Cervical cancer is the fifth most common cancer in United States with more than 12,000 women diagnosed each year and more than 4,000 preventable deaths with minorities disproportionally represented. Cervical cancer prevention strategies rarely focus on the management of abnormal screening results. The purpose of this quality improvement project was to standardize the management program for abnormal cervical cancer screening results within an integrated health delivery system serving a large minority community. The Plan-Do-Study-Act model guided a comprehensive program evaluation with process improvement, including the creation of an electronic quality data reporting tool to formalize the work process and a quality control and assurance program with exception reports. The evaluation was completed with data to measure the timeliness of abnormal results outreach and continued clinical management. The data were evaluated over time with run charts. Also, an analysis of the data was done through pre- and post-test comparisons with 2-sample t tests to evaluate abnormal cervical cancer screening management before and after the revisions. Although the project did not show a statistically significant difference in the timeliness of outreach and follow-up of abnormal cervical cancer screening results due to the limited data set, the run charts trended positively for timeliness and consistent data reporting with no missed screening reports. Effective cervical cancer screening includes the accurate and timely management of abnormal results to reduce disparities in cervical cancer deaths. This project contributes to positive social change by responding to the Healthy People 2020 goal to reduce the incidence of cervical cancer deaths through a formal process to insure timely intervention for abnormal results in a largely minority community.

African American women tend to have lower attendance rates at cervical cancer screenings compared to the attendance rates of women from other ethnic groups. The purpose of this research project was to understand how perceptions of African American women affects attendance of future cervical cancer screenings. The goal was to understand what contributes to low attendance. Previous research did not focus on factors contributing or interfering with appointment attendance among African American women, aged 30-65. The conceptual framework was based on individual health behavior. The research questions examined lived experiences affecting attendance of cervical cancer screenings, attendance of future screenings, and perceptions of experiences. Data collection was based on a phenomenological approach. Open-ended questions were used to gather descriptions of 5 participants' experiences via telephone interviews. These interviews were recorded, transcribed, and coded for recurring themes and patterns. Findings revealed 3 emergent themes related to the attendance of screenings: being knowledgeable of the purpose of cervical cancer screening, a female examiner performing the screening, and the encouragement of family and friends. The implications for social change would be increased knowledge among African American women aged 30-65 and the medical community.

In 2015, there were 257,524 women with cervical cancer (CC) in the United States (U.S.). CC is preventable; screening detects early-stage cancer when treatment is most successful. This study aimed to identify predictors for CC screening adherence among U.S. women, describe predictors for screening adherence by marital status, and examine physician recommendation for CC screening and adherence to those recommendations. Predictors were grouped as demographic, acculturation, access to care, chronic conditions, and health behaviors. Descriptive analyses were performed on a sample of 10,667 women from the 2015 National Health Interview Survey, and multiple logistic regression models determined predictors of CC screening adherence, physician recommendations, and adherence to physician recommendations. Overall, 81.7% (95%CI=80.7-82.7%) of U.S. women adhered to CC screening guidelines. Adherence declined with increasing age after 39 years old. Never married women (adjusted odds ratio[aOR]=0.67, CI=0.56-0.79) or current smokers (aOR=0.70, CI=0.59-0.84) had lower odds, while college-educated women had greater odds (aOR=1.38, CI=1.14-1.67) of CC screening adherence. Among unmarried women, 78.6% adhered to CC screening. Unmarried women who were unemployed (aOR=0.48, CI=0.38-0.62), had no physician visits (aOR=0.58, CI=0.40-0.85), no usual source of care (aOR=0.67, CI=0.50-0.89), never heard of HPV (aOR=0.59, CI=0.46-0.76), never received HPV vaccine (aOR=0.50, CI=0.34-0.75), no birth control use (aOR=0.33, CI=0.23-0.47), no flu shot (aOR=0.62, CI=0.48-0.80), and perceived low breast cancer risk (aOR=0.66, CI=0.47-0.92) had lower odds of adherence. Among women with a physician, 55.6% received screening recommendations. Race/ethnicity, access to care, HPV knowledge and vaccine receipt, age when first child was born, and flu shot were significant predictors of physician recommendation for CC screening. Significant predictors of adherence to physician recommendation included education, employment, English proficiency, outpatient clinic visits, usual source of care, age when first child was born, birth control, alcohol use, smoking status, flu shot, and health status. Based on our results, two levels of intervention should be explored. First, targeted interventions are needed for women who are unmarried, have low socio-economic status, and limited access to care to reduce cervical cancer risk. Second, interventions for physicians to increase screening recommendations to all eligible women are needed to improve national screening rates.

Community Health Centers (CHCs) are the nation's primary care safety-net for vulnerable populations, including racial/ethnic minorities, migrant workers and the uninsured. Women from these populations contribute disproportionately to cervical cancer morbidity and mortality, largely due to underutilization of Pap smear screening. The purpose of this cross-sectional study was to identify factors that may be related to Pap smear screening compliance among a large cohort of women seen at 10 Community Health Centers in Florida. Building upon an ecologic framework, this research went beyond patient-level risk factors, which are generally well-known, and explored provider and organizational variables that may also be associated with Pap smear screening compliance in this population. Ten CHCs in Florida met study inclusion criteria of having at least four complete years of claims and patient registration data stored in an Electronic Health Record (HER) data system maintained at HCN. EHR data were merged with provider gender obtained from a credentialing database and with data from a short organizational survey administered to the Medical Directors of the CHCs. Descriptive statistics, chi-squared analysis, and multiple logistic regression were used to examine Pap smear screening rates for women (n=71,234) in relation to a variety of patient, provider and organizational variables. Younger, Hispanic and insured women were most likely to have had a screening in the past three years compared to older, white non- Hispanic and uninsured women. Among providers, patients who received care from female providers generally had higher Pap smear compliance rates, but these findings differed by patient insurance and race/ethnicity group. Organizational factors that appeared to be associated with higher Pap compliance rates included diffusion of an EHR system, implementation of "Care Model Principals", and having recently implemented a Pap smear screening process improvement project. Results demonstrated that multi-level factors, operating on the patient, provider and organizational levels, contribute to Pap smear compliance among women seen at CHCs. Results suggested that improving screening compliance within this population of women requires interventions that are ecologic in scope, incorporate targeted education to high-risk women and providers, and include organizational strategies that can optimize care delivery at point-of-care.

Cervical cancer is a disease that annually claims the lives of over a quarter of a million women. A substantial number of these deaths could be prevented if population wide cancer screening, based on the Papanicolaou test, were globally available. The Papanicolaou test involves a visual review of cellular material obtained from the uterine cervix. While being relatively inexpensive from a material standpoint, the test requires highly trained cytology specialists to conduct the analysis. There is a great shortage of such specialists in developing countries, causing these to be grossly overrepresented in the mortality statistics. For the last 60 years, numerous attempts at constructing an automated system, able to perform the screening, have been made. Unfortunately, a cost-effective, automated system has yet to be produced. In this thesis, a set of methods, aimed to be used in the development of an automated screening system, are presented. These have been produced as part of an international cooperative effort to create a low-cost cervical cancer screening system. The contributions are linked to a number of key problems associated with the screening: Deciding which areas of a specimen that warrant analysis, delineating cervical cell nuclei, rejecting artefacts to make sure that only cells of diagnostic value are included when drawing conclusions regarding the final diagnosis of the specimen. Also, to facilitate efficient method development, two methods for creating synthetic images that mimic images acquired from specimen are described.

Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations. The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer. In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008. The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis. The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly. Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.

Thesis (M.S.D.)--Indiana University School of Dentistry, 2010. / Title from PDF t. p. (viewed July 28, 2010) Advisor(s): Mychel Vail, Chair of the Research Committee, Joseph Legan, B. Keith Moore, Kenneth Spolnik, Susan Zunt. Curriculum vitae. Includes abstract. Includes bibliographical references (leaves 93-109).

O objetivo do presente estudo foi determinar a capacidade de dissolução tecidual, tensão superficial, e capacidade de limpeza de soluções Ca(OCl)2 e compará-las ao NaOCl. A dissolução tecidual foi testada em fragmentos de polpas bovinas divididos em 18 grupos, metade deles utilizando as amostras livremente depositadas em poços de cultura de células e a outra metade utilizando as amostras fixadas em bases de dentina bovina. As soluções testadas foram o NaOCl a 0,5%, 1%, 2,5% e 5,25% e o Ca(OCl)2 a 0,5%, 1%, 2,5% e 5,25%. O grupo controle foi o soro fisiológico. Essas soluções foram empregadas sobre as amostras com dez irrigações/aspirações sucessivas de 1 minuto. A capacidade de dissolução foi mensurada pela percentagem de perda de peso. A tensão superficial do NaOCl a 0,5%, 1%, 2,5% e 5,25% e do Ca(OCl)2 a 0,5%, 1%, 2,5% e 5,25%, além de um grupo controle, água destilada, foi mensurada através da técnica do anel de platina com um tensiômetro de Du Noüy. Foram realizadas nove mensurações de cada solução e o resultado expresso em média e desvio padrão. Para a análise da capacidade de limpeza foram utilizados 50 dentes monorradiculares humanos, divididos em 5 grupos, que foram preparados com limas tipo K e irrigados com NaOCl a 2,5%, NaOCl 5,25%, Ca(OCl)2 2,5% ou Ca(OCl)2 5,25%. O grupo controle foi irrigado com soro fisiológico. Através da microscopia eletrônica de varredura foram analisados os diferentes terços dos canais quanto à remoção de debris e à presença de smear layer. Foram atribuídos escores de 1 a 4 e a frequência destes foi verificada para cada grupo. Os resultados mostraram que quanto à dissolução não houve diferença significante entre NaOCl e Ca(OCl)2 para iguais concentrações. As soluções mais concentradas foram mais eficazes na dissolução. Os valores de tensão superficial das soluções de Ca(OCl)2 variaram de 68,48 a 72,88 mJ/m. A remoção de debris do grupo do Ca(OCl)2 a 5,25% foi inferior ao grupo controle no terço cervical. Nos demais terços não houve diferença entre os grupos. Quanto à remoção de smear layer, não houve diferença entre os grupos. As soluções de hipoclorito de cálcio apresentam capacidade de dissolução tecidual, entretanto suas tensões superficiais foram superiores quando comparadas às soluções de hipoclorito de sódio. Além disso, não foram capazes de remover a smear layer e debris. / The aim of this study was to determine the tissue dissolution capacity, surface tension, and cleaning ability of Ca(OCl)2 solutions and compare to the NaOCl properties. The dissolution was tested on bovine pulps fragments divided into 18 groups, half of them was freely deposited samples in cell culture wells and the remaining samples were fixed on bovine dentin bases. The solutions tested were 0.5% NaOCl, 1.0% NaOCl, 2.5% NaOCl and 5.25% NaOCl, and 0.5% Ca(OCl)2, 1.0% Ca(OCl)2, 2.5% Ca(OCl)2, and 5.25% Ca(OCl)2. The control group was saline. These solutions were used on samples and were successively irrigated/aspirated 10 times, for 1 minute each. The dissolving capacity was measured by the percentual weight loss. The surface tension of all tested solutions and control was measured by the platinum ring technique with a Du Noüy tensiometer. Nine measurements were taken of each solution and the result expressed as mean and standard deviation. For the analysis of cleaning capacity, 50 monoradicular human teeth were divided into five groups. They were prepared with K files and irrigated with 2.5% NaOCl, 5.25% NaOCl, 2.5% Ca(OCl)2 or 5.25% Ca(OCl)2. The control group was irrigated with saline. The samples were analyzed by scanning electron microscopy. Each third of the root canals received a score regarding the removal of debris and the presence of smear layer. Scores were assigned from 1 to 4 and their frequency for each group was determined. There was no significant difference between NaOCl and Ca(OCl)2 with the same concentrations. The most concentrated solutions were more effectively in dissolution. The surface tension values of solutions for Ca(OCl)2 varied from 68.48 to 72.88 mJ/m. Debris removal for 5.25% Ca(OCl)2 was lower than the control group in the cervical third. In the other thirds there was no difference among groups. There was no difference for the smear layer removal among groups. Calcium hypochlorite solutions showed tissue dissolution ability, however their surface tensions were higher when compared with sodium hypochlorite solutions. Moreover, were not able to remove debris and smear layer.

Background: Cervical cancer may be fatal to women if not identified and treated early. In Iraq, cervical cancer ranks as the 10th most frequent cancer among women between 15-44 years of age, with about 291 new cervical cancer cases diagnosed annually. Cervical cancer can be prevented in two ways: primary prevention aimed at preventing HPV infection through prophylactic HPV vaccinations; and secondary prevention aimed at preventing precancerous lesions from progressing into invasive lesions through screening. Cervical cancer screening is under researched in Iraq. It is clear that Iraq’s years of isolation and disorder has resulted in a loss of research capacity. Aim: To provide evidence–based strategies to establish population based cervical cancer screening services in Iraq. Methods: A mixed methods sequential exploratory design was used; an iterative mixed method approach which included the triangulation of qualitative, quantitative and systematic review methods. Results of all phases were used to develop an emergent theory around the barriers for establishing cervical screening programme and to provide evidence to enhance cervical cancer screening services to be established in Iraq. Findings: The findings from the systematic review indicated significant health inequalities for Arab Muslim women, in that no population-based cervical cancer screening programmes have been implemented in most of Western Asian and Middle Eastern Arab countries. Findings from the qualitative phase revealed gap in theoretical and practical knowledge among the health care professionals regarding cervical cancer screening programmes with a lack of the capacity and infrastructure to establish population based cervical screening programme in Kirkuk, Iraq. Also, results suggest that the health behaviour of women living in Kirkuk is influenced by cultural ‘stigma’ around the word ‘cancer’, in addition to women’s lack of awareness in relation to smear test and cervical screening. Conclusion: Women in Iraq are more likely to be diagnosed at an advanced, rather than early stage of cervical cancer. These women should be targeted by cervical cancer screening and health education programmes. Policy makers need to improve the cervical screening infrastructure and make the cervical screening service more accessible to women. The current opportunistic cervical screening services are insufficient; there is an urgent need to developing cervical cancer intervention programmes.

71f. / Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-04-23T13:53:14Z No. of bitstreams: 3 Biblioteca- Ana Raquel3.pdf: 296421 bytes, checksum: 7fbbfec8c50b5ea955fca6011a25673c (MD5) Biblioteca- Ana Raquel2.pdf: 393653 bytes, checksum: 73570d5c5d748db504cd3d04b5bb01b7 (MD5) Biblioteca- Ana Raquel1.pdf: 128471 bytes, checksum: f09e83f242a8a3cce146311a97024814 (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-05-08T11:48:59Z (GMT) No. of bitstreams: 3 Biblioteca- Ana Raquel3.pdf: 296421 bytes, checksum: 7fbbfec8c50b5ea955fca6011a25673c (MD5) Biblioteca- Ana Raquel2.pdf: 393653 bytes, checksum: 73570d5c5d748db504cd3d04b5bb01b7 (MD5) Biblioteca- Ana Raquel1.pdf: 128471 bytes, checksum: f09e83f242a8a3cce146311a97024814 (MD5) / Made available in DSpace on 2013-05-08T11:48:59Z (GMT). No. of bitstreams: 3 Biblioteca- Ana Raquel3.pdf: 296421 bytes, checksum: 7fbbfec8c50b5ea955fca6011a25673c (MD5) Biblioteca- Ana Raquel2.pdf: 393653 bytes, checksum: 73570d5c5d748db504cd3d04b5bb01b7 (MD5) Biblioteca- Ana Raquel1.pdf: 128471 bytes, checksum: f09e83f242a8a3cce146311a97024814 (MD5) Previous issue date: 2006 / Foi realizado um estudo in vitro para avaliar a resistência de dentes anteriores tratados endodonticamente, que foram irrigados com EDTA 17%, pH 7,0 durante 1 e 3 minutos e portadores de retentor intra-radicular, fundido em liga de Níquel-Cromo. Foram utilizados 30 incisivos centrais superiores de dimensões semelhantes. As raízes foram instrumentadas pela técnica escalonada e a irrigação final foi feita com a solução em estudo. Posteriormente os retentores foram cimentados com fosfato de zinco e os corpos de prova levados à máquina de ensaio Instrom 1122, com velocidade de 0,5 mm/min, para ser submetidos a teste de compressão. Os resultados foram avaliados, usando-se a Análise de Variância (ANOVA), o Teste de Tukey, o teste t de Student e o teste de Kolmogorov-Smirnov, mostrando que houve diferença, estatisticamente significante (p= 0.014), entre o grupo irrigado com EDTA 1 min e o grupo irrigado com detergente. / Salvador