Cervical and vaginal cancer - aspects on risk factors, prevention and treatment

Background: Participation in screening is associated with a major risk reduction in cervical cancer, but there is a lack of knowledge on whether the cost to the individual has an effect on the participation rate. Women with abnormal findings at screenings are referred for colposcopy. The use of the Swedescore scoring system is recommended by the Swedish national guidelines for cervical cancer prevention. There is, however, a lack of effectiveness studies evaluating this assessment. Previous studies have shown that women with cervical high-grade lesions have an increased risk for vaginal cancer, but there is a knowledge gap regarding the risk for hysterectomised women with and without risk factors. Women with early-stage cervical cancer are treated with radical hysterectomy, which can be performed via open or minimally invasive surgery (MIS). Inferior oncologic results of MIS have been reported in international studies, which emphasises the need for further assessment of the technique’s oncological safety. Aims: To study factors influencing the prevention of cervical and vaginal cancer by means of the screening programme for cervical cancer and to evaluate surgical treatment modalities for early-stage cervical cancer. Material and methods: Paper I was a randomised controlled trial (RCT) performed on female (n = 3124) residents of low-resource areas of Gothenburg in 2013. The intervention group did not have a fee, and the control group had the standard fee. Attendance was defined as registered cytological smear within three months of invitation. In paper II, population-based register data from the National Patient Register and the Swedish Cancer Register were used in a cohort study design 1987–2011. The cohort was divided into four groups: hysterectomised with benign cervical history, hysterectomised with a history of cervical intraepithelial lesion grade 3 (CIN3), hysterectomised with prevalent CIN at surgery and non-hysterectomised. The main outcome was vaginal cancer. Paper III was a cross-sectional study linking data from the Swedish National Cervical Screening Registry (NKCx) with histological samples and a Swedescore assessment and/or colposcopic assessment by identifiable colposcopists. In Paper IV, five-year overall survival (OS) and disease-free survival (DFS) were assessed in a population-based cohort study that included all Swedish women with IA1-IB1 cervical cancer treated with radical hysterectomy from 2011 to 2017. The Swedish Quality Register for Gynecological Cancer (SQRGC) was used for identification. Results: Paper I: No difference in attendance was noted between the intervention and control groups (RR=0.93 95% CI 0.83-1.02). Nor were there any differences according to previous participation or non-participation or between the districts. Paper II: 898 vaginal cancers were included. Women with prevalent CIN at hysterectomy had a high incidence rate (IR 51.3/100 000 95% CI 34.4-76.5), followed by women with CIN3 history (IR 17.1/100 000 95% CI 12.5-23.4). Paper III: 11 317 colposcopic assessments by Swedescore were included. Sensitivity at Swedescore ≥2 was 97.5%, and the negative predictive value (NPV) was 90.2%. Specificity at ≥8 was 93.3%, and the positive predictive value (PPV) was 60.1%. Area under the ROC curve (AUC) = 0.71. In total, 24 362 colposcopies with identifiable colposcopists were analysed for accuracy. The variability in accuracy differed significantly (p-value <0.001), no effect of experience was noted (k= 0.0024). Paper IV: In total, 864 women, 236 open and 628 robotic radical hysterectomies were identified and included. There was no difference in five-year OS between groups (Hazard Ratio (HR) 1.00; 95% CI 0.50-2.01) or DFS (HR 1.08 95% CI 0.66-1.78). Conclusions: Abolishment of a fee in low-resource settings did not increase attendance. Surveillance should be offered to hysterectomised women with prevalent CIN since their risk of vaginal cancer is elevated. Abstaining from biopsy is not recommended at any Swedescore step; a referral smear should be taken into consideration before “see and treat” to lower the risk for overtreatment. The experience of colposcopists did not affect accuracy. Long-term oncological outcomes did not differ between open and robotic radical hysterectomies

Relativization of double jeopardy: standards of american court criminal law applied to colombian

El presente artículo analiza el principio de la cosa juzgada, el cual es concebido como un elemento necesario en todo estado de derecho para dar seguridad jurídica y garantizar el fin de las controversias que se presentan entre sus conciudadanos. Sin embargo, los estándares establecidos por instrumentos penales internacionales y por diferentes organismos de protección de los derechos humanos, han dado paso, para que sea replanteado el carácter de inmutabilidad de los efectos de este principio, los cuales son recogidos por la Corte Interamericana aplicando la teoría de la cosa juzgada fraudulenta. Por ende, el objetivo de la investigación es identificar el desarrollo de la relativización de la cosa juzgada en la jurisprudencia de la Corte Interamericana y encontrar los criterios que son considerados por este cuerpo colegiado, para declarar la cosa juzgada fraudulenta o aparente y confrontarlos con los criterios establecidos en la legislación penal colombiana para encontrar si los estándares de la Corte Interamericana se aplican o no. Así entonces, la pregunta problema que se propuso dar respuesta el presente artículo es ¿Cuáles son los criterios que la Corte Interamericana aplica para decretar la cosa juzgada fraudulenta o aparente? Para lograr dicho objetivo y dar respuesta a la pregunta planteada, la metodología que se utilizó es la analítica descriptiva, a través de fuentes doctrinales, legales y jurisprudenciales de los casos en que la Corte Interamericana de Derechos Humanos, ha decidido en su potestad contenciosa condenar a los Estados partes de la Convención, a reabrir, anular, iniciar los procesos internos; además de la legislación penal y jurisprudencia de las altas cortes colombianas.This article will analyze the principle of the res judicata which is conceived as necessary principle in every States of Right to give juridical security and the guarantee the finished of to the controversies that the society have. However, the standards established for the international criminal instruments and different organisms for the protection of human rights, have given way to be rethought the character unchangeable of the effects of these principle that is collected by the Inter-American Court of Human Rights. The object of this investigation is identify the development of the relative that could be the res judicata in the Inter-American Court of Human Rights jurisprudence and found the standards that the Court have on they consideration to declare the fraudulent res judicata, besides compare to the standards established in the Colombian criminal law and found if they are compatible with the requirement of the Inter-American Court of Human Rights. Then, the problem question that we are answering in these pepper is ¿Witch one are the standards to declare the fraudulent res judicata that apply the Inter-American Court of Human Rights? To found the answer for the question, the methodology used is the describe analytic, trough the doctrinal, legal and jurisprudential founts of the different cases where the Inter-American Court of Human Rights decided condemn States part of the Convention, to reopen, cancel, start with internal process; besides of the criminal law y highs courts jurisprudence

Influencia del plaguicida cloropirifos sobre la fotosíntesis, transpiración y conductancia estomática en

The objective was to evaluate the effect of chlorpyrifos on stomatal conductance, photosynthesis and transpiration on yerba mate (Ilex paraguariensis A. St.-Hil.) plants. The experiment was conducted in a chamber under controlled conditions. The plants (one/pot) were sprayed with three doses (50, 100 and 150 ppm of chlorpyrifos) and a non pesticide-sprayed control. Stomatal conductance, photosynthesis and transpiration were evaluated at 1, 7 and 21 days after pesticide application. The mentioned traits were not affected by the pesticide application doses. However, significative differences were found as the plants were growing and traits increased between 7 and 21 days in 300% for stomatal conductance, 116% for photosynthesis and 285% for transpiration.Este trabajo tuvo como objetivo observar los efectos del pesticida cloropirifos sobre la conductancia estomática, fotosíntesis y transpiración en yerba mate (Ilex paraguariensis A. St.-Hil.). Se realizó un ensayo en cámara con condiciones controladas y plantas de yerba mate, una por maceta, a las que se les aplicaron tres dosis de cloropirifos (50, 100 y 150 ppm) y un testigo sin pesticida. Uno, 7 y 21 días después de la aplicación se evaluaron la fotosíntesis, transpiración y conductancia estomática. Ninguna de las variables evaluadas fue afectada con las dosis aplicadas. Sin embargo, con la edad de las plantas incrementaron significativamente la conductancia estomática (300%), la fotosíntesis (116%) y la transpiración (285%) entre los 7 y 21 días

Influencia del plaguicida cloropirifos sobre la fotosíntesis, transpiración y conductancia estomática en yerba mate ( Ilex paraguariensis A. St.-Hil.)

The objective was to evaluate the effect of chlorpyrifos on stomatal conductance, photosynthesis and transpiration on yerba mate (Ilex paraguariensis A. St.-Hil.) plants. The experiment was conducted in a chamber under controlled conditions. The plants (one/pot) were sprayed with three doses (50, 100 and 150 ppm of chlorpyrifos) and a non pesticide-sprayed control. Stomatal conductance, photosynthesis and transpiration were evaluated at 1, 7 and 21 days after pesticide application. The mentioned traits were not affected by the pesticide application doses. However, significative differences were found as the plants were growing and traits increased between 7 and 21 days in 300% for stomatal conductance, 116% for photosynthesis and 285% for transpiration.Este trabajo tuvo como objetivo observar los efectos del pesticida cloropirifos sobre la conductancia estomática, fotosíntesis y transpiración en yerba mate (Ilex paraguariensis A. St.-Hil.). Se realizó un ensayo en cámara con condiciones controladas y plantas de yerba mate, una por maceta, a las que se les aplicaron tres dosis de cloropirifos (50, 100 y 150 ppm) y un testigo sin pesticida. Uno, 7 y 21 días después de la aplicación se evaluaron la fotosíntesis, transpiración y conductancia estomática. Ninguna de las variables evaluadas fue afectada con las dosis aplicadas. Sin embargo, con la edad de las plantas incrementaron significativamente la conductancia estomática (300%), la fotosíntesis (116%) y la transpiración (285%) entre los 7 y 21 días

Effect of Fee on Cervical Cancer Screening Attendance—ScreenFee, a Swedish Population-Based Randomised Trial

<div><p>Background</p><p>Attendance in the cervical cancer screening programme is one of the most important factors to lower the risk of contracting the disease. Attendance rates are often low in areas with low socioeconomic status. Charging a fee for screening might possibly decrease attendance in this population. Screening programme coverage is low in low socio-economic status areas in Gothenburg, Sweden, but has increased slightly after multiple interventions in recent years. For many years, women in the region have paid a fee for screening. We studied the effect of abolishing this fee in a trial emanating from the regular cervical cancer screening programme.</p><p>Method</p><p>Individually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out.</p><p>Results</p><p>Attendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85–1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking.</p><p>Conclusion</p><p>Abolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="https://clinicaltrials.gov/ct2/show/NCT02378324" target="_blank">NCT02378324</a></p></div

Flow chart of the study.

<p>There were no exclusions and no protocol violations.</p

Attendance in intervention and control arm.

<p>Attendance in intervention and control arm.</p

Attendance in intervention and control arm stratified by previous history of registered smear and previous documented non-attendance.

<p>Attendance in intervention and control arm stratified by previous history of registered smear and previous documented non-attendance.</p

Comparison of age between the intervention and control arm.

<p>The central middle line is the median age. The boxes contain 50% of the data, the arms 25 and 25% of the remaining data. No outliers were found.</p

Attendance 2011–2013 in the districts included in the study.

<p>Attendance rate is calculated as smears taken within 90 days after sending invitation. Yearly re-invitations to non-participants are not included in the denominators.</p