Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normali...Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normality and various degrees of lesion, to carcinoma. Aim: To confirm the diagnostic capacity of the methodology based on fractal and Euclidian geometry for the mathematical diagnosis through a blind study of normal cells and with different types of lesion, as atypia of undetermined significance (ASCUS), low grade squamous intra-epithelial lesion (LGSIL) and high grade squamous intra-epithelial lesion (HGSIL). Methods: 100 cells of Papanicolaou tests were analyzed and divided into 4 groups according to conventional parameters: 25 normal, 25 ASCUS, 25 LGSIL and 25 HGSIL. By means of the Box-counting Fractal Space, we calculated the fractal dimension and occupying spaces of the border and surface in pixels of the cell nucleus and cytoplasm. The diagnostic parameters of the previously developed methodology were applied and compared with the conventional diagnosis, setting up sensibility, specificity, negative likelihood ratio and Kappa coefficient. Results: The values of the occupation of the border and surface of the cell nucleus and cytoplasm were consistent with the values found by the diagnostic methodology previously found. The subtraction of the nucleus and cytoplasm frontiers presented values between: 189 and 482 for normality;159 and 432 for ASCUS;126 to 401 for LGSIL and 39 to 122 for HGSIL. A sensitivity and specificity of 100%, and a Kappa coefficient of 1 were obtained. Conclusions: The capacity of the methodology to diagnose quantitatively the different stages in the evolution of the cervical cells observed in Papanicolaou tests was confirmed, from normality to HGSIL.展开更多
Background: There is a complex interplay between women’s preferences, abortion services availability and the context in which these are provided. Even in countries where it is legal, denial of abortion is common, esp...Background: There is a complex interplay between women’s preferences, abortion services availability and the context in which these are provided. Even in countries where it is legal, denial of abortion is common, especially in low and middle income countries, forcing women to look for the service elsewhere and bringing serious consequences to the health and wellbeing of many women and their families. This non-systematic review pretends to answer the question: Which are the barriers to and facilitators for the access to legal abortion services in low and middle income countries? Methods: A non-systematic bibliographical review. Inclusion criteria: all quantitative, qualitative and evidence synthesis studies performed in low and middle income countries according to the World Bank classification for 2015 and published in English, Spanish and Portuguese language, between 2005 and 2017. Exclusion criteria: articles evaluating the efficacy of interventions, addressing the knowledge about abortion procedures among health care students and personnel, as well as those that only included sex workers. Results: The database search yield 199 articles in MEDLINE. 24 in Scopus and 38 in Scielo. A total of 22 articles including 15 countries from Africa (n = 6), Asia (n = 5), Central and South America (n = 3) and Europe (n = 1). The legal status of abortion in each of these countries was studied and described. For the analysis of the information, three categories of deepening were established: Laws and policies, Service delivery and Women’s abortion care-seeking behavior. Conclusion: the determinants of access to abortion in low and middle income countries are convoluted as multiple delays and barriers usually overlap. Similarly, stigmatization has a great impact across all the steps of abortion provision. Multiple facilitators were proposed in the three aspects of abortion provision, but they need to be adjusted depending on the context of each country.展开更多
文摘Background: The concomitant use of fractal and Euclidian measurements has led to the development of new methodologies of cell evaluation, including a diagnosis of cervical cells that set up differences between normality and various degrees of lesion, to carcinoma. Aim: To confirm the diagnostic capacity of the methodology based on fractal and Euclidian geometry for the mathematical diagnosis through a blind study of normal cells and with different types of lesion, as atypia of undetermined significance (ASCUS), low grade squamous intra-epithelial lesion (LGSIL) and high grade squamous intra-epithelial lesion (HGSIL). Methods: 100 cells of Papanicolaou tests were analyzed and divided into 4 groups according to conventional parameters: 25 normal, 25 ASCUS, 25 LGSIL and 25 HGSIL. By means of the Box-counting Fractal Space, we calculated the fractal dimension and occupying spaces of the border and surface in pixels of the cell nucleus and cytoplasm. The diagnostic parameters of the previously developed methodology were applied and compared with the conventional diagnosis, setting up sensibility, specificity, negative likelihood ratio and Kappa coefficient. Results: The values of the occupation of the border and surface of the cell nucleus and cytoplasm were consistent with the values found by the diagnostic methodology previously found. The subtraction of the nucleus and cytoplasm frontiers presented values between: 189 and 482 for normality;159 and 432 for ASCUS;126 to 401 for LGSIL and 39 to 122 for HGSIL. A sensitivity and specificity of 100%, and a Kappa coefficient of 1 were obtained. Conclusions: The capacity of the methodology to diagnose quantitatively the different stages in the evolution of the cervical cells observed in Papanicolaou tests was confirmed, from normality to HGSIL.
文摘Background: There is a complex interplay between women’s preferences, abortion services availability and the context in which these are provided. Even in countries where it is legal, denial of abortion is common, especially in low and middle income countries, forcing women to look for the service elsewhere and bringing serious consequences to the health and wellbeing of many women and their families. This non-systematic review pretends to answer the question: Which are the barriers to and facilitators for the access to legal abortion services in low and middle income countries? Methods: A non-systematic bibliographical review. Inclusion criteria: all quantitative, qualitative and evidence synthesis studies performed in low and middle income countries according to the World Bank classification for 2015 and published in English, Spanish and Portuguese language, between 2005 and 2017. Exclusion criteria: articles evaluating the efficacy of interventions, addressing the knowledge about abortion procedures among health care students and personnel, as well as those that only included sex workers. Results: The database search yield 199 articles in MEDLINE. 24 in Scopus and 38 in Scielo. A total of 22 articles including 15 countries from Africa (n = 6), Asia (n = 5), Central and South America (n = 3) and Europe (n = 1). The legal status of abortion in each of these countries was studied and described. For the analysis of the information, three categories of deepening were established: Laws and policies, Service delivery and Women’s abortion care-seeking behavior. Conclusion: the determinants of access to abortion in low and middle income countries are convoluted as multiple delays and barriers usually overlap. Similarly, stigmatization has a great impact across all the steps of abortion provision. Multiple facilitators were proposed in the three aspects of abortion provision, but they need to be adjusted depending on the context of each country.
