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<p>In diagnostic accuracy studies, sensitivity and specificity are the most common measures to assess the performance of diagnostic or screening tests. The estimation of these measures can be done using empirical or model-based methods. The primary objective of this thesis is to use both the empirical and the model-based (logistic regression) approach to assess the effects of covariates on the performance of the visual inspection with acetic acid (VIA) and lugol iodine (VILI) tests using the data from women screened for cervical cancer in Kinshasa, the Democratic Republic of Congo. The secondary objectives are: first, to adjust for the false negative and false positive error rates by the two tests through latent class models (LCM), and second, to evaluate the effects of covariates on the agreement between the measurements of the two tests taken by nurse and physician through Kappa statistic.</p> <p>No particular pattern could be observed in the trend of empirically estimated sensitivity and specificity of the VIA and VILI tests measured by the nurse and by the physician across age and parity categories. From the logistic regression models, both age, parity, and their respective quadratic terms have significant effects on the probability of VIA and VILI tests to detect cervical cancer. However, there is no significant effect of marital status, smoking, and hybrid capture2 (HPV DNA) on the probability of VIA and VILI tests measured by nurse to detect cervical cancer while HPV DNA does in the probability of VIA and VILI tests measured by physician to detect cervical cancer. The trend of the estimated sensitivity of VIA and VILI tests measured by the nurse is not different across age groups but the specificity does vary. The trend of both the sensitivity and specificity of VIA and VILI tests are significantly different across parity groups. The reverse is the case for the sensitivity and specificity of VIA and VILI tests measured by physician across age and parity groups. The false negative and false positive error rates in the sensitivity and specificity of VIA and VILI tests measured by nurse are higher compared to that of physician. With Kappa statistic results, there is almost perfect agreement between the ratings by the nurse and physician for the dichotomized VIA and VILI test outcomes.</p> <p>In conclusion, there is a significant effects of age, parity and the quadratic term of age on the performance of VIA and VILI tests outcomes measured by nurse. On the VIA and VILI test outcomes measured by physician, age, parity, HPV DNA and quadratic term of age have shown significant effects on the performance of VIA and VILI tests outcomes measured by physician alone.</p> / Master of Science (MSc)

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第25214号 / 人健博第120号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 杉本 直三, 教授 高桑 徹也, 教授 溝脇 尚志 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Yes / Nanoparticles are increasingly used in industry and medicine due to their unique physiochemical properties such as their small size, charge, shape, chemical architecture, large surface area, surface reactivity and media interactions, etc [1-5]. However, very little is still known on the interactions between nanoparticles and the biological system. This study aims to evaluate the cytotoxicity of polystyrene latex bead nanoparticles on HaCat and HeLa cell lines. Carboxyl-modified 20 nm polystyrene NPs core labelled with fluorophore were from Invitogen. We chose to use polystyrene NPs because this specific type of NP is being increasingly characterized for use in nanosensors and drug nanocarrier investigations. 1x 104 cells/100 μl of cell culture medium were plated into 96-well plates in triplicate, measuring activity post 24 hours at concentrations of 10, 50, 100 μg/ml of polystyrene NPs exposure. The extracellular lactate dehydrogenase release was measured by using a colorimetric CytoTox 96 nonradioactive assay kit from Promega and the absorbance were recorded at 450nm (FLUO-star) with Elisa micro plate reader. The MTT assay was used to evaluate mitochondrial activity. This was performed by inserting a premixed optimized dye solution in the culture wells. The Absorbance was recorded at 570 nm, from the recorded absorbance is directly proportional to the number of live cells. The cell lines were kept in a plastic T-75cm2 tissue culture flasks grown in DMEM. We found that cytotoxicity of polystyrene NPs on both cells was concentration dependent. For Hela cells, with exporesure of polystyrene NPs at concentrations of 10, 50, 100 μg/ml for 24 hrs, the percentage cytotoxicity of positive control for LDH assay was 35.9%, 49.5% and 73.4% respectively. With the MTT cell viability assay the percentage MTT reduction of negative control was 88.9%, 42.9% and 26.4% respectively. Cell toxicity increased with increasing polystyrene NPs concentration. For HaCaT cells, the cytotoxic effect is less significant than those on Hela cells. With MTT assay, when compared to HaCaT cells exposed to a negative control containing only PBS, the cell viability decreased as the concentrations of NPs increased. Cells exposed to 100μg/ml of polystyrene NPs for a period of 24 hours compared to those exposed to a positive control (100% cell viability) had an average cell viability of 49%, with those numbers decreasing from 59% for cells exposed to 10μg/ml of polystyrene NPs to 57% for cells exposed to 50μg/ml of polystyrene NPs. Our results indicated that polystyrene NPs acted differently in two different cell types and that cautions should be taken about its cytotoxicity. Further understanding of the mechanism involving the ROS generation could provide more information on how polystyrene NPs increase cytotoxicity.

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. / Health Studies / D. Litt. et Phil. (Health Studies)

Free cervical cancer screening services are provided in Malawi’s public healthcare institutionssince 1999. Few women aged 42 and older, utilise these services. Cervical cancer continues to be a major cause of morbidity and mortality among this group of women. Structured interviews were conducted with 381 women who attended three healthcare centers in Blantyre and semi-structured interviews with 14 nurse/midwives working at the same centers. The results for both phases arepresented within the Health Belief Model’s constructs. Phase 1 revealed that women had low levels of perceived susceptibility to cervical cancer. Although the interviewed women perceived cervical cancer to be a serious condition, they did not regard themselves to be at risk of suffering from cervical cancer. Knowledge that cervical cancer screening could detect this cancer at an early stage, embarrassment, stigma, social support, financial costs, traditional practices and available sources of information, influenced women’s intentions to be screened for cervical cancer. In phase 2, the nurse/midwives indicated that Malawian women lacked information about cervical cancer, available screening tests and the purpose of such screening.These women perceived cervical canceras being incurable and linked to witchcraft. Women’s utilisation of cervical screening services was hampered by barriers relating to healthcare institutions, women themselves and nurse/midwives. Local radio and television broadcasts, friends and nurse/midwives motivated individual women to use these screening services.Women preferred receiving information about cervical cancer screening during community activities. Health education should be intensified, nurse/midwives should be more empathetic, clinic days and hours should be extended. Misconceptions should be addressed and more service providers should be trained. This would enable more Malawian women to use cervical screening services, enhancing early detection and treatment of cervical cancer and reducing the morbidity and mortality statistics related to this condition in Malawi. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / The purpose of the study was to explore perceptions, knowledge and attitudes of women undergoing cervical cancer screening in Omaheke, Namibia. A qualitative exploratory study was conducted. Data were collected from a purposive sample of eight participants using a self-developed interview guide. Data were analysed using Tesch’s descriptive method of open coding. Three themes were identified namely; cervical cancer as a disease, perception of cervical cancer and service delivery at the facility. The findings also revealed some suggestions for the facility that could improve screening uptake. The study proposes a community education programme on cervical cancer and related topics to be covered during health education sessions. In addition the study recommends the Omaheke directorate to look into operational issues in order to facilitate access to cervical cancer screening. / Health Studies / M.P.H.

The purpose of this study was to describe the factors that determine the utilisation of VIA, and to investigate the socio-economic status of women who undergone VIA. A retrospective document analysis of 323 clinical records was conducted at a specific rural hospital in Zimbabwe. A retrospective, cross-sectional, non-experimental, descriptive, analysis of clinical records was conducted using a checklist to extract data from the records of women who have undergone VIA for cervical screening at the specific rural hospital. The results revealed that 70% (N=225) were from outside the catchment area, 73% (N=234) were poor, 54% (N=173) were of high parity, 85% (N=275) were ill with conditions that included lower back and abdominal pains, excessive vaginal discharge and vaginal bleeding after intercourse. The study further revealed that 72% (N=226) had no prior cervical cancer screening and 87% (N=277) were screened by chance. The conclusion drawn was that socio-economic and logistical constraints hinder cervical cancer screening among rural women. It is recommended that VIA screening and health education on cervical cancer be offered to all women visiting healthcare facilities. Furthermore, the government should consider funding in order to prioritise women’s health issues. / Health Studies / M.A. (Nursing Science)