ABSTRACT
BACKGROUND: Cervical cancer is the commonest cause of cancer-related death in Sub Sahara Africa (SSA). Both primary and secondary preventive services are available but utilisation remain low. This systematic review aims to summarise reported barriers preventing women from utilising cervical cancer screening services in SSA. METHOD: Electronic searches on MEDLINE, EMBASE, PsycINFO, BIOSIS preview, Global Health, PubMed, Cochrane library, CINAHL, ISI Web of Knowledge and Google scholar and quality assessment of the included studies were performed. A meta-analysis was applied to identify major themes. RESULTS: Eight studies exploring reasons women did not utilise cervical cancer screening were included. Women in SSA reported similar barriers despite cultural and language diversity in the region. Women reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude. CONCLUSION: Strategies for improving uptake and utilisation of cervical screening in SSA should focus on improving cervical health education, addressing cultural beliefs and practices and improving spousal support and empowering women, as well as addressing physical access problem, costs and improving staff attitude.
Subject(s)
Early Detection of Cancer/statistics & numerical data , Uterine Cervical Neoplasms/prevention & control , Africa South of the Sahara , Attitude of Health Personnel , Communication Barriers , Costs and Cost Analysis , Culture , Fear , Female , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Household Work , Humans , Interpersonal Relations , Patient Acceptance of Health Care/psychology , Patient Education as Topic , Self Concept , Shame , Spouses/psychology , Stereotyping , Uterine Cervical Neoplasms/psychologyABSTRACT
In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.
Subject(s)
Attitude of Health Personnel , Early Detection of Cancer/psychology , Uterine Cervical Neoplasms/prevention & control , Advertising , Awareness , Costs and Cost Analysis , Early Detection of Cancer/economics , Female , Health Education , Health Expenditures , Health Knowledge, Attitudes, Practice , Humans , Libya , Male , Motivation , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Patient Compliance , Perception , Practice Guidelines as Topic , Private Sector , Public Sector , Quality of Health Care , Reminder Systems , Vaginal Smears/economics , Vaginal Smears/psychology , Vaginal Smears/statistics & numerical dataABSTRACT
cis-9, trans-11 Conjugated linoleic acid (CLA) is one of the most extensively studied CLA isomers due to its multiple isomer-specific effects. However, the molecular mechanisms of cis-9,trans-11 CLA synthesis in ruminant mammary gland are still not clearly understood. This process may be mediated, to a certain extent, by trans-11 C18:1 regulated by stearoyl-CoA desaturase-1 (SCD1) and/or its syntrophic proteins. This study aimed to investigate the effects of TVA on SCD1-mediated cis-9,trans-11 CLA synthesis in MAC-T cells and its potential molecular mechanism. Results showed that trans-11 C18:1 was continually taken up and converted into cis-9,trans-11 CLA in MAC-T cells during the 4-h incubation of 50 µM trans-11 C18:1. SCD1 protein expression increased more than twofold at 2 h (P < 0.01) and 2.5 h (P < 0.05) before decreasing to less than half of the normal level at 4 h (P < 0.05). One up-regulated (RAS guanyl releasing protein 4 isoform 1 [RASGRP4]) and six down-regulated proteins (glucosamine-6-phosphate deaminase 1 [GNPDA1], triosephosphate isomerase [TPI1], phosphoglycerate mutase 1 [PGAM1], heat shock protein beta-1 [HSPB1], annexin A3 [ANXA3], thiopurine S-methyltransferase [TPMT]) were found in MAC-T cells treated with trans-11 C18:1. Of these seven identified proteins, the presence of GNPDA1 and PGAM1 was verified in several models. More trans-11 C18:1 was taken up after PGAM1 knockdown by small interfering RNA (siRNA). In conclusion, our data suggested that PGAM1 may have a negative relationship with SCD1 and seemed to be involved in cis-9, trans-11 CLA synthesis by facilitating the absorption of trans-11 C18:1 in the bovine mammary gland.
Subject(s)
Linoleic Acids, Conjugated/metabolism , Mammary Glands, Animal/enzymology , Phosphoglycerate Mutase/metabolism , Proteomics/methods , Stearoyl-CoA Desaturase/metabolism , Animals , Cattle , Cells, Cultured , Female , Gene Expression Regulation , Gene Knockdown Techniques , Linoleic Acids, Conjugated/genetics , Mammary Glands, Animal/cytology , Mammary Glands, Animal/metabolism , Trans Fatty Acids/metabolismABSTRACT
The goal of this study was to evaluate the effects of lactation stage and individual performance on milk cis-9, trans-11 conjugated linoleic acid (CLA) content in dairy cows. In experiment 1, the milk cis-9, trans-11 CLA content from dairy cows in early (0.33±0.014%), middle (0.37±0.010%), and late stages (0.44±0.020%) showed significant differences (p<0.05); and the individual contents of the major fatty acids, especially cis-9, trans-11 CLA in cows of the same lactation were also variable. In the second experiment design as a validation test, our results once again showed that the individual contents of cis-9, trans-11 CLA were various, and a difference of about 2-fold (0.55% vs 0.95%) was observed, although the animals were offered same diet. These data demonstrated that lactation stage and individual performance have considerable effects on milk cis-9, trans-11 CLA contents.
Subject(s)
Anti-Asthmatic Agents/administration & dosage , Asthma/drug therapy , Cost-Benefit Analysis , Nebulizers and Vaporizers/economics , Nebulizers and Vaporizers/standards , Treatment Outcome , Adolescent , Asthma/prevention & control , Child , Chronic Disease , Female , Humans , Male , Quality-Adjusted Life Years , State Medicine , United KingdomABSTRACT
This paper attempts to define quality (particularly in terms of evidence-based health care) and considers the incentives available to bring about improvements in quality. It examines the contribution that economics, as a discipline, can make to the debate on clinical governance. It considers the nature and importance of clinical governance, measuring quality, objectives and behaviour in questions raised concerning objectives and individual and team behaviour.