Prognostic factors for esophageal squamous cell Carcinoma-A Population-Based study in Golestan province, Iran, a high incidence area

Golestan Province in northern Iran is an area with a high incidence of esophageal squamous cell carcinoma (ESCC). We aimed to investigate prognostic factors for ESCC and survival of cases in Golestan, on which little data were available. We followed-up 426 ESCC cases participating in a population-based case-control study. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Median survival was 7 months. Age at diagnosis was inversely associated with survival, but the association was disappeared with adjustment for treatment. Residing in urban areas (hazard ratio, HR = 0.70; 95 CI 0.54-0.90) and being of non-Turkmen ethnic groups (HR = 0.76; 95 CI 0.61-0.96) were associated with better prognosis. In contrast to other types of tobacco use, nass (a smokeless tobacco product) chewing was associated with a slightly poorer prognosis even in models adjusted for other factors including stage of disease and treatment (HR = 1.38; 95 CI 0.99-1.92). Opium use was associated with poorer prognosis in crude analyses but not in adjusted models. Almost all of potentially curative treatments were associated with longer survival. Prognosis of ESCC in Golestan is very poor. Easier access to treatment facilities may improve the prognosis of ESCC in Golestan. The observed association between nass chewing and poorer prognosis needs further investigations; this association may suggest a possible role for ingestion of nass constituents in prognosis of ESCC. © 2011 Aghcheli et al

The CEA Second-Look Trial: a randomised controlled trial of carcinoembryonic antigen prompted reoperation for recurrent colorectal cancer

Objective In patients who have undergone a potentially curative resection of colorectal cancer, does a ‘second-look’ operation to resect recurrence, prompted by monthly monitoring of carcinoembryonic antigen, confer a survival benefit?Design A randomised controlled trial recruiting patients from 1982 to 1993 was recovered under the Restoring Invisible and Abandoned Trials (RIAT) initiative.Setting 58 hospitals in the UK.Participants From 1982 to 1993, 1447 patients were enrolled. Of these 216 met the criteria for carcinoembryonic antigen (CEA) elevation and were randomised to ‘Aggressive’ or ‘Conventional’ arms.Interventions ‘Second-look’ surgery with intention to remove any recurrence discovered.Primary outcome measure Survival.Results By February 1993, 91/108 patients had died in the ‘Aggressive arm’ and 88/108 in the ‘Conventional’ arm (relative risk=1.16, 95% CI 0.87 to 1.37). By 2011 a further 25 randomised patients had died. Kaplan-Meier analysis showed no difference in long-term survival.Conclusions The trial was closed in 1993 following a recommendation from the Data Monitoring Committee that it was highly unlikely that any survival advantage would be demonstrated for CEA prompted second-look surgery. This conclusion was confirmed by repeat analysis of survival times after 20 years.Trial registration number ISRCTN76694943

Risk Adjustment and Primary Health Care in Chile

Chile´s primary health care (PHC) payment system uses income of the municipalities and the geographic location of health centres (HCs) to adjust current capitation payments. Concerns over the ability of the formula to direct health resources where greater health needs are discussed. We uses a sample of 10,000 individuals was drawn and two years data was collected from a region in Chile. Three models were tested: i) age and gender, ii) age, gender and the presence of two key diagnoses and iii) age, gender and the presence of seven key diagnoses, to estimate how significant their effects were on utilization and per-capita expenditures. Regression analysis was performed to calculate the predictive values of the independent variables and two tests applied to select the best and next best model. The main results are the following. First, the use of services by age and gender confirmed international trends, where children under five, women and elderly were the main users of PHC services. Second, women consulted twice as much as men. Thrid, clear difference by SES were observed, indigents aged 65+ under-utilised PHC services. From the three models simulated, the major improvement in the predictive power took place from the demographic to the demographic plus two diagnoses model. Improvements were limited when five other diagnoses were added (Rsquare= 28%). The conclusion is that the current normative formula used by the MOH provides little incentives to care appropriately for indigents and people with chronic conditions such as diabetes and hypertension. A capitation payment that adjusts for age, gender, and presence of hypertension and diabetes will better guide resources to those with poorer health and lower SES. Keywords: Primary health care, Payment system, Risk adjustment

Out-Of-Pocket Expenditures on Dental Care for Schoolchildren Aged 6 to 12 Years: A Cross-Sectional Estimate in a Less-Developed Country Setting

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US$53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US$70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden

Immunogenic Modulations Induced by Prospective Anti-Malarial Herbal Extracts in Murine Model

Keeping in view the ever increasing problem of drug resistance and affordability of the antimalarial drugs by the poor mass, herbal medicines can become an important and alternative sustainable strategy for malaria treatment. Aqueous extracts of three Himalayan herbs― _Equisetum ravense_, _Artemisia vulgaris_ and _Centella asiatica_, with reported antimalarial property were screened for clinical efficacy against a local strain of _Plasmodium vivax_ antigen in murine model. _E. arvense_ extract was consistent in boosting phagocytic activity, nitric oxide generation, acid phosphatase and alkaline phosphatase activities in the peritoneal macrophages. The effectiveness of the rest herbals was discrete. A need for further detailed investigation to evaluate the clinical efficacy of these herbals seems essential

Associated factors of hope in cancer patients during treatment : a systematic literature review

Aim: To identify the associated factors of hope during treatment in cancer patients. Background: Hope is very important to cancer patients at all stages of the disease process. Hope is seen as an important coping mechanism. Most research about hope in cancer patients considered the end of life or in palliative care. Several and different factors are associated with hope. It is not yet sufficiently clear which factors are associated with hope during the treatment. Design: A systematic literature review of quantitative empirical studies on hope in cancer patients during treatment. Data Sources: Search in MEDLINE (PubMed interface), CINAHL (EBSCO interface), Psychinfo and Cochrane (January 2009-December 2018). Review Methods: Empirical quantitative studies were included regardless of the disease stage, written in English or Dutch, measuring hope from the perspective of cancer patients. Two authors independently screened all the studies and assessed their quality. Results: Thirty-three studies were included. Positive relationship has been established between hope and quality of life, social support, spiritual and existential well-being. Hope appears to be negatively associated with symptom burden, psychological distress and depression. There appears to be no relationship between hope and demographic and clinical variables. The relationship between anxiety and hope remains unclear. Conclusions: Hope primarily seems to be a process that takes place in a person's inner being rather than being determined from outside. Impact: Health professionals may want to focus on the meaning of hope for cancer patients in relation to the associated factors. A better understanding of the meaning of hope during treatment can be of great value in supporting cancer patients with regard to treatment decisions, psychosocial support, the experienced quality of life and symptom burden and any wishes they may have with regard to advanced care planning

ISLAMIC PSYCHOLOGY IN TREATING VICTIMS OF CHILD SEXUAL ABUSE (Family Therapy and Story Telling Therapy) IN TREATING VICTIMS OF CHILD SEXUAL ABUSE

The purpose of this study was to describe the changes experienced by the subjects after family therapy and storytelling therapy. This research used descriptive qualitative study with Curative Therapy methods and the Observational Analysis. Subjects of the research were two children in their middle childhood (6-8 years) who were chosen through purposive sampling, their families were included in the therapy, and live in Semarang. Islamic Psychological approach were applied through family therapy in the form of understanding of the nature of sexual identity of children, understanding puberty, giving family support, as well as doing of Islamic religious ritual by reviewing the interpretation on the Qur'an and Sunnah with the child and planting the moral and beliefs in the family. Those efforts were accompanied by storytelling therapy based on Islamic psychology approach, namely through the implementation of Islamic siroh through storytelling and role playing. The results shows that the impact of sexual violence to the subjects are reluctant to go to school, have a sense of inferiority, tend to withdraw from society, experience irritability and aggressiveness. When the subject and family participate in the therapy for 6 months, it can be seen that those children showed a noticeable progress in their behavior by getting back to school, showing their happiness, starting to play with their friends although the intensity was still less than usual. Another finding in the study is the formation of family cohesiveness. Treatment will continue until the next 1-2 years, and it is expected that it will become a habit in the family

Gender and Health Care Utilisation in Pakistan

This study is undertaken to test whether or not there exists gender bias in health care utilisation of sick children in Pakistan. Overall, the results are encouraging, as medical consultation has been sought for by a very high proportion (79 percent) of sick children. Moreover, there do not appear to be significant differences by gender in health care utilisation, be it curative or preventive. This is so in spite of the fact that many studies on various gender-related issues in Pakistan have generally shown significant gender bias in favour of male children. Thus one may conclude that parental altruism prevails at least in the provision of health care to sick children. However, the extent and magnitude of effect varies by geographical, socio-economic, and demographic characteristics of the mother. In view of these findings, efforts should be made to minimise gender differentials among various categories of people so that children living in any circumstances may have equal opportunity of health care utilisation. This will be possible when health care facilities are easily accessible to all. The Lady Health Workers Programme of the Government of Pakistan is a major positive step in this regard. Under this programme, health care facilities are provided at people’s door-step. The expansion of this programme will be extremely beneficial in helping parents to provide health care facilities to sick children, both male and female.

Under-Utilization of Community Health Centers in Purworejo Regency, Central Java

The basic strategy of the Ministry of Health to achieve Health For All In Indonesia 2010 is through health paradigm, decentralization, professionalism and health service management. Community health centers play an important role to achieve the goal. Unfortunately, underutilization of community health centers is still a problem in Purworejo. The purpose of this study was to know the utilization of community health centers using a sociological health approach. Qualitative research by observation, in-depth interview and focus group discussion were done among different types of group. The study was done in Purworejo District on February and March 2000. The main problems related to under-utilization of community health centers are mostly on administration (less quality services, un-efficient, long hours waiting), strong bureaucratic system (physician has a dominant power, overlapping programs, poor coordination and integration with other divisions) and cultural behavior of the community (labeling/stigma, self-care dominant, lack of community participation). To overcome under-utilization of community health centers the administration and bureaucracy should be changed into more efficient, not bureaucratic management. In addition social changes of the community culture is needed. As a consequence through these changes the staff of the health centers will be more efficient and effective. &nbsp

Treatment options for PNET liver metastases. a systematic review

Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40-80% of patients with PNET are metastatic at presentation, usually involving the liver (40-93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs