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Objective To evaluate oral cancer screening by visual inspection. Methods A cluster randomized controlled trial was initiated in Trivandrum district, Kerala, India. Of 13 population clusters, seven were randomly allocated to three rounds of screening between 1996 and 2004, while standard care was provided in six (control arm). An activity-based approach was employed to calculate costs associated with various components of the screening trial. Information on the resources used and on clinical events in each trial arm was derived from trial databases. Total costs for each cluster were estimated in 2004 United States dollars (US$). The incremental cost per life-year saved was calculated for all eligible individuals and for high-risk individuals (i.e. tobacco or alcohol users). Findings The proportion of oral cancers detected at an early stage (i.e. stage I or II) was higher in the intervention arm than the control arm (42% versus 24%, respectively). The incremental cost per life-year saved was US$ 835 for all individuals eligible for screening and US$156 for high-risk individuals. Oral cancer screening by visual inspection was performed for under US$ 6 per person. Conclusion The most cost-effective approach to oral cancer screening by visual inspection is to offer it to the high- risk population. Targeted screening of this group will ensure that screening can be offered at a reasonable cost in a limited-resource setting. Objectif Evaluer le depistage du cancer buccal par examen visuel. Methodes Un essai controle randomise en grappes a ete lance dans le district de Trivandrum, dans l'Etat du Kerala, en Inde. Parmi les 13 grappes de population, 7 avaient ete affectees aleatoirement a trois tournees de depistage entre 1996 et 2004, tandis que les 6 autres (bras temoins) recevaient des soins standard. Les couts associes aux differentes composantes de l'essai de depistage ont ete calcules en procedant par activites. Des informations sur les ressources utilisees et les evenements cliniques dans chaque bras de l'essai ont ete tirees de bases de donnees d'essai. Le cout total pour chaque grappe a ete estime en dollars des Etats-Unis d'Amerique (US $) de 2004. Le cout marginal par annee de vie epargnee a ete calcule pour tous les individus admissibles dans l'etude et pour ceux a haut risque (c.-a-d. les consommateurs de tabac et d'alcool). Resultats La proportion de cancers buccaux detectes a un stade precoce (c.-a-d. au stade I ou II) etait plus elevee dans le bras d'intervention que dans le bras temoin (42 % contre 24 % respectivement). Le cout marginal par annee de vie epargnee etait de US $ 835 pour l'ensemble des individus admissibles dans l'etude et de US $156 pour les individus a haut risque. Le depistage du cancer buccal par examen visuel a ete pratique pour un cout inferieur a US $ 6 par personne. Conclusion La demarche la plus efficace sur le plan economique pour depister le cancer buccal par examen visuel consiste a proposer cet examen a la population a haut risque. Le depistage cible de ce groupe garantit la possibilite de proposer ce depistage a un cout raisonnable dans un pays a ressources limitees. Objetivo Evaluar el cribado del cancer de boca mediante inspeccion visual. Metodos Se llevo a cabo un ensayo controlado aleatorizado por conglomerados en el distrito de Trivandrum, Kerala, India. De 13 conglomerados de poblacion, siete se asignaron aleatoriamente a tres rondas de cribado realizadas entre 1996 y 2004, y en los otros seis se ofrecio la atencion habitual (grupo control). Se empleo un metodo basado en la actividad para calcular los costos asociados a diversos componentes del ensayo de cribado. La informacion relativa a los recursos empleados y los eventos clinicos en cada grupo de ensayo se extrajo de la base de datos correspondiente. Los costos totales para cada conglomerado se estimaron en dolares de los Estados Unidos (US$) de 2004. Se calculo el costo marginal por ano de vida ganado para todas las personas elegibles y para las personas de alto riesgo (es decir, consumidores de tabaco o alcohol). Resultados La proporcion de canceres de boca detectados en un estadio inicial (es decir, estadio I o II) fue mayor en el grupo de intervencion que en el grupo de control (42% frente a 24%, respectivamente). El costo marginal por ano de vida ganado fue de US$ 835 para todas las personas elegibles para el cribado, y de US$156 para las personas de alto riesgo. El cribado mediante inspeccion visual costo menos de US$ 6 por persona. Conclusion La opcion mas costoeficaz para cribar el cancer de boca mediante inspeccion visual consiste en ofrecer el tamizaje a la poblacion de alto riesgo. El cribado focalizado de tales grupos garantiza que ese tipo de examen se pueda ofrecer a un costo razonable en los entornos con recursos limitados., Une traduction en francais de ce resume figure 2, la fin del article. Al final de/articulo se facilita una traduccion al espanol Introduction Oral cancer is a major health problem [...] more...

The significant trend of the obesity epidemic leading to treatment of expensive, lifelong illnesses, especially among Hispanic children, confirms the need for efforts to increase provider adherence to clinical guidelines. This Quality Improvement Project was designed to examine how a practice intervention influenced provider adherence to childhood obesity guidelines among Hispanic children. The practice intervention, based on a unique practice model, consisted of provider awareness, provider involvement, and collaborative support by the researcher. Statistically significant results were obtained regarding guideline adherence. The practice model developed for implementing guidelines in this study will be of benefit to other clinicians. The main project outcome was that the model resulted in significant changes in practice patterns and increased provider adherence to aspects of childhood obesity clinical guidelines. The Practice Improvement Model should be replicated in other settings to evaluate its contribution to improved adherence to any clinical practice guideline. [ABSTRACT FROM AUTHOR] more...

Objective: The aim of the study was to evaluate the role of alcohol drinking and patterns of consumption in oral cancer incidence and mortality in a cohort study using data from the Trivandrum Oral Cancer Screening Study, India. Methods: At baseline, the study participants completed a lifestyle questionnaire including items on frequency and duration of alcohol consumption. They were followed up for oral cancer incidence and mortality. Data from 32 347 subjects, of whom 134 eventually developed oral cancer, were analysed to estimate risk of oral cancer incidence and mortality according to drinking patterns, using a Cox regression model adjusted for age, religion, education, occupation, body mass index (BMI), standard of living index, chewing habits, smoking habits, and vegetable and fruit intake. Results: Current and past drinkers were each associated with significantly increased risk of developing oral cancer. The hazard ratio increased significantly by 49% (95% CI = 1–121%) among current drinkers and 90% (95% CI = 13–218%) among past drinkers. A significant dose–response relationship between intake frequency, duration and oral cancer risk (incidence and mortality) was observed. Conclusions: As with other lifestyle factors, alcohol intake plays an important role in oral carcinogenesis in this population, and understanding this role is relevant to developing public health policies targeting at-risk population. [ABSTRACT FROM AUTHOR] more...

Oral cancer is one of the commonest cancers among males in India. This study was carried out to evaluate the demographics, risk profile, clinicopathologic features, and treatment outcome in young patients with squamous cell carcinoma (SCC) of the tongue. Patients under the age of 35 years with SCC of the tongue presenting between 1982 and 1996 were identified using institutions centralized electronic database. Demographic, clinical, and pathologic characteristics were abstracted from the case records. Survival was calculated by Kaplan-Meier method. One hundred and fifteen patients with histologically confirmed SCC of the tongue were analyzed. The mean age at presentation was 30.5 years with a 1.7:1 male to female ratio. Prior exposure to tobacco and alcohol was noted in 58 (50.5%) patients. At presentation, 70 (60.9%) were in stages III and IV, and 59 (51.3%) patients had regional lymph node involvement. The overall disease-free survival (DFS) at 3 and 5 years were 63% and 54.9%, respectively. A statistically significant difference in DFS was seen between patients with N 0 and N 1 disease compared to N 2 or N 3 disease. Various other factors like age, sex, habits, and stage of the disease were found to have no significant effect on DFS. Results of the present study suggest that contrary to the belief, the survival among young patients is almost similar to that in older patients. Neoplasia (2001) 3, 273–277. [ABSTRACT FROM AUTHOR] more...

Non-Hodgkin's lymphoma usually involves lymph nodes, but can involve extranodal sites. Oral lymphomas are relatively rare and often difficult to diagnose in a clinical setting. A case of non-Hodgkin's lymphoma of the hard palate who had undergone external beam radiation therapy and was found to be well one year following treatment is reported. more...