Dissertations / Theses on the topic 'Cervix uteri Cancer Victoria Prevention'

Background. Cervical cancer is a common female cancer in Hong Kong. Cervical screening has been used in detecting cervical lesions for several decades. Given that human papillomavirus (HPV) infection is the etiological cause of cervical cancer, highly efficacious HPV vaccines are recently developed for preventing against HPV infection. Hong Kong has a well-developed healthcare system but relatively high cervical cancer incidence compared to other developed countries partly due to its suboptimal cervical screening program. This highlights the significance to evaluate the potential of implementing organized HPV vaccination programs for further reducing cervical cancer burden on top of cervical screening in Hong Kong. Methods. Cross-sectional, population-based surveys were conducted to assess the acceptability of female adolescent HPV vaccination among girls from secondary schools in 2008 and among mothers of adolescent daughters in 2008 and 2012. Mathematical model with transmission dynamic and stochastic individual-based components was constructed to model the natural history of HPV infection and cervical cancer and thus to project the public health and economic impacts of organized female adolescent HPV vaccination programs in a societal perspective. The model used Markov Chain Monte Carlo algorithm to estimate natural history parameters of HPV infection and probabilistic sensitivity analysis to consider the uncertainty of costs and health utilities in the economic evaluation of organized HPV vaccination. Results. Reported vaccine uptake among11–18 year-old girls increased from 2.4% among schoolgirls in 2008 to 9.1% among daughters of interviewed mothers in 2012. Among interviewed mothers, 27.5% and 37.6% of them were willing to have their daughters vaccinated at market price in 2008 and 2012, respectively. The mathematical model projected that HPV prevalence decreased soon after mass HPV vaccination and vaccine-induced cervical cancer reduction became obvious after vaccination programs have been launched for 30 years. If HPV vaccinesprovided30-year protection, the median incremental cost-effectiveness ratio (ICER) of routine HPV vaccination programs for 12 year-old girls at 25–75% vaccination coverage was US$26,367–32,527 per quality-adjusted life-year (QALY). The median ICER was above US$48,000/QALY if adding 2-year catch-up program for13–18 year-old girls and above US$58,000/QALY if vaccines protect against HPV infection for only 15 years. Conclusions. This study presented the first evaluation of organized HPV vaccination programs in Hong Kong. If vaccine protection lasted for 30 years or longer, organized routine HPV vaccination for 12 year-old girls would potentially be a cost-effective add-on in substantially reducing cervical cancers and HPV-related diseases on top of cervical screening in Hong Kong at an ICER threshold of US$33,218/QALY. However, the current estimated vaccine uptake was unexpectedly low and vaccine acceptability was only moderate. The findings indicated the importance to devise efficient strategies in achieving high and universal coverage for maximizing the population-level benefits of HPV vaccination. Policymakers should consider integrating the organized HPV vaccination programs with existing infrastructures to promote higher acceptability, to translate willingness to vaccinate to actual uptake, to assess population effectiveness, and to monitor safety issue and potential replacement effect of non-vaccine targeted HPV types following mass vaccination.
published_or_final_version
Public Health
Doctoral
Doctor of Philosophy

Thesis (MFamMed)--Stellenbosch University, 2014.
OBJECTIVE: The purpose of the study was to assess the safety, acceptability and feasibility of Visual Inspection with Acetic Acid and Cervicography (VIAC) followed by Cryotherapy or Loop Electrical Excision Procedure (LEEP) at a single visit for prevention of cancer of the cervix in Bulawayo, Zimbabwe. STUDY DESIGN: The study was descriptive using retrospective data extracted from electronic medical records of women attending the VIAC clinic at United Bulawayo Hospital in the period 1st February2010 to 31st December2012.Over 24 months 4641 women visited the clinic and were screened for cervical cancer using VIAC. If positive and eligible, cryotherapy or LEEP was offered immediately. Treated women were followed up at 3months and 1 year. RESULTS: The VIAC test positive rate was 10.8%.Of those eligible,17.0% received immediate cryotherapy, 44.1%received immediate LEEP, 1.9% delayed treatment and 37.0% were referred to a gynaecologist. No major complications were recorded after cryotherapy or LEEP. Among those treated99.5% expressed satisfaction with their experience. Only 3.2% of those treated at the clinic were VIAC positive one year later. The service was shown to be feasible to sustain over time with the necessary consumables. There were no service-related treatment postponements and the clinic staff and facility were able to meet the demand for the service. CONCLUSION: A single visit approach using VIAC, followed by cryotherapy or LEEP proved to be safe, acceptable and feasible in an urban African setting in Bulawayo, Zimbabwe.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.

Cervical cancer is one of the common cancers among women and poses a great burden to the public health. Currently there are two human papillomavirus vaccines, CervarixTM and Gardasil®, against HPV type 16/18 and type 6/11/16/18 cervical cancer available in the market. Most clinical trials about immunogenicity and safety of the two vaccines were conducted among Caucasian females, rather than on Asian female populations. This systematic review aims to summarize and evaluate immunogenicity and safety of the two vaccines conducted mainly at the setting of randomized control trials on Asian female populations. This investigation would enhance understanding about whether ethnic difference impacts antibody responses, what were the severe adverse events in Asian populations, and whether the vaccines demonstrate satisfactory immunogenicity. Eleven relevant studies were identified from Pubmed and Medline with totally 4026 subjects involved. The quality and validity of these studies was critically appraised in terms of randomization, allocation ratio, blinding, analytical methods and other potential limitations. The two vaccines demonstrated high geometric mean antibody titer levels among Asian females. Injection-site pain was the mostly complained solicited local symptom, followed by redness and swelling. Few severe solicited local symptoms were reported. The unsolicited symptoms were not as common as solicited symptoms and quite a few of them were not related to the vaccination. One severe adverse event was confirmed in Japan’s study – a spontaneous abortion had taken place 15 days after vaccination. China lacks of systematic cancer registries, therefore it is difficult to estimate the disease burden. China’s Gross Domestic Product only reached $5445 per capita in 2011. HPV vaccination would not be cost-effective in the countries which had Gross Domestic Product lower than $8505 per capita, therefore piloting the HPV vaccination in major economic powerhouses like Shanghai and Beijing would be more realistic. To sum up, this systematic review demonstrated satisfactory immunogenicity on Asian females. The safety data were acceptable to some extent except one spontaneous abortion occurred in Japan’s study.
published_or_final_version
Public Health
Master
Master of Public Health

Cervical cancer remains a significant cause of death in women. There is a notable age related decrease in levels of screening and women aged over 50 years with later, more invasive disease. One hundred and forty women aged between 50 and 69 years (M "'58.21 years) and 23 Pap smear providers completed a Cervical Cancer Screening Questionnaire designed to identify the relative importance of barriers to attendance for cervical screening, as well as providers own barriers and issues. Responsibility for health, familiarity with, and ratings of the usefulness of Pap smears were the major dimensions along which regular and non-regular attenders differed supporting the hypothesis. Additionally, women who had regular Pap smears were younger, with higher levels of confidence in their provider, in the ability of the test to detect cervical cancer and in their overall value for the usefulness of the test. The application of the findings of the present study may improve the currently inconsistent promotion of cervical screening to older women. The use of a theoretical framework informed by the Theory of Reasoned Action and Multi-Attribute Utility Theory showed promising results in incorporating the diverse factors involved in participating. in preventative health screening. Recommendations are made on the necessity of both targeted and general intervention strategies to increase the uptake of preventative screening by at-risk groups.

First Nations women face nearly three times the risk of cervical cancer and mortality rates of up to six times higher than their non-Aboriginal counterparts. While cervical cancer is almost completely preventable, Southern Alberta First Nations women seldom access cervical screening services. The purpose of this qualitative focused ethnography was to gain an understanding of the cervical screening needs of un- and under-served First Nations women living off-reserve. Thirteen purposefully selected First Nations women participated in three focus groups utilizing semi-structured interviews. Personal self-worth and cervical screening awareness and relevance are essential to the pursuit of cervical screening. Barriers and incentives for screening and opportunities for acceptability and sustainability are explored. A holistic approach, intersectoral collaboration and cultural safety are described by focus group participants as foundational for optimal service delivery.
xii, 223 leaves ; 29 cm.

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 (MMed) -- Stellenbosch University, 2010.
Bibliography
Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.

Cervical cancer is the most common malignancy after breast cancer in women worldwide. It accounts for 83% of all new cases and 85% cancer death in developing countries. In South Africa, cervical cancer is the common cancer in women with an annual crude incidence rate of 30.2 per 100,000 women and the highest rate were found to be in women between the ages of 66-69 years. Approximately 6800 women in S.A face new case of cervical cancer while accounting for 3700 cancer death annually. Because of unequal access to the health facilities, socio-economic differences, HPV and HIV infection, the rate of cervical cancer in black women is higher (42.1%) compared to the low rate in white women. Because of the name “cancer bush’ given to Sutherlandia Frutescence(S.F) plant by the traditional healers as well as Xhosas, Zulu, Sotho and cape Dutch for its anti-cancer activity, the plant was in this study to confirm its cytotoxic effect on the cervical cancer cell lines. Aim of the study: to evaluate the methanolic extracts of Sutherlandia Frutescens on cervical cancer cell lines. Materials and Methods: The MTT assay was performed to evaluate SiHa cell lines treated with methanolic extract of S.F (50μg/ml, 100μg/ml, 150μg/ml and 200μg/ml). The three compounds (Canavanine, GABA and Pinitol) were also evaluated for its anti-tumour activity. The cell growth was then showed in real time using Xcilligence. Flow cytometry was employed to determine the mode of action. Caspase 3/7 assay was performed to confirm if cell death was via caspase-dependent or independent and ATP was done to assess the ATP level in S.F treated cells. Results: MTT shows a significant decline in cells treated with 50μg/ml, 100μg/ml and 200μg/ml of the extract and 50μg/ml was concluded to be the concentration at which 50% of the cells die. The ATP results are inconsistent with MTT result; the ATP level increased in S.F treated cells. Cell index which represents the quantitative measure of cell growth in real time decline upon treatment with 50μg/ml. Flow cytometry showed cells are dying by apoptosis and the cell cycle arrest is mostly in the S phase. The cell death was caspase-dependent as it shows an increased luminescence which is proportional to the number of caspase. The concentrations of the compounds used, Canavanine (1000μM, 1500μM and 2500μM), GABA (100μM, 300μM and 500μM) and Pinitol (30μM, 90μM and 120μM) induce cell death and cell death shows to decrease after the maximum concentration. Conclusion: Sutherlandia Frutescence has proven with number of research that it induces cell death via apoptosis. After evaluating its cytotoxicity, the plant shows to be a promising anti-tumor agent that needs to be clinically proven.
Life Sciences
M. Sc. (Life Science)

Indiana University-Purdue University Indianapolis (IUPUI)
In this study we compared the distribution of HPV types in cervical cancer specimens from women living in either Indiana or Botswana. Paraffin-embedded blocks of formalin-fixed cervical cancer specimens were identified from women living in Indiana (n=51) or Botswana (n=171)

Thesis (M. A. (Social Work)) --University of Limpopo, 2018
Cancer of the cervix is second type of cancer among women in developing countries, and a common problem among women of low socio-economic status in rural communities. The spiral increase of the problem is aggravated by some socio-economic, structural, cultural and political factors. Understanding the risk factors associated with the disease is a step forward towards effective prevention and treatment. Numerous studies have been conducted on knowledge and perceptions of cervical cancer however the information on cervical cancer is still not reaching the majority of women. The study explored the perceptions and attitudes of rural women of Matebeleng village towards cervical cancer, the risk factors, screening tests and the HPV vaccines. A qualitative exploratory case study was conducted. Self-reported data was collected from 22 women. Two focus groups of 7 and 9 and 6 face-face individual interviews were conducted using a semi-structured interview guide. Data was analysed thematically. The research findings revealed that the majority of women in the rural area where the study was conducted never heard of cervical cancer and only few received inadequate information. Few highlighted some of the risk factors but some information was incorrect. Very few participants had only once been screened and the majority have never been tested for cervical cancer. Some became aware of the vaccine through the consent forms from school even though they did not exactly understand the content. The sources of information were the radio, health clinic and random women. The concerns of those who were screened were lack of feedback from the clinic nursing staff after the test, lack of adequate preparation and information before been screened to allay fear and doubt of the unknown and lack of reach out programmes to rural communities. The methods of disseminating information to rural women in their distinct contexts should be examined. Conventional traditional ways of reaching out to rural women could perhaps produce improved results through the integrated approach involving multi-disciplinary teams in educating communities. Key Words: Perceptions, attitudes, rural-based women, cervical cancer, risk factors, screening tests, HPV vaccine

A model was developed in this study to understand women's cervical screening behaviour. It revealed that the interaction among institutional factors, risk appraisal, coping appraisal, and health beliefs and cultural factors contributed to the complex nature of screening behaviour among Chinese women. The institutional component provided the contextual factors within which women perceived the risk of cervical cancer, perceived the practice of cervical screening, and decided to take or not to take cervical screening. Risk appraisal provided the premise factor that induces women to seek coping strategies to reduce or remove the risk. During the process of coping appraisal, women's motivation to have cervical screening could be increased or decreased as the perceived benefits and costs of screening interacted with each other. The importance of the women's health beliefs and cultural factors was reflected in the way that they were affected by their notions of health behaviour and their cultural beliefs about cervical cancer risk and cervical screening participation. Commitment to participate in screening was a reinforcing factor inducing women to take up an offer of cervical screening.
Aim: To explore the knowledge and the perception of the risk of cervical cancer, identify the factors determining cervical screening behaviour, and develop a model to understand cervical screening behaviour among women in mainland China.
Background: Cervical cancer is the most common type of cancer, and is the second most common cause of cancer death in women in mainland China. Cervical screening is the most important intervention for the secondary prevention of cervical cancer. Theories of health behaviour and empirical research highlight risk perception as a significant factor motivating people to opt for cancer screening. However, little is known about the risk perception of cervical cancer and the factors influencing the screening participation of women in mainland China.
Conclusion: This study provides evidence of the complex factors influencing cervical screening behaviour and contributes new knowledge to the understanding of cervical screening behaviour within the Chinese cultural context. It further informs programmes for the promotion of cervical screening among this population.
Methods: A mixed method design consisting of two phases was used, employing both quantitative and qualitative methods of data collection. First, a cross-sectional survey was conducted to collect a baseline assessment of women's knowledge of cervical cancer and screening, their perceptions of the risk of cervical cancer, and the relationship between these factors and their cervical screening behaviour. Findings from this phase also guided the purposive sampling of participants in phase two.
Results: The findings from phase one demonstrated that the availability of an organized screening programme was a major motivator for women to opt for cervical screening. Multivariate analysis shows that having children (OR=2.57, p=0.026), a perception that visiting doctors regularly is important for health (OR-2.66, p=0.025), average (OR-4.84, 1)=0.006) and high levels of knowledge about cervical screening (OR-9.66, p=0.001) were significantly associated with having been screened in the previous three years.
Then in phase two, qualitative research was conducted using semi-structured interviews of 27 women, 16 of whom had been screened and 11 had not. The interview structure was based on an initial analysis of the data from phase one and from a review of the related literature. The data from the interviews were analyzed using latent content analysis, involving an interpretative reading of the symbolism underlying the surface structure in the text. The audio recordings of the interviews were transcribed verbatim in Chinese, and then the key phrases which were important for the objectives of the study were identified. The key phrases and words were grouped according to their commonality of meaning. Then, these groups of data were sorted and classified to create categories and sub-categories, which were mutually exclusive, explicit and accurate without overlapping.
Two themes emerged from the qualitative data from phase two. Theme I was that perceptions of cervical cancer and cervical screening included five categories: the perceived effects of suffering from cervical cancer; the perception of cervical screening; a lack of understanding about cervical cancer and screening; the perceived risk of cervical cancer; and factors related to the cultural beliefs system. Theme II was that the institutional and health care practitioner system included two categories: availability of an organised physical examination programme and the role of the health care practitioner in encouraging cervical screening utilization.
Gu, Can.
Adviser: Chan, Carmen.
Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 244-267).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.

研究背景：
2009年起，中國政府發起並資助了一項覆蓋全國31個省221個鄉村、針對100萬名農村婦女的細胞學及肉眼觀察宮頸癌篩查試點項目。國家及地方政府需要對可行的篩查策略進行衛生經濟學評估，為下一步擴大規模的篩查提供政策依據。
研究目標：
應用人群特異性Markov模型，對巴氏塗片及肉眼觀察的宮頸癌篩查策略進行成本效果及成本效用兩方面的衛生經濟學評估，進而為中國農村婦女宮頸癌篩查政策的制定提供依據。
研究方法：
本論文工作建立了Markov人群動態擬合模型，該模型能夠整合與中國農村宮頸癌流行情況相吻合的成本及健康狀況的數據，進而用於擬合20年內35-59歲中國農村婦女在有/無篩查幹預下的成本、效用和效果。本文分析的八個備選篩查策略包括：採用醋酸染色肉眼觀察（VIA）或傳統細胞學（巴氏塗片）分別進行10年，5年，3年及1年一次的篩查。
本文從社會學角度出發，成本數據涵蓋篩查、診斷及治療過程中產生的直接及間接成本。模型在結構上綜合了已被廣泛認可的宮頸癌自然發展史模型，以及宮頸癌及其癌前病變（CIN）在中國農村進行篩查和治療的標準臨床路徑。模型輸入參數盡可能地使用了能夠反映中國農村婦女人群特異性的數據。通過對比國家報告數據與模型預測結果，本文從全死因死亡率、宮頸癌死亡率及宮頸癌發病率三個方面驗證了模型的可信度。
模型的結局變量包括：累計成本、累計生命年(LYs)、累計質量調整生命年(QALYs)、預期宮頸癌死亡率及發病率降低百分比(%)、CIN 相對風險、宮頸浸潤癌相對風險，增量成本效用比(ICUR, 表述為每挽救一個質量調整生命年消耗的成本)及增量成本效果比(ICER, 表述為每挽救一個生命年消耗的成本)等。與無篩查幹預相比，我們界定ICUR及ICER小於三倍人均國內生產總值（76,824元，2009年)的優勢策略為‘具有成本效益’的選擇，並將其中ICUR和ICER最低的策略，定義為‘最具成本效益’的策略，將具有最大健康效益的策略（挽救最多質量調整生命年或生命年的策略），定義為‘最有效’的策略。同時，我們對可能影響決策的不確定因素進行了敏感性分析。
結果：
與無篩查幹預相比，肉眼觀察及巴氏塗片篩查均能夠減少宮頸癌患病例數，進而顯示出一定的健康效益。較短的篩查間隔具有更高的健康效益。模型預測在不同的篩查策略幹預下，宮頸癌死亡率和發病率分別有望降低6.67-31.95%和5.12-24.71%，預期CIN發病相對風險為0.89-0.98，預期宮頸癌發病相對風險為0.73-0.95。篩查幹預對健康的保護作用在本研究中得到了證實。
成本效用分析顯示，10年一次的肉眼觀察策略最具成本效益，其次為5年一次、3年一次、1年一次的肉眼觀察篩查策略及1年一次的巴氏塗片篩查策略。與無篩查幹預相比，如上策略每挽救一個質量調整生命年消耗的成本為11,921至26,069元（1,892-4,138美元，2012年）。同時成本效果分析也顯示，10年一次的肉眼觀察策略最具成本效益，其次為5年一次的肉眼觀察策略及5年一次的巴氏塗片篩查策略。同樣與無篩查幹預相比，如上策略每挽救一個生命年消耗的成本為37,211至68,226元（5,906-18,830美元，2012年）。
對於某一既定策略，相應的ICUR和ICER受當地經濟狀況相關因素的影響最大，這些因素包括治療成本、篩查成本和成本貼現率。從檢測技術水平上看，肉眼觀察對分析結果的影響小於巴氏塗片，原因是前者敏感度範圍較小。篩查覆蓋率、初篩陽性隨訪率、診斷陽性治療率也都與相應的ICUR和ICER呈負相關性。敏感性分析結果顯示本文中模型對於健康結局的預測，及相關的衛生經濟學分析，受自然史模型中HPV感染和CIN之間轉移概率的不確定性的影響最大。HPV感染與CIN間的進展和逆轉概率是該項模型研究的核心參數。
結論：
本文中成本效用和成本效果分析均顯示，相較於傳統的細胞學篩查策略，採用間隔時間較長（10年或5年）的肉眼觀察篩查策略，對一般發病地區的35-59歲的農村婦女來說，是更具‘成本效益’的選擇。對於宮頸癌高發地區，其篩查頻率可以提高到1年一次。1年一次的巴氏塗片篩查策略，是最有效的篩查策略，可以挽救最多的生命。但採用該策略時，應在財政預算允許的前提下，確保篩查技術和項目完成的質量。
篩查項目的高覆蓋率，對篩查陽性患者良好的隨訪和診治，初篩檢測技術平均水平以上的表現，以及較低的篩查和治療成本是確保篩查項目具備成本效益優勢的核心因素。本文完成的成本效用及成本效果分析，能夠為公共衛生決策提供重要的輔助作用。
Background:
A Chinese government-sponsored cytology/visual inspection pilot cervical cancer screening program covered 10 million rural women in 221 counties of 31 provinces was initiated in 2009. Both the local and national governments in China need health economic evaluations of feasible strategies so as to make better policies for the next-step enlarging screening.
Objectives:
To perform health economic evaluations of Pap smear and visual inspection cervical cancer screening strategies using population-specific Markov modeling cost-utility (CUA) and cost-effectiveness (CEA) analyses, in order to assist screening policy making for women in rural China.
Methods:
Markov simulation models were developed to synthesize the evidence on costs and health outcomes related to cervical cancer epidemiology in rural China, and applied to predict the long-term utility, effectiveness and costs for hypothetical cohorts of 35-59 years old rural Chinese women, with or without the presence of screening over 20 years. The eight alternative screening strategies assessed were visual inspection with acetic acid (VIA) or traditional cytology (Pap smear) each with ten-year, five-year, three-year and one year screening intervals.
The study was conducted from the societal perspective, thus both directed and non-direct costs related to screening, diagnosis and treatment interventions were considered. The model structures incorporated with the well-accepted the natural history model of cervical cancer and the standard clinical pathway of screening and treatment interventions for precancerous lesions (CIN) and cervical cancer in real practice in rural China. Population-specific data were used as much as possible to be the model inputs. The model estimates were validated by comparison of our predictions of all-cause mortality, cervical cancer mortality and cervical cancer incidence with the national reported data.
Outcome variables included cumulative cost, life years (LYs), quality-adjusted life years (QALYs), predicted reduction(%) in cervical cancer mortality and incidence, relative risk of CIN, relative risk of cervical cancer, incremental cost-utility ratio (ICUR, presented as cost per QALY saved) and incremental cost-effectiveness ratio (ICER, presented as cost per life year saved). Compared with no screening, not-dominated strategies with ICUR and ICER less than three times China’s GDP per capita (76,824 CNY, 2009) were considered to be ‘cost-effective’ options. Among the identified ‘cost-effective’ options, the strategy with lowest ICUR or ICER was defined as the most cost-effective strategy, and the strategy with the highest health benefit (largest QALY saved or life year saved) was defined as the most effective strategy. Sensitivity analyses were conducted to test the effect of uncertainties on decision making.
Results:
All of the VIA and Pap smear screening strategies of showed certain benefits due to the decreased number of women developing cervical cancer, when compared with no screening. A trend for shorter screening interval to have greater benefit was also found. Cervical cancer mortality and incidence were expected to be reduced by 6.67-31.95% and 5.12-24.71% with different screening strategies. And the predicted relative risks of CIN and invasive cervical cancer of 0.89-0.98 and 0.73-0.95, respectively, also demonstrated the protective effect of screenings.
Modeling cost-utility analysis identified ten years VIA screening as the most cost-effective strategy followed by VIA screening with five-, three- and one year interval and Pap smear screening with a one year interval. Compared with no screening, the incremental costs per QALY saved of these strategies ranged from 11,921 to 26,069 Yuan (1,892-4,138 US dollars, 2012). In the meanwhile, modeling cost-effectiveness analysis also identified ten-years VIA screening as the most cost-effective strategy followed by VIA screening with five-year intervals and Pap smear screening with five-year intervals. Compared with no screening, the incremental costs per life year saved of these strategies ranged from 37,211 to 68,226 Yuan (5,906-18,830 US dollars, 2012).
Both ICUR and ICER of a selelected strategy were greatest influnced by factors related to variations in local economies , including treatment cost, screening cost and discounting rate of the cost. The influence of primary test performance of VIA was rather less than that of Pap smear due to the narrower ranges of the VIA sensitivities. Screening coverage, follow-up rate and treatment rate were also negatively associated with ICUR and ICER. Health outcome predictions and health economic analyses were mostly influenced by the uncertainties in HPV infection and CIN transitions in the natural history. Progression and regression probabilities between HPV infection and CIN were considered to be the key parameters of the simulation models.
Conclusions:
Baseline CUA and CEA results suggested that in comparison with traditional cytology screening strategies, organized VIA screening with long intervals (ten or five years) were more cost-effective options than for 35-59 years old women in normal incidence areas of rural China. The VIA screening interval can be shorten to one year in high incidence areas. Pap smear strategy with one year interval can be utilized as the most effective strategy with most lives saved when budget allows and the performances of program and test are ensured.
High coverage of the screening program, good management of screening positives, average or above performance of primary test, and lower screening and treatment costs are key elements for a cost-effective screening program. Cost-utility and cost-effectiveness analyses, such as the one conducted in this thesis study, can be considered important adjuncts to policy decision-making about public health objectives.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Li, Xue.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 388-401).
Abstracts also in Chinese; appendixes includes Chinese.
Abstract of thesis --- p.i
中文摘要 --- p.v
ACKNOWLEDGEMENTS --- p.viii
TABLE OF CONTENTS --- p.1
LIST OF TABLES --- p.8
LIST OF FIGURES --- p.11
ABBREVIATIONS --- p.12
Chapter CHAPTER 1 --- INTRODUCTION --- p.14
Chapter 1.1 --- Epidemiological patterns and disease burden of cervical cancer --- p.14
Chapter 1.1.1 --- Cervical cancer incidence and mortality worldwide --- p.14
Chapter 1.1.2 --- Risk factors for cervical cancer --- p.15
Chapter 1.1.2.1 --- Human Papillomavirus (HPV) --- p.15
Chapter 1.1.2.2 --- Parity --- p.16
Chapter 1.1.2.3 --- Smoking --- p.16
Chapter 1.1.2.4 --- Human Immunodeficiency Virus (HIV) --- p.17
Chapter 1.1.2.5 --- Contraception --- p.17
Chapter 1.1.2.6 --- Sexual behavior, nutrition and other factors --- p.18
Chapter 1.1.3 --- Disease burden of cervical cancer in China --- p.18
Chapter 1.1.3.1 --- Epidemiology of Cervical Cancer in China --- p.18
Chapter 1.1.3.2 --- Cervical cancer in different geographic areas of China --- p.20
Chapter 1.2 --- The need for cost-effectiveness analysis of cervical screening strategies in China --- p.21
Chapter 1.2.1 --- Cervical cancer prevention in China --- p.21
Chapter 1.2.2 --- Why do we need a modeling cost-effectiveness analysis? --- p.23
Chapter 1.3 --- Natural history of cervical cancer --- p.25
Chapter 1.3.1 --- Terminology --- p.25
Chapter 1.3.2 --- Natural history of cervical cancer --- p.27
Chapter 1.4 --- Secondary prevention strategies of cervical cancer --- p.29
Chapter 1.4.1 --- Screening tests --- p.29
Chapter 1.4.1.1 --- Cervical cytology --- p.29
Chapter 1.4.1.2 --- Visual Inspection --- p.32
Chapter 1.4.1.3 --- HPV testing --- p.36
Chapter 1.4.2 --- Summary of different screening strategies all over the world --- p.37
Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.40
Chapter 2.1 --- Background --- p.40
Chapter 2.2 --- Objectives of the literature review --- p.41
Chapter 2.3 --- Search strategies and results --- p.41
Chapter 2.3.1 --- Search strategies --- p.41
Chapter 2.3.2 --- Inclusion and exclusion criteria --- p.42
Chapter 2.4 --- Literature results summary --- p.44
Chapter 2.4.1 --- Methodology, target population and analytical perspective --- p.44
Chapter 2.4.2 --- Screening test and program performance --- p.47
Chapter 2.4.3 --- Cost and utility estimation --- p.49
Chapter 2.4.4 --- Model parameter sources and validation --- p.53
Chapter 2.4.5 --- Alternatives and identified cost-effective strategies --- p.58
Chapter 2.5 --- Conclusions --- p.63
Chapter CHAPTER 3 --- OBJECTIVES --- p.64
Chapter 3.1 --- General Objectives --- p.64
Chapter 3.2 --- Alternative cervical cancer screening strategies in this study --- p.64
Chapter 3.3 --- Decision rules for recommended cost-effective options --- p.65
Chapter 3.4 --- Analytical perspective and time horizon --- p.65
Chapter 3.5 --- Objectives --- p.66
Chapter 3.6 --- Analytical scenario in this study --- p.66
Chapter 3.6.1 --- Patterns of cervical screening program delivery in rural China --- p.67
Chapter 3.6.2 --- Demographic profile of the simulated hypothetical cohort --- p.67
Chapter 3.6.3 --- Summary of model assumptions --- p.68
Chapter 3.6.3.1 --- Assumptions related to screening performance and clinical practice --- p.68
Chapter 3.6.3.2 --- Assumptions related to epidemiological characteristics of cervical cancer --- p.68
Chapter 3.6.3.3 --- Assumptions related to economic evaluation --- p.69
Chapter CHAPTER 4 --- METHODOLOGY --- p.70
Chapter 4.1 --- Alternative strategies in this study --- p.70
Chapter 4.2 --- Markov Model Developments and Applications --- p.72
Chapter 4.2.1 --- General introduction of Markov Transition Model --- p.72
Chapter 4.2.2 --- Structure of Markov models --- p.76
Chapter 4.2.2.1 --- Natural history model of cervical cancer --- p.76
Chapter 4.2.2.2 --- Structure of Pap smear and Visual Inspection screening models --- p.82
Chapter 4.2.2.3 --- Structure of precancerous lesion and invasive cancer treatment models --- p.83
Chapter 4.2.2.4 --- Interaction of the models --- p.85
Chapter 4.2.3 --- Demographic profile of the hypothetical cohort --- p.86
Chapter 4.2.4 --- Probabilities --- p.88
Chapter 4.2.4.1 --- Identification and converting between rate and probability --- p.89
Chapter 4.2.4.2 --- Initial probabilities --- p.90
Chapter 4.2.4.3 --- Transition probabilities --- p.91
Chapter 4.2.5 --- Screening, diagnosis and treatment characteristics --- p.101
Chapter 4.2.5.1 --- Screening program characteristics --- p.101
Chapter 4.2.5.2 --- Diagnosis test performance --- p.104
Chapter 4.2.5.3 --- Precancerous lesions treatment characteristics --- p.104
Chapter 4.2.5.4 --- Invasive cancer and treatment characteristics --- p.106
Chapter 4.2.6 --- Model validation --- p.111
Chapter 4.3 --- Cost data collection --- p.112
Chapter 4.3.1 --- Perspective of study --- p.112
Chapter 4.3.2 --- Selection of study sites --- p.113
Chapter 4.3.3 --- Screening cost data collection --- p.113
Chapter 4.3.4 --- Treatment cost data collection --- p.115
Chapter 4.4 --- Cost-utility analysis and cost-effectiveness analysis --- p.117
Chapter 4.4.1 --- General introduction of these two analyses --- p.117
Chapter 4.4.2 --- Utility Estimates --- p.118
Chapter 4.4.3 --- Screening utility and effectiveness evaluation --- p.120
Chapter 4.4.4 --- Cost-effectiveness and cost-utility analysis method --- p.122
Chapter 4.5 --- Time horizon and discounting rate --- p.125
Chapter 4.6 --- Summary of modeling assumptions --- p.126
Chapter 4.6.1 --- Assumptions related to screening performance and clinical practice --- p.126
Chapter 4.6.2 --- Assumptions related to epidemiological characteristics of cervical cancer --- p.127
Chapter 4.6.3 --- Assumptions related to economic evaluation --- p.128
Chapter 4.7 --- Sensitivity analysis --- p.128
Chapter 4.8 --- Ethical approval --- p.129
Chapter CHAPTER 5 --- RESULTS --- p.130
Chapter 5.1 --- Model validation --- p.130
Chapter 5.2 --- Cost analysis results --- p.134
Chapter 5.2.1 --- Screening costs results --- p.134
Chapter 5.2.2 --- Treatment cost results --- p.136
Chapter 5.2.3 --- The proportional costs breakdown for different screening strategies --- p.139
Chapter 5.3 --- Utility estimation results --- p.141
Chapter 5.4 --- Cost-utility analysis results --- p.144
Chapter 5.4.1 --- Baseline analysis --- p.144
Chapter 5.4.2 --- Influence of screening program performance --- p.148
Chapter 5.4.2.1 --- Coverage of the screening program --- p.148
Chapter 5.4.2.2 --- Follow up rate and treatment rate of positives --- p.155
Chapter 5.4.3 --- Influence of screening test performance --- p.159
Chapter 5.4.4 --- Influence of costs --- p.165
Chapter 5.4.4.1 --- Influence of screening costs --- p.165
Chapter 5.4.4.2 --- Influence of treatment costs --- p.168
Chapter 5.4.5 --- Influence of discounting --- p.171
Chapter 5.4.6 --- Summary of factors and their influences on the baseline CUA results --- p.174
Chapter 5.5 --- Cost-Effectiveness analysis results --- p.180
Chapter 5.5.1 --- Baseline analysis --- p.180
Chapter 5.5.1.1 --- Life year saved --- p.181
Chapter 5.5.1.2 --- Cervical cancer mortality reduction --- p.185
Chapter 5.5.1.3 --- Cervical cancer incidence reduction --- p.187
Chapter 5.5.1.4 --- Relative risk of CIN and cervical cancer --- p.189
Chapter 5.5.1.5 --- Effectiveness summary of alternative screening strategies on the hypothetical 100,000 rural Chinese women --- p.191
Chapter 5.5.2 --- Factors that influence the CEA results --- p.195
Chapter 5.5.2.1 --- Best scenario analysis --- p.196
Chapter 5.5.2.2 --- Worst scenario analysis --- p.201
Chapter 5.5.2.3 --- Summary of the possible ranges of costs and effectiveness in different scenarios --- p.206
Chapter 5.6 --- Sensitivity analysis --- p.209
Chapter 5.6.1 --- Sensitivity analysis of Cost-Utility analysis results --- p.209
Chapter 5.6.1.1 --- Tornado analysis --- p.209
Chapter 5.6.1.2 --- One-way sensitivity analysis --- p.213
Chapter 5.6.2 --- Sensitivity analysis of Cost-Effectiveness analysis results --- p.220
Chapter 5.6.2.1 --- Tornado analysis --- p.220
Chapter 5.6.2.2 --- One-way sensitivity --- p.224
Chapter 5.6.3 --- Summary of sensitivity results --- p.236
Chapter CHAPTER 6 --- SUMMARY, DISSICUSSION AND CONCLUSIONS --- p.240
Chapter 6.1 --- Summary of Markov model development and validation --- p.240
Chapter 6.1.1 --- Category and source summary of input parameters --- p.240
Chapter 6.1.2 --- Model validation --- p.244
Chapter 6.2 --- Summary of modeling results --- p.245
Chapter 6.2.1 --- Summary of Cost-Utility Analysis --- p.245
Chapter 6.2.1.2 --- Baseline analysis findings --- p.245
Chapter 6.2.1.2 --- Influential factors on the cost-effective manner of alternative strategies --- p.246
Chapter 6.2.2 --- Summary of Cost-Effectiveness Analysis --- p.250
Chapter 6.2.2.1 --- Baseline analysis findings --- p.251
Chapter 6.2.2.2 --- Possible ranges for cost and effectiveness of alternative strategies under different scenarios --- p.253
Chapter 6.2.3 --- Summary of CUA and CEA findings --- p.257
Chapter 6.2.4 --- Summary of sensitivity analysis --- p.259
Chapter 6.2.4.1 --- Important variables on health outcome predictions --- p.259
Chapter 6.2.4.2 --- Sensitive variables to the baseline CUA and CEA recommendations --- p.260
Chapter 6.2.4.3 --- Overview of the sensitivity analysis --- p.263
Chapter 6.3 --- Discussion --- p.264
Chapter 6.3.1 --- Alternative strategies of cervical cancer screening in rural China --- p.264
Chapter 6.3.1.1 --- Target ages --- p.265
Chapter 6.3.1.2 --- Screening intervals --- p.266
Chapter 6.3.1.3 --- Feasible primary screening tests --- p.267
Chapter 6.3.1.4 --- Service delivering patterns --- p.269
Chapter 6.3.1.5 --- Time horizon of this thesis study --- p.270
Chapter 6.3.2 --- Transition probability estimation --- p.271
Chapter 6.3.3 --- Screening and treatment cost estimation --- p.276
Chapter 6.3.3.1 --- Representativeness of the selected counties --- p.276
Chapter 6.3.3.2 --- Screening costs of VIA and Pap smear --- p.277
Chapter 6.3.3.3 --- Treatment costs --- p.279
Chapter 6.3.4 --- Utility estimation --- p.280
Chapter 6.3.4.1 --- Instrument selection --- p.280
Chapter 6.3.4.2 --- Utility estimation between studies --- p.281
Chapter 6.3.5 --- Baseline cost-utility and cost-effectiveness analyses --- p.283
Chapter 6.3.6 --- Sensitivity Analysis --- p.284
Chapter 6.3.7 --- Strengths and limitations --- p.286
Chapter 6.3.7.1 --- Limitations --- p.286
Chapter 6.3.7.2 --- Strengths --- p.288
Chapter 6.4 --- Policy implications --- p.289
Chapter 6.4.1 --- How to manage a cost-effective cervical cancer screening program? --- p.289
Chapter 6.4.2 --- How can VIA screening be adopted? --- p.290
Chapter 6.4.3 --- How can Pap smear screening be adopted? --- p.291
Chapter 6.4.4 --- Framework for policy decision making --- p.292
Chapter 6.5 --- Conclusions --- p.295
Chapter APPENDIX --- p.300
Chapter Appendix 1-1 --- The 2001 Bethesda System* --- p.300
Chapter Appendix 1-2 --- The FIGO Staging for cervical cancers* --- p.301
Chapter Appendix 1-3 --- Cervical Cancer Screening Program in different countries --- p.302
Chapter Appendix 4-1 --- WHO World Standardized Population Distribution (%) --- p.305
Chapter Appendix 4-2 --- Summary of transition probabilities literature review --- p.306
Chapter Appendix 4-3 --- Price Indices from 1978 to 2010 --- p.326
Chapter Appendix 4-4 --- Screening Cost Questionnaire --- p.327
Chapter Appendix 4-5 --- Programmatic Cost Survey Questionnaire --- p.339
Chapter Appendix 4-6 --- Treatment Cost Survey Questionnaire --- p.342
Chapter Appendix 4-7 --- EQ-5D Algorism (UK) --- p.344
Chapter Appendix 4-8 --- Chinese Version of EQ5D----HQOL score questionnaire --- p.345
Chapter Appendix 5-1 --- Calibrated variables and its final settings --- p.348
Chapter Appendix 5-2 --- Cervical cancer new cases and deaths all over the world in 2008 --- p.349
Chapter Appendix 5-3 --- Data distribution of CIN2-3 and cervical cancer treatment costs --- p.350
Chapter Appendix 5-4 --- Relative risk of CIN and cervical cancer by age groups of alternative screening strategies --- p.361
Chapter Appendix 5-5 --- Influence of discounting rate of life years on the CEA results --- p.363
Chapter Appendix 5-6 --- Tornado analysis results based on the effect on QALYs predictions --- p.367
Chapter Appendix 5-7 --- Tornado analysis results based on the effect on life-year predictions --- p.372
Chapter Appendix 6-1 --- Summary of Markov Model Inputs and Sources --- p.377
REFERENCE --- p.388

A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Masters in Science. December 2015
Cervical cancer remains a global health related issue among females of Sub-Saharan Africa, with over half a million new cases reported each year. Different therapeutic regimens have been suggested in various regions of Africa, however, over a quarter of a million women die of cervical cancer, annually. This makes it the most lethal cancer amongst black women in this area, and makes it important to search for new effective therapeutic drugs through screening of medicinal plant extracts used by many in Sub-Saharan Africa as potential anti-cervical cancer agents. The aim of this study was to evaluate the anti-proliferative effects of Cannabis sativa extracts and its isolate, cannabidiol on cervical cancer cell lines HeLa, SiHa, and ME-180. To achieve our aim, phytochemical screening, MTT assay, cell growth analysis, flow cytometry, morphology analysis, Western blot, caspase 3/7 assay, and ATP measurement assay were conducted were conducted. Results obtained indicate that both plant extracts induced cell death at an IC50 of 50 – 100μg/ml and the Inhibition of cell growth was cell line dependent. Flow cytometry confirmed that, with or without cell cycle arrest, the type of induced cell death was apoptosis. Cannabis sativa extracts led to the up-regulation of apoptosis proteins (p53, Bax, caspase-3, and caspase-9) and the down regulation of anti-apoptosis proteins (Bcl-2 and RBBP6), signalling the execution of apoptosis. Apoptosis induction was further confirmed by morphological changes, an increase in Caspase 3/7 and a decrease in the ATP levels. In conclusion, this data implies Cannabis sativa crude extracts has the potential to inhibit growth and induce apoptosis in cervical cancer cell lines, which may be due to the presence of cannabidiol. Key words: Apoptosis, cervical cancer cells, cannabidiol, and Cannabis sativa extracts

Background: Cervical cancer is the second most common cause of death from cancer among women in Kenya. Various international studies indicate that the knowledge level of cervical cancer and its predisposing and preventive measures is low among the nurses as well as general population. This study aimed to assess knowledge, practices and attitudes of nurses with regards to cervical cancer screening and preventive measures at two Nairobi hospitals in Kenya. Across-sectional quantitative descriptive study design was used. Convenience sampling method was applied and data were collected from respondents using self-administered questionnaire. About 114 nurses aged 18 years and above participated in the study. The study revealed that nurses have the information about cervical cancer, available screening tests and the purpose of screening. Nurses have the knowledge that cancer screening could detect this cancer at an early stage; however, uptake is low. Cervical screening services were hampered by barriers relating to health care institutions, nurses perception and fear of screening technique, embarrassment, stigma, social influence, financial costs and available sources of information
Health Studies
M.A. (Nursing Science)

Text in English
Cervical cancer remains the leading cause of cancer mortality among women worldwide, a burden in the developing countries and commonly detected through symptoms at later invasive stages. The study aimed at establishing knowledge and awareness of the importance of cervical cancer screening in the Makhuduthamaga Sub-district by exploring the perceptions of women and professional nurses and through the review of the National Cervical Cancer Screening Policy (2013). Recommendations to address the gap in knowledge and to inform the National Cervical Cancer Screening Policy were developed based on the study findings. A mixed-method approach was used in this study through a sequential explanatory design, which is quantitatively driven was used. Quantitative data were obtained by using a researcher developed checklist. The checklist was developed from variables stated in the National Cervical Cancer Screening Policy and was used to review its implementation. Qualitative data was obtained through in-depth interviews with individual women and focus group discussions with professional nurses. The study was conducted in ten randomly selected clinics of Makhuduthamaga Sub-district. Purposive sampling was done to obtain qualitative data. An average score of 9.7 was obtained for all ten clinics that participated in the study with regard to the evaluation of the implementation of the National Cervical Cancer Screening Policy. Only 6 (60%) clinics implemented the policy whereas 4 (40%) clinics did not implement the policy. Women and professional nurses perceived cervical cancer screening as important. Lack of knowledge among women regarding cervical cancer screening contributed to the majority of women not screening for cervical cancer. Lack of resources, the 10 year interval of normal cervical cancer screening, the use of disposable vaginal speculums and brushes, lack of standardized cervical cancer screening training, centralization of cytology laboratories came out as factors that negatively influence the uptake of cervical cancer screening. Cervical cancer screening awareness campaigns, availability of resources and standardized in-service trainings on cervical cancer screening were recommended to enhance the cervical cancer screening uptake. Key concepts:
Health Studies
D. Litt. et Phil. (Health Studies)

Text in English
The purpose of the study was to explore perceptions, knowledge and attitudes of women undergoing cervical cancer screening in Omaheke, Namibia. A qualitative exploratory study was conducted. Data were collected from a purposive sample of eight participants using a self-developed interview guide. Data were analysed using Tesch’s descriptive method of open coding. Three themes were identified namely; cervical cancer as a disease, perception of cervical cancer and service delivery at the facility. The findings also revealed some suggestions for the facility that could improve screening uptake. The study proposes a community education programme on cervical cancer and related topics to be covered during health education sessions. In addition the study recommends the Omaheke directorate to look into operational issues in order to facilitate access to cervical cancer screening.
Health Studies
M.P.H.

Indiana University-Purdue University Indianapolis (IUPUI)
Human papillomavirus (HPV) infection results in serious health issues including cervical, anal, vulvar, penile and oropharyngeal cancers. There are three vaccines against HPV but vaccination rates in the United States remain low. One barrier to uptake is a concern that individuals who are vaccinated may increase their risky sexual behaviors or decrease their use of cervical cancer screenings, an adjustment in perceived level of risk for HPV that can be studied using risk compensation theory. Methods Three distinct studies examined risk compensation after HPV vaccination. A systematic review examined literature from January 1, 2008-June 30, 2015, using three databases. A qualitative study using semi-structured interviews of 22 healthcare providers that assessed their beliefs regarding sexual disinhibition and cervical cancer screening following vaccination. A cross-sectional survey that assessed cervical cancer screening practices, awareness and comfort with recommendations, and knowledge regarding the purpose of a Papanicolaou (Pap) test. Results Twenty articles were included in the systematic review. None of the studies of sexual behaviors and/or biological outcomes found evidence of riskier behaviors after HPV vaccination. Instead, the studies found vaccinated individuals were less likely to report risky sexual behaviors, sexually transmitted infections (STIs), and pregnancy. Qualitative interviews found no healthcare providers believed the HPV vaccine would result in increased risky sexual behavior or decreased cervical cancer screening, and these concerns would not influence their vaccination recommendations. The survey included 291 women 21-35 years old; 62% were non-Hispanic black, 84% had a Pap test in the last three years, and 33% had at least one HPV vaccine. Logistic regression showed that vaccinated women did not have greater odds of having a Pap test in the past three years (OR=1.32; 95% CI=0.66-2.65; p=0.427). However, this odds ratio was significant when controlling for age and race (AOR=3.06; 95% CI=1.37-6.83; p=0.006). Conclusion These studies found no evidence of increased risky sexual behaviors or decreased cervical cancer screening rates after HPV vaccination. Furthermore, vaccinated women showed less evidence of risk compensation. These results should alleviate concerns about administering the HPV vaccination among parents and providers.

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)

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.

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

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)