Factors associated with public awareness of the Crown Health Program in the Al-Jouf Region.

OBJECTIVES: A community-based intervention, the Crown Health Project (CHP), was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. METHODS: A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics (e.g., age, gender, education, occupation, urban/rural residence) and CHP awareness (its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities). Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. RESULTS: Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying "health education" as the main goal of the CHP (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1-5.5), "noncommunicable diseases" as the main diseases targeted (OR, 4.8; 95% CI, 3.6-6.4) and "attention to health" as the purpose (OR, 6.0; 95% CI, 4.0-8.9). CONCLUSION: The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf.

Tumor regression with a combination of drugs interfering with the tumor metabolism: efficacy of hydroxycitrate, lipoic acid and capsaicin.

Cellular metabolic alterations are now well described as implicated in cancer and some strategies are currently developed to target these different pathways. In previous papers, we demonstrated that a combination of molecules (namely alpha-lipoic acid and hydroxycitrate, i.e. Metabloc™) targeting the cancer metabolism markedly decreased tumor cell growth in mice. In this work, we demonstrate that the addition of capsaicin further delays tumor growth in mice in a dose dependant manner. This is true for the three animal model tested: lung (LLC) cancer, bladder cancer (MBT-2) and melanoma B16F10. There was no apparent side effect of this ternary combination. The addition of a fourth drug (octreotide) is even more effective resulting in tumor regression in mice bearing LLC cancer. These four compounds are all known to target the cellular metabolism not its DNA. The efficacy, the apparent lack of toxicity, the long clinical track records of these medications in human medicine, all points toward the need for a clinical trial. The dramatic efficacy of treatment suggests that cancer may simply be a disease of dysregulated cellular metabolism.

An investigation of the apparent breast cancer epidemic in France: screening and incidence trends in birth cohorts.

BACKGROUND: Official descriptive data from France showed a strong increase in breast-cancer incidence between 1980 to 2005 without a corresponding change in breast-cancer mortality. This study quantifies the part of incidence increase due to secular changes in risk factor exposure and in overdiagnosis due to organised or opportunistic screening. Overdiagnosis was defined as non progressive tumours diagnosed as cancer at histology or progressive cancer that would remain asymptomatic until time of death for another cause. METHODS: Comparison between age-matched cohorts from 1980 to 2005. All women residing in France and born 1911-1915, 1926-1930 and 1941-1945 are included. Sources are official data sets and published French reports on screening by mammography, age and time specific breast-cancer incidence and mortality, hormone replacement therapy, alcohol and obesity. Outcome measures include breast-cancer incidence differences adjusted for changes in risk factor distributions between pairs of age-matched cohorts who had experienced different levels of screening intensity. RESULTS: There was an 8-fold increase in the number of mammography machines operating in France between 1980 and 2000. Opportunistic and organised screening increased over time. In comparison to age-matched cohorts born 15 years earlier, recent cohorts had adjusted incidence proportion over 11 years that were 76% higher [95% confidence limits (CL) 67%, 85%] for women aged 50 to 64 years and 23% higher [95% CL 15%, 31%] for women aged 65 to 79 years. Given that mortality did not change correspondingly, this increase in adjusted 11 year incidence proportion was considered as an estimate of overdiagnosis. CONCLUSIONS: Breast cancer may be overdiagnosed because screening increases diagnosis of slowly progressing non-life threatening cancer and increases misdiagnosis among women without progressive cancer. We suggest that these effects could largely explain the reported "epidemic" of breast cancer in France. Better predictive classification of tumours is needed in order to avoid unnecessary cancer diagnoses and subsequent procedures.

Does ozonation of drinking water reduce the risk of bladder cancer?

BACKGROUND: Epidemiologic studies of drinking water disinfection byproducts have focused primarily on the carcinogenic potential of chlorination byproducts. Because drinking water has been ozonated in France for decades, we were able to assess the carcinogenic risk of the disinfection byproducts generated by both ozonation and chlorination. METHODS: We used data from a case-control study of bladder cancer conducted between 1985 and 1987 in 7 French hospitals. We compared 281 cases and 272 controls for whom we could reconstruct at least 70% of the residential exposure to drinking water contaminants over a 30-year period. RESULTS: When we took potential confounders and exposure to chlorination byproducts into account, the risk of bladder cancer decreased as duration of exposure to ozonated water increased (OR = 0.60 [95% CI = 0.3-1.3] for 1-9 years; OR = 0.31 [0.1-0.7] for 10 years or more). Simultaneously, the risk of bladder cancer increased with duration of exposure to chlorinated surface water and with the estimated trihalomethane content of the water. Our data suggest that ozonation reduces the risk associated with the chlorination of surface water and that ozonation alone could have an independent beneficial effect on bladder cancer risk. CONCLUSIONS: Our results are consistent with experimental evidence that ozonation in combination with chlorination decreases the concentration of trihalomethane in treated water and eliminates some of the mutagenicity of raw water.

¿Funciona el flujo de información entre los niveles primario y especializado? Análisis de la continuidad asistencial en un área de salud* / Does the information flow between primary and specialized levels? The analysis of assistance continuity in a healthcare area

Objetivo: 1. Evaluar la continuidad asistencial mediante la información transmitida entre los dos niveles, primario y especializado, en una Área de Salud, tanto a través del documento de interconsulta, como en otros documentos escritos o transmitida verbalmente por el paciente. 2. Comparar la información existente sobre los mismos procesos en ambos niveles. Material y Método: Diseño del estudio: observacional, retrospectivo, utilizando criterios explícitos. Ámbito: un Área de Salud, con tres Centros de Especialidades y 31 Centros de Atención Primaria. Población de estudio: una muestra aleatoria de derivaciones de primer día, estratificada por el número de consultas atendidas en cada especialidad, n= 293 (e= ñ5 por ciento).Para conseguir los objetivos se revisaron tanto las historias de atención primaria como las de especializada, buscando en ellas la información correspondiente a las interconsultas que se evaluaban, éstas fueron extraídas de los listados de citaciones de los centros de especializada. Resultados: La existencia de copia del documento de interconsulta en atención primaria se constató en 87 (30,10 por ciento) y en atención especializada en 160 (55,36 por ciento). Los documentos de interconsulta con las tres copias localizados en las historias de especializada fueron 67 (41,87 por ciento).En las historias clínicas de atención primaria consta el diagnóstico del especialista en 107 casos (37,02 por ciento) y la pauta de actuación en 115 ocasiones (39,79 por ciento), mientras que en las historias del nivel especializado encontramos diagnóstico en 246 casos (85,12 por ciento) y pauta de actuación en 244 (84,42 por ciento).Conclusiones: Hay un elevado número de pacientes en los que el médico de atención primaria carece de información sobre los resultados de la derivación al especialista. Paradójicamente, se aprecian buenos niveles de cumplimentación de las variables estudiadas en dichos pacientes, en las historias de atención especializada, pero esta información no se transmite, lo que pone en evidencia que el déficit está en los mecanismos de comunicación que deben ser prioritariamente mejorados (AU)