Chinese women's experiences and images of the Pap smear examination

The key role of sphingolipid metabolism in cancer: New therapeutic targets, diagnostic and prognostic values, and anti-tumor immunotherapy resistance

Biologically active sphingolipids are closely related to the growth, differentiation, aging, and apoptosis of cancer cells. Some sphingolipids, such as ceramides, are favorable metabolites in the sphingolipid metabolic pathway, usually mediating antiproliferative responses, through inhibiting cancer cell growth and migration, as well as inducing autophagy and apoptosis. However, other sphingolipids, such as S1P, play the opposite role, which induces cancer cell transformation, migration and growth and promotes drug resistance. There are also other sphingolipids, as well as enzymes, played potentially critical roles in cancer physiology and therapeutics. This review aimed to explore the important roles of sphingolipid metabolism in cancer. In this article, we summarized the role and value of sphingolipid metabolism in cancer, including the distribution of sphingolipids, the functions, and their relevance to cancer diagnosis and prognosis. We also summarized the known and potential antitumor targets present in sphingolipid metabolism, analyzed the correlation between sphingolipid metabolism and tumor immunity, and summarize the antitumor effects of natural compounds based on sphingolipids. Through the analysis and summary of sphingolipid antitumor therapeutic targets and immune correlation, we aim to provide ideas for the development of new antitumor drugs, exploration of new therapeutic means for tumors, and study of immunotherapy resistance mechanisms.

Identification of 14 Differentially-Expressed Metabolism-Related Genes as Potential Targets of Gastric Cancer by Integrated Proteomics and Transcriptomics

Although research on the metabolism related to gastric cancer (GC) is gradually gaining increasing interest, there are few studies regarding metabolism-related genes in GC. Understanding the characteristic changes of metabolism-related genes at the transcriptional and protein levels in GC will help us to identify new biomarkers and novel therapeutic targets. We harvested six pairs of samples from GC patients and evaluated the differentially expressed proteins using mass spectrometry-based proteomics. RNA sequencing was conducted simultaneously to detect the corresponding expression of mRNAs, and bioinformatics analysis was used to reveal the correlation of significant differentially expressed genes. A total of 57 genes were observed to be dysregulated both in proteomics and transcriptomics. Bioinformatics analysis showed that these differentially expressed genes were significantly associated with regulating metabolic activity. Further, 14 metabolic genes were identified as potential targets for GC patients and were related to immune cell infiltration. Moreover, we found that dysregulation of branched-chain amino acid transaminase 2 (BCAT2), one of the 14 differentially expressed metabolism-related genes, was associated with the overall survival time in GC patients. We believe that this study provides comprehensive information to better understand the mechanism underlying the progression of GC metastasis and explores the potential therapeutic and prognostic metabolism-related targets for GC.

Comparisons of Papanicolaou Utilization and Cervical Cancer Detection between Rural and Urban Women in Taiwan

Using the claims data of one million insured residents in Taiwan from 1996–2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25–0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03–2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.

Celastrol enhances TRAIL-induced apoptosis in human glioblastoma via the death receptor pathway

PURPOSE

Glioblastoma is the most common, malignant and devastating type of primary brain tumor. Tumor necrosis factor-related apoptosis-induced ligand (TRAIL) is characterized by its lethality to precancerous and cancerous cells. However, many kinds of tumor cells, including most glioma cells, tend to evade TRAIL-induced apoptosis. Celastrol is a pleiotropic compound from a traditional Chinese medicine that has proven to be useful as a sensitizer for TRAIL treatment. However, the underlying mechanism and role of celastrol in the sensitization of glioma cells remain to be elucidated.

METHODS

The viability of glioma cell lines was examined by the CCK-8 assay. The expression of DR5 was detected by reverse transcriptase quantitative real-time PCR. The protein expression of DR5, cleaved caspase-8, cleaved caspase-3 and PARP were measured by western blot. The apoptosis rates and the sub-G1 population were detected by flow cytometry. The cellular morphological changes were assessed by TUNEL apoptosis and Hoechst 33258 staining assays. The knockdown of DR5 expression was conducted by siRNA.

RESULTS

In this study, we observed that celastrol treatment inhibited cell viability in a dose-dependent manner, while glioma and normal human astroglial cell lines were resistant to TRAIL treatment. We also observed that the antiproliferative effects of TRAIL in combination with a noncytotoxic concentration of celastrol were significantly greater than those of celastrol or TRAIL alone. In addition, cell death induced by the combination treatment was apoptotic and occurred through the death receptor pathway via activation of caspase-8, caspase-3, and PARP. Furthermore, celastrol upregulated death receptor 5 (DR5) at the mRNA and protein levels, and siRNA-mediated DR5 knockdown reduced the killing effect of the combination drug treatment on glioma cells and reduced the activation of caspase-3, caspase-8 and PARP.

CONCLUSIONS

Taken together, the results of our study demonstrate that celastrol sensitizes glioma cells to TRAIL via the death receptor pathway and that DR5 plays an important role in the effects of this cotreatment. The results indicate that this cotreatment is a promising tumor-killing therapeutic strategy with high efficacy and low toxicity.

Calcium Dobesilate Restores Autophagy by Inhibiting the VEGF/PI3K/AKT/mTOR Signaling Pathway

Objective: Calcium dobesilate (CaD), an effective drug for the treatment of diabetic microvascular complications, especially diabetic retinopathy, is widely used in the clinic. Interestingly, several studies have indicated that CaD is therapeutic for diabetic kidney disease (DKD). Recently, evidence has indicated that altered vascular endothelial growth factor (VEGF) expression and decreased autophagy are the main pathological mechanisms of proteinuria. Thus, this study was conducted to explore the effect of CaD on restoring autophagy in DKD and the possible signaling pathway between VEGF and autophagy. Methods: Obese mice with spontaneous diabetes (KK-Ay) and high-fat diet- and streptozotocin-induced diabetic mice (HFD/STZ) were used in this study. Biochemical staining, western blotting, and immunohistochemistry were conducted to determine the angioprotective effect of CaD and the underlying mechanism between autophagy and VEGF/VEGFR. Results: Our results showed that CaD was capable of reducing albuminuria and restoring renal histological changes in KK-Ay and HFD/STZ-induced diabetic mice. CaD restored autophagy by decreasing the protein expression of LC3 II, Atg5, and beclin 1 and increasing the expression of P62. Moreover, CaD reduced the activation of the autophagy-related PI3K/AKT/mTOR pathway possibly via decreasing VEGF and downregulating VEGF receptor 2. Conclusion: Overall, CaD, as a novel potential therapeutic drug for DKD, plays a key role in protecting renal function and restoring autophagy by blocking VEGF/VEGFR2 and inhibiting the PI3K/AKT/mTOR signaling pathway.

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study

OBJECTIVES

Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans.

DESIGN

Nationwide cross-sectional study.

SETTING

Republic of Korea.

PARTICIPANTS

3734.

MAIN OUTCOME MEASURES

The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis.

RESULTS

The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job status among women aged 15-39 were associated with participation in cervical cancer screening (p<0.05). After age stratification, the associated factors differed by age groups. Moreover, a dose-response between participation in cervical cancer screening and high total household income in the 30-39 age group was seen.

CONCLUSIONS

Predictive factors differed among young women (aged 15-29 vs 30-39). Thus, age-specific tailored interventions and policies are needed to increase the participation rate in screening for cervical cancer.

Cultural Affiliation and Mammography Screening of Chinese Women in an Urban County of Michigan

The aim of this study is to explore the relationship of culturally based attitudes on breast cancer screening behavior of Chinese women currently residing in the United States. This cross-sectional study used a survey instrument that was administered to a consecutive nonprobability sample of 202 Chinese women residing in an urban Michigan county. Mood’s strength of cultural affiliation scale (SCAS) was modified for cultural appropriateness prior to being translated into Chinese, back-translated, and pretested prior to use for this study. Data were analyzed using descriptive, correlational, and multivariate analysis techniques. Statistical analyses revealed that cultural diversity within the Chinese sample was associated with differing health behaviors and that the SCAS had indirect effects, through access to health care, on women’s mammography screening use (R2 = 28.3%). These study’s findings reveal that cultural affiliation and beliefs are related to the breast cancer screening behavior of immigrant Chinese women.

The experience of Chinese immigrant women in caring for a terminally ill family member in Australia

The Chinese community, a heterogeneous, highly visible non-English speaking ethnic group in Australia, remains mostly hidden and underrepresented in palliative care service delivery along with participation in health research despite being the fastest growing such group in the country. There is a lack of Australian research information concerning the impact of migration on the caregiving experience of women carers within the Chinese cultural framework and the Australian palliative care context. This paper aims to explore the influence of Chinese cultural norms and immigration on the experience of immigrant women of Chinese ancestry caring for a terminally ill family member at home in Sydney. This study also seeks to identify factors that may present access barriers to palliative care support services. A qualitative approach was used in this study. Data were collected from semi-structured interviews with five home-based Chinese women carers and were analysed using thematic analysis. Findings identified that the participants found being a carer is a lonely and isolating experience. Sources of isolation and loneliness included social isolation experienced as a solitary carer without meaningful family and social relationships; loss of familiar cultural understandings and family values; and emotional isolators expressed in response to the physical and emotional role commitment and other constraints. The study results suggest the need for palliative care educational programmes designed to help nurses to understand the impact of cultural background within the palliative care context. Results also indicate that health care professionals should provide culturally appropriate and competent palliative care services, sensitive to the diverse socio-cultural influences and individual needs of Chinese migrants.

Avoiding piecemeal research on participation in cervical cancer screening: the advantages of a social identity framework

BACKGROUND

Cervical cancer screening research has predominantly focused on one type of participation, namely compliance with medical recommendations, and has largely ignored other types of participation. While there is some research that has taken a different approach, findings in this research area are not well integrated under a theoretical framework.

OBJECTIVE

The aim of this study is to show how consideration of a broader definition of participation and better integration of the theoretical conceptualization of participation in cervical cancer screening are both possible and desirable to enable a better understanding of women's experiences of cervical cancer screening specifically and to improve women's health generally.

MAIN CONCLUSION

It is suggested that alternative types of participation in cervical cancer screening warrant further investigation and that a social identity theoretical approach offers one way of integrating such conceptualizations of participation. The paper also argues for more explicit consideration of the role of social processes and of the variables, such as power, social identity and relational justice, which are involved in participation in cervical cancer screening.

Cervical cancer screening: knowledge, health perception and attendance rate among Hong Kong Chinese women

Purpose:

Cervical cancer screening has been consistently shown to be effective in reducing the incidence rate and mortality from cervical cancer. However, cervical screening attendance rates are still far from satisfactory in many countries. Strategies, health promotion and education programs need to be developed with clear evidence of the causes and factors relating to the low attendance rate. The study aims to assess the prediction of cervical screening attendance rate by Chinese women’s knowledge about cervical cancer and cervical screening as well as their perception of health.

Patients and methods:

A survey with self-reported questionnaires was conducted on 385 Chinese women recruited from a community clinic in Hong Kong. Participants were Chinese women, Hong Kong residents, aged 18–65 years, able to read Chinese or English, and were not pregnant.

Results:

Women aged 37 years or less, with at least tertiary education, who perceived having control over their own health and had better knowledge on risk factors, were more likely to attend cervical cancer screening. Many participants had adequate general knowledge but were unable to identify correct answers on the risk factors.

Conclusion:

Health promotion efforts need to focus on increasing women’s knowledge on risk factors and enhancing their perceived health control by providing more information on the link between screening and early detection with lower incidence rates and mortality from cervical cancer.

Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005

OBJECTIVE

This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea.

METHODS

Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability.

RESULTS

The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology.

CONCLUSION

In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.

Student nurses' experiences and challenges in providing health education in Hong Kong

Despite a call for increased emphasis on health education within the Hong Kong acute healthcare setting, in reality nurses conduct only minimal health education and do not model good educational practice for students. At the baccalaureate level, nursing education programmes aim to provide students with practical experience of best practice and international standards of care. This study describes the experiences of nursing students in providing health education to in-patients at an obstetric unit in Hong Kong. A qualitative research study using a phenomenological approach was conducted at a major public hospital. Data were collected using participant observation, debriefing notes, students' reflective journals and semi-structured interviews. Four themes emerged from the data: (a) effective knowledge building, (b) being a professional nurse, (c) refining learned skills, and (d) greater cultural awareness. The student experiences were further influenced by the patients' responses, the expectations of both patients and nurses concerning the health educator's role, and the role of the clinical teacher. Study findings highlight the experience of the students in conducting health education, something which has not been adequately examined previously, and demonstrates the benefits of independent clinical learning.

Adherence characteristics after abnormal screening results between mammogram and Papanicolaou test groups

The purpose of this study was to evaluate whether the adherence concerns related to follow-up were different between groups of women after abnormal screening results of mammography (Mam) and Papanicolaou (Pap) test. Taiwanese women with abnormal Mam screening results (n = 42) and abnormal Pap test results (n = 109) provided data via a self-administered survey. Data were collected in 2005. After providing informed consent, women completed the AFAR, an 18 item questionnaire that measured the Adherence concerns of Follow-up after Abnormal screening Results. The results showed that (1) for both Mam and Pap test groups, the most important adherence concern for clinical follow-up after abnormal screening results is disease related, followed by others' response and resource accessibility; and (2) in these 2 clinical follow-up groups, women in the Mam group were more likely to be concerned with all of the 18 adherence factors than those in the Pap test group (OR, 2.46-9.86). The most important adherence concern on clinical follow-up after abnormal screening results for Mam and Pap test women is disease related. Mammography women considered significantly more adherence concerns than Pap test women. These differences imply that improving follow-up after Mam or Pap screen may require different interventions.

Negative opinions about cancer screening and contraceptive measures by female emergency department patients

We sought to determine the extent to which adult female emergency department participants viewed two women's cancer screening and two contraceptive measures negatively. The study also explored the relationship between having a negative opinion about these measures and participant demography, lack of knowledge, and lack of usage of these measures. Few women expressed negative opinions about these measures. Lack of knowledge about and lack of use of these measures were associated with having negative opinions on these cancer screening and contraceptive measures. Having any negative opinion about one cancer screening or contraceptive measure was associated with a higher risk of having any negative opinion on another measure. The results suggest that influencing opinion and knowledge about these measures might impact the success of emergency department-based cancer screening and contraceptive health programs. Editors' Strategic Implications: Emergency departments (and primary care settings) provide key opportunities for prevention. Replication is needed, but the authors present important data on knowledge, attitudes, and characteristics that might influence women's receptivity to consent to and engage in behaviors consistent with prevention, screening, and health promotion.

How do women who choose not to participate in population-based cervical cancer screening reason about their decision?

In Stockholm, Sweden, women are invited to a cost-free population-based cervical cancer screening programme (PCCSP) at regular intervals. Despite this, many women choose not to attend screening at all or to take opportunistic tests instead. This study explores how women who actively declined participation in the PCCSP reasoned about their choice. Qualitative telephone interviews and fax messages from women who actively declined participation in the PCCSP were analysed inductively. The manner in which women defined and conceptualized distinctions between, and the roles and responsibilities of, both private and public spheres were found to be central in explanations of decision making. Factors related to women's decisions not to participate in screening at all include a lack of confidence in the benefits of screening, previous negative health care and preventive experiences, a belief in one's own ability to discern health changes or a belief that one was not at risk for cervical cancer, as well as a number of unconventional standpoints on social and political issues. Women who chose not to participate in the organized PCCSP, but who did use private opportunistic screening, generally motivated this with direct or indirect criticism of the screening programme itself. Not only was the examination itself sensitive but also all facets of the PCCSP, from invitation letter on, were found to influence women's decisions. Using Jepson et al.'s ethical framework to peruse the evidence-base underlying women's 'informed decision-making' about CCS is suggested to be more constructive than discussing potential participants' knowledge versus lack of knowledge.

Being asked not to tell: nurses' experiences of caring for cancer patients not told their diagnosis

AIMS AND OBJECTIVES

The aim of the primary research was to investigate the impact of the nurse-patient relationship on clinical learning and subsequently clinical practice. Coincidently, 32 participants, all Registered Nurses in Hong Kong, provided details of nurse-patient encounters involving withholding of a cancer diagnosis.

BACKGROUND

The changing face of clinical practice and cancer care has fuelled discussion and debate around disclosure or non-disclosure of the diagnosis of cancer, global consensus on this issue still does not exist. In different countries there is marked variation in how and what a patient may be told about their diagnosis and prognosis. There is considerable variability in the reported rate of cancer diagnosis disclosure across studies and countries. Being asked not to tell a patient their diagnosis of cancer presents many problems for nurses caring for those patients. The issue of non-disclosure directly affects nurses and their clinical practice.

METHODS

This paper reports one of the findings of a large international qualitative study informed by phenomenology into the perceptions of nurses about caring for a patient with a diagnosis of cancer.

RESULTS

Responses from participants revealed considerable difficulties for nurses when caring for patients who were not informed of their diagnosis. They recounted having learned from the encounters but remarked on the negativity of the experience. They discussed their inability to act decisively in the past situations but expressed hope that they had found a resolve to act in future.

RELEVANCE TO CLINICAL PRACTICE

Although, overwhelmingly, participants doubted they would actually be able to change the reality of practice. The identified care episode and the nurse-patient relationship, according to participants, did change their clinical practice but often not for the better.

Balancing uncertainty and acceptance: understanding Chinese women's responses to an abnormal cervical smear result

AIMS AND OBJECTIVES

The aims of this study were to examine the responses of Hong Kong Chinese women receiving an abnormal smear result and to compare any differences in responses depending on the diagnosis of the abnormal smear.

BACKGROUND

The implementation of cervical screening programmes has resulted in an increasing number of women receiving an abnormal smear result requiring cytological surveillance or referral for colposcopy. Evidence suggests that women frequently misunderstood such results, believing that they already have cancer. However, little is known about the responses of Chinese women in this situation.

DESIGN

An exploratory qualitative study.

METHODS

Face-to-face semi-structured tape-recorded interviews were undertaken with 66 women sampled opportunistically from an urban centre of a major non-governmental service provider. Amongst this sample, 22 women required cytological surveillance, 20 required treatment for vaginitis and 24 were referred for colposcopy. Thematic analysis was undertaken of the translated interviews within and across groups to identify categories and themes illustrating women's responses to an abnormal smear result.

FINDINGS

An important difference in the comparison of the data sets was that of women's understanding of the cause of the abnormal result. Women with vaginitis understood the cause of their abnormality, whereas those in the other groups remained unclear about their abnormality, generating feelings of fear and uncertainty. Trust in practitioners influenced women's acceptance of the result.

CONCLUSIONS

Although responses of Chinese women are similar to those in other population groups, with those referred for colposcopy experiencing greater anxiety than those undergoing cytological surveillance, balancing feelings of uncertainty and acceptance influenced Chinese women's responses to their abnormal results and allowed them to make sense of their result in their everyday life. Trust in the practitioner was essential to the acceptance of their result.

RELEVANCE TO CLINICAL PRACTICE

Such findings highlight implications for nursing practice, in particular developing information-giving strategies and targeted information to help women manage feelings of uncertainty. The importance of trusting professional relationships in determining women's acceptance of an abnormal result is also highlighted. The findings suggest nurses working with Chinese women should consider the underlying influence of culture on women's beliefs and actions.

Effects of a cognition-emotion focused program to increase public participation in Papanicolaou smear screening

OBJECTIVE

Despite high incidence rates of cervical cancer in Korea, Papanicolaou (Pap) tests are not utilized as a preventive behavior. This study examined the effects of an emotion-cognition focused program on the decision of taking Pap tests in Korean women.

DESIGN

A non-equivalent control group post-test only design was utilized.

SAMPLE

A convenience sample was randomly assigned to either experimental (N=48) or control group (N=48) after matching for education and age.

MEASUREMENTS

Knowledge of Cervical Cancer and Pap Smear Test, Champion's Health Belief Model, and Self-Efficacy Scale were used. Intention and stage of adoption to take a Pap test were measured with single items.

RESULTS

Women in the experimental group had significantly higher scores on knowledge of cervical cancer (t=6.99, p<.001) and perceived benefits of Pap tests (t=2.91, p<.05), lower scores on procedural (t=-2.45, p<.05) and cognitive (t=-2.66, p<.01) barriers to testing. Improvement in self-efficacy (t=3.38, p<.01), strong intention to have the test (t=2.99, p<.01), and advanced stages of behavior adoption (chi2=12.93, p<.01) were also found.

CONCLUSIONS

Women's perspectives, attitudes of health care practitioners, and clinical environment need to be considered if change is to happen in women's preventive behavior related to Pap test screening.

Cancer preventive screening: a cross-border comparison of United States and Canadian Chinese women

OBJECTIVE

To compare screening mammography and Pap testing among Chinese women in Seattle, Washington to Vancouver, and British Columbia.

METHODS

Using community-based sampling methods, trilingual female interviewers surveyed Chinese women in Seattle and Vancouver. Multiple preventive health behaviors and health care access variables were assessed. Mammography analysis included 409 women aged 50-74 years. Pap testing analysis included 973 women aged 20-69 years. Main outcome measures were ever use and use in the last 2 years of screening mammography and Pap testing.

RESULTS

Chinese women in Vancouver were younger, more educated and fluent in English. Unadjusted rates of mammography and Pap testing were similar between the two cities. Provider type was consistently associated with screening in both cities; female providers had the highest rates and Chinese male providers the lowest. Adjusted logistic regression analysis demonstrated similar mammography use in the two cities. However, for Pap testing, women in Seattle had higher odds of screening compared to Vancouver.

CONCLUSION

Despite universal health care coverage and baseline characteristics typically associated with greater utilization of preventive screening services, Chinese women in Vancouver did not have higher rates of screening mammography and Pap testing compared to Chinese women in Seattle.

Veda-scope: More comfortable than the bivalve speculum and cytologically equivalent

OBJECTIVE

The aim of the present study was to confirm that the Veda-scope is equivalent to the bivalve speculum in the collection of endocervical cells, as confirmation of adequate cervical sampling for Pap smear testing. The study also aimed to assess the comfort level of the Veda-scope compared to the traditional bivalve speculum and the patient preference of the Veda-scope compared to the bivalve speculum.

METHODOLOGY

Multicentre, randomised, controlled crossover, cytologist blinded study.

POPULATION

The total number of subjects enrolled in the study were 250. The number of evaluable subjects were 210.

RESULTS

In primary efficacy analysis, no significant difference was seen between the presence or absence of endocervical cells in the smears using either the Veda-scope or the bivalve speculum. There was a high concordance level between the diagnosis assigned to each specimen of a paired sample, the diagnosis agreeing in 97.6% cases. The primary reason given by many women for avoidance of regular Pap smear examinations is the discomfort or pain experienced with sample collection with the bivalve speculum. In the present study, 92% of subjects indicated a preference for the Veda-scope for Pap smear collection, while only 8.4% preferred the bivalve speculum. Subject preference was also assessed with respect to how the subject rated the comfort level of her previous Pap smear. In subjects who rated their previous Pap smear as very comfortable or comfortable, 86% expressed a preference for the Veda-scope. This rose to 93% in subjects who rated their previous Pap smear as only tolerable.

CONCLUSION

The results of the present study show that Pap smear collections with the Veda-scope are of equal quality to those collected with the bivalve speculum, with an equivalent diagnostic outcome. A very strong preference for the Veda-scope was shown by the women enrolled in the present study based on the comfort levels experienced with the two devices.

Health needs of Hong Kong Chinese pregnant adolescents

BACKGROUND

The outcomes of adolescent pregnancy have been associated with health risks such as obstetric complications and depression, and educational risks such as school dropout and reduced employment opportunities. These outcomes arise from a range of needs including perceived health needs, which are the focus of this paper.

AIM

This paper reports a study to identify the perceived needs of Hong Kong Chinese adolescents following confirmation of an unintended pregnancy.

METHODS

An exploratory qualitative approach was used with a purposive sample of 10 Hong Kong Chinese pregnant adolescents. The study was undertaken during their stay in a non-government organization maternal shelter. Semi-structured interviews were used to explore adolescents' perceptions of their psychological, social and health needs and the extent to which each of these needs was met.

FINDINGS

Six major categories were identified within the context of need, of which three were related to health needs: acceptance of the pregnancy; psychological reactions to the pregnancy; and use of contraception and health advice.

CONCLUSIONS

The findings contribute to an understanding of the perceived health needs of Chinese adolescents, in particular those that are culturally determined. Implications for nursing practice indicate the significance of comprehensive health assessments and health promotion strategies to help adolescents increase their knowledge about sexual health and contraception.

Socio-cultural influences on Chinese women's attendance for cervical screening

BACKGROUND

Compared with other countries, Hong Kong has a relatively high rate of cervical cancer. Much of this morbidity should be avoidable with cervical screening, but uptake rates for screening in Hong Kong are low. In programmes to promote cervical screening attendance, it is essential that aspects of the socio-cultural system be taken into account to provide appropriate preventive health strategies.

AIM

This paper outlines an investigation of the cultural and social factors contributing to Chinese women's attendance for cervical screening.

METHOD

A mixed methods design was employed, combining and comparing two data sets. The initial data set was drawn from 10 focus groups involving both screened and unscreened Chinese women (n = 54). The second data set was drawn from a total population of Hong Kong doctors, and involved face-to-face semi-structured interviews (n = 28).

RESULTS

Thematic analysis of the data from women indicated that the social factors of cost, educational base, knowledge of risk, the social value of early detection and cultural issues such as modesty and embarrassment contributed to screening attendance. The doctors perceived a cultural tendency towards fatalism, as well as seeing the gender, interpersonal and interprofessional skills of the practitioner to be important in influencing levels of Chinese women's shyness and discomfort, and hence affecting attendance. The lay and practitioner data sets varied in the perceptions of women's pain, embarrassment and risk factors.

CONCLUSION

Programmes providing services for Chinese women need to ensure that the philosophy of the staff and the approach and materials used are culturally relevant. Recommendations are that nurses equipped with relevant social and cultural knowledge of population groups should have a central role in health promotion and screening services.

Investigating Hong Kong's Filipino domestic workers' healthcare behavior, knowledge, beliefs and attitudes towards cervical cancer and cervical screening

The aim of this study was to investigate Hong Kong Filipino domestic workers health behaviors, knowledge, beliefs and attitudes about cervical screening and cancer. A concurrent cross sectional survey design used a snowball method of recruitment was used because of the acknowledged problematic access to a random sample of immigrant women. A total of 98 female domestic helpers were actively recruited through designated recreation centers. The women were between 24-45 years old (mean = 37.9, SD = 7.7). The majority of these women were employed as full-time domestic helpers (91%), were earning less than dollar 4000 Hong Kong dollars/month (92%), were married (82%), with children (91%), were non-smokers (88%), and had at least a secondary level of education (100%), with 66% of these women having completed post-secondary education. While the majority of women had previously heard about cervical smears (78%) more than half (53%) reported never having a cervical smear taken. Women who had a prior cervical smear had significantly more knowledge about cervical smears and cervical cancer (mean = 51.34, SD = 2.5) than those who never had a cervical smear (mean = 49.72, SD = 3.2). Recommendations are made for culturally tailored mass screening programmers out of office hours and health information to be provided in both written and oral Tagalong. Doctors and nurse ideally of Filipino origin should be used to deliver health messages that prioritize the importance of self protection for the family and future fertility issues, culturally prized within Filipino society.

Relationship between the intention to repeat a papanicolaou smear test and affective response to a previous test among Korean women

The purposes of this descriptive cross-sectional study were to describe (1). women's affective (emotional) responses before, during, and after a Papanicolaou smear test and after receiving the test result and (2.) the difference in affective response between women who did or did not intend to repeat the Papanicolaou smear test in the future. The theory of reasoned action was used as the theoretical basis for this study. Participants were selected by convenience sampling and included 515 women aged 24 to 69 years who had a previous Papanicolaou smear test, did not have cervical cancer, and who agreed to participate. Affective response was measured with an instrument developed by Park. Intention to repeat the Papanicolaou smear test was measured with a single question on intention of repeating the Papanicolaou smear test. Women with intention to repeat the Papanicolaou smear test showed higher apprehension after the test ( = 2.695, =.04) and higher positive affective responses such as feeling relieved, great, and comfortable after receiving the test result ( = 3.014, =.003). This result suggests that women with the intention to repeat the test are more concerned with the test result and that emotional relief after confirming normal findings is an important motivator for repeating the Papanicolaou smear test.

Women's knowledge about cervical cancer and cervical screening practice: a pilot study of Hong Kong Chinese women

Cervical cancer is the seventh leading cause of death and the fourth most common type of cancer among Hong Kong Chinese women. Despite the provision of cervical screening programs, women's attendance for screening remains low at 59%. Evidence suggests that women's knowledge about cervical cancer and preventive strategies are significant to their screening practice. A preliminary pilot study consisting of a two-phase descriptive design using quantitative and qualitative methods of data collection was undertaken to investigate the level of knowledge about cervical cancer and cervical screening among a population of Hong Kong Chinese women. From a total sample of 467 women, 242 (52%) responded to a confidential questionnaire, 18 of whom, aged between 30 and 54 years, volunteered to participate in a semistructured interview. A total of 135 (57%) women had attended screening, with those who were married with children significantly more likely to attend. Although no significant difference was found between the overall level of knowledge of attenders and nonattenders, individual items such as women's knowledge of risk factors were significant. The need for further knowledge about the preventive nature of cervical screening and regular screening was demonstrated. Other factors influencing Chinese women's attendance patterns included advice from practitioners and the significance of children to women's propensity for self-care. The implications of these findings to women's attendance patterns for screening are considered, particularly the need for culturally sensitive health promotion and intervention strategies.

Cervical screening: time to change the policy

1. In 1991, the "organised approach to preventing cancer of the cervix" recommended Pap smears every two years for women aged 18-70 years who have ever been sexually active. 2. The two-year interval was a compromise step towards the scientifically supported three-year interval, as many influential groups were strongly attached to annual screening. When other components of the organised approach were in place, the policy was to be reviewed. 3. Since the safeguards in the "organised approach" have been proven effective, it is appropriate to change the policy to recommend a three-year interval. Increasing the interval would allow more resources to be allocated to enrolling women currently underscreened and to evaluating and improving the program. 4. The age of commencing smears could also be reconsidered to reflect the balance of potential benefits and harm in young women, for whom cancer is very rare but follow-up investigation common. 5. If consensus is not reached within the profession, an evidence-based decision may need to be made at the political level.