Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 129-137).

Thesis (Ph. D)--UCLA, 2007. / Vita. Includes bibliographical references (leaves 197-214).

Thesis (M.P.H.)--University of Texas at El Paso, 2009. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

BACKGROUND : Cervical cancer is the second most common malignancy in women worldwide, and the leading cause of mortality among women. It affects approximately 500 000 women each year with about 270 000 deaths. Almost 80% of the mortalities occur in developing countries. The National Department of Health in South Africa introduced a cervical cancer screening policy in the year 2000. The aim of the policy was to screen more that 70% of the women aged 30 – 59 by the end of 10 years. Women aged 30 – 59 years are offered 3 Pap smears per life time, with an interval of 10 years between the smears. AIM: The aim of the study was to determine the uptake of cervical cancer screening among eligible women (age 30 – 59 years), their practice, knowledge and attitude, as well as the capacity of the facility and the service providers to offer cervical cancer screening service. METHODS: A health systems descriptive study. A two stage sampling technique was done. Purposeful sampling of the healthcare facilities in the defined area was done, targeting the Provincial Health clinics. Records were reviewed at the facility to determine the percent of women aged 30 – 39 years, who used the facility and had Pap smears over the period: August 2003 to July 2007. Facility managers at the Holani clinic and Stanza Bopape Community Health Center were interviewed. Self administered questionnaires were distributed to doctors and professional nurses at both facilities. Questionnaires were also distributed to the women aged 30 – 59 years who visited the facilities during data collection to determine the knowledge, attitude and practice of these women concerning Pap smear. Data entry was done using Epi-Info and Microsoft Excel. Data was analyzed using STATA version 9. Methods applied were frequencies, percentages and cross tabulations. Differences between groups were examined using Fisher’s exact test and Chi-square test. Results were presented in tables and graphs. RESULTS : Record review at Holani clinic indicated that the percent of women aged 30 – 59 years who had undergone Pap smears while attending clinic from January 2004 to July 2007 was 8%. Stanza Bopape had incomplete records. Only about 50% of the women interviewed had undergone Pap smear. Socio-demographic factors like age, education and employment did not have a significant effect on the knowledge, attitude and practice of cervical cancer screening by the targeted service users. Women of lower parity had undergone more Pap smears than those of higher parity. Women of lower parity had more knowledge about Pap smear (p-value=0.05). The knowledge and practice of Pap smear among women aged 30 – 59 years who attended the clinics were significantly associated with getting information from the nurse (p=0.01). Knowledge of the National Cervical Cancer Screening Policy by the service providers was limited. Both facilities had adequate resources for performing the procedure. The number of trained staff per facility was adequate for the performance of the procedure. There was enough privacy to do the procedure. Specimen transportation was adequate, and turn around time was acceptable. CONCLUSION : The extent of Pap smear investigation at the facilities is inadequate. The Service Providers need to calculate the minimum number of Pap smears needed per day to reach the required targets. Nurses at the primary healthcare setting play a major role in improving the uptake of cervical cancer screening. There is a need to actively recruit women to come for Pap smear, while at the same time strengthening health education. Copyright / Dissertation (MMed)--University of Pretoria, 2010. / School of Health Systems and Public Health (SHSPH) / Unrestricted

The purpose of this dissertation was to explore the determinants of Pap screening completion among sub-Saharan African immigrant women. Cervical cancer is a public health problem globally. The risk of invasive cervical cancer remains high among sub- Saharan African immigrant women in the US despite being a preventable cancer. Early detection through Pap screening is crucial for prevention, treatment and prognosis. The specific aims of this dissertation were to 1) examine Pap screening practices among African immigrant women and to identify gaps to guide future research; 2) explore barriers and motivators that influence Pap screening decisions among African immigrant women; and 3) explore African immigrant men’s knowledge of Pap screening and attitudes about supporting their wives/female partners to utilize Pap screening, and 4) explore predictors of Pap screening use among sub-Saharan African immigrant women, Specific aim one was addressed by a review and synthesis of literature focused on Pap screening among African immigrant women. Common factors influencing Pap screening completion included immigration status, health care interactions, knowledge deficiency, religiosity, and certain personal characteristics. Specific aim two was addressed by the conduct of a qualitative descriptive study of barriers and motivators contributing to Pap screening decisions in 22 African immigrant women. Women experienced different barriers including low knowledge of screening, cultural beliefs, fear and communication issues. Addressing knowledge gaps and other barriers related to Pap screening may improve Pap screening participation in this group. Specific aim three was addressed by a qualitative descriptive study of men’s attitudes and beliefs regarding Pap screening and support for their wives for Pap screening participation. African immigrant men demonstrated suboptimal knowledge and awareness of cervical cancer screening. Most men had a lack of knowledge regarding HPV and its link with cervical cancer. Despite knowledge deficiency men showed significant interest in supporting their wife/female partners. Specific aim four was addressed by conducting an analysis of cross sectional data collected from 108 sub-Saharan African women. Predictors of Pap screening completion was determined using logistic regression while controlling for age and education. Pap screening awareness and provider’s recommendations were independent predictors of Pap screening. Given the unequitable burden of cervical cancer experienced by this population, the findings from this dissertation point to the need for a multilevel targeted health interventions directed toward African immigrant population are needed to increase the rates of Pap screening among African immigrant women. Prevention efforts should focus on individual level factors and develop culturally relevant strategies that will effectively provide educational outreach interventions and alleviate barriers to Pap screening. Engaging spousal support and addressing social norms related to spouses/partners’ roles that may influence partaking in cervical cancer screening is important among African immigrant women. Cervical cancer is preventable; Pap screening will lead to early detection of cervical cancer in female African immigrants.

The purpose of this study is to investigate specific contributing factors affecting quality assurance in the diagnosis of conventional cervical smears. More than half of South- African women fail to have one cervical smear in their lifetime and +/- 50 percent of those who do have cervical smears taken, are lost to follow-up. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen all women in South Africa, due to far-off rural areas, shortage of medical professionals and the lack of knowledge of some women of the necessity of cervical smears. Many newly qualified South-African doctors leave the country to go and work elsewhere. South Africa then in turn has to recruit doctors from other countries to staff the State hospitals and clinics. Some areas have one doctor to thousands of patients, insufficient nursing personnel and inadequate equipment. Doctors in some areas cannot cope with the volume of work and the long hours. One has to accept that the quality of the management of some patients is affected negatively. There are a number of medico-legal issues (world wide) in relation to aspects of cervical cancer prevention practices which are controversial and are of particular concern to all of those involved in cervical cancer prevention. Various countries have therefore formed different national organizations to address the medico-legal issues in screening for the prevention of cancer. These organizations monitors procedures, internal quality control as well as external quality control. In South Africa, medico-legal cases are not so prevalent, but may become so shortly. The South-African medical professionals therefore have to ensure that their quality of work conforms to accepted good practice in all circumstances. State hospitals serve thousands of patients per month and it is an every day occurrence to see long queues of patients sitting waiting for doctors and who often have to come back the following day. The situation appears to be much improved in private practice and since patients have medical cover and accessible medical facilities. Since cervical cancer is the most common malignancy amongst women in developing countries, the medical profession will have to endeavor to screen a higher rate of women and ensure a 100 percent quality assurance with every patient treated in order to reduce the unacceptable high incidence of cervical carcinoma. At this stage it seems like an impossible task to screen 100 percent of women in South Africa, due to far-off rural areas, the shortage of medical professionals and ignorance of patients. Quality assurance is therefore of paramount importance to every medical professional for every patient treated. Laboratories all worldwide have been, or are in the process of being accredited by their specific accreditation authorities. The main reason for this is improvement of quality control and therefore quality assurance. The South African National Accreditation Society (SANAS) now accredits various laboratories in South Africa with the view of accreditting all laboratories within a certain time limit. The Ampath laboratory Port Elizabeth was successfully accredited during 2001. Accredited laboratories have to uphold a very high degree of quality to remain accredited. A team of professionals inspects the laboratory every 2 years and other quality assurance staff inspects the laboratories every few months. All aspects of the laboratory are checked, e.g. the qualification of staff, their registration with the Health Professions Council of South Africa (HPCSA), their curriculum vitaes, equipment, safety of the laboratory etc. Since the laboratory chosen for this study, is accredited, the author evaluated every cervical smear that was received in the laboratory since the year 2000, with the following objectives in mind: · Whether the presence or absence of an endocervical component has an effect on the adequacy of cervical smears · To determine the effect of using smaller coverslips on quality assurance in the cytology laboratory · Evaluate the effect that manual re-screening of smears has on quality assurance in the cytology laboratory. As there is a shortage of cytotechnologists and pathologists worldwide, several countries make use of automated screening devices as primary screening or secondary screening for quality assurance. These devices were tested in some laboratories in South Africa but were found to be very expensive and sensitivity and specificity were not up to standard. Sensitivity is a measure of the ability of a test to detect the abnormal - Sensitivity is the ratio of true positives to true positives + false negatives. Specificity is a measure of the ability of a test to correctly identify the negative - Specificity is the ratio of true negative to true negatives + false positives. The automated screening machines failed to identify abnormal cells amongst inflammatory cells, as well as in very blood stained smears. Several other problems also occurred and an increasing number of smears had to be manually rescreened, thus making this exercise costly and not helpful as a quality assurance instrument. The slides used for this thesis, have been retrieved from the archives of the Ampath laboratory in Port Elizabeth. Fourteen specific contributing factors affecting quality assurance in the diagnosis of cervical smears are also discussed and conclusions and recommendations given.

A conservative strategy for women with a low-grade abnormal cervical smear is continued cytological surveillance by repeat Papinacolaou testing, but there is surprisingly little information on the management of such follow-up. Our objectives were to investigate such management pathways, their determinants, and psychological implications using data from the cytological surveillance arm of the Trial of Management of Borderline and Other Low-grade Abnormal cervical smears. A substantial proportion of participants had ongoing unresolved cytology at last follow-up (42.7%); a policy of following women solely though cytological surveillance to manage these women may be inefficient. A high-risk human papillomavirus test, smoking and age were significantly associated with the management pathways (p-value <0.05). While there were some limitations, our results were reassuring with respect to this group of women with ongoing unresolved cytology, since there were no differences in anxiety and depression scores across the management pathways after thirty months of follow-up.

Bakgrund: Begreppet fysisk aktivitet beskrivs som alla former av kroppsrörelse som förbättrar hälsa samt individens fysiska kapacitet. Fysisk aktivitet minskar risken för ett flertal sjukdomar och förtida död. Regelbunden fysisk aktivitet minskar risken för ohälsa och används som behandling i att bota, lindra symtom och förebygga sjukdomar. FaR är en förskrivning av fysisk aktivitet och användas för att ersätta eller komplettera läkemedel. Syfte: Syftet var att beskriva patienters upplevelser av fysisk aktivitet på recept. Metod: Allmän litteraturstudie baserad på elva vetenskapliga artiklar där tio är av kvalitativ metod och en av mixad metod. Resultat: Fyra huvudteman identifierades: upplevelser av delaktighet, upplevelser av individanpassad fysisk aktivitet, upplevelser av stöd och upplevelser av att ha kontroll över sin hälsa. Litteraturstudien visar att motivation krävs för ett gott genomförande av FaR. En individanpassad förskrivning och ett gott stöd kan stärka följsamhet till ordinationen. FaR kan ge en ökad livskvalitet. Konklusion: Motivation, stöd och en individanpassad förskrivning krävs för ett gott genomförande av FaR. Det ger även en ökad fysisk aktivitet vilket främjar livskvalité.

"This study attempts to provide a picture of how parliaments have been contributing to the protection of human rights and democracy and how the Pan-African Parliament (PAP) can draw lessons from the different mechanisms adopted by these parliaments. This study consists of five chapters. The first chapter sets out the problem that this study aims to address and reviews existing studies that have touched upon the issue. The second chapter discusses the dynamics that lead to the establishment of the continental parliament by putting it in the context of continental efforts towards better human rights protection and democratic consolidation. It also discusses the objectives of the parliament and particularly its human rights and democartic mandate. The third chapter sets out a framework for analysis. This is done by examining how parliaments have been dealing with issues of human rights and democracy with particular focus on the European Parliament (EP). This chapter looks at the different structures and mechanisms that the parliaments have employed towards this end but also tries to look further into the powers and compositions of parliaments that [have] enabled them to use such mechanisms and effectively engage in the promotion of human rights and democracy. The fourth chapter discusses in detail the powers, functions and their implications on how PAP promotes human rights and democracy. The activities so far carried out, institutional mechanisms adopted and the potential role it could have and mechanisms it could employ by taking lessons from the design, internal workings, and mechanisms discussed in the previous chapter is provided. Finally the relevant conclusions will be made with recommendations on the way forward for the continental institution in terms of organisation, composition, structures and mechanisms it could adopt towards promotion of human rights and democracy." -- Introduction. / Mini Dissertation (LLM)--University of Pretoria, 2006. / http://www.chr.up.ac.za/academic_pro/llm1/dissertations.html / Centre for Human Rights / LLM

Small cell (neuroendocrine) carcinoma of the uterine cervix (SMCC) is a rare, highly aggressive malignant neoplasm. Both conventional and liquid-based cytology (LBC) cervical smears have low sensitivity in diagnosing SMCC, requiring immunocytochemical (ICH) confirmation. We present the first series of SMCC primarily diagnosed in cytology specimens, and ICH studies performed on the residual LBC specimens with subsequent confirmation of the diagnosis on surgical pathology specimens. Immunocytochemical stains for keratin, p16INK4, and neuroendocrine markers (synaptophysin, chromogranin, CD56) were performed on additional ThinPrep slides. HPV test used chromogenic in situ hybridization high risk HPV DNA probe. The Pap smears in all three specimens were highly cellular with a mixture of squamous cells and numerous well-preserved single or small cohesive clusters of malignant epithelial cells. Tumor cells were small, monomorphic with minimal cytoplasm and high nuclear/cytoplasmic ratio. There was significant nuclear overlap, but no nuclear molding, or smudging of nuclear chromatin. The chromatin pattern was stippled. A background tumor diathesis was prominent. Atypical squamous cells of undetermined significance (ASCUS) were noted in one case, and markedly abnormal squamous cells were seen in another case. The main cytology differential diagnoses included high-grade squamous intraepithelial lesion and an endometrial adenocarcinoma. Immunocytochemical positivity for the neuroendocrine markers supported the diagnoses of SMCC in all three cases. The morphologic features of the concurrent surgical pathology specimens were typical of SMCC. The tissue diagnoses were also confirmed by immunohistochemistry. Our study allows us to conclude that SMCC can be primarily diagnosed in LBC specimens using a panel of immunocytochemical stains.