Knowledge and Health Belief Attitudes of Oral Cancer and Its Screening Among At-Risk Southern Thai Muslims

Oral cancer epidemiology in relation to inter-country disparities in human development in south and Southeast Asia

OBJECTIVES

South Asia (SA) and Southeast Asia (SEA) are geographically close; however, discrepancies in oral cancer (OC) epidemiology exist between the two regions. Socioeconomic disparities may influence the OC burden. The aim of this study was to assess the epidemiology of OC and its relationship with the Inequality Adjusted Human Development Index (IHDI) and its components in SA and SEA.

METHODS

Cancer data for this ecological study was obtained from GLOBOCAN 2020, while the IHDI was obtained from the Human Development Report 2020. Based on data availability, 14 SA and SEA countries were chosen. Poisson log-weighted regression models were employed to examine IHDI and its components in relation to incidence and mortality. Univariate linear regression models were utilized to determine the association between the mortality-to-incidence ratio (MIR) and the IHDI.

RESULTS

Mortality and MIR of OC were negatively correlated with all sub-indices of the IHDI, including education, health and income. However, incidence and mortality of OC were influenced by region and sex.

CONCLUSIONS

Higher IHDI countries tended to have lower MIR. SA and males showed higher incidence and mortality. Reducing intra-country inequalities in development may be a pragmatic approach to enhancing the OC burden and prognosis.

Relationship between social support and self-perceived burden in patients with obstructive sleep apnea: an analysis of chain-mediated effects

OBJECTIVE

To estigate the relationship between social support, self-efficacy, coping style, and self-perceived burden and the mechanisms that underlie the action in Chinese OSA patients.

METHODS

Between October 2022 and June 2023,316 OSA patients from two hospitals were surveyed. Data were collected using the General Demographic Characteristics Questionnaire, Social Support Rating Scale (SSRS), Self-Efficacy for Chronic Disease Scale (SECD6), and Simple Coping Style Questionnaire (SCSQ). Correlation analysis was performed using Pearson correlation. Regression analysis was performed using multiple linear regression analysis. The mediation effect analysis was performed using the Process macro (version 3.4.1) in SPSS.

RESULTS

(1)This study confirmed that social support, self-efficacy, and coping styles had significant negative predictions regarding self-perceived burden. (2)The influence of social support on self-perceived burden in OSA patients is mainly through three indirect effects: single mediation effect of self-efficacy and coping style and interlocking mediation effect of self-efficacy→coping style.

CONCLUSION

Social support can indirectly predict self-efficacy in OSA patients through the single mediation effect of self-efficacy and coping style and indirectly predict the self-perception burden in OSA patients through the linked mediation effects of self-efficacy and coping style.

The duration of intervals on the oral cancer care pathway and implications for survival: a systematic review and meta-analysis

Introduction

Previous studies measuring intervals on the oral cancer care pathway have been heterogenous, showing mixed results with regard to patient outcomes. The aims of this research were (1) to calculate pooled meta-analytic estimates for the duration of the patient, diagnostic and treatment intervals in oral cancer, considering the income level of the country, and (2) to review the evidence on the relationship of these three intervals with tumor stage at diagnosis and survival.

Materials and methods

We conducted a systematic review with meta-analysis following PRISMA 2020 guidelines (pre-registered protocol CRD42020200752). Following the Aarhus statement, studies were eligible if they reported data on the length of the patient (first symptom to first presentation to a healthcare professional), diagnostic (first presentation to diagnosis), or treatment (diagnosis to start of treatment) intervals in adult patients diagnosed with primary oral cancer. The risk of bias was assessed with the Aarhus checklist.

Results

Twenty-eight studies reporting on 30,845 patients met the inclusion criteria. The pooled median duration of the patient interval was 47 days (95% CI = 31-73), k = 18, of the diagnosis interval 35 days (95% CI = 21-38), k = 11, and of the treatment interval 30 days (95% CI = 23-53), k = 19. In lower-income countries, the patient and treatment intervals were significantly longer, and longer patient intervals were related to later stage at diagnosis. In studies with a lower risk of bias from high-income countries, longer treatment intervals were associated with lower survival rates.

Conclusion

Interval duration on the oral cancer care pathway is influenced by the socio-economic context and may have implications for patient outcomes.

Factors influencing patient delay in individuals with obstructive sleep apnoea: a study based on an integrated model

BACKGROUND

Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder, yet it remains undiagnosed in a large proportion of adults.

OBJECTIVE

This study aims to investigate the status of patient delay and provider delay in OSA patients and examine related factors affecting patient delay in OSA individuals in China.

METHODS

A cross-sectional design was conducted on a sample of 309 OSA patients (aged from 18 to 76, median age of 47 years, 84.8% male) in Northeast China. Participants were required to complete the sociodemographic questionnaire, the symptom characteristics questionnaire, the help-seeking attitude scale (HSAS), the social support rating scale and the chronic disease self-efficacy scales (CDSES) to test the hypothesis. Binary logistic regression analysis was conducted to explore factors that account for the patient delay.

RESULTS

The median patient delay among OAS patients in this study was 22 months, the median provider delay was one month, and the median total delay was 26 months. As shown by multivariate analysis results, patients who have snored for over 6 years (OR = 3.377, 95%CI: 1.175-9.702) were more likely to experience prolonged patient delays. Per capita monthly family income above 3000 RMB (OR = 0.172, 95%CI: 0.052-0.571), taking up residence in cities or towns (OR = 0.484, 95%CI: 0.248-0.946), higher self-recognition of the disease (OR = 0.793, 95%CI: 0.647-0.972), higher objective support (OR = 0.825, 95%CI: 0.739-0.921) and stronger self-efficacy (OR = 0.674, 95%CI: 0.525-0.867) were significantly associated with shorter patient delays.

CONCLUSION

Patient delay is common in Chinese OSA patients. The upstream factors affecting the patient delay in individuals with OSA include income, place of residence, and objective support; midstream factors include self-recognition of the disease and self-efficacy; downstream factors include years of snoring.KEY MESSAGESDespite being a high-prevalence disease, many obstructive sleep apnoea (OSA) patients are not clearly diagnosed and treated.The factors affecting the delay in seeking medical treatment in individuals with OSA included income, place of residence, objective support, self-recognition of the disease, self-efficacy and years of snoring.Investigations into OSA patients' care-seeking behaviours can better reflect the secondary prevention of OSA, and it is crucial to pay attention to the delayed phase of patients.

The Big Five personality traits and regularity of lifetime dental visit attendance: evidence of the Survey of Health, Ageing, and Retirement in Europe (SHARE)

Background

Regular dental visits are essential for the prevention, early detection and treatment of worldwide highly prevalent oral diseases. Personality traits were previously associated with treatment compliance, medication adherence and regular doctor visits, however, the link between personality traits and regular dental visit attendance remains largely unexplored. Thus, the objective of this study is to clarify this link.

Methods

Data (wave 7) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used, focusing on Germany (n = 2822). Personality was assessed using the 10-item Big Five Inventory (BFI-10). Regular dental visits were assessed. Multiple logistic regressions were used, adjusting for various covariates.

Results

Majority of the participants (84%) reported to attend regular dental visits during lifetime. Regularity of lifetime dental visit attendance was positively and significantly associated with increased extraversion [OR 1.13, 95% CI (1.01–1.26)], increased conscientiousness [OR 1.26, 95% CI (1.10–1.44)], and increased openness to experience [OR 1.12, 95% CI (1.01–1.26)]. However, there was a lack of association with agreeableness and neuroticism. Moreover, the outcome measure was positively associated with younger age, being female, born in Germany, being married, higher education, being retired (compared to being homemaker), whereas it was not associated with obesity or chronic diseases.

Conclusions

Identification of personality traits that are associated with regular dental visits can support prevention, screening and clinical management of oral diseases. Further research in this field may facilitate the development and increase the incorporation of individualized concepts to enhance patient compliance and attendance, and thus the provision of oral and dental care services.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-02051-2.

Promoting Colorectal Cancer Screening in South Asian Muslims Living in the USA

Colorectal cancer is one of the more common forms of cancer in South Asian men and women. Despite the rates of colorectal cancer (CRC) in South Asians, the CRC screening rates remain low in South Asians and Muslims compared with those in Whites and other ethnic minorities in the USA. Religious and cultural barriers have been examined in relation to other types of cancer such as breast and cervical cancers. However, few data are available about CRC screening among Muslims, particularly South Asian American Muslims. A community-based participatory research approach was used to assess attitudes toward CRC screening and various cultural, religious, and gender barriers that prevent CRC screening expressed by Muslim South Asian men and women in the larger San Francisco Bay Area. Six focus groups were conducted (three males and three females) with South Asian American Muslims. The focus groups consisted of a total sample size of n = 32, with 15 men and 17 women, with the average age of participants being 57 years old. This study highlighted key religious, cultural, and gender barriers to CRC screening including lack of awareness of CRC, the notion of fatalism as it relates to screening, lack of emphasis on preventive health, the need to preserve modesty, and stigma around certain CRC screening practices. Religiously tailored interventions and culturally sensitive healthcare providers are needed to better promote CRC screening in South Asian Muslim communities and to help inform the design of health interventions and outreach strategies.

The Prevalence and Correlates of Prehospital Delay and Health Belief in Chinese Patients With Colorectal Cancer

The objective of this study was to describe prehospital delay and health beliefs in Chinese patients with colorectal cancer. A total of 756 adult Chinese patients with a first-time diagnosis of colorectal cancer were recruited during 2016 in Guangzhou, China. All patients completed the Chinese-language version of a questionnaire developed specifically for this study as well as the Chinese-language version of the Champion Health Belief Model Scale. The results of this study showed that the median length of the prehospital delay was 12 weeks and that the average delay was 18.29 (SD = 14.66) weeks. The rate of prehospital delay was 47.35%. The score of health beliefs among these patients was 115.56 (SD = 9.00) and the average score of the entries was 3.21 (SD = 0.25). Health beliefs about colorectal cancer were negatively correlated with prehospital delay. A multiple logistic regression showed that the level of health beliefs, frequency of physical examinations, occupation, and the site of the cancer were the major factors influencing prehospital delay (p < .05). The patients had a low rate of physical examination (41.40%), and colorectal cancer screening was not routine prior to their physical examination. This study showed that the incidence of prehospital delay among Chinese patients with colorectal cancer was 47.35%. Multiple factors influenced prehospital delay among Chinese patients with colorectal cancer.

The Effect of an Educational Intervention Based on PRECEDE Model on Oral Cancer Prevention Behaviors in Hookah Users

Educational intervention about oral cancer prevention is essential for all people, especially in hookah users. The aim of this study is investigating the effect of an educational intervention based on PRECEDE model on oral cancer prevention in hookah users living in Fasa, Fars Province, Iran, in 2017-2018. In this quasi-experimental study, 360 hookah users were selected and divided into experimental and control groups (180 subjects for each group). Educational intervention was performed for experimental group in 12 sessions. A questionnaire consisting of items evaluating demographic information and PRECEDE model constructs (knowledge, attitude, self-efficacy, enabling factors, and reinforcing factors) was used to measure oral cancer prevention behaviors and nicotine dependency of subjects before and 6 months after intervention. Obtained data were analyzed by SPSS-22 software through paired t test, independent t test, and chi-square test at significance level of P < 0.05. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, reinforcing factors, oral cancer prevention behaviors, and reduction of nicotine dependency compared with control group. This study showed the efficiency of educational intervention based on PRECEDE model in adoption of oral cancer prevention behaviors and reduction of nicotine dependency of hookah users 6 months after intervention.

Screening for oral cancer: Future prospects, research and policy development for Asia

Although the incidence of oral cavity cancer is high among low and middle income countries in Asia where the risk habits (tobacco smoking, tobacco chewing and betel quid use) are common, the benefits for introducing oral cancer screening for the whole population in these countries still remains controversial. It is disappointing, but not surprising that many of studies, without control arms, could not provide a clear answer as to whether screening is effective in reducing mortality or combating rising incidence trends. Only one Indian study that reported a randomized controlled trial (RCT) elucidated that mass screening for high risk groups could significantly reduce the cancer mortality or down-stage cancers detected by screening. Several professional organizations that considered any potential benefits of oral cancer screening remain unconvinced that the current knowledge on its natural history, available tests and interventions to treat potentially malignant disorders satisfy the desirable criteria to recommend organized screening for oral cancer. In this review we discuss advantages and disadvantages for oral cancer screening particularly with reference to high incidence countries in Asia. If screening is undertaken, we propose that it is targeted to high risk groups and to combine screening with education on risky life-styles so that overall incidence can be reduced in the future. Further research on increasing public awarenes and impact of professional education such as e-learning to reduce diagnostic delays, studies on the natural history of oral potentially malignant disorders and cancer, comprehensive tobacco and areca nut cessation programs, developing tools to identify high-risk individuals and high-risk lesions are proposed.

Barriers to cervical cancer screening and acceptability of HPV self-testing: a cross-sectional comparison between ethnic groups in Southern Thailand

BACKGROUND

Cervical cancer rates are higher in low-resourced countries than high, partly due to lower rates of screening. Incidence in Thailand is nearly three times higher than in the USA (16.2 vs 6.5 age-standardised incidence), even with Thailand's universal health coverage, which includes screening, suggesting that alternative methods are needed to reduce the burden. We investigated barriers to screening, as well as acceptability of self-collection human papillomavirus (HPV) testing as a primary form of cervical cancer screening among Buddhist and Muslim communities in Southern Thailand.

METHODS

267 women from the Buddhist district of Ranot and Muslim district of Na Thawi, Songkhla were recruited to complete a survey assessing knowledge and risk factors of HPV and cervical cancer. Participants were offered an HPV self-collection test with a follow-up survey assessing acceptability. Samples were processed at Prince of Songkhla University and results were returned to participants.

RESULTS

267 women participated in the study (132 Buddhist, 135 Muslim), 264 (99%) self-collecting. 98% reported comfort and ease, and 70% preferred it to doctor-facilitated cytology. The main predictor of prior screening was religion (92% Buddhist vs 73% Muslim reporting prior Pap). After adjustment with multivariate logistic models, Muslim women had an OR of prior Pap of 0.30 compared with Buddhist (95% CI: 0.12 to 0.66).

CONCLUSIONS

Self-collection HPV testing was highly acceptable across religious groups, suggesting that it could be beneficial for cervical cancer reduction in this region. Focus should be put into educating women from all backgrounds about the importance of screening to further improve screening rates among Thai women.

Effectiveness of Health Belief Model on Oral Cancer Prevention in Smoker Men

The purpose of the present study is investigating the effect of educational intervention based on health belief model (HBM) on oral cancer prevention in smoker men. This is a quasi-experimental study carried out on 200 smoker men with the age of 40 or older (100 subjects for the experimental group and 100 subjects for control group) resident in Fasa City, Fars Province, Iran, in 2017-2018. The educational intervention for the experimental group included seven educational sessions for 50 or 55 min-based HBM. A questionnaire consisted of items about demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action) was used to measure the oral cancer prevention before and 6 months after the intervention. The mean age of the men was 51.35±8.41 years in the experimental group and 52.28±8.09 years in the control group. Based on the obtained results, significant enhancement is observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors in experimental group; however, no significant changes are observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors of control group. Also, results indicated that, the educational program based on HBM model have positive effect on oral cancer prevention with the improvement of subject's knowledge, perceived susceptibility, severity, benefits, and self-efficacy.

Potential of Zerumbone as an Anti-Cancer Agent

Cancer is still a major risk factor to public health globally, causing approximately 9.8 million deaths worldwide in 2018. Despite advances in conventional treatment modalities for cancer treatment, there are still few effective therapies available due to the lack of selectivity, adverse side effects, non-specific toxicities, and tumour recurrence. Therefore, there is an immediate need for essential alternative therapeutics, which can prove to be beneficial and safe against cancer. Various phytochemicals from natural sources have been found to exhibit beneficial medicinal properties against various human diseases. Zerumbone is one such compound isolated from Zingiber zerumbet Smith that possesses diverse pharmacological properties including those of antioxidant, antibacterial, antipyretic, anti-inflammatory, immunomodulatory, as well as anti-neoplastic. Zerumbone has shown its anti-cancer effects by causing significant suppression of proliferation, survival, angiogenesis, invasion, and metastasis through the molecular modulation of different pathways such as NF-κB, Akt, and IL-6/JAK2/STAT3 (interleukin-6/janus kinase-2/signal transducer and activator of transcription 3) and their downstream target proteins. The current review briefly summarizes the modes of action and therapeutic potential of zerumbone against various cancers.

Differences in prostate tumor characteristics and survival among religious groups in Songkhla, Thailand

BACKGROUND

The incidence and mortality from prostate cancer is expected to increase in the next decade in Thailand. Despite the perceived lower risk in this population vs. developed, western countries, it is becoming an important public health issue. Prostate cancer incidence varies between the most predominant religious groups in Thailand, Buddhists and Muslims. However limited data is available describing the prostate cancer survival in these two populations. Here we examine differences in prostate tumor characteristics and survival between Buddhists and Muslims in the province of Songkhla, Thailand.

METHODS

945 incident prostate cancer cases (1990-2014) from the population-based Songkhla Cancer Registry were used in this analysis. Age, grade, stage, and year at diagnosis were compared across religious groups, using Wilcoxon or Chi-square tests. Kaplan Meier methods were used to estimate the median survival time and 5-year survival probabilities. Cox proportional hazards models were used to estimate hazard ratios (HR) between religious groups and 95% confidence intervals (CI) for mortality in age-adjusted and fully-adjusted models.

RESULTS

Prostate tumor characteristics, age, and year at diagnosis were similar across religious groups. The median survival time after diagnosis of prostate cancer was longer in Buddhists 3.8 years compared with Muslims 3.2 years (p = 0.08). The age-adjusted risk of death after prostate cancer diagnosis was higher in Muslims compared with Buddhists (HR: 1.31; 95%CI: 1.00, 1.72). After adjustment by stage and grade, results were slightly attenuated (HR: 1.27, 95%CI: 0.97, 1.67).

CONCLUSION

Muslims have shorter survival after prostate cancer diagnosis than do Buddhists in Thailand. The reasons underlying this difference require additional investigation in order to design targeted interventions for both populations.