RESUMO
OBJECTIVES: Several studies addressed the association between antibiotic use and breast cancer risk. The objective of this study was to assess the association between antibiotic use and risk of cervical, ovarian, and uterine cancer. STUDY DESIGN: We carried out a population-based case-control study using data from Saskatchewan Health administrative databases (Canada) between the years 1981 and 2000. Cases were matched to 4 controls, using incidence density sampling. The effect of dosage and timing of antibiotic use, over a minimum of 15 years before diagnosis, on cervical, ovarian, or uterine cancer risk was assessed. Number of prescriptions and number of pills were used as exposure definitions. The effect of different classes of antibiotics on cancer risk was also studied. RESULTS: A total of 1225 cancer cases [192 cervical, 445 ovarian, and 588 uterine] and 4900 matched controls were included in this study. Antibiotic exposure (number of prescriptions) during the period of 1-15 years in the past was significantly associated with a reduced risk of cervical cancer; Relative Risk (RR)=0.40, 0.31, 0.26, and 0.29 for the four exposure quartiles, respectively. No association was found for ovarian or uterine cancer. When number of pills was considered, similar results were found. There was no effect of the timing or class of antibiotic exposure on cervical cancer risk. CONCLUSIONS: Antibiotic exposure up to 15 years in the past was associated with a decreased risk of cervical cancer. The lack of temporal trends and the absence of class specific effects suggest a non-causal relationship.
Assuntos
Antibacterianos/uso terapêutico , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Anticarcinógenos/administração & dosagem , Anticarcinógenos/efeitos adversos , Anticarcinógenos/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Relação Dose-Resposta a Droga , Prescrições de Medicamentos , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias Ovarianas/induzido quimicamente , Neoplasias Ovarianas/etiologia , Neoplasias Ovarianas/prevenção & controle , Risco , Saskatchewan/epidemiologia , Medicina Estatal , Neoplasias do Colo do Útero/induzido quimicamente , Neoplasias do Colo do Útero/etiologia , Neoplasias Uterinas/induzido quimicamente , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/prevenção & controle , Adulto JovemRESUMO
Changing educational assessment program represent a challenge to any organization. This change usually aims to achieve reliable and valid tests and assessment program that make a shift from individual assessment method to an integral program intertwined with the educational curriculum. This paper examines critically the recent developments in the assessment theory and practice, and establishes practical advices for redesigning educational assessment programs. Faculty development, availability of resources, administrative support, and competency based education are prerequisites to an effective successful change. Various elements should be considered when re-designing assessment program such as curriculum objectives, educational activities, standard settings, and program evaluation. Assessment programs should be part of the educational activities rather than being a separate objective on its own, linked to students' high quality learning.