INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro / INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeks

Text in English / Cervical cancer accounts for 34.6% of all the female cancers in Zimbabwe. The purpose of this study was to explore the knowledge, attitudes and perceptions of female student nurses regarding cervical cancer in Zimbabwe using the Health Belief Model (HBM) as a theoretical framework. The ultimate aim was to analyse female student nurses’ risk perception of contracting cervical cancer. A quantitative, cross-sectional descriptive research design was used, using a structured questionnaire for data collection. One hundred and thirty-two (132) respondents were conveniently selected. Descriptive and inferential statistics were calculated using Statistical Package for Social Sciences (SPSS) version 21 software program. The study revealed that 57.9% of the respondents perceive that they are at risk of developing cervical cancer. They believe that screening for cervical cancer is not embarrassing. Knowledge improved with increase in the level of study, there was lack of knowledge of HPV and cervical cancer link. More emphasis on cervical cancer should be put on curricula taught in undergraduate education earlier on in the programme. / Health Studies / M.A. (Nursing Science)

Tang, Shing Tung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 114-126). / Abstracts in English and Chinese; some appendixes in Chinese. / Chapter Chapter 1: --- Introduction --- p.1 / Chapter Chapter 2: --- Background --- p.5 / HPV Vaccination and Cervical Cancer --- p.5 / Overview of HPV Vaccination in the West and Asia --- p.6 / Chapter Chapter 3: --- Literature Review --- p.9 / Applying the Theory of Planned Behavior in Vaccination Context --- p.9 / Effects of Mass and Interpersonal Communication --- p.22 / Relationship between Mass and Interpersonal Communication --- p.33 / Differential Effects of Mass and Interpersonal Communication --- p.39 / Chapter Chapter 4: --- Methodology --- p.45 / Participants and Procedure --- p.45 / Measures --- p.49 / Chapter Chapter 5: --- Results --- p.54 / Model Fit and Adjustments --- p.54 / Testing the Alternative Model --- p.56 / Evaluating Individual and Contextual Predictors --- p.59 / Examining the Context-to-intention Pathways --- p.60 / Summary of Findings --- p.61 / Chapter Chapter 6: --- Discussion --- p.63 / Comparing the Proposed and Alternative Model --- p.63 / Evaluating the TPB in Vaccination Context --- p.65 / Evaluating Mass and Interpersonal Communication as Contextual Predictors --- p.73 / Further Exploration on the Differential Effects --- p.76 / Theoretical Contributions and Practical Implications --- p.80 / Chapter Chapter 7: --- Limitations and Directions for Future Research --- p.85 / Limitations --- p.85 / Directions for Future Research --- p.90 / Chapter Chapter 8: --- Conclusion --- p.93 / Appendix --- p.96 / References --- p.114

Text in English / Cervical cancer accounts for 34.6% of all the female cancers in Zimbabwe. The purpose of this study was to explore the knowledge, attitudes and perceptions of female student nurses regarding cervical cancer in Zimbabwe using the Health Belief Model (HBM) as a theoretical framework. The ultimate aim was to analyse female student nurses’ risk perception of contracting cervical cancer. A quantitative, cross-sectional descriptive research design was used, using a structured questionnaire for data collection. One hundred and thirty-two (132) respondents were conveniently selected. Descriptive and inferential statistics were calculated using Statistical Package for Social Sciences (SPSS) version 21 software program. The study revealed that 57.9% of the respondents perceive that they are at risk of developing cervical cancer. They believe that screening for cervical cancer is not embarrassing. Knowledge improved with increase in the level of study, there was lack of knowledge of HPV and cervical cancer link. More emphasis on cervical cancer should be put on curricula taught in undergraduate education earlier on in the programme. / Health Studies / M.A. (Nursing Science)

The aim of the study was to gain an in-depth understanding of the girl children’s parents perceptions regarding the papillomavirus vaccine roll-out programme at schools in Tshwane District, Gauteng Province. The researcher used a qualitative exploratory research design to address the research objective of the study as the qualitative method enables the researcher to explore and describe the study phenomenon. Data were collected from 12 parents of girl children who received the papillomavirus vaccine at one of the schools in Soshanguve township, which is one of the biggest townships in the Tshwane District. Data was analysed manually using content analysis. The following four superordinate themes emerged from data analysis: a) Communication of the programme, b) Motivation for allowing their children to be immunized. c) Response to immunisation, d) Suggested ways of enhancing the programme. These themes were discussed in relation to existing literature. Recommendations were made based on the findings to enhance the papillomavirus vaccination programme and for future research. / Health Studies / M.A. (Nursing Science)

Indiana University-Purdue University Indianapolis (IUPUI) / A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.