Cancer prevention and control in the eastern mediterranean region: the need for a public health approach

Cancer is increasingly recognized as a major health Concern in the Eastern Mediterranean [EM] region. The emergence of cancer and other non-communicable diseases [NCDs] in most EM region countries is related to increases in life expectancy, an increasing proportion of elderly people, and the successful control of most childhood communicable diseases, along with rapid strides in socioeconomic development. In the next 15 years, cancer incidence in the EM is expected to increase by 100% to 180%, according to World Health Organization [WHO] projection modelling, the largest increase foreseen among developing countries. Even though 30% of cancers can be prevented and controlled using available knowledge, death rates will increase by 17% by 2015 because of the challenges and barriers to implementing national strategic action plans. Other problems facing countries in the region are the lack of national cancer surveillance and little harmonization in monitoring and surveillance methodologies. Data on cancer mortality in the 21 countries is limited or lacking, with only 7 countries having national population-based registries. There is no linking of cancer mortality data to NCD prevention and control. A model of integrated care for NCD prevention programs in general and cancer in particular is lacking, and finally, there is inadequate national capacity-building and a lack of program sustainability. The WHO Regional Committee for the EM has adopted a resolution recognizing the considerable magnitude of cancer as a major cause of morbidity, human suffering, and mortality in the region. In the last 15 years, the WHO Cancer Control Programme has fostered the development of national cancer control programs as a primary intervention strategy for a comprehensive and cost-effective approach at the country level

[Prevention and public approach to diabetic foot]

Diabetes among Eastern Mediterranean [EM] population above age of 20 years is around 10.5% and is ranked among the leading causes of blindness, renal failure and lower limb amputation. While 50% of EM people with diabetes will die of cardiovascular diseases. This means that in our region, there are pandemic trends in prevalence of diabetes and associated complications. Globally, people with diabetes are 25 times more likely to have a leg amputated than those without the condition, and up to 70% of all leg amputations happen to people with diabetes. Somewhere in the world, a leg is lost to diabetes every 30 seconds. Foot ulcer is the most common single precursor to lower extremity amputations among diabetics. Hyperglycemia, impaired immunologic responses, neuropathy, and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. Diabetic foot represents a health problem and economic burden among majority of EM Countries. Infection in a diabetic foot is limb-threatening and must be treated empirically and aggressively. Treatment of infected foot wounds is the most common reason for diabetes- related hospitalization. The good news is that up to 85 percent of diabetic amputations can be prevented. As to above challenge, the best approach for EMR is education, community awareness and prevention of diabetic foot. The public approach and education that emphasize on proper footwear and foot care are best preventive and cost-effective modalities that can be easily implemented among EM Countries. EM Countries need to strengthen national health services that promote the concept of prevention and tight control of diabetes in order to prevention diabetes complications. This also necessitates building/strengthening diabetes registry and complications

Database by meta-analysis: health behavior and health services for cardiovascular diseases in Egypt

Cardiovascular diseases [CVDs] represent major public health problem in many countries including Egypt. There are limited national data about morbidity and mortality of CVDs in Egypt. Purpose: was to evaluate the health behavior changes and health services regarding risk factors of CVDs for all age groups in Egypt through data base by Meta-analysis [Type 3]

Methods: data were collected from the available electronic national data base from available theses, medical and nursing reports, and published research relevant to CVDs from allover Egypt

Results: The total number of persons included in this project was 4110 cases from 104 medical, and 14 nursing studies, hospital and population based. The cardiovascular cases included 2906 males and 1204 females. These studies extended from 1995-2002. Most of studies were at Ain Shams, Cairo and Alexandria University hospitals, and the Ministry of Health and Population hospitals. The studies revealed that, CVDs were higher in the year 1997, among age group 40-60 years and in male group. Also, the study indicated a significant correlation between adverse life-style [increase serum lipids, hypertension, smoking, obesity and inactivity] and occurrence of CVDs. Although more than half of cases attended to the university hospitals for obtaining health services, two thirds of the cases did not receive follow-up services

Conclusion: According to this preliminary study concerning Egyptian data, CVDs are still a presentable problem. There is relative increase of prevalence of CVDs in the exception of the last two years

Recommendations: The study revealed 1] the importance of utilizing the available data from theses and other sources of data related to CVDs to build up an electronic database for these diseases and this procedure can be used similarly in other medical and nursing areas, 2] Governmental commitment is urgently required for the establishment of a national program for prevention and control of CVDs

Palliative care initiative for the eastern mediterranean regions: a proposal

The Eastern Mediterranean Region [EMR], with 22 countries and about half a billion people, has scarce palliative care services that are far from meeting the needs of the region. The authors of this paper believe that the resources and international influence of the World Health Organization could be combined with the excellent palliative care expertise of King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia to establish a collaborative initiative for promotion of palliative care services in the region. This proposal is based on the major components of professional training, development of regional guidelines, integration of palliative care into health plans and polices, and ensuring availability of essential medications. Investment in developing palliative care in the EMR would be expected to relieve the suffering of hundreds of thousands of patients and families in this part of the world