Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 61-66).

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.

No description available.

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.

Background: The efficacy of interventions to prevent in-hospital transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is poorly defined, particularly for admission screening. Methods: Variability in ESBL-E infection control practices was evaluated with a survey of 15 hospitals. All ESBL-E positive clinical and screening specimens at 12 hospitals (6 screening and 6 non-screening) from 2005-2009 were included and defined as hospital-onset or community-onset using standard definitions. ESBL-E incidence and susceptibility were studied. Screening efficacy was evaluated with a negative binomial model, adjusting for study year and incidence of community-onset cases. Results: Diverse practices in infection control for ESBL-E were found with 53.3% of hospitals utilizing admission screening. Overall incidence and hospital-onset cases increased 4-fold and 2-fold, respectively. Fluoroquinolone susceptibility for E. coli (12.8%) and K. pneumoniae (9.0%) was low. Hospital-onset cases were 49.1% lower in screening compared to non-screening hospitals (p<0.001). Conclusion: Admission screening can reduce the incidence of hospital-onset ESBL-E cases.

Background: The efficacy of interventions to prevent in-hospital transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is poorly defined, particularly for admission screening. Methods: Variability in ESBL-E infection control practices was evaluated with a survey of 15 hospitals. All ESBL-E positive clinical and screening specimens at 12 hospitals (6 screening and 6 non-screening) from 2005-2009 were included and defined as hospital-onset or community-onset using standard definitions. ESBL-E incidence and susceptibility were studied. Screening efficacy was evaluated with a negative binomial model, adjusting for study year and incidence of community-onset cases. Results: Diverse practices in infection control for ESBL-E were found with 53.3% of hospitals utilizing admission screening. Overall incidence and hospital-onset cases increased 4-fold and 2-fold, respectively. Fluoroquinolone susceptibility for E. coli (12.8%) and K. pneumoniae (9.0%) was low. Hospital-onset cases were 49.1% lower in screening compared to non-screening hospitals (p<0.001). Conclusion: Admission screening can reduce the incidence of hospital-onset ESBL-E cases.

No description available.

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.

Screening pregnant women for substance use appears unworthy of debate given the harmful impacts on the fetus, pregnancy outcomes, the woman herself and her offspring to adulthood. However while screening is routine for conditions such as impaired glucose control, obstetric care providers are often reluctant to intervene with substance use, citing knowledge deficits and a lack of effective screening tools. General negativity about the value of intervention and stereotypical views of substance users have also been identified. This study examined existing screening tools and investigated the World Health Organization’s ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) Version 3.0, focussed on tobacco, alcohol and cannabis, the substances most used in the targetted public hospital clinics. The ASSIST Version 3.0’s performance in pregnancy was assessed using a two-pronged harm categorization: risk to the fetus and risk to the woman as an individual user. For the latter, levels of risk concordant with cut-offs for the general population were utilized. The ASSIST Version 3.0 performed only moderately well versus established self-report tools: the Revised Fagerstrom Tolerance Questionnaire (RTQ) for tobacco, the T-ACE for alcohol, and the Timeline FollowBack (TLFB) for cannabis. Most participants used tobacco (98 of 104); predominance of tobacco use was likely linked to the recognized difficulty in stopping, despite cessation of other substances. Kappa analyses of Specific Substance Involvement Scores (SSIS) on ASSIST Version 3.0 for tobacco did not support changing cut-offs for the woman as an individual user; however, ROC curves delineated an SSIS of 4 as indicative of fetal risk for both alcohol and cannabis. As all 98 tobacco users were ‘high risk’ users, a cut-off indicative of fetal risk for tobacco could not be determined but may be feasible by further research with first trimester women. Identifying tobacco use with an established tobacco-specific tool should be the first screening for pregnant women. If tobacco use is identified, screening for other substance use can be initiated and there may be a place for the ASSIST Version 3.0 in that context. Obstetric care providers need to then be willing and competent to address identified use, whilst avoiding unhelpful stereotyping. / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2010