Indiana University-Purdue University Indianapolis (IUPUI) / In this study we compared the distribution of HPV types in cervical cancer specimens from women living in either Indiana or Botswana. Paraffin-embedded blocks of formalin-fixed cervical cancer specimens were identified from women living in Indiana (n=51) or Botswana (n=171)

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

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

One hundred women aged 20 to 50 were asked to compare their sexual experience before diagnosis and following treatment for benign and malignant cervical disease. The subjects were divided into five groups: three groups had definite cervical intraepithelial neoplasia (CIN), (Class II or III). Two groups were treated with cryotherapy, and one with hysterectomy. One group had a provisional diagnosis of CIN I, but received no treatment. Subjects in the last group had microinvasive cervical carcinoma and were also treated with hysterectomy. All subjects had ovarian function; all were sexually active at the time of treatment. They were interviewed at least six months post-cryotherapy and 15 months post-hysterectomy. All subjects completed a variant version of the Derogatis Sexual Function Inventory (DSFI).

The study is informed by inadequate information on factors associated with the prevalence, incidence and mortality of cervical cancer cytological abnormalities in Swaziland. The aim of the study was to explore and describe factors associated with cervical cancer among women of reproductive age between 15 and 49 years in Swaziland. Quantitative descriptive design with a data extraction tool was used to retrospectively generate observational data from 1748 patients’ records in Mbabane Government Hospital from January 2014 through to December 2014. Bivariate logistic regression was used to establish relationship between cervical cancer and each explanatory variable. The overall prevalence of cervical cytology test results was 24.9%. The combination of marital status, HIV status, ART status, age at sexual debut have been identified as factors associated with cervical abnormalities. Most importantly, the results will also serve as evidence for the development of a national cervical cancer screening policy and also strengthening the cancer registry in Swaziland. / Health Studies / M.A. (Public Health)

Thesis (M. Tech.) - Central University of Technology, Free State, 2009

Ho, Ching Sze. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 142-160). / Abstracts in English and Chinese. / DECLARATION --- p.I / ACKNOWLEDGEMENTS --- p.II / ABSTRACT (ENGLISH VERSION) --- p.IV / ABSTRACT (CHINESE VERSION) --- p.VII / TABLE OF CONTENTS --- p.IX / LIST OF FUGURES --- p.XII / LIST OF TABLES --- p.XIII / LIST OF ABBREVIATIONS --- p.XV / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Biology of human papillomavirus --- p.2 / Chapter 1.1.1 --- History --- p.2 / Chapter 1.1.2 --- Classification --- p.3 / Chapter 1.1.3 --- Genome structure --- p.5 / Chapter 1.1.4 --- Life cycle --- p.9 / Chapter 1.2 --- Epidemiology of cervical cancer --- p.10 / Chapter 1.2.1 --- Cervical intraepithelial neoplasia and cervical cancer --- p.10 / Chapter 1.2.2 --- Spectrum of cervical neoplasia --- p.13 / Chapter 1.2.3 --- Incidence of cervical cancer --- p.15 / Chapter 1.2.4 --- Screening programme --- p.16 / Chapter 1.3 --- Risk factors for cervical cancer --- p.17 / Chapter 1.4 --- Oncogenic HPV infection --- p.20 / Chapter 1.4.1 --- Risk association --- p.21 / Chapter 1.4.2 --- Geographical distribution --- p.23 / Chapter 1.4.3 --- Age distribution --- p.24 / Chapter 1.4.4 --- Oncogenic property of HPV --- p.25 / Chapter 1.4.5 --- Sequence variation --- p.28 / Chapter 1.5 --- Prevention by vaccination --- p.30 / Chapter 1.6 --- Objectives --- p.31 / Chapter CHAPTER 2: --- MATERIALS AND METHODS --- p.33 / Chapter 2.1 --- HPV type and prevalence distribution --- p.34 / Chapter 2.1.1 --- Study population --- p.34 / Chapter 2.1.2 --- Specimen and epidemiological data collection --- p.34 / Chapter 2.1.3 --- DNA extraction --- p.35 / Chapter 2.1.4 --- PCR amplification of DNA --- p.36 / Chapter 2.1.4.1 --- PCR for Beta-globin --- p.36 / Chapter 2.1.4.2 --- PCR for HPV DNA --- p.37 / Chapter 2.1.5 --- HPV typing by reverse line-blot hybridization --- p.39 / Chapter 2.1.6 --- Statistical method --- p.40 / Chapter 2.2 --- HPV 52 SEQUENCE VARIATION --- p.43 / Chapter 2.2.1 --- Study population --- p.43 / Chapter 2.2.2 --- Specimen processing --- p.43 / Chapter 2.2.3 --- DNA extraction --- p.44 / Chapter 2.2.4 --- PCR amplification for sequencing --- p.45 / Chapter 2.2.4.1 --- Optimization of gene-specific PCR --- p.45 / Chapter 2.2.4.2 --- Validation of type-specificity of gene-specific PCR --- p.46 / Chapter 2.2.4.3 --- PCR for HPV52 E6 and E7 --- p.46 / Chapter 2.2.4.4 --- PCR for LI gene --- p.47 / Chapter 2.2.4.5 --- PCR for long control region (LCR) --- p.48 / Chapter 2.2.5 --- Purification of PCR products --- p.49 / Chapter 2.2.6 --- Sequencing --- p.50 / Chapter 2.2.6.1 --- Preparation of template --- p.50 / Chapter 2.2.6.2 --- Purification of template --- p.50 / Chapter 2.2.6.3 --- Sequencer and data analysis --- p.51 / Chapter 2.2.7 --- Statistical methods --- p.51 / Chapter CHAPTER 3: --- RESULTS --- p.54 / Chapter 3.1 --- HPV TYPE AND PREVALENCE DISTRIBUTION --- p.55 / Chapter 3.1.1 --- Study population --- p.55 / Chapter 3.1.2 --- HPV prevalence --- p.59 / Chapter 3.1.2.1 --- Prevalence for HPV infection --- p.59 / Chapter 3.1.2.2 --- HPV age-specific prevalence --- p.68 / Chapter 3.1.3 --- Epidemiological risk profile --- p.73 / Chapter 3.1.3.1 --- Age-adjusted analyses --- p.73 / Chapter 3.1.3.2 --- Multivariate analyses --- p.76 / Chapter 3.2 --- HPV52 SEQUENCE VARIATION --- p.79 / Chapter 3.2.1 --- Study population --- p.79 / Chapter 3.2.2 --- Sequence variability of HPV52 --- p.79 / Chapter 3.2.3 --- HPV52 --- p.82 / Chapter 3.2.3.1 --- Sequence variation of E6 ORF --- p.82 / Chapter 3.2.3.2. --- HPV52 E6 variants and risk for cervical neoplasia --- p.86 / Chapter 3.2.4 --- HPV52 E7 --- p.89 / Chapter 3.2.4.1 --- Sequence variation of E7 ORF --- p.89 / Chapter 3.2.4.2 --- HPV52 E7 variants and risk for cervical neoplasia --- p.93 / Chapter 3.2.5 --- HPV52 LI --- p.95 / Chapter 3.2.5.1 --- Sequence variation of LI ORF --- p.95 / Chapter 3.2.5.2 --- HPV52 LI variants and risk for cervical neoplasia --- p.100 / Chapter 3.2.6 --- HPV52 long control region (LCR) --- p.104 / Chapter 3.2.6.1 --- Sequence variation of LCR --- p.104 / Chapter 3.2.6.2 --- HPV52 LCR variants and risk for cervical neoplasia --- p.110 / Chapter CHAPTER 4: --- DISCUSSION --- p.113 / Chapter 4.1 --- HPV PREVALENCE AND TYPE DISTRIBUTION --- p.114 / Chapter 4.1.1 --- HPV prevalence --- p.114 / Chapter 4.1.2 --- Age-specific prevalence --- p.116 / Chapter 4.1.3 --- Epidemiological risk profile --- p.121 / Chapter 4.1.4 --- Conclusions --- p.126 / Chapter 4.2 --- HPV 52 SEQUENCE VARIATION --- p.127 / Chapter 4.2.1 --- Sequence variability of HPV52 --- p.127 / Chapter 4.2.2 --- Sequence variation of E6 gene --- p.129 / Chapter 4.2.3 --- Sequence variation of E7 gene --- p.132 / Chapter 4.2.4 --- Sequence variation of LI gene --- p.134 / Chapter 4.2.5 --- Sequence variation of LCR --- p.135 / Chapter 4.2.6 --- Conclusions --- p.139 / Chapter 4.3 --- FURTHER STUDIES --- p.140 / REFERENCES --- p.142 / APPENDIXES --- p.A

Thesis (M. A. (Social Work)) --University of Limpopo, 2018 / Cancer of the cervix is second type of cancer among women in developing countries, and a common problem among women of low socio-economic status in rural communities. The spiral increase of the problem is aggravated by some socio-economic, structural, cultural and political factors. Understanding the risk factors associated with the disease is a step forward towards effective prevention and treatment. Numerous studies have been conducted on knowledge and perceptions of cervical cancer however the information on cervical cancer is still not reaching the majority of women. The study explored the perceptions and attitudes of rural women of Matebeleng village towards cervical cancer, the risk factors, screening tests and the HPV vaccines. A qualitative exploratory case study was conducted. Self-reported data was collected from 22 women. Two focus groups of 7 and 9 and 6 face-face individual interviews were conducted using a semi-structured interview guide. Data was analysed thematically. The research findings revealed that the majority of women in the rural area where the study was conducted never heard of cervical cancer and only few received inadequate information. Few highlighted some of the risk factors but some information was incorrect. Very few participants had only once been screened and the majority have never been tested for cervical cancer. Some became aware of the vaccine through the consent forms from school even though they did not exactly understand the content. The sources of information were the radio, health clinic and random women. The concerns of those who were screened were lack of feedback from the clinic nursing staff after the test, lack of adequate preparation and information before been screened to allay fear and doubt of the unknown and lack of reach out programmes to rural communities. The methods of disseminating information to rural women in their distinct contexts should be examined. Conventional traditional ways of reaching out to rural women could perhaps produce improved results through the integrated approach involving multi-disciplinary teams in educating communities. Key Words: Perceptions, attitudes, rural-based women, cervical cancer, risk factors, screening tests, HPV vaccine

published_or_final_version / Public Health / Master / Master of Public Health

Orientador: Luiz Carlos Zeferino / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T19:33:51Z (GMT). No. of bitstreams: 1 Vale_DiamaBhadraAndradePeixotodo_M.pdf: 6577919 bytes, checksum: 70e533105be682a7083418f3bad0b3a0 (MD5) Previous issue date: 2010 / Resumo: O rastreamento do câncer do colo do útero no Brasil não tem sido efetivo em reduzir as altas taxas de incidência e mortalidade desta neoplasia, apesar de o Ministério da Saúde ter estabelecido há mais de 20 anos as normas definindo a população-alvo e a periodicidade dos controles. A territorialização e o cadastramento das famílias pelo Programa de Saúde da Família favorecem a ruptura com o padrão oportunístico do rastreamento e com a identificação das mulheres que nunca fizeram o exame citológico ou estão há mais de três anos sem fazê-lo. Este estudo analisou se o rastreamento do câncer do colo do útero avançou no sentido de seguir as recomendações vigentes, ao longo de sete anos de implantação do Programa de Saúde da Família em Amparo, município do interior de São Paulo, referência em ações de atenção básica. Os objetivos foram verificar a variação da frequência dos exames realizados em função do intervalo desde o último controle, do grupo etário, da cobertura das ações de rastreamento e dos exames realizados em excesso. O estudo foi longitudinal e retrospectivo. Os sujeitos foram todas as mulheres usuárias do Sistema Único de Saúde que realizaram o exame citológico de rastreamento de janeiro de 2001 a dezembro de 2007. Para análise estatística, foi utilizado o teste de qui-quadrado modificado por Cochran-Armitage para tendência. A periodicidade anual manteve-se alta no período do estudo, variando entre 51,2% e 59,7% do total dos controles realizados. Houve aumento estatisticamente significante, ainda que discreto, em números relativos, dos exames realizados com intervalo de dois anos ou mais desde o último controle, como também houve redução das mulheres realizando exame pela primeira vez. A distribuição de exames tendeu a aumentar no grupo etário 40-59 anos e a diminuir no grupo etário com mais de 60 anos. Os percentuais de exames em excesso variaram de 61,2% a 65,5%. Concluindo, a qualificação do rastreamento do câncer do colo do útero foi discreta e não modificou o padrão oportunístico dos controles. O Programa da Saúde da Família, ainda que possa ser uma estratégia com potencial para organizar o rastreamento do câncer do colo do útero no Brasil, não mostrou impactos evidentes neste sentido. Os agentes comunitários de saúde, componentes das equipes de saúde da família, podem atuar no sentido de identificar as mulheres-alvo que não estão realizando regularmente os controles periódicos. Portanto é essencial capacitá-los para cumprir este papel / Abstract: Cervical cancer screening in Brazil has failed to reduce the high incidence and mortality rates associated with this disease despite the fact that the Brazilian Ministry of Health established regulations defining the target population and the periodicity of screening tests over 20 years ago. The territorial distribution and the registration of families in the Family Health Program should interrupt the opportunistic screening pattern, identifying women who have never been screened or who were last screened over three years previously. This study evaluated whether any progress had been achieved in cervical cancer screening in terms of compliance with the current recommendations over the period of seven years since implementation of the Family Health Program in Amparo, a township in the state of São Paulo and a reference in primary healthcare. The objectives of this longitudinal, retrospective study were to analyze the variation in the frequency of testing in accordance with the interval since previous screening, age group, the coverage provided by the screening actions and the extent of unwarranted testing. The subjects consisted of all the women using the Brazilian National Health Service who had been submitted to a cervical smear test between January 2001 and December 2007. The Cochran-Armitage test for trend was used in the statistical analysis. Annual periodicity remained high throughout the observation time of the study, ranging from 51.2% to 59.7% of the total number of screening tests performed. There was a statistically significant increase in the tests performed within an interval of two years or more since the previous screening; however, this increase was modest in relative numbers. In addition, a reduction was found in the number of women undergoing testing for the first time. The distribution of tests according to age group showed a tendency towards an increase in the 40-59 year age group and a decrease in the over-60s age group. The percentage of unwarranted tests ranged from 61.2% to 65.5%. In conclusion, the improvement in cervical cancer screening was slight and was insufficient to alter the opportunistic pattern of screening. Although Brazil?s Family Health Program has the potential to organize cervical cancer screening in the country, there is no evidence of any significant change at this moment. The community healthcare agents working in the Family Health Program teams could implement measures for identifying target women who are not being submitted to regular screening; hence they should be trained to perform this role / Mestrado / Oncologia Ginecológica e Mamária / Mestre em Ciências da Saúde