Modes de vie et santé bucco-dentaire chez les pêcheurs sénégalais.

Oral health is determined by several factors that are individual and socially dependent. The objective of this study was to describe the lifestyles, eating habits and oral hygiene habits of Senegalese fishermen at sea. The study was cross-sectional and focused on fishermen in the Dakar, Thiès and Saint Louis regions. The study took place in some of the main fishing quays of Thiès (Kayar, Mboro and Mbour), Dakar (Yoff and Hann) and Saint Louis (Guet Ndar).  A 3-stage cluster sampling was carried out. The sample size was 604 individuals. Epidemiological data collected were dietary habits: dairy, meat, fish, etc., lifestyles: smoking, alcohol, coffee, tea, etc., oral hygiene habits: means, products, methods and dental status ( DMFT). Seventy-nine percent of the fishermen surveyed consumed dairy products at sea, 31.5% consumed tobacco. More than one fifth of the fishermen who smoked smoked more than 10 cigarettes per day. Nearly 75% of the sample reported using sea water to relieve their pain. More than 37.3% of the fishermen reported brushing their teeth twice a day. The consumption of fish products was significantly associated with DMFT (p=0.04). The average DMFTof tea drinkers (7.75) was lower than that of non-drinkers (8.48) without a significant difference (p value = 0.073). This work, carried out among fishermen in Senegal, has shown us that the lifestyle, hygiene and dietary habits used are negative for oral health.  La santé bucco-dentaire est déterminée par plusieurs facteurs qui sont d’ordre individuel et d’ordre dépendante de la société. L’objectif de ce travail était de décrire les modes de vie, les habitudes alimentaires et les habitudes d’hygiène orale en mer des pêcheurs sénégalais. L’étude était de type transversal et portait sur les pêcheurs de la région de Dakar, de Thiès et de Saint Louis. L’étude s’est déroulée dans certains principaux quais de pêche de Thiès (Kayar, Mboro et Mbour), de Dakar (Yoff et Hann) et de Saint-Louis (Guet Ndar).  Un échantillonnage en grappes à 3 degrés a été effectué. La taille de l’échantillon était de 604 individus. Les données épidémiologiques recueillies étaient les habitudes alimentaires : laitage, viande, poisson, etc., les modes de vie : tabagisme, alcool, café, thé, etc., les habitudes d’hygiène orale : moyens, produits, méthodes et état dentaire (CAO).Soixante-dix-neuf pour cent des pêcheurs enquêtés consommaient des produits laitiers en mer, 31,5% consommaient le tabac. Plus du cinquième des pêcheurs tabagiques fumaient plus de10 cigarettes par jour. Près de 75% de l’échantillon déclaraient utiliser l’eau de la mer pour soulager leur douleur. Plus de 37,3% des pêcheurs déclaraient se brosser les dents avec une fréquence de deux fois par jour.La consommation de  produits halieutiques étaient associés significativement au CAO (p=0,04). La moyenne CAO des buveurs de thé (7,75) était inférieure à celle des non-buveurs (8,48) sans une différence significative (p value = 0,073). Ce travail, mené chez les pêcheurs au Sénégal, nous a montré que les modes de vie, habitudes d’hygiène mais aussi alimentaire utilisés sont négatifs à la santé bucco-dentaire.

Modes de vie et santé bucco-dentaire chez les pêcheurs sénégalais.

Oral health is determined by several factors that are individual and socially dependent. The objective of this study was to describe the lifestyles, eating habits and oral hygiene habits of Senegalese fishermen at sea. The study was cross-sectional and focused on fishermen in the Dakar, Thiès and Saint Louis regions. The study took place in some of the main fishing quays of Thiès (Kayar, Mboro and Mbour), Dakar (Yoff and Hann) and Saint Louis (Guet Ndar).  A 3-stage cluster sampling was carried out. The sample size was 604 individuals. Epidemiological data collected were dietary habits: dairy, meat, fish, etc., lifestyles: smoking, alcohol, coffee, tea, etc., oral hygiene habits: means, products, methods and dental status ( DMFT). Seventy-nine percent of the fishermen surveyed consumed dairy products at sea, 31.5% consumed tobacco. More than one fifth of the fishermen who smoked smoked more than 10 cigarettes per day. Nearly 75% of the sample reported using sea water to relieve their pain. More than 37.3% of the fishermen reported brushing their teeth twice a day. The consumption of fish products was significantly associated with DMFT (p=0.04). The average DMFTof tea drinkers (7.75) was lower than that of non-drinkers (8.48) without a significant difference (p value = 0.073). This work, carried out among fishermen in Senegal, has shown us that the lifestyle, hygiene and dietary habits used are negative for oral health.  La santé bucco-dentaire est déterminée par plusieurs facteurs qui sont d’ordre individuel et d’ordre dépendante de la société. L’objectif de ce travail était de décrire les modes de vie, les habitudes alimentaires et les habitudes d’hygiène orale en mer des pêcheurs sénégalais. L’étude était de type transversal et portait sur les pêcheurs de la région de Dakar, de Thiès et de Saint Louis. L’étude s’est déroulée dans certains principaux quais de pêche de Thiès (Kayar, Mboro et Mbour), de Dakar (Yoff et Hann) et de Saint-Louis (Guet Ndar).  Un échantillonnage en grappes à 3 degrés a été effectué. La taille de l’échantillon était de 604 individus. Les données épidémiologiques recueillies étaient les habitudes alimentaires : laitage, viande, poisson, etc., les modes de vie : tabagisme, alcool, café, thé, etc., les habitudes d’hygiène orale : moyens, produits, méthodes et état dentaire (CAO).Soixante-dix-neuf pour cent des pêcheurs enquêtés consommaient des produits laitiers en mer, 31,5% consommaient le tabac. Plus du cinquième des pêcheurs tabagiques fumaient plus de10 cigarettes par jour. Près de 75% de l’échantillon déclaraient utiliser l’eau de la mer pour soulager leur douleur. Plus de 37,3% des pêcheurs déclaraient se brosser les dents avec une fréquence de deux fois par jour.La consommation de  produits halieutiques étaient associés significativement au CAO (p=0,04). La moyenne CAO des buveurs de thé (7,75) était inférieure à celle des non-buveurs (8,48) sans une différence significative (p value = 0,073). Ce travail, mené chez les pêcheurs au Sénégal, nous a montré que les modes de vie, habitudes d’hygiène mais aussi alimentaire utilisés sont négatifs à la santé bucco-dentaire.

Economic evaluations of psychosocial interventions in cancer: A systematic review

Objective: Although the effectiveness of many psychosocial interventions for people with cancer has been established, one barrier to implementation in routine clinical care is a lack of data on cost-effectiveness. We conducted a systematic review to assess the cost-effectiveness of psychosocial interventions for improving psychological adjustment among people with cancer. Methods: Systematic review of the literature, study appraisal, and narrative synthesis. Results: Eight studies involving 1,668 patients were identified. Four of these reported outcomes in a cost per quality adjusted life year (QALY) framework. Six studies reported psychosocial interventions to be cost-effective for improving health-related quality of life, mood, pain, distress, or fear of cancer progression, compared to usual care. Of the six psychosocial interventions identified as cost-effective, three were cognitive behavioural therapy based interventions, one was a nurse-delivered telephone follow-up plus educational group program, one was a group-based exercise and psychosocial intervention, and one was a series of 10 face-to-face or telephone-based individual support sessions delivered by a nurse. The quality of studies according to the CHEC-list criteria was good overall; however, some studies were limited by their choice of outcome measure and omission of important categories of costs. Conclusions: Several psychosocial interventions, particularly those based on cognitive behavioural therapy, have been demonstrated to represent good value for money in cancer care. Future research should include a clear definition of the economic question, inclusion of all relevant costs, and consideration of utility-based quality of life measures for QALY estimation. Systematic review registration: PROSPERO Registration Number: CRD42014006370

Economic evaluations of psychosocial interventions in cancer: A systematic review

Objective: Although the effectiveness of many psychosocial interventions for people with cancer has been established, one barrier to implementation in routine clinical care is a lack of data on cost-effectiveness. We conducted a systematic review to assess the cost-effectiveness of psychosocial interventions for improving psychological adjustment among people with cancer. Methods: Systematic review of the literature, study appraisal, and narrative synthesis. Results: Eight studies involving 1,668 patients were identified. Four of these reported outcomes in a cost per quality adjusted life year (QALY) framework. Six studies reported psychosocial interventions to be cost-effective for improving health-related quality of life, mood, pain, distress, or fear of cancer progression, compared to usual care. Of the six psychosocial interventions identified as cost-effective, three were cognitive behavioural therapy based interventions, one was a nurse-delivered telephone follow-up plus educational group program, one was a group-based exercise and psychosocial intervention, and one was a series of 10 face-to-face or telephone-based individual support sessions delivered by a nurse. The quality of studies according to the CHEC-list criteria was good overall; however, some studies were limited by their choice of outcome measure and omission of important categories of costs. Conclusions: Several psychosocial interventions, particularly those based on cognitive behavioural therapy, have been demonstrated to represent good value for money in cancer care. Future research should include a clear definition of the economic question, inclusion of all relevant costs, and consideration of utility-based quality of life measures for QALY estimation. Systematic review registration: PROSPERO Registration Number: CRD42014006370

Psychoeducational intervention for people at high risk of developing another melanoma: a pilot randomised controlled trial

Introduction Information and psychological needs have been reported as one of the greatest areas of unmet needs for patients with melanoma. To respond to these needs, we developed the Melanoma Care Intervention, a developed psychoeducational intervention for people at high risk of developing another melanoma comprising of a newly developed melanoma educational booklet and individually tailored telephone support sessions provided by trained psychologists. The purpose of this study was to investigate the acceptability and feasibility of the Melanoma Care Intervention. Methods Twenty-four adults (14 men, 10 women, mean age: 58 years, SD: 12.2) at high risk of developing a subsequent primary melanoma were recruited and randomly assigned 1:1 to the intervention (a psychoeducational booklet, a Cancer Council booklet on melanoma and up to five telephone-based sessions with a psychologist) or usual care (Cancer Council booklet only). Acceptability, feasibility, fear of cancer recurrence and secondary psychosocial outcomes were assessed at baseline, 1 and 6 months. Results Satisfaction and perceived benefits were rated highly for all intervention components, particularly the telephone-based psychology sessions (mean satisfaction and benefits: both 9.27 out of 10, SD=2.41). The quality of information and support provided throughout the trial was rated as ‘high’ by the intervention group, with a mean score of 4.6 out of a possible 5 (SD=0.9) and 4.2 (SD=1.2) for the control group. Conclusions The intervention was feasible and acceptable for improving psychological adjustment. Timely access to effective, evidence-based, psychological care is a recognised need for people with melanoma. The intervention is designed to directly address this need in a way that is feasible in a clinical setting, acceptable to patients and health professionals

Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Aims Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention’s energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. Results The environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission

Improving subjective perception of personal cancer risk: systematic review and meta-analysis of educational interventions for people with cancer or at high risk of cancer

BACKGROUND: Newly diagnosed patients with cancer require education about the disease, the available treatments and potential consequences of treatment. Greater understanding of cancer risk has been found to be associated with greater health-related quality of life, improved psychological adjustment and greater health-related behaviours. The aim of this sytematic review was to assess the effectiveness of educational interventions in improving subjective cancer risk perception and to appraise the quality of the studies. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective observational studies. Eligible studies were identified via Medline, PsycINFO, AMED, CINAHL and Embase databases. After screening titles and abstracts, two reviewers independently assessed the eligibility of 206 full-text articles. RESULTS: Forty papers were included in the review; the majority of studies were conducted among breast cancer patients (n = 29) and evaluated the effect of genetic counselling on personal perceived risk (n = 25). Pooled results from RCTs (n = 12) showed that, both in the short and long term, educational interventions did not significantly influence risk perception level (standardised mean difference 0.05, 95% CI -0.24-0.34; p = 0.74) or accuracy (odds ratio = 1.96, 95% CI: 0.61-6.25; p = 0.26). Only one RCT reported a short-term difference in risk ratings (p = 0.01). Of prospective observational studies (n = 28), many did demonstrate changes in the level of perceived risk and improved risk accuracy and risk ratings in both the short and long term. However, only one (of three) observational studies reported a short-term difference in risk ratings (p < = 0.003). CONCLUSION: Further development and investigation of educational interventions using good quality, RCTs are warranted

Implementation of patient-reported outcome measures and patient-reported experience measures in melanoma clinical quality registries: a systematic review

Abstract Objectives To identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in clinical quality registries, for people with cutaneous melanoma, to inform a new Australian Melanoma Clinical Outcomes Registry; and describe opportunities and challenges of routine PROM/PREM collection, especially in primary care. Design Systematic review. Primary and secondary outcome measures Which PROMs and PREMs are used in clinical quality registries for people with cutaneous melanoma, how they are collected, frequency of collection, participant recruitment methods and funding models for each registry. Results 1134 studies were identified from MEDLINE, PreMEDLINE, Embase, PsychInfo, Cochrane Database of Abstracts of Reviews of Effects databases and TUFTS Cost-Effectiveness Analysis Registry, alongside grey literature, from database inception to 5th February 2020. Following screening, 14 studies were included, identifying four relevant registries: Dutch Melanoma Registry, Adelphi Real-World Disease-Specific Programme (Melanoma), Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship Registry, and Cancer Experience Registry. These used seven PROMs: EuroQol-5 Dimensions, Functional Assessment of Cancer-General (FACT-G) and FACT-Melanoma (FACT-M), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer 30 (EORTC QLQ-C30), Fatigue Assessment Scale Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measures Information System-29 and one PREM; EORTC QLQ-Information Module 26. PROMs/PREMs in registries were reported to improve transparency of care; facilitate clinical auditing for quality assessment; enable cost-effectiveness analyses and create large-scale research platforms. Challenges included resource burden for data entry and potential collection bias toward younger, more affluent respondents. Feedback from patients with melanoma highlighted the relevance of PROMs/PREMs in assessing patient outcomes and patient experiences. Conclusions Clinical registries indicate PROMs/PREMs for melanoma care can be incorporated and address important gaps, however cost and collection bias may limit generalisability

Cost-Effectiveness of PET/CT Surveillance Schedules to Detect Distant Recurrence of Resected Stage III Melanoma

Objective: To estimate the cost-effectiveness of three surveillance imaging strategies using whole-body positron emission tomography (PET) with computed tomography (CT) (PET/CT) in a follow-up program for adults with resected stage III melanoma. Methods: An analytic decision model was constructed to estimate the costs and benefits of PET/CT surveillance imaging performed 3-monthly, 6-monthly, or 12-monthly compared with no surveillance imaging. Results: At 5 years, 3-monthly PET/CT surveillance imaging incurred a total cost of AUD 88,387 per patient, versus AUD 77,998 for 6-monthly, AUD 52,560 for 12-monthly imaging, and AUD 51,149 for no surveillance imaging. When compared with no surveillance imaging, 12-monthly PET/CT imaging was associated with a 4% increase in correctly diagnosed and treated distant disease; a 0.5% increase with 6-monthly imaging and 1% increase with 3-monthly imaging. The incremental cost-effectiveness ratio (ICER) of 12-monthly PET/CT surveillance imaging was AUD 34,362 for each additional distant recurrence correctly diagnosed and treated, compared with no surveillance imaging. For the outcome of cost per diagnostic error avoided, the no surveillance imaging strategy was the least costly and most effective. Conclusion: With the ICER for this strategy less than AUD 50,000 per unit of health benefit, the 12-monthly surveillance imaging strategy is considered good value for money

Cost-effectiveness analysis of PET/CT surveillance imaging to detect systemic recurrence in resected stage III melanoma: study protocol

Introduction In the new era of effective systemic therapies for advanced melanoma, early detection of lower volume recurrent disease using surveillance imaging can improve survival. However, intensive imaging follow-up strategies are likely to increase costs to health systems and may pose risks to patients. The objective of this study is to estimate from the Australian health system perspective the cost-effectiveness of four follow-up strategies in resected stage III melanoma over a 5-year period following surgical treatment with curative intent. Methods and analysis A decision-analytic model will be built to estimate the costs and benefits of (1) 12 monthly, (2) 6 monthly, (3) 3–4 monthly positron emission tomography/CT imaging for 5 years, compared with (4) no imaging follow-up. The model will be populated with probabilities of disease recurrence, test performance measures using data from >1000 consecutive resected stage III melanoma patients from Melanoma Institute Australia diagnosed between 2000 and 2017. Healthcare resource use, including surveillance imaging, doctor’s visits, subsequent tests and procedures to investigate suspicious findings, will be quantified from detailed patient records and valued using Australian reference pricing. Economic outcomes include cost per new distant melanoma recurrence detected and cost per diagnostic error avoided, for no imaging compared with the other strategies. Deterministic sensitivity analyses will examine the robustness of model results. Ethics and dissemination This study was approved by the Sydney Local Health District, Sydney Local Health District Ethics Review Committee (RPAH Zone), AU/1/830638 and the Australian Institute of Health and Welfare (EO2019-1-454). The results of this study will be published in peer-reviewed medical and health economics journals and will inform melanoma management guidelines