admission and the presence of gastrointestinal bleeding or haematuria. Mild drug reactions were well recognised by these patients, but not severe ones. Breast examination is important in older women, in whom the incidence of breast cancer is higher. 1 It is, however, an intimate examination, and older patients and doctors may be deterred for several reasons. The attitudes of older women to this procedure have not previously been established. Both this and the attitudes of doctors may determine whether the procedure remains part of the routine physical examination. Subjects, methods, and resultsThe study was approved by the Wirral district's ethics committee. One hundred elderly (mean (range) age 83 (71-94) years) female inpatients (abbreviated mental test score 8/10 or more) were interviewed by a doctor not involved in their medical care. All patients were fully recovered from their acute illness. A questionnaire (available from us) was administered and the responses recorded. The case notes of the same 100 patients were audited by using a standardised proforma.One hundred hospital doctors working in two hospitals were given a questionnaire (available from us); 75 responded. Replies were anonymous so non-responders could not be recontacted.Review of 100 case notes showed only 11 of the patients had had a breast examination documented (two of which yielded abnormal results). Of 10 patients with a history of bone pain, only one had a breast examination, while four with weight loss had no breast examination documented. Liver function tests gave abnormal results in 15 women, only two of whom had a breast examination. There were five patients with a history of breast cancer, none of whom had a breast examination documented.None of the patients said they would be offended if they were asked to undergo a breast examination. Fifty four patients felt neutral about it, 32 would be pleased to be asked, 10 would be reluctant about being examined, two would be upset, and two would be embarassed. Most patients (86) thought a breast examination was important and would give permission for this examination. Most (88) also had not had mammography or a breast examination previously. A few patients (12) said that they would always want a chaperone, while 18 wanted a chaperone only when a male doctor was examining. Most (70) were not concerned whether a chaperone was present or not. Only a few patients (13) thought a breast examination would worry them, while 45 thought it would reassure them. None of the patients had refused to undergo a breast examination. Some (25) would prefer a female doctor to examine them, but most (70) had no preference.Of the hospital doctors interviewed, only five said that they would routinely do a breast examination on every woman over the age of 50 years, though 43 thought breast examinations should be a routine part of the physical examination. Some doctors (15) felt uncomfortable in performing breast examinations, and 34 (all men) would insist on a chaperone. Only 12 would be deterred because of the ...

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BACKGROUND:The objective of this international field study was to test the reliability, validity, and responsiveness of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BM22 module to assess healthrelated quality of life (HRQOL) in patients with bone metastases. METHODS: Patients undergoing a variety of bone metastases-specific treatments were accrued. The QLQ-BM22 was administered with the QLQ-C30 at baseline and at 1 follow-up time point internationally. A debriefing questionnaire was administered to determine patient acceptability and understanding. RESULTS: Large-scale field testing of the QLQ-BM22 in addition to the QLQ-C30 took place in 7 countries: Brazil,

Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.

Most of the participants in the settings had the awareness of hazards of plastic bag usage. However, there is a need for spreading the awareness of using alternative strategies and effective implementation of legislation in order to minimize the usage of plastics in the community.

Background: India houses 2.5 million people living with HIV/AIDS. Once a fatal illness, HIV/ AIDS has become a chronic illness due to advent of antiretroviral therapy. Morbidity and mortality indicators used in measuring health of the community only quantify the health but quality of life is not measured. Quality of life is a multidimensional aspect and several factors influence it in a different way. Aims & Objectives: Assess quality of life and its determinants among people living with HIV/AIDS. Materials and Methods: A cross sectional study conducted during Jan 2012 to June 2012, at outpatient clinic of tertiary care centre involved 200 people living with HIV/AIDS. Interview method was used to collect the data. Quality of life was assessed using WHOQOL-BREF questionnaire and other part of the questionnaire contained the socio-demographic and HIV related characteristics. The data was analyzed by using excel 2007, Z test was used wherever necessary and presented. Results: Mean age of the study subjects was 33.77 years and 61.5% of the participants were females. Quality of life was rated as poor by 26% of the study subjects and 27% of the subjects are dissatisfied with their overall health status. Quality of life score was highest in environmental domain (11.61 ± 1.83) and lowest in Social relationships domain (8.97 ± 3.36). Age lesser than or equal to 30 years had better Quality of life mean in environmental and social domain. Subjects from urban area had better mean in physical, psychological and environmental domain. Education associated with social and environment domain. Higher CD4 count is associated with better mean in physical domain. Conclusion: Many socio-demographic factors influence quality of life. These factors should be considered in planning care of HIV infected people.

PURPOSE Lower socioeconomic status is associated with inferior cancer survival in high-income countries, but whether this applies to low- and middle-income countries is not well described. Here, we use a population-based cancer registry to explore the association between educational level and stage of cancer at diagnosis in South India. METHODS We used the Trivandrum District population-based cancer registry to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) who were diagnosed from 2012 to 2014. Educational status—classified as illiterate/primary school, middle school, or secondary school or higher—was the primary exposure of interest. Primary outcome was the proportion of patients with advanced stage disease at diagnosis defined as stage III and IV (breast, cervix, or OC) or regional/metastatic (lung). RESULTS The study population included 4,547 patients with breast (n = 2,283), cervix (n = 481), OC (n = 797), and lung (n = 986) cancer. Educational status was 22%, 19%, and 26% for illiterate/primary, middle, and secondary school or higher, respectively. Educational status was missing for 33% of patients. The proportion of all patients with advanced stage disease was 37% (breast), 39% (cervix), 67% (OC), and 88% (lung). Patients with illiterate/primary school educational status were considerably more likely to have advanced breast cancer (50% v 39% v 36%; P < .001), cervix cancer (46% v 43% v 24%; P = .002), and OC cancer (77% v 76% v 59%; P < .001) compared with patients with higher educational levels. The proportion of patients with advanced lung cancer did not vary across educational levels (89% v 84% v 88%; P = .350). CONCLUSION A substantial proportion of patients in South India have advanced cancer at the time of diagnosis. This is particularly true among those with the lowest levels of education. Future health awareness and preventive interventions must target less-educated communities to reduce delays in seeking medical care for cancer.

Adenoid cystic carcinoma of vulva is an extremely rare, slowly progressing neoplasm mostly involving the Bartholin's gland. The usual treatment includes wide excision and adjuvant radiotherapy (if required). There may be late local and distant recurrence.