BackgroundAlthough health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.MethodsWe reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.ResultsWe found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.ConclusionThese findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.

We compared the detection of carcinogenic human papillomavirus DNA in cervicovaginal specimens selfcollected using a novel device to the detection in physician-collected cervical specimens from 137 women. The kappa value was 0.66 (95% confidence interval, 0.53 to 0.78), with an 83% overall test agreement and a 68% positive test agreement.Based on the central role of carcinogenic human papillomavirus (HPV) types in the development of cervical cancer (1, 3, 7) and its immediate precursor lesions (5), HPV testing has now been approved in the United States as an adjunct to cytology for triage at all ages and for general screening in women aged 30 years and older (8). One possible method to expand HPV-based cervical cancer screening to underserved populations is self-collection of cervicovaginal specimens. Numerous studies have evaluated self-collection in combination with HPV DNA testing as a potential alternative to cytology in low-resource settings. A new device (1a) was designed to physically mimic tampons and perhaps improve sampling of the cervix while minimizing sampling of the vagina. The self-sampling device has an ejectable tip, which is protected during insertion and removal by a retractable outer sheath. In this pilot validation study, we compare the detection of carcinogenic HPV DNA in cervicovaginal specimens self-collected using the Fournier device to detection in cervical specimens collected from the cervix by a physician. MATERIALS AND METHODSThe study was carried out at the Department of Obstetrics and Gynecology Division of Gynecologic Oncology at the University of Miami School of Medicine. The institutional review board of the university approved the study. In total, 146 nonpregnant, nonhysterectomized women were recruited from the colposcopy and general gynecology clinics at Jackson Memorial Hospital, and 137 women (94%) agreed to participate and provided written, signed, informed consent. A research nurse assigned to the study explained the use of the selfsampling device (Fournier device) to the study subjects. A video demonstration was also shown to the study participants. Upon completion of the self-collection, women underwent a standard pelvic examination during which cervical specimens were collected using plastic disposable specula, cytobrushes, and Ayer's spatulas.The tip of the self-sampling device was ejected into a vial containing a liquidbased cytology medium (SurePath; TriPath, Burlington, NC) and vortexed to release cells. Cytobrushes and Ayer's spatulas were immersed and agitated in a separate vial containing the SurePath medium to release cells. Specimens were then processed for the production of cytology slides according to the manufacturer's specifications. HPV DNA testing.A Hybrid Capture 2 (HC2) (Digene Corporation, Gaithersburg, MD) test, a pooled-probe DNA test for one or more carcinogenic HPV types (HPV16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, and -68) (4), with probe set B was performed on residual SurePath specimens as previously described (6).Statistical ...

No abstract

The impact of a test on teaching and learning is commonly referred to as the washback effect. This study investigated the nature and scope of the washback effect from the Intermediate English examination on teachers and students of a public sector college in Pakistan. The research relied on qualitative approach utilizing interviews to collect data from six teachers and six students. The data was analysed using open-coding. The results revealed that there seems to be a strong negative washback from the examinations on teaching methodology, content and learning. The pedagogical implications of the current study in the form of recommendations related to English language assessment procedures include the employment of formative assessment, the use of authentic tasks and focus on all four language skills.

This study investigated how textbooks influence learning experiences and aims to highlight the pedagogical implications of the incorporation of materials as the backbone of language-teaching programme. It analysed and evaluated a prescribed textbook ("Prose and Heroes"-a Compulsory English course book for intermediate classes in Pakistan), and explored the degree it benefited and challenged both the learners and the teachers. The research project utilized both the teacher's and the learner's perspectives and was based on Dubin and Olshtain (1986) textbook evaluation model. The main purpose of this study was to arrive at conclusions that would contribute to the improvement of the English language programmes in Pakistani colleges. The results of this study show that the relevant textbook does not cater to the needs of the learners. The data also implied that more attention needs to be given to the English language textbooks being utilized in language programmes.