High risk HPV testing following treatment for cervical intraepithelial neoplasia.

AIM: To determine the results of combined cytology and high-risk human papilloma virus (HR HPV) tests at 6 and 18 months postcolposcopy treatment at one Irish colposcopy centre. METHODS: All women who attended the centre's colposcopy smear clinic for a co-test 6 months (initial test) posttreatment were included in the audit (n = 251). RESULTS: The results revealed negative HR HPV for 79 % (n = 198) of women tested 6 months after treatment and positive results for 21 % (n = 53). HR HPV testing was more sensitive than cytology and led to early detection of residual disease. No women with negative HR HPV had high-grade cytology. CONCLUSION: HR HPV is more sensitive than cytology for detection of persistent CIN. However, 19 women with positive HR HPV had normal colposcopy with no persistent CIN detected. A national cost-benefit analysis is recommended to determine the value of the second co-test.

Why are children in the same family so different? Nonshared environment a decade later.

OBJECTIVE: To review recent developments in the study of nonshared environment; that is, the environmental influences that make children growing up in the same family different, rather than similar. METHOD: We review several recent influential books and papers on the subject of nonshared environment from the decade following the 1987 paper that highlighted its importance in psychological development. RESULTS: Modest progress has been made toward identifying the specific aspects of the environment responsible for nonshared environment. Although parents treat their multiple children differently, such differential treatment accounts for only a small amount of nonshared environmental influence, once genetic factors are controlled. It has been suggested that some degree of nonshared environment may be due to the fact that siblings react differently to ostensibly shared environmental influences. Peer influence and other experiences outside the family may be more important sources of systematic nonshared environment. CONCLUSIONS: Despite the difficulties encountered in identifying specific sources of nonshared environment, the fact remains that most environmental variance affecting the development of psychological dimensions and psychiatric disorders is not shared by children growing up in the same family. More research and theory are needed to explain why such siblings are so different. Chance, in the sense of idiosyncratic experiences, also needs to be considered.