Current understanding concerning the human deep cervical fascia (DCF) differs between anatomists, surgeons, and radiologists. One reason has been the varying methodologies used to examine the DCF and the terminology assigned to each layer or potential space formed. Previous knowledge concerning the DCF originally came from cadaveric studies. However, such findings were highly subjective, reliant on the dissectionist�s skill with a scalpel. With the recent advent of radiological imaging and sheet plastination, there has been a re-examination of the fascial layers (investing, pretracheal, and prevertebral) that constitute the DCF. Although there is general consensus regarding the existence of the three layers, there is continuing conjecture over the concise anatomical description of these fascial structures. Recently, the investing (superficial) fascia, as a separate fibrous structure, has been questioned with a small number of plastination studies reporting its absence in the postereolateral regions of the neck. Within the suboccipital region (SOS) it is widely reported that the nuchal ligament, extending from the investing layer, directly connects with the spinal dura mater. However, a recent plastination study by Johnson et al. (2000b) found these fibres to dissipate in the SOS.The question remains as to what fibres directly communicate with the spinal dura? The fibrous connective bridge is reported in some clinical studies to originate from the rectus capitis posterior minor (RCPm) via the SOS. The origin of the connective fibrous bridge is essential in understanding the mechanism in the prevention of the phenomenon of 'infolding' and cervicogenic neck pain? Anteriorly, the investing fascia is regarded as a continuance of a 'fibrous collar' that encapsulates the entire neck, yet if it does not truly exist in the posterior neck region, does it actually exist as a tangible structure in the anterior neck? With regard to the deep midline fascial structures that arise from the pretracheal fascia, the presence of two separate spaces, the retropharyngeal and danger space, divided by the alar fascia in the posterior pharyngeal region, is still debated and is yet resolved in the clinical literature. The aims of this qualitative study were to: 1. determine the dural ligamentous and tendinous connections in the posterior atlanto-occipital (PAO) interspace region, and establish the morphology of the PAO membrane, 2. determine whether the investing layer of the DCF is a distinct fibrous structure in the anterior neck and examine the relationship with the subcutaneous platysma muscle, and 3. determine the relationship between the RPS and DS in the posterior pharynx region and identify the configuration of the alar fascia. Twenty-seven cadavers were examined at the gross, macro- and, microscopic level. Blunt and sharp dissections were conducted on 12 specimens. Fifteen cadavers were prepared as epoxy sheet plastinates. Light, fluorescent and confocal microscopy was conducted on the sheet plastinations.The findings of the first study demonstrated that small discrete bundles from medial tendinous fibres of RCPm formed a fibrous connective tissue bridge directly with the spinal dura in the SOS (in all 6 median-sectioned plastinated specimens), not the nuchal ligament as commonly reported. The RCPm fascia, in conjunction with lateral contributions from the perivascular sheath, formed the PAO membrane (ligamentum flavum) which was not continuous with the neural arch of C1 as often cited in anatomical texts. The cerebrospinal junction was also demonstrated to be a naturally formed multi-layered structure in all plastinates and not the result of pathological change as widely reported in clinical literature.The Gross dissection findings of the second study supported the traditional view that the investing layer formed a covering over the anterior triangle neck region. However, findings from plastinations, in conjunction with confocal microscopy, demonstrated clearly that the investing layer is formed from the epimysium of superficial muscles in the anterior neck. In the suprahyoid neck, it appeared disjointed with the fascia of the sternocleidomastoid (SCM) fascia isolated from the neighbouring submandibular fascia. In the infrahyoid neck, it was formed by medial fascial extensions from the omohyoid fascia, SCM fascia, and fused at the midline to the infrahyoid fascia, (pretracheal layer) resulting in two ipsilateral compartments. Distal 'finger-like' fascicles of platysma presented with individual epimysial fascia, which gave the false appearance of a thickened investing layer. These findings contravene those of the traditional view that the investing fascia is continuous at the mid-line.The findings of the third study agreed with both those reported in radiological and cadaveric studies respectively, in that the alar fascia was not present above the level of C1 as purported by radiologists, but became more apparent below this level. The alar fascia was observed to be formed from medial extensions of the carotid sheath, with some minor contributions from the lateral slips of the prevertebral fascia posteriorly, and was visible within transverse plastinated slices to the level of C7. However, at the levels of C4 and C6, the alar fascia appeared to fuse with the buccopharyngeal fascia, (posterior pretracheal layer of the DCF), a finding not previously reported. This study demonstrated, through E12 sheeted plastinated sections, that the morphology and topography of the DCF is complex, and a more precise understanding of the anatomy of the DCF and associated potential spaces is paramount clinically in otolaryngology, concerning the cervical fascial pathways of potentially life-threatening commutative pathologies.

Abstract The research of Knowledge and Behavior on Cervical cancer. It is an index of a nation¡¦s competition ability and merit goods referring to citizen health. In additions, it also saves amount of cost from medicine and resource regarding to overall government policy of prevention. In the 20th century, cancer is one of the most concerning matters. From 1982 to 2000,cancer has been a major cause of death. It also rapidly results in 30 thousand deaths per year. Moreover, the Cervical Cancer is a major cause of death for female. (44 out of 100,000 people are affected). It also effects highest rate of death or occurrences of cervical cancer results from overdue treatment according to 60~70% domestic female. In this period, it is essential to consider how we can prevent and reduce occurrences of cervical cancer which are harmful or have threats to all of the women, family and society. Prevention is better than treatment. Cervical Cancer is a major threat of illness to female, however, it is also one of malignance, which can easily be found. Consequently, it needs properly ideas, knowledge and attitude and aggressive actions of health such as injection of vaccine or period body examination in order to achieve the goal of ¡§early found and early treatment¡¨. According to the research, we do believe people have different attitudes, knowledge or behaviors toward cervical cancer prevention due to diverse personal attributions. (Background and character). And it causes different results of cervical cancer healing. In this research of survey, we found the younger age of females such as single female or married without pregnancy, don¡¦t get adequate information or awareness of Cervical cancer and result in readily increasing trends of cervical cancer from 16 to 30 years old female. At the moment, they are the major concerned targets as well as it should be strengthened the way in order to ease the occurrences of cervical Cancer. In this research, we also found it should be improved from ineffectiveness of national organization; consequently, it should be aggressively reinforced on public knowledge and awareness. Finally, people always concern the matters of price, safety and effectiveness of therapy. First, we should raise the functions of effectiveness of therapy and safety in order to reinforce the knowledge and effective vaccine on public. Second, we should build up welfare such as allowance of plans between the ages of 16 to 30 female. Third, government should advocate policy of vaccine injection in order to shrink most rates of cervical cancer and to achieve the goal of ¡§early found and early treatment¡¨. Key words¡Gcervical cancer, screening

published_or_final_version / Public Health / Master / Master of Public Health

Cervical cancer is a global health problem and the most common cancer in women living in sub- Saharan Africa (SSA). Various barriers to cervical screening have been identified. These include cytology based screening. Cervical screening by means of visual inspection with 3% to 5% acetic acid (VIA) can be implemented in a wide range of settings as no laboratory processing is required. This study was a pilot study to determine the knowledge of women, employed by one institution in Tshwane, regarding cervical cancer, whether VIA screening would be acceptable, what the results of such screening would be as well as the practical lessons that could be learnt to improve the screening process. The research study was an exploratory, descriptive and contextual survey. The sampling method was convenient (n=31). Data were gathered by means of self-reports using structured interviews. The results of the screening were documented on a clinical record. The study provides evidence that VIA screening was acceptable to women. However the knowledge of women, despite having a higher level of education, was low. Although one of the participants was VIA positive, none was VIA positive/invasive cancer. Lessons learnt included that the number of women that could be screened in a given time should not be overestimated and that clinical breast examinations should be offered concurrently with cervical screening campaigns.

Neck pain is an increasing problem in industrialized societies. Research is necessary to find ways to objectively measure neck dysfunction. The purpose of this Master's project was to examine the test-retest properties of a dynamometric system for neck force measurements and to obtain reference measures on isometric cervical strength in a healthy population. Twenty-eight healthy subjects participated in this study; 16 males and 12 females. Cervical strength was measured using the MCU(TM) Multi-Cervical Unit (BTE Technologies(c)) in six directions: flexion, extension, protraction, retraction and right and left lateral flexion. The test-retest reliability was good to excellent (≥ 0.85) for all directions. Males were on average 58% stronger than females, with the greatest difference in t1exion. The standard error of measurement and minimal detectable change values were found to be much smaller than the average strength measures. Studies are needed to address the implementation of the MCU in clinical settings.

The purpose of this study was to evaluate the effectiveness of an invitation letter on cervical cancer screening participation among unscreened Manitoba women 30 to 69 years of age. A cluster randomized trial design was used in which unscreened women (n=31,452) were randomly assigned by the forward sortation area (FSA) of their postal code to an intervention group that was sent an invitation letter (n=17,068) or a control group that was not sent an invitation letter (n=14,384). In order to ensure access to screening, a Pap test clinic was held by a health centre in 20 of the 27 FSAs in the intervention group two to three weeks after the invitation letters were mailed. Six months after the letters were mailed, 1,010 women in the intervention group (5.92%) and 441 women in the control group (3.06%) had a Pap test. Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next six months compared to women who were not sent an invitation letter (Odds Ratio (OR) = 2.05, 95% Confidence Interval (CI) 1.78-2.37, p<0.001). However, women who had a Pap test clinic in their FSA were not significantly more likely to have had a Pap test compared to women who did not have a Pap test clinic in their FSA (OR = 1.04, 95% CI 0.82-1.32, p=0.76). Using the Behavioural Model of Health Services Use as a theoretical framework, predisposing, enabling, and need factors that might influence screening participation were also included as covariables in multivariable logistic regression Generalized Estimating Equation (GEE) models. There was a significant main effect of age group (p<0.001), average household income (p=0.01), area of residence (p=0.01), residential mobility (p=0.05), and access (p=0.001). Interactions between the invitation letter and each significant variable were tested. The interaction between the invitation letter and age group remained significant (p=0.02); therefore, the effectiveness of the invitation letter was related to age. Overall, 21 women (1.45%) had a high-grade Pap test result.

If the problems of the subjective nature of colposcopy could be avoided, colposcopy could be a non-invasive method of allowing women to remain under safe surveillance whilst avoiding having tissue biopsies taken. This thesis presents an evaluation of different methods to identify a high risk group from women with mild dyskaryosis in the context of a prospective randomised trial. Chapter 1 describes the historical background to the management of low grade cytological abnormalities and the changes brought about by the introduction of colposcopy. This is used to put into context the current dilemma regarding the management of mild dyskaryosis. The role of human papillomavirus in the development of cervical neoplasia will be discussed with a literature review of current evidence to support its use as a secondary screening tool for cervical disease. Chapter 2 describes the design of this prospective randomised controlled trial including patient recruitment and randomisation and the trial protocol. Chapter 3 presents the histopathological outcome for each trial arm and evaluates the use of semi-quantitative HPV 16 detection with the current use of cytological surveillance as a method of secondary screening. Chapter 4 presents the results of a pilot study to compare the efficiency of a commercial HPV detection kit, hybrid capture, with semi-quantitative HPV 16 detection by polymerase chain reaction for women with mild dyskaryosis. Chapter 5 compares the value of objective measurement of colposcopic features of cervical intraepithelial neoplasia on digitised colposcopic images with subjective colposcopic assessment and comments on image digitising in the surveillance of women with mild dyskaryosis. Chapter 6 presents the socio-demographic data on the trial women and evaluates the ability of high risk behaviour to identify a high risk group from those women with mild dyskaryosis. Chapter 7 summarises the results of this trial and presents the main conclusions.

The aim of this study was to investigate putative progression markers in cells from normal and dyskariotic cervical smears. Specifically, the pattern of cytokeratin expression in normal and abnormal cervical cells was investigated using well characterised monoclonal antibodies, and the role and prevalence of Epstein-Barr virus (EBV) in the cervix was determined using the Polymerase Chain Reaction (PCR). Cytospin prepared from cells from normal cervical smears were stained using the APAAP method with monoclonal antibodies to specific cytokeratins. No meaningful results were obtained, and the pattern of expression of cytokeratins within cells from smears found to be normal and satisfactory could not be determined. No investigations of abnormal smears was undertaken. DNA was extracted from cells obtained from cervical smears and assayed by PCR of the presence of EBV. Overall the prevalence of EBV in the adult uterine cervix in the NE of Scotland was determined to be 42.8%. A total of 200/467 patient samples, investigated for the presence of EBV, were positive. Of these 98/235 (41.7%) were Control patients, 59/151 (39.1%) were Birthright patients, and 43/81 (53%) were Colposcopy patients. When the 98/235 (41.7%) Normal (Control group) and 102/232 (43.9%) Abnormal (Birthright and Colposcopy group) patients were compared, no significant differences (p=0.05) were observed in positivity to EBV. These results would seem to preclude a primary role in carcingenesis for Epstein-Barr virus, but does not exclude its role as a promoting agent for further events leading to carcinoma of the cervix.

The purpose of this study was to evaluate the effectiveness of an invitation letter on cervical cancer screening participation among unscreened Manitoba women 30 to 69 years of age. A cluster randomized trial design was used in which unscreened women (n=31,452) were randomly assigned by the forward sortation area (FSA) of their postal code to an intervention group that was sent an invitation letter (n=17,068) or a control group that was not sent an invitation letter (n=14,384). In order to ensure access to screening, a Pap test clinic was held by a health centre in 20 of the 27 FSAs in the intervention group two to three weeks after the invitation letters were mailed. Six months after the letters were mailed, 1,010 women in the intervention group (5.92%) and 441 women in the control group (3.06%) had a Pap test. Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next six months compared to women who were not sent an invitation letter (Odds Ratio (OR) = 2.05, 95% Confidence Interval (CI) 1.78-2.37, p<0.001). However, women who had a Pap test clinic in their FSA were not significantly more likely to have had a Pap test compared to women who did not have a Pap test clinic in their FSA (OR = 1.04, 95% CI 0.82-1.32, p=0.76). Using the Behavioural Model of Health Services Use as a theoretical framework, predisposing, enabling, and need factors that might influence screening participation were also included as covariables in multivariable logistic regression Generalized Estimating Equation (GEE) models. There was a significant main effect of age group (p<0.001), average household income (p=0.01), area of residence (p=0.01), residential mobility (p=0.05), and access (p=0.001). Interactions between the invitation letter and each significant variable were tested. The interaction between the invitation letter and age group remained significant (p=0.02); therefore, the effectiveness of the invitation letter was related to age. Overall, 21 women (1.45%) had a high-grade Pap test result.

No description available.