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

Thesis (M. Tech.) -- Central University of Technology, Free State, 2007

published_or_final_version / abstract / toc / Obstetrics and Gynaecology / Master / Master of Philosophy

published_or_final_version / abstract / Community Medicine / Doctoral / Doctor of Philosophy

published_or_final_version / Obstetrics and Gynaecology / Doctoral / Doctor of Philosophy

A mini-dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Nursing, Technikon Natal, 2002. / Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1:40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening. policyand-. programme was implemented in the province. The KZN Department of Health and the Sub-Directorate Maternal, Child and. Women's Health needed to know what was happening currently in terms of implementation of the cervical screening programme since it was first implemented three years ago. Therefore, the purpose of the study was to evaluate the implementation of the Provincial Cervical Screening Programme in selected Primary Health Care clinics in lIembe Region, KZN. This study took the form of formative evaluation research. The target population consisted of PHC clinics in KZN that have implemented the cervical screening policy and the programme. The accessible population for this study consisted of the clinics in the lIembe Region. A four-stage selection plan was applied to select the sample from the accessible population. The first stage involved a random selection of two clinics from an urban area and two from a rural area. Within each of the selected clinics, three types of evidence for the evaluation of the implementation of the cervical screening programme were sampled. Therefore, the second stage of the plan was the selection of records. A purposive sample of all records of clients who were diagnosed with abnormal smears was assessed. The third stage involved the selection of all Professional Nurses from each of the selected clinics. Lastly, the fourth stage involved the selection of the day for collecting data on the facilities and resources. The sources of evidence that were used to evaluate the implementation of cervical screening programme by the clinics were non-participant observation, which involved clinic audit, a review of abnormal smear records and self-reports from nurses regarding the cervical screening programme. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. The researcher also found that nurses lacked knowledge regarding the indications for taking smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. There was lack of necessary resources such as telephones needed to do proper follow-up. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results also indicated thatthe mechanisms of record keeping were poor. Nurses were of the opinion that women should have their first Pap smear at the age of 20 and thereafter at intervals of five years, once they start to be sexually active because of the high rate of sexually transmitted infections and HIV/AIDS in KZN. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme. / M

No description available.

Au Yeung Chi Lam. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 204-221). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Orientador: Christiane Pienna Soares / Coorientador: André Gonzaga dos Santos / Coorientador: Valéria Valente / Banca: Raquel Alves dos Santos / Banca: Marlus Chorilli / Resumo: Atualmente, o câncer cervical é considerado o terceiro tumor mais frequente nas mulheres do Brasil e o seu desenvolvimento, na maioria dos casos, esta relacionado com o Papilomavírus Humano (HPV). Frente ao exposto, tornam-se necessários à busca por tratamentos alternativos no combate do câncer cervical a partir dos produtos naturais, como a cordialina A, isolada da planta Cordia verbenacea DC. A cordialina A possui forte atividade antineoplásica, como também insolubilidade em meio aquoso. Dessa forma, os Sistemas Nanoemulsionados Lipídicos (SNL) têm sido explorados como ferramentas para aumentar a solubilidade de bioativos poucos polares em meio aquoso, como também aumentar a sua eficácia terapêutica. Assim, o presente estudo teve por objetivo avaliar, in vitro, a atividade antineoplásica e os mecanismos de morte celular promovidos pela cordialina A, encapsulada e não encapsulada no SNL, nas linhagens celulares de câncer de colo uterino HPV-16 (SiHa), de HPV negativo (C-33A) e de queratinócitos humanos normais (HaCaT). Para a formulação do SNL foi acrescido de colesterol, tampão fosfato e sistema tensoativo composto por polioxietileno 20-cetil éter e Fosfatidilcolina de Soja (FS). O diâmetro de partícula encontrado nas formulações foi de 159,53 ± 8,0444 nm e 107 ± 0,3333 nm, o índice de polidispersão (PDI) médio foi de 0,38 ± 0,0466 e 0,214 ± 0,0126 e o potencial zeta foi de -16,83 ± 3,15 mV e -20,16 ± 1,68 mV para SNL e cordialina A + SNL, respectivamente. As fotomicrografi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Currently, cervical cancer is considered the third most frequent tumor in Brazilian women and its development, in most cases, is related to Human Papillomavirus (HPV). In view of the above, they are necessary to search for alternative treatments in the fight against cervical cancer from natural products, such as cordialina A, isolated from the Cordia verbenacea DC plant. The cordialina A has strong antineoplastic activity, as well as insolubility in aqueous medium. Thus, Lipid Nanoemulsion Systems (SNL) have been explored as tools to increase the solubility of a few polar bioactive in aqueous medium, as well as to increase its therapeutic efficacy. The aim of the present study was to evaluate in vitro the antineoplastic activity and mechanisms of cell death promoted by cordialin A, encapsulated and non-encapsulated in the SNL, in cervical cancer cell lines HPV-16 (SiHa) of HPV negative (C-33A) and normal human keratinocytes (HaCaT). For the formulation of the SNL was added cholesterol, phosphate buffer and surfactant system composed of polyoxyethylene 20-cetyl ether and Soy Phosphatidylcholine (FS). The particle diameter found in the formulations was 159.53 ± 8.0444 nm and 107 ± 0.3333 nm, the average polydispersion index (PDI) was 0.38 ± 0.0466 and 0.214 ± 0.0126 and the zeta potential was -16.83 ± 3.15 mV and -20.16 ± 1.68 mV for SNL and A + SNL, respectively. The photomicrographs... (Complete abstract click electronic access below) / Mestre

The timely remodeling of the cervix from a mechanical barrier into a soft, compliant structure, which dilates in response to uterine contractions is crucial for the safe delivery for a term baby. A cervix which softens too early in the pregnancy is implicated in spontaneous preterm births (sPTB). Currently, 15 million babies are affected by PTB annually, early diagnosis is difficult, and 95% of all PTBs are unmanageable by available therapies. These statistics highlight the need to better understand the biological processes involved in cervical remodeling and its downstream effects on material properties. To address this need, we propose the development of a hormone-mediated material constitutive model for the cervix where steroid hormone actions on key tissue constituents are incorporated into a microstructure-inspired material model. As the first steps towards the development of this model, the main objective of this dissertation work is to understand the key structure-mechanical function relationships involved in pregnancy. To understand cervical material property changes, the equilibrium swelling and tensile response of the nonpregnant and pregnant mouse cervix is measured, a porous fiber composite material model is proposed, and the model is fit to the mechanical data then validated. To better understand key tissue constituents involved, the evolution of intermolecular collagen crosslinks is determined in normal pregnancy and the role of the small proteoglycan, decorin, and elastic fiber structure on cervical mechanical function is investigated. The results presented here demonstrate that a porous, continuously distributed fiber composite model captures the three-dimensional mechanical properties of the nonpregnant and pregnant cervix. The material property changes of the cervix in a 19-day mouse gestation is described as a four order of magnitude decrease in the parameter associated with the fiber stiffness. We provide quantitative evidence to demonstrate the role of collagen crosslinks on tissue softening in the first 15 days, but not in the latter stages of a mouse pregnancy. A role of elastic fiber structure on cervical mechanical function is demonstrated, as well as distinct roles of estrogen on elastic fiber structure and progesterone on collagen fibril structure. Lastly, an analysis of the time-dependent response of cervices from nonpregnant, normal pregnant, and induced PTB mice are presented. This dissertation concludes by reviewing the presented data within the context of the proposed framework to suggest future directions towards its development.