Dissertations / Theses on the topic 'Generative organs, Female – Cancer – Radiotherapy'

Merkel cell polyomavirus (MCPyV) is an oncogenic virus exist in about 80% of Merkel Cell Carcinoma (MCC), an aggressive human skin cancer. Evidence of MCPyV existing in other kind of skin neoplasms such as cutaneous squamous cell carcinomas (SCCs) has been reported. Since the major type of cervical cancer is SCCs, MCPyV may be associated with cervical cancer tumorigenesis. A Japanese research group has documented the presence of MCPyV DNA in both cervical SCCs and cervical adenocarcinomas (ACs) from Japanese patients. Nevertheless, the association between MCPyV and cervical cancer remains inconclusive and the prevalence of MCPyV in cervical cancer may show demographic variation. This study is aimed to examine whether MCPyV is present in some of the most common gynaecological cancers, namely cervical cancer, ovarian cancer, endometrial cancer, and gestational choriocarcinoma, in Hong Kong patients. Genomic DNA was obtained from 50 cases of cervical cancer, 20 cases of ovarian cancer, and 35 common gynaecological cancers cell lines. Genomic DNA extracted from four MCC samples were used as positive controls. The integrity of the samples was first checked by β-globin PCR. Detection of MCPyV was then performed by MCPyV Large T antigen (LT-ag) PCR. Our PCR analysis showed that only 1 out of 50 (2%) of the cervical cancer samples was positive for MCPyV DNA. The PCR product was purified and cloned for sequencing analysis. Comparing the LT-ag sequence obtained from the only MCPyV positive cervical cancer with reference sequence and with the MCPyV sequence from one of the control cases revealed the presence of different MCPyV variants in Hong Kong patients. None of the ovarian cancer, endometrial cancer, or choriocarcinoma was positive for MCPyV. Our data did not support the notion that MCPyV is associated with gynaecological malignancies. MCPyV may hence be a fairly specific oncogenic agent for Merkel cell carcinoma.
published_or_final_version
Pathology
Master
Master of Medical Sciences

Thesis (DMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010.
ENGLISH ABSTRACT: Chapter 1 is a literature review investigating the incidence of cancer in children and young adults. It describes the most important treatment options including chemotherapy, radiotherapy and surgery and the effect of treatment on future endocrine development and fertility. Different primary cancer sites are discussed in more detail. Chapter 2 is a literature review on the effects of cancer surgery in women and the options for fertility sparing. Cervical cancer and pre-cancer are discussed in detail with options for more conservative surgery in selected patients. A summary of the available published cases of trachelectomy with pregnancy outcomes is included. Other gynaecological cancers requiring surgery are also discussed with reference to conservative options. Chapter 3 is a literature review about the medical (pharmacological) options for protection of ovarian function in patients undergoing oncotherapy. The role of gonadotrophin releasing hormone analogues and hormonal contraceptives in ovarian suppression is discussed in detail. Chapter 4 This chapter examines germ cell physiology with reference to cryopreservation. It includes two major parts. Part 1 is the description of germ cell- and follicle physiology, the principles of cryobiology followed by a review of oocyte cryopreservation and ovarian tissue preservation. Both slow freezing and vitrification techniques are described. The second part of chapter 4 is a report on a randomised controlled evaluation of two different slow freezing cryopreservation protocols. This experimental study compared ultrastructural changes in fresh and previously cryopreserved ovarian cortical tissue after equilibration and thawing using two different cryoprotectants. This is the first randomised investigation into DMSO and PROH as cryoprotectants. Chapter 5 is an investigation into cryopreservation of ovarian tissue as a strategy to protect hormonal function and fertility against gonadotoxic treatment. This chapter consists of two parts. The first part is a thorough literature review of all the published work about grafting of previously cryopreserved ovarian tissue. The largest case series found from a single institution was five patients. Another report of six patients included patients from various sites in Denmark. Part 2 is a description of a cohort of patients followed up after re-implantation of previously cryopreserved ovarian cortical tissue. Follow-up hormone levels of 13 individual cases are described in detail. This is the largest case series ever reported. The experimental study described in Chapter 4 and the clinical study described in Chapter 5 was approved by the ethical research committee of the Faculty of Health Sciences, Stellenbosch University, project number N05/10/182. Chapter 6 provides an integrated overview of the incidence and treatment of cancer in young women and how its negative effects may be prevented or mitigated. Aspects of chemotherapy, radiotherapy and surgery are evaluated where it may affect future reproductive health. The role of oocyte and ovarian tissue cryopreservation is discussed. Guidelines are provided for clinicians.
AFRIKAANSE OPSOMMING: Hoofstuk 1 Hierdie is ‘n literatuuroorsig wat die insidensie van kanker in kinders en jong volwassenes ondersoek. Dit sluit die mees belangrike behandelingsopsies in, naamlik chemoterapie, radioterapie en chirurgie en die effek wat behandeling mag hê op toekomstige endokriene ontwikkeling en fertiliteit. ‘n Verskeidenheid kanker tipes word in meer detail beskryf. Hoofstuk 2 Hoofstuk 2 is ‘n literatuuroorsig oor die effekte van kankerchirurgie in vroue en die geleenthede tot beskerming van fertiliteit. Servikale kanker en voorlopers van servikale kanker word bespreek en die opsies vir konserwatiewe chirurgie in uitgesoekte pasiënte word gegee. ‘n Opsomming van die inligting wat beskikbaar is oor tragelektomie en swangerskap uitkomste word ingesluit. Ander ginekologiese kankers wat chirurgie mag benodig, word ook bespreek met verwysing na konserwatiewe hantering. Hoofstuk 3 ‘n Literatuuroorsig oor die mediese (farmakologiese) opsies vir die beskerming van ovariële funksie in pasiënte wat behandeling ontvang vir kanker. Die rol van gonadotropien-vrystellingshormoon-analoë en hormonale kontrasepsie vir ovariële onderdrukking word in detail bespreek. Hoofstuk 4 Hierdie hoofstuk ondersoek kiemselfisiologie met verwysing na vriesbewaring. Dit is verdeel in twee dele. Deel 1 is ‘n beskrywing van kiemsel- en follikelfisiologie en die beginsels van vriesbiologie. Dit word gevolg deur ‘n oorsig van oösiet vriesbewaring en ovariële weefselbewaring. Stadige bevriesing en vitrifikasie- metodes word bespreek. Die tweede deel van hoofstuk 4 is ‘n verslag oor ‘n gerandomiseerde, gekontroleerde evaluasie van twee stadige bevriesingsmetodes. Hierdie eksperimentele studie het die ultrastrukturele veranderinge vergelyk in vars en voorheen bevrore ovariële kortikale weefsel na ekwilibrasie en ontdooiing met twee verskillende vriesbeskermers. Dit is die eerste gerandomiseerde studie oor DMSO en PROH as vriesbeskermers. Hoofstuk 5 Hierdie hoofstuk handel oor ‘n ondersoek na vriesbewaring van ovariële weefsel as ‘n benadering tot beskerming van hormonale funksie en fertiliteit teen gonadotoksiese behandeling. Die hoofstuk bestaan uit twee dele. Die eerste deel is ‘n deeglike oorsig van die literatuur oor al die beskikbare werk wat handel oor terugplasing van voorheen bevrore ovariële weefsel. Die grootste pasiëntreeks van ‘n enkel instelling was slegs vyf pasiënte. ‘n Ander beskrywing van ses pasiënte het pasiënte van verskeie eenhede in Denemarke ingesluit. Deel 2 is ‘n beskrywing van ‘n groep pasiënte wat opgevolg is na oorplanting van voorheen bevrore ovariële kortikale weefsel. Opvolg hormoonvlakke van 13 gevalle word in detail bespreek. Hierdie is die grootste pasiëntreeks wat tot nog toe beskryf is. Die eksperimentele studie wat in hoofstuk 4 beskryf word en die kliniese studie wat in hoofstuk 5 beskryf word, is goedgekeur deur die etiese navorsingskomitee van die Fakulteit Gesondheidswetenskappe van die Universiteit Stellenbosch met die projeknommer N05/10/182 Hoofstuk 6 Hierdie is ‘n geïntegreerde oorsig van die voorkoms en behandeling van kanker in jong vroue en hoe die negatiewe effekte daarvan voorkom of verminder kan word. Aspekte van chemoterapie, radioterapie en chirurgie word geëvalueer ten opsigte van die effek op toekomstige reproduktiewe gesondheid. Die rol van oösiet- en ovariële weefselvriesbewaring word bespreek. Riglyne vir klinici word gegee.

The management of advanced cervical and ovarian cancers remains a significant challenge as many women fail to respond to recommended therapy, resulting in disease progression and ultimately patient death. Because of tumour heterogeneity, it is rare for all cancers of a particular type to respond to a specific therapy. Many patients therefore receive treatment from which they derive little or no benefit, leading to increased morbidity and costs. A marker that could rapidly predict disease outcome would clearly be beneficial in allowing the administration of tailored therapy while reducing toxicity and cost. Novel functional imaging techniques have the ability to characterise biological tissues and non-invasively integrate physical and metabolic information. These include diffusion weighted MRI (DW-MRI), which is particularly sensitive to the microscopic motion of water molecules and changes in tissue cellularity, as well as dynamic contrast-enhanced MRI (DCE-MRI) which can assess tumour vascular characteristics during the passage of a paramagnetic contrast agent through tissues. Both imaging techniques have demonstrated potential as biomarkers of tumour response in various malignancies such as brain tumours, but have not been fully explored in gynaecological cancers.

Thesis (M.S.)--University of Missouri-Columbia, 2007.
The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on March 21, 2008) Includes bibliographical references.

Orientador: Rogério Saad Hossne
Coorientador: Sidney Roberto Nadal
Banca: Fábio Vieira Teixeira
Banca: Maria Aparecida C. Arruda Henry
Resumo: O Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal
Abstract: Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse
Mestre

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O Papiloma Vírus Humano (HPV), é considerado um problema mundial de saúde pública, sendo a doença sexualmente transmissível mais prevalente. Guarda uma relação direta com o risco e a incidência do câncer do canal anal. Seu diagnóstico, tratamento e seguimento são de extrema importância. Neste sentido o escovado do canal anal tem um papel fundamental no rastreamento e seguimento das lesões HPV induzidas e consequente evolução para o câncer anal. Determinar a ocorrência de lesão HPV induzida em mulheres que participam dos programas de prevenção do câncer de colo uterino nas Unidades Básicas de Saúde (UBS) no município de Botucatu. Trata-se de um estudo transversal observacional que teve 228 mulheres submetidas ao escovado do canal anal a fim de estabelecer a ocorrência de lesão HPV induzida e suas correlações com dados sociais e comportamentais. Os 11 casos que apresentaram alteração de ASCUS e LSIL no escovado do canal anal traziam relação com estado civil, baixa escolaridade, não prática do sexo seguro, e a prática do sexo anal
Human Papillomavirus (HPV) has been a world concern in Public Health, and it is the most prevalent sexually transmitted disease. It has a direct association with the risk and incidence of cancer in the anal canal. Its diagnosis, treatment and follow-up are extremely important. Using this approach, the smear of the anal canal has a crucial role in the screening and follow up of HPV-induced lesions and in the resulting development of anal cancer. To determine the occurrence of HPVinduced lesions in women who attended programs of uterine cervix cancer prevention in Basic Health Units (BHU) in Botucatu city. It is a cross sectional observational study, in which 228 women underwent brushing of the anal canal in order to establish the occurrence of HPV-induced lesion and its correlation with social and behavioral data. The 11 cases which had ASCUS and LSIL changes in the smear of the anal canal were associated with marital status, low education level, practice of unsafe intercourse and anal intercourse

Les infections génitales par les virus du papillome humains (HPV) sont les infections virales sexuellement transmises, les plus communes chez les femmes en âge de procréer. Il est désormais bien établi que l’infection persistante par les HPV classés «à haut risque» est l’un des facteurs indispensables au développement de lésions précancéreuses et cancéreuses du col de l’utérus. Ces HPV semblent aussi être impliqués dans le développement d’autres cancers de la région ano-génitale et pourraient être également impliqués dans les cancers de la tête et du cou. Durant cette dernière décennie, des études croissantes tendent à établir un rôle étiologique des HPV dans les dysfonctionnements gestationnels. La détection des ADN HPV dans les placentas issus d’avortements spontanés et leur capacité exceptionnelle à se répliquer in vitro dans les cellules trophoblastiques cultivées en monocouche, ont apporté de nouvelles perspectives quant à la possibilité que le placenta pourrait constituer aussi un tropisme naturel des infections par HPV.

Six jours après la fécondation et suite à l’accolement du blastocyste à l’épithélium utérin, le trophoblaste s’engage dans des processus actifs de prolifération, d’invasion et de différenciation complexe pour la construction de l’interface physiologique indispensable aux échanges essentiels entre la mère et l’enfant ;le placenta. De façon intéressante, ses propriétés sont similaires à celles de la cellule tumorale maligne. Néanmoins, ses mécanismes sont étroitement régulés dans le trophoblaste, à la fois dans l’espace et le temps, assurant un développement normal à chaque étape de la grossesse.

Devant toutes ces données, nous avions émis l’hypothèse que l’expression des protéines précoces E5, E6 et E7 d’HPV de type 16 (de haut risque), pourraient modifier le développement des trophoblastes infectés. Les résultats obtenus durant ce travail de doctorat démontrent que la protéine virale E5, hautement hydrophobe, est cytotoxique et affecte la viabilité du trophoblaste. Cette cytotoxicité est neutralisée, et la viabilité est améliorée, lorsque les oncoprotéines majeures E6 et E7 sont exprimées en présence de la protéine E5. Lorsque toutes les protéines précoces sont exprimées sous le contrôle de leur propre promoteur (LCR), la viabilité est favorisée. Ces observations ont été confirmées dans les cellules cervicales également. Il a été précédemment rapporté que les oncoprotéines E6 et E7 affectaient l’adhésion du trophoblaste aux cellules endométriales. Dans le présent travail, il a été retrouvé que la protéine E5 diminuait elle aussi l’adhésion, non seulement aux cellules endométriales, mais aussi au support de culture cellulaire. Les capacités de migration et d’invasion de la matrice extracellulaire sont augmentées par l’expression de E5 et dans une plus large proportion par l’expression de E6 et E7. Des résultats similaires ont été obtenus lorsque toutes les protéines de la région précoces sont exprimées sous le contrôle de leur propre promoteur (LCR). La diminution de l’expression de la E-cadhérine est considérée comme un marqueur de malignité et de mauvais pronostic pour les cancers. Nous avons démontré que l’expression de E5, E6 ou de E7, inhibait l’expression de la E-cadhérine, reflétant l’impact des oncoprotéines du virus HPV-16 sur la diminution de l’adhésion et l’augmentation du pouvoir invasif des cellules trophoblastiques. L’investigation d’autres marqueurs de malignité et de tolérance immunitaire, l’étude de l’impact du virus HPV-6 (de bas risque) sur la migration et l’invasion des cellules trophoblastiques, et l’étude de la capacité des protéines précoces d’HPV-16 à influencer l’entrée des particules virales, ont fait l’objet de résultats préliminaires, ouvrant de larges perspectives.

Genital Human Papillomavirus (HPV) infections are the most common sexually transmitted infections amongst women on the age of reproduction. It is well established that persistent infection with high-risk HPVs is the necessary factor in the causation of precancerous and cancerous cervical lesions. High-risk HPVs have also been reported to be involved in the causation of head and neck cancers and other anogenital cancers. On this last decade, growing data are attempting to study the potential etiological association of HPV with gestational dysfunctions. The detection of HPV DNA in placentas resulting from spontaneous abortions and the unique ability of multiple HPV types to replicate in vitro in trophoblastic cells cultured in a monolayer system, rise new questions over the HPV tropism.

Six days following fertilization and once the apposition of the blastocyst on the uterine wall takes place, the trophoblast, in a very active and complex process, starts to proliferate, invade and to differentiate in order to build a physiological interface; the placenta, from where multiple mother/foetus exchanges occur. Interestingly, the way that the trophoblast behaves is very similar to malignant tumoural cells. However, the trophoblast obeys to strict spatial-temporal regulatory confines, insuring a proper development all along the pregnancy.

In regard to these data, we hypothesised that the expression of the high-risk HPV type 16 oncoproteins E5, E6 and E7, might modify the development of the infected trophoblast. During my Ph.D study, I demonstrated that the highly hydrophobic protein E5 is localized in many interne membranes compartments of the transfected trophoblast. E5 affects the viability of transiently and stably transfected trophoblastic cells. E6 and E7, favouring cell growth, neutralised the E5 cytotoxic effect. All HPV-16 early proteins, when expressed under the control of their endogenous promoter (LCR), favoured trophoblastic growth. These observations were also observed in cervical cell lines. In addition, E5 decreased the adhesiveness of trophoblastic cells to the tissue culture plastic and to endometrial cells similarly as previously described for E6 and E7. Cells expressing E6, E7 and in less extend E5 favoured chemotaxic migration and matrigel invasion compared to the cells expressing the LacZ control. These effects were also observed when early proteins were expressed under the control of their own viral promoter (LCR). Interestingly, the E-cadherin was down regulated in trophoblastic cells expressing E5, E6 and E7. In conclusion, HPV-16 early proteins enhanced trophoblastic growth and intensify the malignant phenotype by impairing cell adhesion leading to increased cellular motile and invasive properties. HPV-16 E5 participated, with E6 and E7, in these changes by impairing E-cadherin expression, a hallmark of malignant progression. Additional preliminary results consisting on the investigation of other markers of malignancy and immune tolerance, on studying the impact of the low-risk HPV type 6 early proteins on the migratory and invasive properties of trophoblastic cells and on the study of the ability of HPV-16 to influence the entry of virus particules, allowed to open wide perspectives.

Doctorat en Sciences
info:eu-repo/semantics/nonPublished

MSc., Faculty of Science, University of the Witwatersrand, 2011
Aim: This study aimed at evaluating the accuracy of the treatment setup margin in external beam radiotherapy in cervical cancer patients treated supine with or without the CIVCO “kneefix and feetfix”TM immobilizing devices. Methods and materials: 2 groups of 30 cervical cancer patients each, who were treated supine with two parallel opposed fields or a four-field “box” technique were selected randomly. The treatment fields were planned with a 2 cm setup margin defined radiographically. The first group was treated without any immobilization and the second group was treated with the “kneefix and feetfix”TM immobilization device. Both groups of patients were selected from the patients treated on one of two linear accelerators (linac), which had weekly mechanical quality control (QC). All patients had pre-treatment verifications on the treatment machine in which a megavoltage Xray film was taken to compare with the planning simulation film. Both films were approved by the radiation oncologist managing the patient. In this study the position of the treatment couch as at the approved machine film was taken as the intended or planned position for the immobilized patients. The digital readouts of the daily treatment position of the couch were recorded for each patient as the absolute X (lateral), Y (longitudinal), and Z (vertical) position of the couch from the record and verify system interfaced to the treatment machine. A total of 1241 (582 for the immobilized and 659 for the non-immobilized patient group) daily treatment setup positions were recorded in terms of the X, Y and Z coordinates of the couch corresponding to the Medio-lateral (ML), Supero-inferior (SI) and Antero-posterior (AP) directions of the patient, respectively. The daily translational setup deviation of the patient was calculated by taking the difference between the planned (approved) and daily treatment setup positions in each direction. Each patient’s systematic setup error (mi) and the population mean setup deviation (M), was calculated. Random ( ) and systematic ( ) setup errors were then calculated for each group in each direction. The translational setup variations found in the AP, iii ML, SI directions were compared with the 2 cm x 2 cm x 2 cm Planning Target Volume (PTV). Couch tolerance limits with the immobilization device were suggested based on the ± 2SD (standard deviation) obtained for each translational movement of the treatment couch. Result: The random and systematic errors for the immobilized patient group were less than those for the non-immobilized patient group. For the immobilized patient group, the systematic setup error was greater than the random error in the ML and SI direction as shown in Table I. Table I: The random and systematic errors in the setup in the Antero-posterior (AP), Medio-lateral (ML) and Supero-inferior (SI) directions and the suggested couch tolerance limits for both patient groups. Almost all treatment setup positions had less than 2 cm variation in the AP setup for both patient groups however; one third of the immobilized positions had more than 2 cm variation in the setup in the ML and SI directions. Conclusion: The “kneefix and feetfix”TM immobilizing device resulted in a minor improvement in both the random and systematic setup errors. The systematic setup errors need to be investigated further. There are measurable patient rotations of more than 2 cm in the setup margin with the immobilizing device and this should be confirmed with an imaging study. The 2 cm margin in the ML and SI directions Immobilized patient group Non-immobilized patient group AP (cm) ML (cm) SI (cm) AP (cm) ML (cm) SI (cm) Random error (!) 0.30 1.35 1.26 0.37 2.74 7.83 Systematic error (") 0.19 1.55 1.64 0.33 1.70 8.11 Suggested couch tolerance limits (±2SD) 0.70 4.04 4.08 0.88 4.76 N/A iv established at simulation should not be changed for these patients. A 1 cm tolerance in the AP setup margin could be introduced at this institution.

This qualitative study explored and described the experience of African women diagnosed with both HIV/AIDS and cervical cancer in order to gain an understanding of the experience of both illnesses as lived by these women. Phenomenological research methods were employed using in-depth semi-structured interviews. Communication as a strategy facilitating diagnosis, disclosure, acceptance and support for women with HIV/AIDS and cervical cancer emerged as the main theme, followed by the experience of physical symptoms and emotional experiences. The study shows the importance of communication in the management and support of these women attending public health institutions and in the community. For communication to occur the relationship between healthcare professionals and women diagnosed with HIV/AIDS and cervical cancer is very important. Treatment approaches in radiation therapy need to be developed for women diagnosed with HIV/AIDS and cervical. More research is needed in this area (HIV/AIDS and cervical cancer).
Health Studies
M.A. (Public Health)

Copies of author's previously published articles inserted.
Bibliography: leaves 187-209.
xiii, 209 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Documents the establishment of a reproducible model of carcinoma implanted into the abdominal wall of an immunocompetent Dark agouli rat to study the relationship between laparoscopy and the development of port site metastases.
Thesis (M.D.)--University of Adelaide, Dept. of Surgery, 1998?

研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。
系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。
試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。
試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。
研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。
研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。
Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive.
Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour.
Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong.
Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes.
Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful.
Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings.
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.
Chow, Ka Ming.
Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 185-204).
Abstracts also in Chinese; appendixes includes Chinese.
Chapter CHAPTER 1 --- INTRODUCTION
Chapter 1.1 --- Introduction --- p.1
Chapter 1.2 --- Aims and significance of the study --- p.4
Chapter 1.3 --- Overview of the thesis --- p.4
Chapter CHAPTER 2 --- LITERATURE REVIEW
Chapter 2.1 --- Introduction --- p.6
Chapter 2.2 --- Impact of GC on sexual functioning --- p.6
Chapter 2.2.1 --- Mixed types of GC --- p.7
Chapter 2.2.2 --- Ovarian cancer --- p.10
Chapter 2.2.3 --- Cervical cancer --- p.11
Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15
Chapter 2.3 --- Impact of GC on quality of life --- p.18
Chapter 2.3.1 --- Mixed types of GC --- p.19
Chapter 2.3.2 --- Cervical cancer --- p.21
Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24
Chapter 2.4 --- Impact of GC on psychological well-being --- p.25
Chapter 2.4.1 --- Mixed types of GC --- p.26
Chapter 2.4.2 --- Cervical cancer --- p.29
Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30
Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30
Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31
Chapter 2.5.2 --- Information needs of GC patients --- p.33
Chapter 2.5.3 --- Sexuality assessment --- p.35
Chapter 2.5.4 --- Sexuality interventions --- p.37
Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38
Chapter 2.6.1 --- Theoretical background --- p.38
Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40
Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42
Chapter 2.7 --- Summary --- p.44
Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I)
Chapter 3.1 --- Introduction --- p.46
Chapter 3.2 --- Review objectives and questions --- p.46
Chapter 3.3 --- Inclusion criteria --- p.48
Chapter 3.3.1 --- Types of studies --- p.48
Chapter 3.3.2 --- Types of participants --- p.48
Chapter 3.3.3 --- Types of interventions --- p.48
Chapter 3.3.4 --- Types of outcome measures --- p.49
Chapter 3.4 --- Search strategy --- p.50
Chapter 3.5 --- Methods of the review --- p.52
Chapter 3.5.1 --- Assessment of methodological quality --- p.52
Chapter 3.5.2 --- Data extraction --- p.52
Chapter 3.5.3 --- Data synthesis --- p.53
Chapter 3.6 --- Systematic review results --- p.54
Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54
Chapter 3.6.2 --- Methodological quality of the included studies --- p.57
Chapter 3.6.2.1 --- Randomization --- p.57
Chapter 3.6.2.2 --- Blinding --- p.57
Chapter 3.6.2.3 --- Consent and completion rates --- p.58
Chapter 3.6.2.4 --- Power estimation --- p.58
Chapter 3.6.2.5 --- Result data --- p.58
Chapter 3.6.3 --- Details of the included studies --- p.59
Chapter 3.6.3.1 --- Country of origin --- p.59
Chapter 3.6.3.2 --- Samples --- p.59
Chapter 3.6.3.3 --- Components of PEIs --- p.59
Chapter 3.6.3.4 --- Comparison group --- p.61
Chapter 3.6.3.5 --- Format of PEIs --- p.62
Chapter 3.6.3.6 --- Provider of PEIs --- p.62
Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63
Chapter 3.6.3.8 --- Duration of PEIs --- p.63
Chapter 3.6.3.9 --- Outcome measurements --- p.64
Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64
Chapter 3.6.4.1 --- Sexual functioning --- p.65
Chapter 3.6.4.2 --- Quality of life --- p.65
Chapter 3.6.4.3 --- Psychological outcomes --- p.68
Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68
Chapter 3.6.4.3.2 --- Distress --- p.70
Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71
Chapter 3.6.4.3.4 --- Mood --- p.71
Chapter 3.6.4.3.5 --- Self-esteem --- p.72
Chapter 3.6.4.3.6 --- Uncertainty --- p.72
Chapter 3.6.4.3.7 --- Coping --- p.72
Chapter 3.6.4.4 --- Brief summary --- p.72
Chapter 3.6.5 --- Design of PEIs --- p.73
Chapter 3.6.5.1 --- Effective components --- p.73
Chapter 3.6.5.2 --- Effective format --- p.75
Chapter 3.6.5.3 --- Effective provider --- p.76
Chapter 3.6.5.4 --- Effective provision time frame --- p.76
Chapter 3.6.5.5 --- Effective duration --- p.77
Chapter 3.7 --- Discussion --- p.78
Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80
Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82
Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84
Chapter 3.7.3.1 --- Anxiety and depression --- p.84
Chapter 3.7.3.2 --- Distress --- p.86
Chapter 3.7.3.3 --- Adjustment to illness --- p.87
Chapter 3.7.3.4 --- Mood --- p.87
Chapter 3.7.3.5 --- Self-esteem --- p.88
Chapter 3.7.3.6 --- Uncertainty --- p.88
Chapter 3.7.3.7 --- Coping --- p.89
Chapter 3.7.4 --- Design of PEIs --- p.89
Chapter 3.7.4.1 --- Effective components and theories --- p.89
Chapter 3.7.4.2 --- Effective format --- p.92
Chapter 3.7.4.3 --- Effective provider --- p.93
Chapter 3.7.4.4 --- Effective provision time frame --- p.93
Chapter 3.7.4.5 --- Effective duration --- p.94
Chapter 3.8 --- Summary of systematic review --- p.95
Chapter 3.8.1 --- Implications for practice --- p.95
Chapter 3.8.2 --- Implications for research --- p.97
Chapter 3.9 --- Summary --- p.100
Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II)
Chapter 4.1 --- Introduction --- p.102
Chapter 4.2 --- Rationale for conducting a pilot study --- p.102
Chapter 4.3 --- Aims and objectives --- p.103
Chapter 4.4 --- Operational definition --- p.104
Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104
Chapter 4.4.2 --- Sexual functioning --- p.105
Chapter 4.4.3 --- Quality of life --- p.105
Chapter 4.4.4 --- Uncertainty --- p.105
Chapter 4.4.5 --- Anxiety --- p.106
Chapter 4.4.6 --- Depression --- p.106
Chapter 4.4.7 --- Social support --- p.106
Chapter 4.5 --- Interventions --- p.107
Chapter 4.5.1 --- Program of PEIs --- p.107
Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107
Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113
Chapter 4.5.1.2.1 --- Information provision --- p.113
Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113
Chapter 4.5.1.2.3 --- Psychological support --- p.114
Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115
Chapter 4.5.2 --- Attention control --- p.121
Chapter 4.5.3 --- Usual care --- p.122
Chapter 4.6 --- Methodology --- p.123
Chapter 4.6.1 --- Study design --- p.123
Chapter 4.6.2 --- Study setting --- p.125
Chapter 4.6.3 --- Sample --- p.126
Chapter 4.6.3.1 --- Sampling method --- p.126
Chapter 4.6.3.2 --- Sample size determination --- p.127
Chapter 4.6.3.3 --- Recruitment process --- p.128
Chapter 4.7 --- Data collection --- p.129
Chapter 4.7.1 --- Measures --- p.129
Chapter 4.7.2 --- Study instruments --- p.130
Chapter 4.7.2.1 --- Demographic data sheet --- p.130
Chapter 4.7.2.2 --- Sexual functioning --- p.131
Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134
Chapter 4.7.2.3 --- Quality of life --- p.134
Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136
Chapter 4.7.2.4 --- Uncertainty --- p.136
Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138
Chapter 4.7.2.5 --- Social support --- p.139
Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141
Chapter 4.7.2.6 --- Anxiety and depression --- p.141
Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143
Chapter 4.7.2.7 --- Semi-structure interview --- p.144
Chapter 4.7.2.7.1 --- Intervention recipients --- p.144
Chapter 4.7.2.7.2 --- Health-care providers --- p.144
Chapter 4.7.3 --- Data collection procedure --- p.145
Chapter 4.8 --- Data analysis --- p.149
Chapter 4.8.1 --- Quantitative data --- p.149
Chapter 4.8.1.1 --- Comparison of baseline data --- p.151
Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151
Chapter 4.8.2 --- Qualitative data --- p.153
Chapter 4.9 --- Ethical considerations --- p.154
Chapter 4.1 --- Summary --- p.155
Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY
Chapter 5.1 --- Introduction --- p.156
Chapter 5.2 --- Recruitment of participants --- p.157
Chapter 5.3 --- Characteristics of all participants --- p.159
Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159
Chapter 5.3.2 --- Homogeneity of the participants --- p.161
Chapter 5.4 --- Baseline outcome variables --- p.164
Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164
Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166
Chapter 5.5 --- Outcome variables within-group changes --- p.168
Chapter 5.5.1 --- Quality of life --- p.168
Chapter 5.5.2 --- Uncertainty --- p.170
Chapter 5.5.3 --- Social support --- p.174
Chapter 5.5.4 --- Anxiety and depression --- p.179
Chapter 5.6 --- Outcome variables between-group changes --- p.181
Chapter 5.6.1 --- Sexual functioning --- p.181
Chapter 5.6.2 --- Quality of life --- p.184
Chapter 5.6.3 --- Uncertainty --- p.185
Chapter 5.6.4 --- Social support --- p.187
Chapter 5.6.5 --- Anxiety and depression --- p.190
Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191
Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191
Chapter 5.7.1.1 --- Emotional support --- p.192
Chapter 5.7.1.1.1 --- Offering psychology support --- p.192
Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192
Chapter 5.7.1.2 --- Informational support --- p.193
Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193
Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193
Chapter 5.7.1.2.3 --- Resources available in the community --- p.194
Chapter 5.7.1.3 --- Elements of the program --- p.194
Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194
Chapter 5.7.1.3.2 --- Content of information provided --- p.195
Chapter 5.7.1.4 --- Feelings towards the program --- p.195
Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195
Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196
Chapter 5.7.2 --- Health-care providers perspective --- p.196
Chapter 5.7.2.1 --- Opinions regarding the program --- p.197
Chapter 5.7.2.1.1 --- Quality of information provided --- p.197
Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197
Chapter 5.7.2.2 --- Suggestions for improvement --- p.198
Chapter 5.7.2.2.1 --- Content of information provided --- p.198
Chapter 5.7.2.2.2 --- Format of the interventions --- p.199
Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199
Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200
Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200
Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201
Chapter 5.8 --- Summary --- p.201
Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY
Chapter 6.1 --- Introduction --- p.205
Chapter 6.2 --- Baseline characteristics of the participants --- p.205
Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206
Chapter 6.2.2 --- Baseline outcome variables --- p.208
Chapter 6.3 --- Effectiveness of the PEI program --- p.211
Chapter 6.3.1 --- Quality of life --- p.211
Chapter 6.3.2 --- Uncertainty --- p.214
Chapter 6.3.3 --- Social support --- p.216
Chapter 6.3.4 --- Anxiety and depression --- p.218
Chapter 6.3.5 --- Sexual functioning --- p.221
Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223
Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223
Chapter 6.4.2 --- Health-care providers’ perspective --- p.226
Chapter 6.5 --- Limitations of the pilot study --- p.229
Chapter 6.5.1 --- Four types of validity threats --- p.229
Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232
Chapter 6.6 --- Summary --- p.234
Chapter CHAPTER 7 --- CONCLUSION
Chapter 7.1 --- Introduction --- p.235
Chapter 7.2 --- Implications for nursing practice --- p.235
Chapter 7.3 --- Implications for future research --- p.236
Chapter 7.4 --- Conclusion --- p.239
REFERENCES --- p.241
APPENDICES --- p.267

by Siu Pik-ngan.
Questionnarie in Chinese.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 74-79).
List of Tables --- p.v
List of Figures --- p.vi
List of Appendices --- p.vii
Introduction --- p.1
Method --- p.28
Results --- p.36
Discussion --- p.55
References --- p.74
Appendices --- p.80

The effects of gynaecological conditions and hysterectomy on psycho-social and sexual health are analysed in relation to the experience of 930 Western Australian women. The participants in the main survey were recruited from a simple random sample of 50 general medical practices in metropolitan Perth. According to their responses they were assigned to one of three groups: healthy, gynaecological conditions, hysterectomy. Although there were no statistically significant differences in the frequency of sexual activity across the groups, depression and self esteem scores were significantly worse for women with gynaecological conditions. Of these women, those with endometriosis were more likely to be depressed and reported on average the lowest scores on self-esteem. Women's ability to orgasm was equally distributed across the three groups and did not appear to be directly associated with gynaecological dysfunction or hysterectomy.

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.

Background Cervical cancer is one of the common cancers worldwide. Despite the available screening services, the uptake of cancer of the cervix is very low. The incidence and mortality in western countries has reduced greatly due to the introduction of cervical cancer screening programmes. However, this is not the same in Africa where cervical cancer is more prevalent in lower resource countries to lack of access to effective screening and services that enhances early detection and treatment. Purpose/Aim of the study The purpose of this research is to determine knowledge of cervical cancer and the level of awareness of screening regimes/routines among HIV positive women in Swaziland. The study was conducted at one hospital specifically at the HIV Care Unit and Public Health Unit between January and June 2015. Methods The questionnaire was administered to collect data and consisted both open and close-ended questions. The questionnaire comprises of three sections: Section A: Socio-demographic data and Section B: Awareness on Cervical Cancer. Section C: Awareness/knowledge on cervical cancer screening. The sample consisted of 123 HIV positive who are on antiretroviral therapy (ART) or ART naive. The mean age for the respondents was 35 years. Results From this study, N=28 (23%) out of 123 (77%) reported to have received annual Pap smear for cervical cancer screening. A low proportion of the respondents (45%) had knowledge on cervical cancer screening. In addition, 63% of those who got information about cervical cancer screening through the radio perceived themselves to be at risk of getting cervical cancer. Only 4% heard about cervical cancer at the ART clinic, despite having been followed up for their care at the HIV clinic. Those who screened for cervical cancer were younger in age 25-34 years (80%). This study also revealed that education increased the changes of a woman to be screened for cervical cancer. If a woman had a university or high school education, she perceived herself to be at risk of getting cervical cancer. Conclusion Knowledge is power, cervical cancer campaigns should be conducted at national level in order to promote prevention through screening. Cervical cancer screening should be fully integrated into HIV services
Health Studies
M.A. (Public Health)

MCur
Department of Advanced Nursing Science
Cervical cancer remains one of the major public health problems globally, despite the fact that it is preventable and curable if identified at an early stage. Currently, cervical cancer is the leading cause of death among women in Sub-Saharan Africa where the knowledge about the disease is scarce among the affected population. Methods A quantitative cross-sectional survey was conducted in Thulamela Municipality of Limpopo Province. The purpose of the study was to assess the knowledge of cervical cancer prevention among women in four villages in Thulamela Municipality. The population of the study was composed of all women aged above 30 in the villages Malamulele, Mhinga, Muledane and Phiphidi. A sample of one thousand five hundred and forty-six (1546) was drawn using random sampling. Quantitative data were collected using a twenty-six-item questionnaire. The data were coded and then processed using the Statistical Package for Social Sciences to produce frequency tables and descriptive statistics such as chi-square and correlation. Results A number of findings were made in this study. The majority of the women in this study had little or no knowledge about cervical cancer, human papilloma virus and vaccines. The majority of the women had little or no knowledge on cervical cancer risk factors and how the disease is spread. These findings were confirmed by chi-squared values at p<0.05 and showed significant association between variables: that young women were likely to be aware of cervical cancer compared to elderly women, educated women were more likely to be knowledgeable about cervical cancer than those with low education attainment, elderly women were more likely to be not worried about cervical cancer compared to young women. Correlation, Pearson rho scores at p<0.05 showed significant correlations knowledge of cervical cancer and age (negative), knowledge and education (positive). The findings signified the need for cervical cancer prevention education in Vhembe District, and the need for primary health care nurses to promote access to such services through robust health education. vi Recommendations The study made a number of practical recommendations likely to educate women about cervical cancer, human papilloma virus and its prevention. These include: The possibility of large hospitals having their own small broadcasting stations that will frequently disseminate information throughout the local municipalities, road shows and use of informal sector like politicians and traditional healers in disseminating information.

MSc (Microbiology)
Department of Microbiology
BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted virus known to be a causative agent of cervical cancer (CC), one of the most frequent cancers in women worldwide. HPV is a double stranded DNA virus of approximately 7,900 bp; belonging to Papillomaviridae family. To date, about 202 low risk (LR) and high risk (HR) HPV genotypes have been identified. However, available vaccines against HPV infection are designed based on the most common known genotypes. Therefore, it is critical to understand the scope and diversity of HPV genotypes in all geographical locations which can help to inform the design and development of future vaccines. OBJECTIVE: The objective of this study was to describe the burden and diversity of HPV genotypes in a cohort of women in routine care in northern South Africa. METHODS: Eighty seven women consented to participate in the study and each provided a specimen for analysis. With the help of qualified health care practitioners, Aptima Cervical Specimen Collection and Transport Kit (Hologic, San Diego, CA) was used to collect cervical specimens from each study participant following the manufacturer’s procedure. Total DNA was purified from the cervical pellet using QIAamp DNA mini kit (Qiagen, Hilden, Germany) according to the manufacturer’s instructions. The purified DNA was then subjected to a single round conventional PCR in a reaction volume of 100 μl to amplify HPV L1 gene comprising of approximately 450 bp. A portion of each PCR amplicon from each participant was denatured, hybridized and genotyped using the Linear Array HPV genotyping Test Kit (Roche Molecular Systems, Inc. Branchburg, NJ USA). The kit is designed to detect 37 HPV genotypes (genotypes 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, 52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, IS39 and CP6108). To detect the HPV genotypes, the Linear Array (LA) reference guide was used for results interpretation following the manufacturer’s instructions. The other portion of each of the amplicons was subjected to next generation sequencing (NGS) using the Illumina MiniSeq platform. Using the Nextera XT DNA Library preparation kit, an initial input of 1ng genomic DNA was tagmented, cleaned up, normalized and pooled. The pooled library was then denatured with 0.1 N NaOH and diluted into a final volume of 500 μl at 1.8 pM then sequenced using the Local Run Manager option following the manufacturer’s instructions. The generated sequence data was downloaded into fastaQ format and analysed using Genious 11.0.5 software. RESULTS: Of the 87 participants, the overall proportion of women harbouring HPV DNA by linear array (LA) PCR was 23% (n=20). Of the 20, 16 (80%) were living with HIV. However, this difference was not significant (p=0.077). Genotyping data generated by Roche LA method was successful for all the 20 positive amplicons. In this study, 27 (73%) of the 37 HPV genotypes incorporated in the Roche Linear Array method were detected. The detected genotypes include: types 84, 83, 81, 73, 72, 71, 70, 69, 68, 66, 62, 61, 59, 54, 53, 52, 51, 45, 42, 39, 35, 26, 18, 16, 6, IS39 and CP6108. Most women (15/20;75%) harboured multiple infections compared to single infection. In terms of genotypes distribution, the most frequent genotypes detected LR HPV types in increasing order of frequency included HPV type 61 and 83 (12%), 62 (36%) and 81 (43%). On the other hand, HPV type 66, 53, 52, 51, 18 and 16 were the most common genotypes detected HR HPV types. In contrast, although genotyping data was successfully generated from 15 of 20 women (75%), NGS technology was seen to be more sensitive compared to Roche LA method. Nearly all the detected genotypes identified by the commercial kit were detected by NGS. In addition, NGS detected 10 namely: HPV types 11, 31, 33, 40, 55, 56, 58, 64, 67, and 82 that were not detected by the LA yet incorporated in the kit. Moreover, it was observed that NGS identified additional 6 HPV types including HPV types 2, 27, 30, 35, 85 and 102 not incorporated in the Roche LA kit. A similar distribution of HPV multiple infections was observed in the study population, however, high frequency of 93% (14 of 15) was detected by NGS. The proportion of women harbouring one or more of the 22 LR HPV types was 100% (n=15).The most frequent LR genotypes in increasing order of frequency was HPV type 62 and 70 (27%), 6 (40%) and 11 (47%). HPV types 40, 42, 54, 72, 64, and 81 were the least detected genotypes with n=1 (7%) each. Furthermore, the common combination observed among the participants was type 6 and 11. In contrast, the most frequent detected genotypes in the study population by NGS under the HR HPV types in increasing order of frequency include type 35 (21%), 39, 56 and 82 (29%), 68 (36%) and 51 (50%). In addition, HPV types 26, 31, 45, 53, 56, 58 and 66 were the least detected genotypes n=1 (7%) in the study population. HPV 39 and 68 were observed as the common combination detected under HR HPV types. Following genotyping by LA and NGS, the demographic and clinical data of all the 20 positive subjects by PCR were subjected to statistical analysis to determine the association between HPV positive DNA status and associated risk factors. Smoking status (p=0.000), age at first sexual intercourse (p=0.011), vaccination status (p=0.000), gender of sexual partner (p=0.000), highest level of education (p=0.004), marital status (p=0.008) and number of sexual partners (p=0.000) were found to be having a positive statistical association. CONCLUSION: Amplification of targeted HPV DNA from cervical specimens demonstrated the presence of HPV infection in the study cohort, with a proportion of 23%. The findings illustrate that there is a diversity of HPV genotypes prevalent in the study population as shown by Roche LA and NGS methods. However, the NGS method was observed to be more sensitive than Roche LA in detecting HPV genotypes. Furthermore, NGS identified 6 additional HPV types not incorporated in the Roche LA. Thus, there are genotypes that may be present in the study population that the Roche commercial kit may fail to detect. Therefore, is it imperative to use both genotyping methods to confirm HPV genotypes.
NRF