Melting Snow: The changing roles of Iqaluit women in family, work and society.

My thesis is a detailed anthropological study of the experiences of women as a result of their changing gender roles in Inuit families, in the labour market and in Inuit society more broadly. Although McElroy reported as early as 1975 that ‘a higher percentage of the total population of women than of men are employed [in Frobisher Bay and Pangnirtung]’ (McElroy 1975:679) the effects of this have never been systematically researched. This thesis is the first to use theoretical constructs from Bourdieu’s toolkit, including the capitals (social, cultural, symbolic), the habitus and the cultural arbitrary as well as theories of empowerment, to analyse how women have constructed and negotiated meaning in their new roles as financial provider for their families. It draws on data collected during ten months of fieldwork in Iqaluit, Canada, using a mix of qualitative methods including in-depth interviews, group discussions and participant observation. My findings show that different ideologies, values, ways of life and habitus shape and are shaped by life experiences of women in contemporary Iqaluit. These differences find their basis in women’s upbringing, ranging from traditional, to transitional, to contemporary; women’s experiences with education; and their interactions with incoming institutions with different cultural origins. Social negotiations characterise the process in which women create roles and identities for themselves, combining these different influences. Women’s access to financial and cultural capital in some cases impacts on and is a consequence of women’s empowerment, and their ability to challenge the cultural arbitrary. However, whilst empowerment is generally seen as a positive development, it can upset the balance between partners or other family members, who may struggle to appropriate economic, cultural and social change to the same extent. For that reason, it is important that the people of Nunavut, both men and women, work together to create for themselves a place in their family, community and society in which they can provide a meaningful contribution

The potential harms of primary human papillomavirus screening in over-screened women: a microsimulation study

Background: It is well acknowledged that HPV testing should not be performed at young age and at short intervals. Cytological screening practices have shown that over-screening, i.e., from a younger age and at shorter intervals than recommended, is hard to avoid. We quantified the consequences of a switch to primary HPV screening for over-screened women, taking into account its higher sensitivity but lower specificity than cytology. Methods: The health effects of using the HPV test instead of cytology as the primary screening method were determined with the MISCAN-Cervix model. We varied the age women start screening and the interval between screens. In the sensitivity analyses, we varied the background risk of cervical cancer, the HPV prevalence, the discount rate, the triage strategy after cytology, and the test characteristics of both cytology and the HPV test. Results: For women screened 5 yearly from age 30, 32 extra deaths per 100,000 simulated women were prevented when switching from primary cytology to primary HPV testing. For annual screening from age 20, such a switch resulted in 6 extra deaths prevented. It was associated with 9,044 more positive primary screens in the former scenario versus 76,480 in the latter. Under all conditions, for women screened annually, switching to HPV screening resulted in a net loss of quality-adjusted life years. Conclusion: For over-screened women, the harms associated with a lower test specificity outweigh the life years gained when switching from primary cytology to primary HPV testing. The extent of over-screening should be considered when deciding on inclusion of primary HPV screening in cervical cancer screening guidelines

Schulden en criminaliteit

Dit onderzoek heeft als doel om meer inzicht te bieden in de mate waarin en manier waarop schulden en criminaliteit met elkaar verweven zijn. Het onderzoek bestaat uit twee delen: (1) een literatuuronderzoek, en (2) interviews met sleutelfiguren werkzaam bij organisaties in Rotterdam. We besteden bijzondere aandacht aan de verwevenheid van schulden en criminaliteit in relatie tot ondermijning en tot jongeren

Cervical cancer screening in partly HPV vaccinated cohorts - A cost-effectiveness analysis

Background: Vaccination against the oncogenic human papillomavirus (HPV) types 16 and 18 will reduce the prevalence of these types, thereby also reducing cervical cancer risk in unvaccinated women. This (measurable) herd effect will be limited at first

The role of acquired immunity in the spread of human papillomavirus (HPV): Explorations with a microsimulation model

__Background:__ Knowledge of the natural history of human papillomavirus (HPV), in particular the role of immunity, is crucial in estimating the (cost-) effectiveness of HPV vaccination and cervical cancer screening strategies, because naturally acquired immunity after clearing an infection may already protect part of the risk population against new HPV infections. __Methods:__ We used STDSIM, an established stochastic microsimulation model, quantified to the Netherlands. We explored different assumptions regarding the natural history of HPV-16 and HPV-18, and estimated the transmission probabilities and durations of acquired immunity necessary to reproduce age-specific prevalence. __Results:__ A model without acquired immunity cannot reproduce the age-specific patterns of HPV. Also, it is necessary to assume a high degree of individual variation in the duration of infection and acquired immunity. According to the model estimates, on average 20% of women are immune for HPV-16 and 15% for HPV-18. After an HPV-16 infection, 50% are immune for less than 1 year, whereas 20% exceed 30 years. For HPV-18, up to 12% of the individuals are immune for less than 1 year, and about 50% over 30 years. Almost half of all women will never acquire HPV-16 or HPV-18. __Conclusions:__ Acquired immunity likely plays a major role in HPV epidemiology, but its duration shows substantial variation. Combined with the lifetime risk, this explains to a large extent why many women will never develop cervical cancer