bluuebunny/crossref_metadata_2025 huggingface dataset:
NK cell development in a human stem cell niche: KIR expression occurs independently of the presence of HLA class I ligands
Authors: Zhao Xiaoyi , Weinhold Sandra , Brands Jens , Hejazi Maryam , Degistirici Özer , Kögler Gesine , Meisel Roland , Uhrberg Markus
Published: September 2018

The development of mature natural killer (NK) cells expressing killer cell immunoglobulin-like receptors (KIRs) depends on cell contact–dependent signals from nonhematopoietic cells. So far, detailed studies of this process have been hampered by the lack of an appropriate in vitro model. Here, human bone marrow–derived mesenchymal stem cells (MSCs), generated under good manufacturing practice (GMP) conditions, are established as a supportive niche for in vitro NK cell differentiation. In the presence of MSCs, cord blood and bone marrow–derived hematopoietic stem and progenitor cells (HSPCs) effectively and reproducibly differentiated into mature KIR-expressing NK cells. Notably, the novel in vitro differentiation assay enabled us to analyze the impact of HLA class I ligands on KIR repertoire development. To this end, a panel of MSC lines divergent for expression of the major KIR ligands C1, C2, and Bw4 was used for NK cell differentiation. The resulting NK cell repertoires were independent of the presence of specific KIR ligands on MSCs and were, in fact, invariably dominated by expression of the C1-specific inhibitory KIR2DL3. Similarly, short hairpin RNA–mediated knockdown of HLA class I ligands on MSCs did not delay or change the course of KIR expression. Our data suggest that the initial acquisition of KIRs during NK cell development is biased toward recognition of C1 ligands, irrespective of the presence of self-ligands. Altogether, the MSC/HSPC model constitutes a novel platform to study NK cell development in a human stem cell niche. Moreover, the system constitutes a promising GMP-compliant platform to develop clinical-grade NK cell products from cord blood HSPCs.
Intensive care and invasive ventilation in the elderly patient, implications of chronic lung disease and comorbidities
Authors: Nielson C , Wingete D
Published: September 2018

Aims: Elderly patients have an increasing prevalence of illness that requires consideration of critical care and invasive ventilatory support. Although critical care of even the very elderly can provide value, with increasing age the potential risks of treatment and diminishing returns with respect to quality and quantity of life result in a need for careful evaluation. Variable combinations of impaired organ function, active disease and residual pathology from past disease and injury all affect critical care, with the consequence that the elderly are a very heterogeneous population. Recognizing that critical care is a limited resource, it is important to identify patients who may be at increased risk or least likely to benefit from treatment. Patients with functional impairments, nutritional deficiencies and multiple comorbidities may be at highest risk of poor outcomes. Those with very severe disease, extreme age and requirements for prolonged ventilatory support have high in-hospital mortality. Functional impairments, comorbidities and severity of illness are usually more important considerations than chronologic age. The objective of this review is to identify how common problems of the elderly affect critical care and decisions concerning use of invasive ventilatory support.
Living and dying with respiratory failure: facilitating decision making
Authors: Simonds Anita K
Published: September 2018

Respiratory failure is a predictable cause of death in end stage lung disease including COPD and neuromuscular disorders, and the symptom burden for these individuals in the last six months of life is significant. Palliative care services are less well-developed for patients with chronic disorders compared to those with malignant disease; and communication problems can be compounded by a mismatch in expectadons between patients and health care providers on prognosis and other issues. Most patients want more information about their illness to facilitate participation in decision making. Noninvasive ventilation may extend life and palliate symptoms in neuromuscular disorders such as Duchenne muscular dystrophy and motor neurone disease/ALS.
Ground Motion Model for Small-to-Moderate Earthquakes in Texas, Oklahoma, and Kansas
Authors: Zalachoris Georgios , Rathje Ellen M.
Published: September 2018

A ground motion model (GMM) tuned to the characteristics of the observed, and potentially induced, seismicity in Texas, Oklahoma, and Kansas is developed using a database of 4,528 ground motions recorded during 376 events of Mw > 3.0 in the region. The GMM is derived using the referenced empirical approach with an existing Central and Eastern North America model as the reference GMM and is applicable for Mw = 3.0–5.8 and hypocentral distances less than 500 km. The proposed model incorporates weaker magnitude scaling than the reference GMM for periods less than about 1.0 s, resulting in smaller predicted ground motions at larger magnitudes. The proposed model predicts larger response spectral accelerations at short hypocentral distances (≤20 km), which is likely because of the shallow hypocenters of events in Texas, Oklahoma, and Kansas. Finally, the VS30 scaling for the newly developed model predicts less amplification at VS30 < 600 m/s than the reference GMM, which is likely because of the generally thinner sediments in the study area. This finding is consistent with recent studies regarding site amplification in Central and Eastern North America.
Improving Health Outcomes for People With Cancer in Rural and Regional Areas by Embedding Evidence-Based Smoking-Cessation Strategies Into Usual Care: A Study Protocol
Authors: Ugalde A. , Aranda S. , Paul C. , Orellana L. , Plueckhahn I. , Segan C. , Baird D. , Otmar R. , Brown S. , Armstrong P. , Wolff A. , Shee A. Wong , Livingston P.
Published: September 2018

Background: Smoking following a diagnosis of cancer is a powerful clinical risk indicator, with known poorer health outcomes and associated health care costs. In Australia, smoking rates are higher in rural and regional areas. There are established and effective interventions to promote smoking cessation after a diagnosis of cancer yet these are not in routine practice. Aim: This protocol paper reports on a study that aims to embed evidence-based smoking cessation strategies for people with cancer who are current smokers into routine care, resulting in in system wide improvements, an implemented program and model for further dissemination. Methods: Across three rural/regional sites, and with partners Quit Victoria and Western Alliance, this study employs a variety of methodologies to embed smoking cessation support to improve outcomes for people with cancer who currently smoke. Specifically, the project will embed a system of responsibilities and training in rural and regional health services to routinely engage people with cancer who smoke in support services. The program will: · Promote routine delivery of smoking cessation care by trained oncology staff (oncologists/nurses/ allied health) · Establish referral pathways to Quitline · Correspond with general practitioners, to: i) outline the benefits of quitting in this context, ii) promote access to nicotine replacement therapy and iii) support quitting in the community. · Improve routine recording of smoking status and documentation of provision of brief intervention (personalised advice given, resources provided) and outcomes. Participants: are oncology staff and general practitioners across three health services: Ballarat Health Service, East Grampians Health Service (Ararat), Wimmera Health Care Group (Horsham), all located in Victoria, Australia. Data collection will occur across four sources: 1) Oncology staff: qualitative and quantitative data collection understanding confidence and views on provision on cessation advice; 2) Monitoring Quitline calls, 3) Interview with local general practitioners and 4) Medical record reviews to explore frequency of recording of smoking status. Data will be collected pre/postintervention. Results: The project is underway with the intervention manuals in development. The project is due for completion in 2020. Conclusion: This project takes a health services approach to integration of smoking cessation support in routine care for people with cancer in rural and regional areas. This program of work has capacity to determine best approaches to integrate smoking cessation into routine care, resulting in reduced mortality and morbidity, improved effectiveness of anticancer treatments, and reduced health care costs; by establishing internationally relevant, embedded health care interventions.
Increasing Community Awareness of Cancer Signs and Symptoms in Samoa: The Vave Campaign
Authors: Spratling T. , Burich S. , Cuesta-Briand B. , Sofija E.
Published: September 2018

Background and context: Cancer is the second most common cause of death in Samoa. Early detection increases the likelihood of successful treatment; however, in Samoa, cancer patients often present late, when treatment options are limited and often reduced to receiving palliative care. Low levels of health literacy in relation to cancer causation, risk factors, and signs and symptoms contribute to poor outcomes for cancer patients in Samoa. Aim: The Vave (Quickly) campaign aimed to increase community awareness about the signs and symptoms of cancer, and promote early detection. Strategy/Tactics: This was a 12-month national social marketing campaign designed to ensure maximum population reach across Samoa. The campaign adopted a multipronged approach with three main components: mass and social media coverage; printed resources; and community education. All components included the campaign messages: early detection; quickly see a doctor; and quickly ring Samoa Cancer Society (SCS). Program/Policy process: The campaign focused on four of the most common cancers in Samoa: stomach, lung, breast, and prostate. Television advertisements and radio scripts were developed for each type of cancer, piloted and broadcast on the main television and radio stations. Printed materials were developed, including brochures, posters and banners. Community educators delivered a total of 29 face-to-face education sessions across Samoa; these sessions prioritized villages, schools and church groups in areas with poor television and radio coverage. Outcomes: The campaign was successful in increasing awareness of cancer signs and symptoms in the community. Approximately 2000 Samoans (over 1% of the population) received the face-to-face education sessions; analysis of pre- and postsession questionnaires showed that the sessions were effective in increasing health literacy around cancer signs and symptoms. In addition, the number of inquiries received by SCS increased significantly as a result of the advertisements, from an average of 18 inquiries per month in the months prior to the implementation of the campaign to 40 inquiries during the campaign. This increase was particularly marked during October (Breast Cancer Awareness Month) when SCS received 112 inquiries. Limited data on patient visits suggests that the campaign resulted in increased numbers of hospital and general practice visits, and is likely to have contributed to the early detection of some cancers. What was learned: · The campaign resulted in an increase in inquiries and requests for check-ups; however, limited availability of medical and screening services must be considered when managing community expectations. · Establishing effective community and professional relationships contributed to the success of the campaign. Formative research and greater involvement of health professionals throughout the campaign would have prevented some implementation issues.
Overcoming Barriers in Conducting a Transatlantic Prostate Cancer Familial Study in Africa: Best Practice From the CaPTC Cohort Study
Authors: Bassey I.E. , Ugbem T. , Akpan U.O. , Anyanwu S. , Glen E.E. , Omonisi A. , Gali R.M. , Oladoyinbo C. , Dagne G.A. , Kaninjing E. , Askins N. , Odedina F.T. ,   Prostate Cancer Transatlantic Consortium (CaPTC) Investigators
Published: September 2018

Background: Collection of data concerning men's health generally and urological health particularly has always had its challenges, especially in the African setting. Some of the difficulties stem from cultural factors that consider sensitive topics pertaining to men's health as taboo. Aim: To determine how to overcome barriers in conducting a transatlantic prostate cancer familial study in Africans. Methods: After the first phase of the TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY, a survey was carried out among the data collectors and principal investigators using Qualtrix software to collect qualitative feedback on the study. The data from the survey was analyzed using SPSS version 18. Results: Presently, 625 people are enrolled for the study and more are waiting to be recruited in the next phase. About 73% of the participants requested a home or office visit rather than visit a data collection center. On the average, the questionnaire required an average of two hours of personal interview rather than the one hour that had been envisaged. However the participants declared that participant incentives were well worth it. 80% of the participants had no preference for interviewer gender. 80% of the interviewers agreed that answers to questions about participants' sexuality were most difficult to obtain but with an in-depth explanation of the importance of the study and assurance of privacy, the answers were obtained. About 46% of the participants requested that their results be typed and given to them personally, 21% requested results be sent as to them as text messages while 26% requested general results of the study be made available to them in form of booklets, flyers and orally in town hall meetings. Conclusion: The TRANSATLANTIC PROSTATE CANCER FAMILIAL PROJECT STUDY survey questionnaire is a very workable tool that has a high acceptance rate among participants. The best practice for engaging the community for research include community mobilization through sensitization visits and one-on-one talks, use of community 'gatekeepers', introduction by relatives, assurance of privacy of health data obtained, the use of incentives and a promise to give feedback on the results of the study both on a personal and community level.
Can Pharmacists Fill the Primary Care Provider Gap in Recommending Breast Screening?
Authors: Scanlon M. , Pridmore V. , Davis M. , Cooper A. , Beauchamp A.
Published: September 2018

Background and context: BreastScreen Victoria (BSV) provides free breast screening to women aged 40+, targeting women aged 50-74. The program reduces breast cancer deaths by up to 28%. Primary care is important in improving uptake of breast screening. In particular, a recommendation from a health professional is a strong influencer. Many general practitioners (GPs) recommend screening, however, it is important to expand recruitment to other health professionals given many women do not visit a GP regularly. Community pharmacists and pharmacy staff may be a trusted source of health information, and are potentially an underutilized opportunity to promote breast screening to women. Based on this gap, BSV developed a three month pharmacy-based screening awareness campaign that was trialed in community pharmacies throughout 2017/18. The campaign is based on a UK community pharmacy model that was shown to successfully increase public awareness about cancer screening. Aim: BSV aims to diversify the types of health professionals that recommend screening to reach women who do not visit a GP regularly. The aim of the pharmacy-based breast screening awareness campaign is to: • build capacity of pharmacy staff to deliver breast screening messages to their communities • increase awareness of breast screening in women aged 50-74 • increase awareness of breast screening among family and friends of women Strategy/Tactics: BSV's pharmacy-based breast screening awareness campaign was trialed in 4 community pharmacies in 2017. Each pharmacy received a grant of up to $1550 which enabled them to: • allow pharmacy staff to attend training to increase their knowledge of breast screening and the campaign • display BreastScreen collateral throughout the store to provide information and prompt queries • initiate conversations and answer questions about breast screening • monitor campaign activity via a number of methods Outcomes: • Posttraining, 100% of staff were confident in promoting breast screening to customers • Staff across 4 pharmacies had 638 conversations about breast screening with customers (average 160/pharmacy). The majority were with women in the target age group • Most pharmacies suggested shortening the campaign to 2 months • All pharmacies said the funding was a critical motivator to participation • All pharmacies stated that the campaign was worthwhile, and allowed them to participate in health promotion Two additional trials are scheduled to test a reduced campaign duration and funding model. Results will be available later in 2018 What was learned: • Many women do not visit their GP regularly • Community pharmacists and pharmacy staff are an underutilized opportunity to promote breast screening • Delivering cancer screening messages through community pharmacies is an effective way to reach women aged 50-74 • Pharmacy funding and training are critical in enabling pharmacies to deliver a breast screening awareness campaign
The Impact of Limited Cancer Health Literacy on Patient Preference for Shared Care
Authors: Chan C.M.H. , Taib N.A. , Wee L.H. , Blanch-Hartigan D. , Krupat E. , Meyer F.
Published: September 2018

Background: Patient are increasingly expected to engage in their own care. However, patients with limited health literacy often struggle with this. The expectation of patients' engagement in health care decisions by their healthcare providers likely increases the burden that cancer patients are already experiencing following a life-changing diagnosis. Involving patients with cancer in medical decision-making requires them to have an adequate understanding their disease and treatment options. Limited health literacy poses a barrier to patient engagement in their own care, contributing to health disparities and poorer cancer outcomes. Aim: Our primary objective was to determine levels of health literacy among patients with cancer and the extent of its association with patient preference for care. We also sought to identify sociodemographic and clinical characteristics associated with limited cancer health literacy. Methods: As part of a larger prospective cohort study, N = 345 adult cancer patients attending a large, university-affiliated outpatient oncology clinic were recruited using consecutive sampling. Face to face interviews were conducted using questionnaires. Instruments used included the 30-item Cancer Health Literacy Test (CHLT-30), and the Patient-Practitioner Orientation Scale (PPOS) to determine patient preference for shared care. The relationship between cancer health literacy and patient preference for shared care was examined using bivariate analysis, with logistic regression used to identify predictors. Results: Mean patient age was 60.0 ± 11.6 years. A greater female preponderance was observed (69.4%), with over half of patients indicating secondary school completion (51.6%). Up to 79.3% of patients reported a monthly household income of less than RM 4000 (approximately USD 1000), placing them in the bottom 40% of household incomes in Malaysia. A total of 59.1% of patients (n = 204) in this sample were found to have limited cancer health literacy, with an average score of 14.40 ± 4.04 out of a full score of 30. Patients with limited cancer literacy were 1.69 times (95% CI 1.42-2.03) less likely to prefer active participation in their care. Conclusion: Rates of limited cancer literacy in this sample (59.1%) appear to be at least three times higher than prevailing rates in high resource countries with established cancer control programs such as the United States (18%). One out of every two patients with cancer in this study were found to possess limited health literacy, making this a significant issue particularly given its association with lesser patient preference for shared care. This study marks an important first step toward increasing health literacy among patients with cancer and empowering patients to participate in their care, which may help mitigate the impact of disparities such as lower educational and socioeconomic levels traditionally associated with poorer cancer outcomes.
Evaluation of a School-Based Cervical Cancer Vaccination Awareness Initiative
Authors: James O. , Onigbogi O. , Okoye I.
Published: September 2018

Background and context: Cervical cancer is the second most commonly-diagnosed cancer among Nigerian women, even though it is one of the most highly-preventable cancers. Worldwide, this most populated country in Africa ranks 10th in terms of cervical cancer mortality and 7 of every 10 Nigerian women diagnosed with cervical cancer annually die annually. With about 47.72 million women aged 15 years and above who are at risk for cervical cancer and median age of first sexual intercourse being 16 years, there is a huge opportunity to prevent cervical cancer deaths through HPV vaccination. Unfortunately, Nigeria has been unable to access GAVI funding for implementation of country-wide HPV vaccination. Hence, most of the HPV vaccination has been by the private sector, NGOs/CSOs and through out-of pocket payments. In spite of this, uptake of HPV vaccines have been reported to be as low as 8% in some studies. Aim: To determine the barriers to uptake of HPV vaccination among mothers of school-age children and opportunities to increase the uptake from the perspective of mothers. Strategy/Tactics: Use qualitative and quantitative methods to gather relevant information about HPV vaccination uptake from all stakeholders including school heads, teachers, school nurses, mothers/guardians and school associations. Program/Policy process: Through funds provided by the American Cancer Society (ACS) and GlaxoSmithkline, Nigeria, we had a one-day HPV vaccination awareness program targeted at school heads, distributed HPV vaccination consent forms, followed-up with awareness in school PTA meetings, gathered data through questionnaires, FGD and KII after a year to determine project effectiveness. Outcomes: Increased understanding of motivators and demotivating factors of HPV vaccination uptake among mothers of school-aged children, increased understanding of strategies to increase uptake and identification of allies in HPV vaccination advocacy. What was learned: 1. There is a need for consistent, “360 campaign” about HPV vaccination as an effective strategy for prevention of cervical cancer targeted at mothers. 2. Since government at federal and state level is unable to access GAVI funding for HPV vaccination, they do have a role to play in validating the effectiveness and safety of HPV vaccines, as well as the efforts of CSOs and NGOs to encourage parents to consent to HPV vaccination for their children. 3. Working in partnership with school associations could be an effective strategy to increasing HPV vaccination uptake among school-aged children. 4. Female teachers are viable advocates for increasing HPV vaccination uptake in schools, if their knowledge is increased and advocacy tools are provided. 5. There is a possibility that reluctance by the government to incorporate awareness of HPV vaccination into its cervical cancer prevention programs is due to its inability to meet the anticipated demand for free HPV vaccination.
Comparison of Different Registration Methods on Patient Set-Up Error During Volumetric Modulated Arc Therapy Using Cone-Beam CT Imaging for Lung Cancer
Authors: Mohandass P. , Khanna D. , Kumar T. Manoj , Thiyagaraj T. , Saravanan C. , Bhalla N.K. , Puri A.
Published: September 2018

Background: The three-dimensional image-guided radiation therapy is very important in volumetric modulated arc therapy (VMAT) to enhance accuracy throughout the course of a patient's radiation treatment. The image guidance can ensure the safe administration of prescribed radiation dose to the patient. Aim: This study investigated patient set-up uncertainties based on three different registration methods in cone bean CT (CBCT) using volumetric modulated arc therapy (VMAT) for different clinical sites. Methods: A total of 396 CBCT performed for lung VMAT plan for patient set-up verification as per institution image guidance protocol. The approved CT images were transferred from treatment planning system (TPS) to x-ray volumetric imaging system (XVI) for reference image registration. The set-up errors in mediolateral (ML), craniocaudal (CC) and anterioposterior (AP) direction were determined using grayscale matching between the reference CT image and onboard CBCT images. For the current study, patient set-up verification was performed based on clip-box registration (CBR) for image matching. By considering clip-box registration as a reference, other two registration methods of mask registration (MR) and dual registration (DR) (clip-box and mask) were performed for comparison. To compare three registration methods, systematic error (∑), random error (σ), mean displacement, mean set-up error and maximum error were analyzed. Results: The systemic and random errors were less in clip-box registration as compared with other two registration ( P > 0.05). Similarly, maximum error, mean displacement error and mean set-up errors were observed less in clip-box registration as compared with mask and dual registration ( P > 0.05). However, statically no significant difference was observed between three different registration methods ( P > 0.05). Conclusion: All three registration methods can be used for patient set-up accuracy for lung VMAT plan. However, the current study suggested that clip-box method will be more efficient as compared with mask and dual registration methods.
Human Rights as a Basis for Health Prevention and Promotion: Lessons Learned From Children's Rights and Tobacco Control
Authors: Gispen M.E. , Toebes B.
Published: September 2018

Background: Exposure to tobacco smoke and tobacco smoking leads to numerous adverse health and developmental outcome including widespread cancers. The tobacco epidemic primarily roots in childhood as many adult smokers have started before the age of 18. Health prevention and promotion laws and policies are key to positive health change. Indeed, tobacco control legislation has positively impacted on child health and human rights may play a valuable basis and mechanism to foster health prevention and promotion strategies. Aim: To gain new knowledge on the added value of human rights law in fostering health prevention and promotion strategies by reference to specific findings in the case of tobacco control and children's rights. Methods: Literature research and document analysis. Interpretation on the basis of the treaty interpretation rules of the Vienna Convention on the Law of Treaties (art. 31-32). Results: Human rights are increasingly standard setting in the field of health prevention and health promotion in general. Even though human rights law largely includes open-ended norms, it provides for key legal obligations to protect child (and ultimately adult) health against the negative consequences of tobacco. The 1989 Convention on the Rights of the Child demonstrates that governments should take into account the best interests of the child, protect and promote the life, survival, and development of children, the right to health and its underlying determinants, and regulate the tobacco industry to the extent that it does not harm children's rights including health. Conclusion: The human rights framework may a valuable mechanism to support health prevention and promotion as it includes legally binding and enforceable obligations.
Financial Toxicity of Cancer in China
Authors: Xu T. , Wu J.
Published: September 2018

Background and context: Cancer is not only a medical problem, but also a socioeconomical issue as the high prevalence with poor prognosis brings heavy financial burden to the society. From 2005 to 2013, the incidence and mortality rates have sharply increased in China. The most common types of cancer in males in China are lung cancer, gastric cancer, and liver cancer while breast cancer, lung cancer, colorectal cancer are the major types of cancer among Chinese females. The prognosis for most types of cancer is poor and the treatment costs have been high and hence cancer has caused significant financial burden on patients and negatively impacted their lives. Since the 1970s, Chinese government has been paying attention to cancer burden and applying the nationwide cancer management strategy. Population-based cancer screening, public health education of cancer prevention and treatment on general population, and catastrophic disease medical insurance policy providing additional funding for cancer treatments have been widely implemented in the country. However, cancer in China still imposes the greatest financial burden on the patients, the families, and the society. It is imperative for the Chinese government to develop effective policies to address the financial toxicity of cancer in China. Aim: Through analyzing the data, we introduce and explain how Chinese government implements cancer control strategy in recent decades and how the national health insurance policies work on curing cancer disease. Strategy/Tactics: With presenting the available data from 2005 to 2013, we analyze the overall prevalence trend of cancer incidence and mortality in China. In terms of cost, we analyze the overall inpatient cost, inpatient expenses on the most common cancers, and anticancer pharmacies to explain the economic loss that cancer caused to Chinese people. Program/Policy process: Considering the alarming prevalence and economic burden of cancer, China has been paying attention to cancer prevention and treatment and conduct national cancer plans and insurance policies. The plans focused on taking actions to lower cancer burden in high risk groups and regions, strengthening public education and professional training, and promoting cancer standardized treatment guidelines in the nation. Insurance policies were emphasized on critical disease health coverage, including cancer. Outcomes: To mitigate the situation where patients have become indigent due to critical diseases, since 2012, the Chinese government has issued the Critical Disease Insurance Policy to provide financial assistance through supplementary insurance to patients who have incurred a critical disease such as pediatric leukemia, lung cancer, and cervical cancer. What was learned: We learned how Chinese national cancer prevention plans and health insurance policies were efficient worked in releasing the cancer prevalence trend and decreasing the economic cost in recent decades.
Qiwam: A Potential Carcinogenic Smokeless Tobacco Product Consumed With Paan
Authors: Sharma V. , Chandra A. , Nandan A. , Mehrotra R.
Published: September 2018

Background: Qiwam (Kimam) is a liquid tobacco preparation consumed with paan. It is mostly consumed in southeast Asian region. Evidences suggest that it causes potentially malignant disorders (PMD), oral cancer (OC) and decreases sperm count. Qiwam was mentioned in earlier research publications, however details are not known. It is produced for self-consumption as well as for commercial purpose. Aim: To study in detail the ingredients and processing steps involved in the production of Qiwam. In addition, also study the adverse health implication of this smokeless tobacco product on humans. Methods: The information on qiwam was collected via literature search study, study tour to different geographical areas of India, where group discussions with the people involved in the production of qiwam, paan vendors and with community members of different age group were done. Results: Qiwam is prepared by the user for his/her own consumption or by industry for sale. Tobacco leaves and tobacco roots are boiled for several hours then soaked in water flavored with varied spices and additives. The resultant mixture is mashed, strained, and finally dried into a thick paste. It is consumed mostly with paan. Conclusion: Processing of qiwam is a complex and time taking process which involves various steps and components that may influence the carcinogenic property of the product. The different processing steps gives different taste and texture to the product. Qiwam increases the risk of cancer and hence needs to be banned or better avoided.
Alternate Splicing in Head and Neck Cancer: An Update
Authors: Nandan A. , Sharma V. , Singh H. , Chandra A. , Tripathi R. , Dhirendra S. , Mehrotra R.
Published: September 2018

Background: Alternate splicing (AS) is a regulatory process during gene expression that allows a single gene to code multiple proteins. Sequencing of RNA (RNA-Seq) is a high throughput technology, which has been used in various studies to identify AS mechanisms in head and neck cancer (HNC). Until date, there is no available review that could update us with the major outcomes from these studies. Aim: To perform a comprehensive literature search for AS studies on HNC via RNA-Seq. Methods: A systematic literature search was performed following PRISMA guidelines to give a complete picture of AS in HNC identified through RNA-Seq. In addition, comprehensive search was also performed to identify the bioinformatics softwares that analyses RNA-Seq data for finding AS in cancer. Results: Six studies were found that used RNA-Seq data for identifying AS events in HNC. Five softwares were used by these studies to identify AS events, of which Suppa and AltAnalyze can also categorize all four AS events to subtypes, i.e., cassette exon skipping (ES), intron retention (IR), mutually exclusive exon (MXE), and alternative 5′ and 3′ splice site (ASS). Additionally, SplAdder, ASprofile, JuncBASE, and MATS softwares have been used to identify and categorize AS events in cancers other than HNC. Conclusion: Alternate splicing in HNC is a complex regulatory process of gene expression. It can be studied through RNA-Seq using various bioinformatics softwares. SplAdder, ASprofile, JuncBASE, and MATS have been used to identify and characterize other cancers, but not implemented in HNC, and hence could be used for studying AS in HNC.
The OncoSim Cancer Simulation Platform: A Tool to Project the Population Effects of Cancer Control Interventions in Canada
Authors: Fitzgerald N. , Gauvreau C. , Memon S. , Hussain S. , Coldman A. , Popadiuk C. , Evans W. , Wolfson M. , Flanagan W. , Nadeau C. , Asakawa K. , Garner R. , Miller A.
Published: September 2018

Background: Cancer control interventions exert their effects over multiple decades. To evaluate diverse and competing opportunities to reduce future cancer burden it is desirable to understand long-term effects prior to any new program implementation or significant change. Internationally, modeling is becoming an accepted source of planning information for decision-makers. Aim: We will describe the construction and use of the OncoSim microsimulation model, which was developed to evaluate cancer control strategies in Canada. Methods: OncoSim is a suite of models (cancers of the lung, colorectum, cervix and breast, plus a composite 32-cancer model) used to address key policy questions and support decision-making. It is led by the Canadian Partnership Against Cancer with model development by Statistics Canada. OncoSim incorporates risk factors, cancer natural history, screening, treatment, survival and end-of-life care. Wherever possible it is informed by Canadian data sources. Models are calibrated to reproduce a range of cancer-specific statistics, e.g., current and historical Canadian cancer-specific incidence and mortality, smoking patterns, and results of screening. The site-specific models have undergone further validation by replicating reported short-term effects of cancer prevention and screening interventions. Users may customize interventions through modifying input parameters. Outputs include incidence, mortality, costs, cost-effectiveness, and resource utilization. Users from the public sector have access at no cost to OncoSim and receive extensive support from a multidisciplinary technical team. The model is continually updated to incorporate emerging knowledge. Results: OncoSim has been used to support cancer control decision-making at the national and provincial/territorial levels. Applications include: national guidelines recommendations for colorectal and lung cancer screening; comparison of cytology vs. HPV based cervical cancer screening; and integration of smoking cessation into low-dose CT lung cancer screening. Conclusion: Validated simulation models such as OncoSim can be a versatile and efficient tool for cancer control planners to evaluate and prioritize cancer control strategies.
Overview of Ten Years (2007-2016) Cervical and Breast Cancer Screening Program in Indonesia
Authors: Wahidin M.
Published: September 2018

Background: Cervical and breast cancer screening have been national program in Indonesia since 2007. The Ministry of Health of Indonesia in collaboration with provincial and district government developed and implemented the program. Method of cervical cancer screening was visual inspection with acetic acid (VIA) or Papanicolaou test and early treatment with cryotherapy for VIA positive. Meanwhile, method of breast cancer screening was clinical breast examination (CBE). After 10 years of implementation, it need to know how the program was conducted and what the results are. Aim: The study was aimed to know activities and results of cervical and breast cancer screening in 10 years (2007-2016). Methods: Design of the study was descriptive study through literature and data review from related data and information sources. Secondary data were collected from Directorate of Non Communicable Disease Control, Ministry of Health, Directorate of Primary Health Service, and professionals. The study was conducted in November-December 2017. Results: Program of cervical and breast cancer screening was started by pilot project in 2007 by 6 districts of 6 provinces in Indonesia: Jakarta, West Java, Central Java, Jogjakarta, North Sumatera, and South Sulawesi. By April 21, 2008 the program was launched as national program by Indonesian First Lady. Then, the program was developed in all province in Indonesia. Activities conducted to develop the program were training of trainers at national level, trainings at district level, socialization to community, providing services of the screening, monitoring, and evaluation. The screening was provided by trained health care provider (general practitioner and midwife) in primary health centers with referral system to district/municipality hospitals. Target of the program was women aged 30-50 years. Since 2007 till 2016, the program was running in all 34 (100%) provinces, 393 out of 514 districts/municipalities (76%), 3706 out of 9813 primary health centers (38%). Clinical trainers of the program were 366 persons consists of OB/GYN oncologist, OB/GYN surgeon oncologist, surgeon, general practitioners, and midwives. Providers of screening were 8526 persons consists of 2783 general practitioners, and 5743 midwives (2.3 providers per primary health center). There were 375 cryotherapy set for early treatment of VIA positive. The result of ten years cervical and breast cancer screening showed that 1,925,943 women have been screened or 5.15% of target 37.4 million women. It was still lower than target of 20% in 2016. VIA positive 73,453 women (3.8%), suspect of cervical cancer 1739 (1 per 1000), lump/tumor in the breast 4030 women (2.1 per 1000). Conclusion: Cervical and breast cancer screening program was running in all provinces and majority of district/municipalities in Indonesia with adequate human resources, but the coverage of the screening was still low.
Users of the Telephone Cancer Information Service Becomes Better at Coping With Their Situation
Authors: Scheuer S.
Published: September 2018

Background: More than 37,000 Danes were diagnosed with cancer last year and approximately 285,000 Danes are cancer survivors. The Danish Cancer Society offers professional information and counseling free of charge to all people affected by cancer. Last year, the telephone cancer information service Kræftlinjen received more than 14,000 inquiries, the majority from patients, relatives and bereaved. User surveys are usually conducted immediately after the users' contact with the cancer information service, and thus, only capture the users' experiences with and short-term effects of the contact. To investigate the long-term effects, a follow-up survey was recently conducted as a supplement to the latest user survey of the cancer information service. Aim: The follow-up survey aims to investigate the long-term effects of using the cancer information service focusing on the users' perception of their situation after the contact including their perceived changes in behavior and their ability to communicate with others about the disease. Methods: In March-April 2017, users of the cancer information service were encouraged to answer a questionnaire about their experiences with this service. The questionnaire was sent by either mail or e-mail. In total, 461 users participated in this survey. Two hundred and twenty six users (49%) agreed to receive a short follow-up questionnaire three months after their initial contact with the telephone cancer information service. One hundred and thirty six users (60%) participated in this follow-up survey. Results: The majority of the respondents reported that their conversation with the telephone cancer information service led to changes in their perception of their situation (77%) and made them better at coping with their situation (79%). As an example, some participants described that the conversation made them more calm and able to accept their situation, which again led them to feel less stressed and anxious. In addition, many users stated that they had become more able to communicate with others about their disease (66%) and that the contact had let to changes in their behavior (63%). Some participants described to have contacted the hospital or their doctor after their contact with the cancer information service and some described that they had become better at asking health personnel questions about the disease. Others had become more aware of their rights and of looking out for themselves or others. Most participants (77%) stated that they had not felt a need to contact the cancer information service again. Conclusion: The majority of the participants experienced that the cancer information service had made them better capable of coping with their situation.
Little Hands Beating Cancer: Building Resource Capacity for Cancer Control in Sub-Saharan Africa
Authors: Ikara B. , Ebusu P. , Mugisha N. , Orem J.
Published: September 2018

Background and context: Uganda Child Cancer Foundation (UCCF) is a nongovernmental organization that was formed in 2006, as an in-house fundraising charity for Uganda Cancer Institute (UCI). UCCF mobilizes treatment and social support for vulnerable children battling cancer and advocates for cancer control in Uganda. It is mainly managed by childhood cancer survivors/volunteers and individuals directly affected by cancer. Children Caring about Cancer (3C) program is a strategic approach through which UCCF supports children in schools to start cancer clubs which are called 3C clubs. Aim: The main aim is to create a platform through which school going children are empowered with knowledge and experiences to enable them appreciate the cancer burden and create opportunities for them to develop and implement interventions addressing the burden of cancer at their level. Strategy/Tactics: UCCF works closely with UCI in cancer control, UCI is a Uganda Ministry of Health national technical arm of government. UCCF was formed to raise awareness about cancer in the communities and public especially with the young people and also to support children with cancer, UCCF reaches high school students and teachers with cancer education and awareness through the ministry of education and school administration structures. UCCF runs a social media campaign dabbed #3ChildrenCaringAboutCancer which uses activities done by the clubs as posts targeting children, policy makers and the community. In addition, UCCF launched a national children cancer conference in 2016 as a unique platform for stakeholder engagements and for highlighting work the children are doing in cancer control. Program/Policy process: The UCCF-3C recruits and works with children in schools by establishing cancer clubs. The clubs run activities geared toward cancer awareness, patient support and community outreach/advocacy. The clubs are headed by patrons and student-led club executives. The executive is responsible for leadership and recruitment of fellow young people through a child to child process. The patrons are trained to act as mentors to the executive to support various 3C programs in school. The patrons have an interschool committee that enables them to network and plan to support the children and club needs. UCCF works with the UCI to coordinate 3C club activities, patrons, and students leaders in sustaining the clubs in schools. Outcomes: In 85 3C school clubs formed, the program has reached; 85,000 children, 3000 teachers and over 170,000 guardians. Young people have been able to contribute to cancer control in Uganda through cancer awareness, advocacy and patient support. What was learned: Children Caring about Cancer (3C) program is strategic for building resource capacity for sustainable cancer control in Uganda.