Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey.

Background Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services. Methods Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple dimensions of health care access and screening focusing on the affordability, availability, accessibility, accommodation and acceptability components. Results About 1 in 4 (25.3%, n = 65) of the women who attended a health care facility in the past year got screened for cervical cancer. Screened women had a significantly higher number of health care providers available compared with unscreened women (mean 125 vs.12, p-value Conclusions Our findings suggest that cost issues (affordability component) and other patient level factors (captured in the acceptability, accessibility and accommodation components) were less important predictors of screening compared with availability of physicians in this population. Meeting cervical cancer screening and HPV vaccination goals will require significant investments in the health care workforce, improving health care worker density in poor and rural areas, and improved training of the existing workforce

The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women

<p>Abstract</p> <p>Background</p> <p>In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics.</p> <p>Methods</p> <p>We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression.</p> <p>Results</p> <p>Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival.</p> <p>Conclusion</p> <p>Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.</p

Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation

Results of the round robin calibration of reference solar cells within the PhotoClass project

An intercomparison of terrestrial photovoltaic (PV) calibrations was performed among a number of European calibration and testing laboratories that participated in the European Metrology Research Programme (EMRP) project “Photoclass”. The purpose of this intercomparison was to evaluate the comparability of calibration and testing services within the stated uncertainties of the individual laboratories. The calibrations objects were two world photovoltaic scale (WPVS)-type reference solar cells, one made from crystalline silicon and one made from GaAs. The calibration value (CV) was the short circuit current under standard test conditions (ISTC). In conclusion, it was found that the CVs are all consistent within the stated uncertainties. This result strengthens the reliance in the calibration chain and in the PV calibration infrastructure in Europe.JRC.C.2-Energy Efficiency and Renewable

Exploring complementarity of Life Cycle Thinking and Landscape & Urban Planning towards sustainable urban co-design.: Case study : Electric based tricycle technologies for last kilometer delivery

International audienceNowadays, sustainability is gaining importance in territorial policies. Yet, no substantial efforts have been deployed for systematically integrating environmental, social and economic aspects in early stages of urban service co-design. While Life Cycle Assessment (LCA) is a suitable method for impact assessment of products and services, Landscape-Urban Planning (LUP) provides information on how these products and services interact at the territorial scale. Our understanding of urban systems’ needs could go a step further towards better consumption patterns and resources optimization by coupling both approaches. This work explores the synergy between Life Cycle Thinking and Landscape-Urban Planning by their application to an essential urban service: logistics. The challenging metabolism of high-density urban systems is taken as an opportunity to consider emergent logistic solutions, specifically electric tricycle technologies for last kilometer delivery. Firstly, we start by applying each approach individually; following LUP perspective, we define a territorial reading grid, based on a set of criteria describing physical, socio-cultural, and economic resources of a landscape. Then, using LCA, we quantify potential impacts or benefits of electric tricycles technology compared to the existing delivery technologies. Electricity for tricycle batteries’ charging is provided by photovoltaic systems. In a second step, results from both approaches are coupled to determine local urban hotspots that describe the main aspects to meet stakeholders’ needs and improve their living conditions. Sustainability design parameters are, thus, defined to optimize the tricycle technology. Finally, the design and optimization of the electric tricycle-based delivery system is carried out. The Geographical Information System (i.e .Quantum GIS) is used to explore local data on solar energy potential spots, cycling infrastructures, potential urban logistic platforms, etc. Energy required has been computed to determine adequate charging infrastructures, taking topography and climate conditions into account. Intelligent logistic planning is performed to improve efficiency, optimize the streamline to reduce environmental impacts and simulate interaction with other urban transportation flows. Based on the current case study, the urban service co-design framework has been fully established in order to gain sustainability in a territorial management scale through LCA and LUP perspectives

La constitution des autorités numériques dans la production et la circulation de l’information

Ce dossier ouvre la complexité de la notion d’autorité aux sciences de l’information et de la communication. Ce concept est utilisépar notre discipline, essentiellementpour étudierl'accès et le partage de l'information, l’organisation des connaissances, la communication organisationnelle et les travaux sur l’e-réputation. Les travaux sélectionnés et publiés dans ce numéro remettent en perspective les liens entre légitimité et autorité, reconnaissance et signatures énonciatives, visibilité et réputation à l’heure des plateformes du web. Les terrains d’investigation représentés se situent dans la communication culturelle, politique et médiatique ainsi que dans celui du document numérique