inhibit PAP activity, most likely by displacement of catalytically important divalent metal ions. Data shows that different aminoglycosides inhibit PAP activity by different mechanisms suggesting that the binding sites for the different aminoglycosides do not completely overlap. It is concluded that aminoglycosides interfere with enzymes important for housekeeping functions in mammalian cell, which may explain some of the toxic side effects caused by aminoglycoside antibiotics in clinical practice.</p>

Community Health Centers (CHCs) are the nation's primary care safety-net for vulnerable populations, including racial/ethnic minorities, migrant workers and the uninsured. Women from these populations contribute disproportionately to cervical cancer morbidity and mortality, largely due to underutilization of Pap smear screening. The purpose of this cross-sectional study was to identify factors that may be related to Pap smear screening compliance among a large cohort of women seen at 10 Community Health Centers in Florida. Building upon an ecologic framework, this research went beyond patient-level risk factors, which are generally well-known, and explored provider and organizational variables that may also be associated with Pap smear screening compliance in this population. Ten CHCs in Florida met study inclusion criteria of having at least four complete years of claims and patient registration data stored in an Electronic Health Record (HER) data system maintained at HCN. EHR data were merged with provider gender obtained from a credentialing database and with data from a short organizational survey administered to the Medical Directors of the CHCs. Descriptive statistics, chi-squared analysis, and multiple logistic regression were used to examine Pap smear screening rates for women (n=71,234) in relation to a variety of patient, provider and organizational variables. Younger, Hispanic and insured women were most likely to have had a screening in the past three years compared to older, white non- Hispanic and uninsured women. Among providers, patients who received care from female providers generally had higher Pap smear compliance rates, but these findings differed by patient insurance and race/ethnicity group. Organizational factors that appeared to be associated with higher Pap compliance rates included diffusion of an EHR system, implementation of "Care Model Principals", and having recently implemented a Pap smear screening process improvement project. Results demonstrated that multi-level factors, operating on the patient, provider and organizational levels, contribute to Pap smear compliance among women seen at CHCs. Results suggested that improving screening compliance within this population of women requires interventions that are ecologic in scope, incorporate targeted education to high-risk women and providers, and include organizational strategies that can optimize care delivery at point-of-care.

Background: In Canada, the prevalence of cervical cancer in Aboriginal women continues to increase with a significantly higher mortality rate than women of non-Aboriginal ancestry. Despite that invasive cervical cancer is highly preventable with regular cervical cancer screening, participation in screening remains lower among Aboriginal women. Since limited information exists on the way cervical cancer screening is perceived and experienced, the purpose of this study was to gain an understanding of Saskatchewan Aboriginal womens perceptions related to and experiences with cervical cancer screening.<p> Methodology: This qualitative exploratory study used an interpretive descriptive approach. Perceptions related to and experiences with cervical cancer screening were elicited through individual interviews with eleven Dakota First Nation women. Women were recruited through purposive sampling techniques. Initially direct quotes from individual transcripts were coded, and then organized with other participant quotes that reflected thematic similarities.<p> Findings: Shared insights reflected a main theme that described perceptions of, experiences with, and factors influencing cervical cancer screening participation among Saskatchewan Aboriginal women. This theme, transitioning from experiencing the negatives of cervical cancer screening participation to living healthier, consisted of the womens mind-set (attitudes and cultural beliefs), knowledge, encounters with the health care system, and sharing information across the generations, which included patterns of communication and a community oriented approach.<p> Discussion: Findings of this study suggest that improving knowledge about cervical cancer screening and cervical cancer may increase screening utilization. Emphasis on health promotion and prevention should be considered when designing education programs. Interventions designed to improve screening rates are more effective when community members are involved in each phase, ensuring cultural relevance. Improving knowledge about, experiences with, and stories shared regarding cervical cancer screening among Aboriginal women may increase screening rates.