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Objective The aim of this study was to compare the incidence of intra-operative and post-operative complications in open and minimally invasive radical hysterectomy for patients with early-stage cervical cancer. Methods Data were collected from the SUCCOR database of 1272 patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO), 2009) who underwent radical hysterectomy in Europe between January 2013 and December 2014. We reviewed the duration of the surgeries, estimated blood loss, length of hospital stay, intra-operative and post-operative complications. The inclusion criteria were age ≥18 years and histologic type (squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma). Pelvic MRI confirming a tumor diameter ≤4 cm with no parametrial invasion and a pre-operative CT scan, MRI, or positron emission tomography CT demonstrating no extra-cervical metastatic disease were mandatory. Outcomes of interest were any grade >3 adverse events, intra-operative adverse events, post-operative adverse events, length of hospital stay, length of operation, and blood loss. Results The study included 1156 patients, 633 (54%) in the open surgery group and 523 (46%) in the minimally invasive surgery group. Median age was 46 years (range 18-82), median body mass index 25 kg/m 2 (range 15-68), and 1022 (88.3%) patients were considered to have an optimal performance status (ECOG Performance Status 0). The most common histologic tumor type was squamous carcinoma (n=794, 68.7%) and the most frequent FIGO staging was IB1 (n=510, 44.1%). In the minimally invasive surgery group the median duration of surgery was longer (240 vs 187 min, p<0.01), median estimated blood loss was lower (100 vs 300 mL, p<0.01), and median length of hospital stay was shorter (4 vs 7 days, p<0.01) compared with the abdominal surgery group. There was no difference in the overall incidence of intra-operative and post-operative complications between th

Background: The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis. Patients and Methods: We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders. Results: The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98–6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04–11.7, p = 0.042) compared with those who underwent LA. Conclusions: Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.

Objective: Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods: Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results: A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17–0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33–3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00–2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion: Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

Plural valuation is about eliciting the diverse values of nature articulated by different stakeholders in order to inform decision making and thus achieve more equitable and sustainable outcomes. We explore what approaches align with plural valuation on the ground, as well as how different social-ecological contexts play a role in translating plural valuation into decisions and outcomes. Based on a co-constructed analytical approach relying on empirical information from ten cases from the Global South, we find that plural valuation contributes to equitable and sustainable outcomes if the valuation process: 1) is based on participatory value elicitation approaches; 2) is framed with a clear action-oriented purpose; 3) provides space for marginalized stakeholders to articulate their values in ways that can be included in decisions; 4) is used as a tool to identify and help reconcile different cognitive models about human-nature relations; and 5) fosters open communication and collaboration among stakeholders. We also find that power asymmetries can hinder plural valuation. As interest and support for undertaking plural valuation grows, a deeper understanding is needed regarding how it can be adapted to different purposes, approaches, and social-ecological contexts in order to contribute to social equity and sustainability. © 2020 Elsevier Ltd

Contains fulltext : 297083.pdf (Publisher’s version ) (Open Access), BACKGROUND: The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis. PATIENTS AND METHODS: We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders. RESULTS: The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98-6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04-11.7, p = 0.042) compared with those who underwent LA. CONCLUSIONS: Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.

Mountain regions and their communities are particularly vulnerable to climate change impacts. However, little is known on the impacts observed and adaptation responses used in Burundi’s mountain region and if these are different to those reported in the contiguous mountain region of Rwanda. This paper aims to fill in these knowledge gaps. Semi-structured interviews were conducted with 300 smallholder farmers, 150 in northern Burundi and 150 in southern Rwanda. Farmers in both countries reported negative impacts on crops, animals, and human health, with small differences between countries driven by the main cultivated crops. More adaptation strategies were used in Burundi than in Rwanda, and more farmers in Burundi were using multiple strategies. In both countries, farmers’ wealth affected farmers’ adaptation responses and their food security. Notably, for all wealth groups (poor, average, rich), food security was lower in Rwanda than in Burundi. We relate our findings to current agricultural intensification policies in both countries and argue for the greater involvement of local farmers in adaptation planning using, for example, science-with-society approaches.

There are growing calls for conservation frameworks that, rather than breaking the relations between people and other parts of nature, capture place-based relationships that have supported social-ecological systems over the long term. Biocultural approaches propose actions based on conservation priorities and cultural values aligned with local priorities, but mechanisms that allow their global uptake are missing. We propose a framework to globally assess the biocultural status of specific components of nature that matter to people and apply it to culturally important species (CIS). Drawing on a literature review and a survey, we identified 385 wild species, mostly plants, which are culturally important. CIS predominate among Indigenous Peoples (57%) and ethnically defined groups (21%). CIS have a larger proportion of Data Deficient species (41%) than the full set of IUCN species (12%), underscoring the disregard of cultural considerations in biological research. Combining information on CIS biological conservation status (IUCN threatened status) and cultural status (language vitality), we found that more CIS are culturally vulnerable or endangered than biologically and that there is a higher share of bioculturally endangered or vulnerable CIS than of either biologically or culturally endangered CIS measured separately. Bioculturally endangered or vulnerable CIS are particularly predominant among Indigenous Peoples, arguably because of the high levels of cultural loss among them. The deliberate connection between biological and cultural values, as developed in our ‘biocultural status’ metric, provides an actionable way to guide decisions and operationalize global actions oriented to enhance place-based practices that have supported social-ecological systems over the long term.

The stability and resilience of the Earth system and human well-being are inseparably linked1,2,3, yet their interdependencies are generally under-recognized; consequently, they are often treated independently4,5. Here, we use modelling and literature assessment to quantify safe and just Earth system boundaries (ESBs) for climate, the biosphere, water and nutrient cycles, and aerosols at global and subglobal scales. We propose ESBs for maintaining the resilience and stability of the Earth system (safe ESBs) and minimizing exposure to significant harm to humans from Earth system change (a necessary but not sufficient condition for justice)4. The stricter of the safe or just boundaries sets the integrated safe and just ESB. Our findings show that justice considerations constrain the integrated ESBs more than safety considerations for climate and atmospheric aerosol loading. Seven of eight globally quantified safe and just ESBs and at least two regional safe and just ESBs in over half of global land area are already exceeded. We propose that our assessment provides a quantitative foundation for safeguarding the global commons for all people now and into the future.

Coastal communities are on the frontlines of three accelerating global change drivers, climate change, blue growth, and the expansion of area-based conservation, leading to a “triple exposure” scenario. Despite efforts to maximize social benefits from climate, development, and conservation, externally driven processes can converge to amplify vulnerabilities and inequalities. Pre-existing social injustices increase the sensitivity of affected individuals to change and limit their capacity to adapt or benefit from the interacting impacts of triple exposure. We argue that external implementors cannot effectively and equitably achieve climate, economic, and conservation goals without prioritizing social justice and building general resilience. We therefore recommend that implementors: (1) address root causes of vulnerability, namely pre-existing social injustices; (2) use participatory systems approaches to improve understanding of local contexts and potential consequences of proposed initiatives; and (3) leverage inclusive partnerships to facilitate collaborative design and implementation. These strategies—applied together and adapted to local contexts—can support well-being, justice, and resilience within coastal communities experiencing rapid change. © 2023 Elsevier Inc.

Protected and conserved areas (PCAs) target at biodiversity conservation and human well-being, but often reflect low levels of effectiveness. Understanding PCAs social-ecological systems in which people and nature interact in so-called social-ecological interactions is key to understanding the roots of (in)effectiveness, and to leverage change toward resilient and sustainable systems. Despite this potential, social-ecological interactions in PCAs are commonly neglected in effectiveness evaluations. To address this gap, we elaborated a thorough understanding of the social-ecological interactions in PCAs through the following steps: In a first step, we extracted from scientific literature which social-ecological interactions influence the effectiveness of PCAs in general and derived influencing factors which shape those interactions. Based on these insights, we developed an analytical framework, which, in a second step, we applied to a case study in North Luangwa, Zambia. We elucidated three dimensions of social-ecological interactions occurring in the study area: care (e.g., conservation programs), conflict (e.g., disease transmission), and use (e.g., hunting). We visualized relationships between these interactions and associated key variables in a causal loop diagram. Finally, we drew on the case study in Zambia's Luangwa Valley to propose system-specific metrics for key variables central to the social-ecological structure of the study area to make effectiveness measurable. Our approach allows for linking site-specific social-ecological interactions to PCA effectiveness. More generally, our findings call for the consideration of the relationships between people and nature when assessing conservation effectiveness. © 2023 The Authors. Conservation Science and Practice published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.

Introduction Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. Objective To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. Methods The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. Results The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m 2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. Conc

Item does not contain fulltext, OBJECTIVE: To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009). METHODS: A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score. RESULTS: We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively). CONCLUSIONS: In this retrospective study, patients undergoing cervical conizatio

Item does not contain fulltext, OBJECTIVE: To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. METHODS: In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. RESULTS: A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant ther

Contains fulltext : 283075.pdf (Publisher’s version ) (Open Access), OBJECTIVE: Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. METHODS: Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. RESULTS: A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17-0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33-3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00-2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). CONCLUSION: Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.

This study provides a long-term (1891–2014) global assessment of precipitation trends using data from two station-based gridded datasets and climate model outputs evolved through the fifth and sixth phases of the Coupled Model Intercomparison Project (CMIP5 and CMIP6, respectively). Our analysis employs a variety of modeling groups that incorporate low- and high-top level members, with the aim of assessing the possible effects of including a well-resolved stratosphere on the model’s ability to reproduce long-term observed annual precipitation trends. Results demonstrate that only a few regions show statistically significant differences in precipitation trends between observations and models. Nevertheless, this pattern is mostly caused by the strong interannual variability of precipitation in most of the world regions. Thus, statistically significant model-observation differences on trends (1891–2014) are found at the zonal mean scale. The different model groups clearly fail to reproduce the spatial patterns of annual precipitation trends and the regions where stronger increases or decreases are recorded. This study also stresses that there are no significant differences between low- and high-top models in capturing observed precipitation trends, indicating that having a well-resolved stratosphere has a low impact on the accuracy of precipitation projections.

The stratosphere can be a source of predictability for surface weather on timescales of several weeks to months. However, the potential predictive skill gained from stratospheric variability can be limited by biases in the representation of stratospheric processes and the coupling of the stratosphere with surface climate in forecast systems. This study provides a first systematic identification of model biases in the stratosphere across a wide range of subseasonal forecast systems. It is found that many of the forecast systems considered exhibit warm global-mean temperature biases from the lower to middle stratosphere, too strong/cold wintertime polar vortices, and too cold extratropical upper-troposphere/lowerstratosphere regions. Furthermore, tropical stratospheric anomalies associated with the Quasi-Biennial Oscillation tend to decay toward each system¿s climatology with lead time. In the Northern Hemisphere (NH), most systems do not capture the seasonal cycle of extreme-vortex-event probabilities, with an underestimation of sudden stratospheric warming events and an overestimation of strong vortex events in January. In the Southern Hemisphere (SH), springtime interannual variability in the polar vortex is generally underestimated, but the timing of the final breakdown of the polar vortex often happens too early in many of the prediction systems. These stratospheric biases tend to be considerably worse in systems with lower model lid heights. In both hemispheres, most systems with low-top atmospheric models also consistently underestimate the upward wave driving that affects the strength of the stratospheric polar vortex. We expect that the biases identified here will help guide model development for subseasonal-to-seasonal forecast systems and further our understanding of the role of the stratosphere in predictive skill in the troposphere.

Mountain environments in East Africa experience more rapid increases in temperature than lower elevations, which, together with changing rainfall patterns, often negatively affect coffee production. However, little is known about the adaptation strategies used by smallholder coffee farmers in Africa. Using the lens of everyday adaptation, semi-structured interviews were carried out with 450 smallholder farmers living near the Bale Mountains in Ethiopia (n = 150), Mount Kenya in Kenya (n = 150), and Kigezi Highlands in Uganda (n = 150). We report similarities in adaptation strategies used (e.g., increased use of improved seeds, inputs, soil-conservation techniques) but also differences across and within regions (e.g., irrigation, coffee-farming abandonment), related to different biophysical, economic, and sociocultural factors. In all regions, access to land, funds, and limited mutual-learning opportunities between farmers and other agents of change constrained further adaptation options. Local people have capacity and means to determine how best they can adapt to climate change, and government agencies and NGOs could implement more participatory engagement with smallholder coffee farmers, attuned to the opportunities and constraints in everyday life to facilitate adaptation to predicted changes in climate.

This study provides a long-term (1891–2014) global assessment of precipitation trends using data from two station-based gridded datasets and climate model outputs evolved through the fifth and sixth phases of the Coupled Model Intercomparison Project (CMIP5 and CMIP6, respectively). Our analysis employs a variety of modeling groups that incorporate low- and high-top level members, with the aim of assessing the possible effects of including a well-resolved stratosphere on the model’s ability to reproduce long-term observed annual precipitation trends. Results demonstrate that only a few regions show statistically significant differences in precipitation trends between observations and models. Nevertheless, this pattern is mostly caused by the strong interannual variability of precipitation in most of the world regions. Thus, statistically significant model-observation differences on trends (1891–2014) are found at the zonal mean scale. The different model groups clearly fail to reproduce the spatial patterns of annual precipitation trends and the regions where stronger increases or decreases are recorded. This study also stresses that there are no significant differences between low- and high-top models in capturing observed precipitation trends, indicating that having a well-resolved stratosphere has a low impact on the accuracy of precipitation projections.

OBJECTIVE: To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009). METHODS: A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width ≤0.2 standard deviations of the logit odds of the estimated propensity score. RESULTS: We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively). CONCLUSIONS: In this retrospective study, patients undergoing cervical conizatio

A systematic review and meta-analysis of cross-sectional and prospective cohort studies was conducted to assess the associations between total dairy consumption and its different subtypes with the prevalence and incidence of overweight, obesity, and overweight/obesity in children and adolescents. A literature search was conducted in Medline through PUBMED and Cochrane Library databases until October 18, 2021. Articles reporting the risk estimates as odd ratios (OR), risk ratios (RR), or hazard ratios and their corresponding 95% confidence interval (CI) for the association between dairy product consumption and the risk of overweight and/or obesity were included. In the meta-analysis from cross-sectional studies, results showed an inverse association between total dairy consumption and obesity prevalence (OR (95% CI): 0.66 (0.48-0.91). No significant associations were found between milk or yogurt and obesity prevalence risk. Regarding prospective studies, total milk consumption was positively associated with overweight prevalence (OR (95% CI): 1.13 (1.01-1.26)) and incidence (RR (95%CI): 1.17 (1.01-1.35)) risk. Evidence from pooled analysis of cross-sectional studies suggested an inverse association between total dairy consumption and obesity. However, there is limited and no conclusive evidence to confirm an inverse relationship from pooled analysis of prospective studies in children and adolescents.

Item does not contain fulltext, INTRODUCTION: Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. OBJECTIVE: To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. METHODS: The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. RESULTS: The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m(2) (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. CO

Global sustainability targets demand transformative changes. Nature-based solutions (NbS) are gaining traction in science and policy, but their potential for transformative change remains unexplored. We provide a framework to evaluate how NbS contribute to transformative change and apply it to 93 NbS from mountain social-ecological systems (SES). The framework serves to assess what elements may catalyze transformative change, how transformative change occurs, and what its outcomes are. Our results show that NbS are as much people based as nature based. Most NbS are based on four elements with transformation potential: nature's values, knowledge types, community engagement, and nature management practices. Our results confirm the potential of NbS for transformative change, observed through changes in non-sustainable trajectories of SES. We illustrate the components of our framework through a novel classification of NbS. The framework provides key components for assessing the effectiveness of NbS and allows tracking long-term transformative change processes. © 2021 Elsevier Inc.

Governance is a fundamental aspect and precondition for conservation strategies, such as protected areas or OECMs. A methodology for Site-level Assessment of Governance and Equity (SAGE) has been proposed by IUCN to explore different aspects of governance, based on ten principles. This article describes the application of SAGE to a candidate OECM for what we believe is the first time: the Andakí Municipal Natural Park in the Amazon region of Colombia. The application of SAGE generated useful insights into different aspects of governance, including the importance of good communication and recognising and respecting the rights and responsibilities of different actors. Based on this experience, we believe that the SAGE methodology could be a useful tool not only to identify priorities for improving governance, but also to assess governance and equity in order to evaluate if an area meets the criteria for an OECM that it is governed and managed to achieve sustained and effective contributions to in situ conservation of biodiversity, associated ecosystem functions and services, and cultural, spiritual, socio-economic and other locally relevant values. © 2021, IUCN - International Union for the Conservation of Nature. All rights reserved.

Debate about what proportion of the Earth to protect often overshadows the question of how nature should be conserved and by whom. We present a systematic review and narrative synthesis of 169 publications investigating how different forms of governance influence conservation outcomes, paying particular attention to the role played by Indigenous peoples and local communities. We find a stark contrast between the outcomes produced by externally controlled conservation, and those produced by locally controlled efforts. Crucially, most studies presenting positive outcomes for both well-being and conservation come from cases where Indigenous peoples and local communities play a central role, such as when they have substantial influence over decision making or when local institutions regulating tenure form a recognized part of governance. In contrast, when interventions are controlled by external organizations and involve strategies to change local practices and supersede customary institutions, they tend to result in relatively ineffective conservation at the same time as producing negative social outcomes. Our findings suggest that equitable conservation, which empowers and supports the environmental stewardship of Indigenous peoples and local communities represents the primary pathway to effective long-term conservation of biodiversity, particularly when upheld in wider law and policy. Whether for protected areas in biodiversity hotspots or restoration of highly modified ecosystems, whether involving highly traditional or diverse and dynamic local communities, conservation can become more effective through an increased focus on governance type and quality, and fostering solutions that reinforce the role, capacity, and rights of Indigenous peoples and local communities. We detail how to enact progressive governance transitions through recommendations for conservation policy, with immediate relevance for how to achieve the next decadeâ s conservation targets under the U

Introduction Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. Objective To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. Methods The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. Results The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m 2 (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. Conc