Cervical Cancer Screening Programme in Finland with an Example on Implementing Alternative Screening Methods

In Finland (population 5 million) the organised Pap screening programme for preventing cervical cancer has been in action already for 45 years. Women aged 30 to 64 are targeted (N 1.25 million) and the screening interval is five years. The programme invites women seven times in a lifetime; the attendance rate per one screening invitational round is 73%. The programme has affected markedly the cervical cancer rates in our country. During the decennia of its action there has been about 80% decrease in the age-adjusted cervical cancer incidence and mortality rates. The current age-standardised incidence rate is 4 and mortality rate 1 per 100,000 woman-years. In the current article we describe the organisational aspects of the programme; and pay attention to renovation of the programme taken place during the last decade when novel technological alternatives have been started to be used as the screening tests. By expanding the coverage and compliance of screening we still expect to increase the impact of the programme. Same time, efforts are needed to avoid overuse of services due to spontaneous screening, in order to decrease potential adverse effects and improve overall costeffectiveness. A large-scale public health policy trial on Human papillomavirus (HPV) screening is on-going. Cross-sectional information available thus far suggests promising results. Follow-up of cancer rates after screening episodes are still required to evaluate optimal screening policies (e.g., screening intervals by age groups, and starting and stopping ages). We propose speeding up the use of modern technological alternatives in organised screening programmes

Implications of middlemen in smallholder teak production systems in Northern Lao People's Democratic Republic (Lao PDR)

The government of Lao PDR has promoted teak planting for over 40 years, resulting in a significant increase in the area of plantation teak. Most of the plantations are managed by individual farmers and play an important role as a kind of financial insurance system, and a ready source of quick income generation. By cultivating a teak plot it may be determined whether a farmer has land tenure to the plot and through cultivation whether they can afford to send children to school. In Northern Lao PDR the primary sales channel for teak in a complex environment are middlemen. The common association with middlemen is rather negative and they are perceived as rent-seeking actors in the value chain. However in the current teak market system in Lao PDR middlemen take responsibility for many time-consuming steps of performing teak sales in compliance with laws and regulations. In addition, unofficial fees in connection with felling and transporting strongly influence teak wood flows by increasing costs and making the process vulnerable to adversity. In general, middlemen save farmers the trouble of having to deal with unofficial costs and marketing, and therefore they represent a convenient sales channel for farmers. These extra costs are difficult for the society to tackle down as long as Lao PDR possess low effectiveness in the national formal and social control systems. This study focuses on the existing practices of teak middlemen and their implications for teak smallholders. Farmers’ perceptions of the various actors and issues with sales to be addressed are presented and discussed. In this study 120 semi-structured interviews with smallholder teak farmers and 11 with Lao authorities and non-governmental organizations throughout the forestry sector were conducted in four small villages and in Vientiane (the capital) in Northern Lao PDR. A middleman case study was included in the study to demonstrate current actions taken by middlemen. According to the results of this study farmers are lacking the time and motivation to participate in the highly regulated formalities of marketing teak, and prefer middlemen as their selling channel for their wood. Farmers do understand and, based on previous support, report of the importance of external development projects providing training and information related to teak markets, yet consider them challenging without more guidance and structural change in official governing practices