Qualitative studies implicate knowledge of cancer symptoms and attitudes towards help-seeking as important factors in patient delay. The present study uses quantitative data from a population-based ...survey to test the hypotheses that (a) a greater knowledge of early cancer symptoms is associated with a higher likelihood of having appraised a symptom as possibly due to cancer, and (b) more negative attitudes towards help-seeking are associated with a lower likelihood of having sought medical advice for that symptom.
Two thousand and seventy-one adults were asked whether they had experienced a symptom that they worried might be cancer in the past 3 months, and if so, whether they had seen a doctor. Respondents also completed the Cancer Awareness Measure (CAM) assessing symptom knowledge and barriers to help-seeking.
Two hundred and thirty-six (11.4%) respondents reported having experienced a possible cancer symptom. In logistic regression analyses controlling for age, sex, and self-rated health, higher CAM symptom knowledge scores were associated with a greater likelihood of having experienced a possible cancer symptom (odds ratio = 1.09; 95% confidence interval, 1.01-1.17). Of those who had experienced a symptom, 75% (177/236) had seen a doctor. Higher scores on the CAM barriers scale were associated with being less likely to have seen a doctor (odds ratio, 0.74; 95% confidence interval, 0.63-0.87).
Better knowledge of the signs and symptoms of cancer might help people recognize possible cancer symptoms and therefore reduce appraisal delay, whereas more positive attitudes towards help-seeking might reduce behavioral delay.
Campaigns to educate the public about cancer symptoms and reduce help-seeking barriers could play a role in promoting early diagnosis.
Objectives Cancer's insidious onset and potentially devastating outcomes have made it one of the most feared diseases of the 20th century. However, advances in early diagnosis and treatment mean that ...death rates are declining, and there are more than 30 million cancer survivors worldwide. This might be expected to result in more sanguine attitudes to the disease. The present study used a qualitative methodology to provide an in-depth exploration of attitudes to cancer and describes the balance of negative and positive perspectives. Design A qualitative study using semistructured interviews with thematic analysis. Setting A university in London, UK. Participants 30 participants (23–73 years), never themselves diagnosed with cancer. Results Accounts of cancer consistently incorporated negative and positive views. In almost all respondents, the first response identified fear, trauma or death. However, this was followed—sometimes within the same sentence—by acknowledgement that improvements in treatment mean that many patients can survive cancer and may even resume a normal life. Some respondents spontaneously reflected on the contradictions, describing their first response as a ‘gut feeling’ and the second as a more rational appraisal—albeit one they struggled to believe. Others switched perspective without apparent awareness. Conclusions People appear to be ‘in two minds’ about cancer. A rapid, intuitive sense of dread and imminent death coexists with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognising cancer's public image could help in the design of effective cancer control messages.
While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ...ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP).
Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks).
The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 - 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 - 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 - 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 - 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 - 1.07, p = 0.74).
Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised.
Abstract Objective To identify levels of cervical cancer risk factor and symptom awareness, as well as predictors of higher awareness in a United Kingdom (UK) female population. Design Population ...based survey. Setting Participants’ homes in the UK. Sample UK representative sample of females aged 16 years and over ( n = 1392). Materials and methods Respondents completed the Cervical Cancer Awareness Measure which included questions on awareness of cervical cancer symptoms and risk factors (both recalled and recognised). Linear regression analyses were used to identify predictors of higher symptom and risk factor recognition scores. Main outcome measures Awareness of cervical cancer symptoms and risk factors. Results Sixty-five percent of respondents were unable to recall any risk factors and 75% were unable to recall any symptoms. Awareness was higher when women were prompted (95% recognised at least one risk factor and 93% at least one symptom). Independent predictors of risk factor recognition were older age and higher education. Symptom recognition was associated with older age, White ethnicity, higher education and having a close experience of cervical cancer. Conclusions To reduce inequalities in awareness, interventions should target younger women with lower education and those from ethnic minority groups.
To develop and validate a lung cancer awareness measure (Lung CAM) and explore the demographical and social predictors of lung cancer awareness in the general population. METHODS STUDY 1: Symptoms ...and risk factors for lung cancer were identified from the medical literature and health professional expertise in an iterative process. Test-retest reliability, internal reliability, item analyses, construct validity and sensitivity to changes in awareness of the Lung CAM were assessed in three samples (total N=191). RESULTS STUDY 1: The Lung CAM demonstrated good internal (Cronbach's α=0.88) and test-retest reliability (r=0.81, p<0.001). Validity was supported by lung cancer experts scoring higher than equally educated controls (t(106)=8.7, p<0.001), and volunteers randomised to read lung cancer information scoring higher than those reading a control leaflet (t(81)=3.66, p<0.001). METHODS STUDY 2: A population-based sample of 1484 adults completed the Lung CAM in a face-to-face, computer-assisted interview. RESULTS STUDY 2: Symptom awareness was low (average recall of one symptom) and there was little awareness of risk factors other than smoking. Familiarity with cancer, and being from a higher socioeconomic group, were associated with greater awareness.
Using a valid and reliable tool for assessing awareness showed the UK population to have low awareness of lung cancer symptoms and risk factors. Interventions to increase lung cancer awareness are needed to improve early detection behaviour.
Fatalistic beliefs about cancer have been implicated in low uptake of screening and delay in presentation particularly in low socioeconomic status (SES) groups, but no studies have systematically ...evaluated interrelationships between SES, fatalism, and early detection behaviors. We explored whether (i) fatalism is associated with negative attitudes toward early detection, (ii) lower SES groups are more fatalistic, and (iii) SES differences in fatalism partly explain SES differences in attitudes toward early detection.
In a population-representative sample of adults in Britain using computer-based interviews in the home setting, respondents (N = 2,018) answered two questions to index fatalism (expectations of cancer survival and cure) and two items on early detection attitudes (the perceived value of early detection and fear of symptom reporting). SES was indexed with a social grade classification.
Fatalism was associated with being less positive about early detection (β = -0.40, P < 0.001) and more fearful about seeking help for a suspicious symptom (β = 0.24, P < 0.001). Lower SES groups were more fatalistic (β = -0.21, P < 0.001). Path analyses suggest that SES differences in fatalism might explain SES differences in attitudes about early detection.
In this population sample, SES differences in fatalism partly explained SES differences in the perceived value of early detection and fear of symptom presentation.
Fatalistic beliefs about cancer should be targeted to promote early presentation of cancer and this may be particularly important for lower SES groups.
This paper describes the development of a Cancer Awareness Measure for colorectal (CRC) cancer (Bowel/Colorectal CAMa) (study 1) and presents key results from a population-representative survey using ...the measure (study 2).
STUDY 1: Items were taken from the literature and reviewed by expert groups. A series of three validation studies assessed reliability and validity of the measure. To establish test-retest reliability, 49 people over 50 years of age completed the Bowel/Colorectal CAM on two occasions (range 9-14 days, mean 13.5 days). Construct validity was assessed by comparing responses from bowel cancer experts (n = 16) and the lay public (n = 35). Lastly, a brief intervention study tested sensitivity to change with participants (n = 70) randomly allocated to be given a control leaflet or an intervention leaflet and their responses were compared. STUDY 2: 1520 respondents completed the Bowel/Colorectal CAM in a population survey carried out by TNS-British Market Research Bureau International (TNS-BMRB) in March 2010.
STUDY 1: Internal reliability (Cronbach's alpha = 0.84) was high. Test-retest reliability was over r = 0.7 for warning signs, risk factors and age people are first invited for screening, but lower (between 0.6 and 0.7) for other items (lifetime risk, awareness of bowel cancer screening, age at risk). Bowel cancer experts achieved higher scores than equally educated controls (54.7 4.3 vs. 42.9 5.7; P < 0.001) demonstrating the measure has construct validity and intervention participants showed higher knowledge than controls (51.4 5.9 vs. 42.9 5.7; P < 0.001) suggesting the measure is sensitive to change. STUDY 2: Respondents recalled on average, one CRC sign and one risk factor. There was particularly low prompted awareness of the signs 'lump in the abdomen' (64%) and 'tiredness' (50%) and several lifestyle risk factors for CRC, e.g. exercise (37%).Respondents from more affluent groups had consistently higher knowledge of signs and risk factors compared to those from more deprived groups.
The Bowel/Colorectal CAM meets accepted psychometric criteria for reliability and construct validity and should therefore provide a useful tool for assessment of CRC awareness. The population survey revealed low awareness of several CRC signs and risk factors and emphasises the importance of continuing public education, particularly about the link between lifestyle behaviours and CRC.
Oral suspensions are heterogeneous disperse systems, and the particle size distribution, crystalline form of the dispersed solid, and composition of the formulation can be listed as parameters that ...control the drug dissolution rate and its bioavailability.
The aim of this work was to develop a discriminative dissolution test, which, in association with in silico methodologies, can make it possible to safely anticipate bioavailability problems.
Nimesulide and ibuprofen (BCS class II) and cephalexin (BCS class I) oral suspensions were studied. Previously, solid-state structure and particle size in active pharmaceutical ingredients were characterized and the impact of differences on solubility was evaluated for the choice of discriminative medium. Afterwards, particle size distribution (0.1 to 360 μm), dissolution profile, and
permeability in Caco-2 cell of commercial suspensions, were determined. These parameters were used as input for the establishment of the
correlation (IVIVC) for the suspensions using the GastroPlus™ with Wagner-Nelson and Loo- Riegelmann deconvolution approach.
The predicted/observed pharmacokinetic model showed good correlation coefficients (r) of 0.960, 0.950, and 0.901, respectively. The IVIVC was established for one nimesulide and two ibuprofen suspensions with r between 0.956 and 0.932, and the percent prediction error (%PE) did not exceed 15%.
In this work, we have performed a complete study combining
approaches with the aim of anticipating the safety and efficacy of oral pharmaceutical suspensions in order to provide a regulatory tool for this category of products in a faster and more economical way.
Symbiotic microorganisms influence health and disease and may contribute to the innate immune defenses of amphibians. The mountain yellow-legged frog,
Rana muscosa, is currently undergoing ...unprecedented population declines. One cause of recent declines is the pathogenic chytrid fungus,
Batrachochytrium dendrobatidis (
Bd). Skin swabs for detection of
Bd, skin peptide secretions, and symbiotic skin bacteria were collected from 70 adult
R. muscosa from two populations designated “Sixty Lake” and “Conness” in 2004–2005. The Conness population has persisted with the presence of
Bd for at least 6 years whereas the Sixty Lake population is newly infected and declining. Of the frogs sampled at Conness, 67.5% were infected; whereas 96.7% of the Sixty Lake frogs were infected. Sixty Lake frogs were also more intensely infected than frogs at Conness. We isolated symbiotic bacteria that may contribute to immune defense. A significantly greater proportion of individuals with at least one anti-
Bd bacterial species present were found at Conness (85%) than at Sixty Lake (62%). We observed no apparent differences in total skin peptides recovered; however, peptide mixtures from frogs at Sixty Lake showed better growth inhibitory activity against
Bd than peptides from frogs at Conness. By MALDI-TOF MS analysis, there were no differences between the two populations in the previously described antimicrobial peptides (ranatuerin-2Ma, ranatuerin-2Mb, and temporin-1M). Antimicrobial skin peptides are only one factor in the resistance of
R. muscosa to
Bd infection. We suggest that symbiotic bacteria with the ability to persist in the presence of mucosal peptides may inhibit infection and colonization of the skin by
Bd and increase the effectiveness of innate defense mechanisms in the skin.
Metformin is a euglycemic drug for the treatment of type 2 diabetes mellitus. To date, there are 13 dissolution methodologies described in the U.S. Pharmacopoeia (USP) to evaluate the release profile ...of metformin from extended-release tablets utilizing either a USP apparatus 1 (basket) or 2 (paddle). In the absence of a protocol for a USP apparatus 3 (reciprocating cylinder), the goal of this work was to develop an in vitro dissolution method for metformin extended-release tablets based on an in vivo–in vitro correlation (IVIVC). Following a systematic evaluation, a final dissolution method, M4, was defined. It applied 30 dips per minute (dpm) over a total period of 10 h into a series of solutions that included 2 h in HCl media (pH 1.2), 1 h in an acetate buffer solution (pH 4.5), 1 h in phosphate buffer solution (PBS) (pH 5.8) and 6 h in PBS (pH 6.8). This method showed a significant IVIVC with a calculated R2 > 0.98 (point-to-point correlation, Level A) and it was successfully used as a tool to assist in the development of generic extended release formulations for metformin consisting of a lipophilic matrix system.
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