Abstract

Although pregnancy and childbirth are not of medical origin, respectively, they signify normal physiological events. Women who are pregnant often anticipate satisfactory childbirth outcomes, with no complications during the birthing process. Maternal and Child health is achieved through comprehensive obstetric interventions. While basic obstetric care is available for pregnant women, socio-cultural beliefs are effective as well to convince them not to access appropriate care during obstetric emergencies. Therefore, this essay explains why pregnant women are often unable to receive care they need and the benefits of accessing essential obstetric care in health facilities.

Socio-cultural Beliefs and Childbirth Practices

Whilst there are many cultures throughout the world, every culture is distinct and varies considerably from one another. Culture is viewed as a main pillar that clearly defines ethnic identity, autonomy, and the tribal dominance of a society (Bravo & Noya, 2014). Its influence is fascinating by the way certain skills, knowledge, and practices are observed and learnt over a period of time to maintain and preserve its existence (Sherry & Ornstein, 2014).

Similarly, different societies have profound cultural beliefs and interpretations in relation to pregnancy and childbirth practices. Though birthing is an individual occasion, it is also an important societal experience that impacts women’s perceptions and certain beliefs between respective societies (Kaphle, Hancock, & Newman, 2013). For instance, during pregnancy, women strictly observe their cultural norms and “taboos” by avoiding certain foods or diets. In general, a particular food that is abundant in protein is avoided due to their mutual belief(s) that may lead to congenital deformed babies, resembling features of food eaten, or their babies may grow big thereby complicating the second stage of labour (Kuzma, et al., 2013). Cultural influences are persuasive, and thus, prevent pregnant women to access essential maternal health care.

Socio-cultural Beliefs and Access to Basic Obstetric Care (BOC)

In spite of the fact that there are many different societies, they are often classified into two broad kinds of societies; patrilineal or matrilineal. Patrilineal society is more common and influential. Patrilineal societies qualify men to own the land, properties, make critical decisions, and decide on family size (Koian, 2010). Land is considered as an important asset for families in ethnic societies. This is why, in patrilineal societies, men would often want to have more male children in their family to inherit the land, and also to take full responsibility during their old age (Tao, 2014). In contrast, women’s responsibilities are often associated with domestic duties, such as cooking, gardening, childbearing and childrearing.

On the other hand, basic medical ailments and maternal health services (for example, Family Planning) are viewed as insignificant to certain societies, and are perceived to only interfere with their cultural beliefs (Kaphle, Hancock, & Newman, 2013). Moreover, any pregnancy or childbirth-related complications are considered abnormal, and the victim (pregnant woman) is condemned for disobedience; as a result, she is cursed by ancestral evil forces (Kuzma, et al., 2013). Such cultural beliefs often have subsequent impact on pregnant women accessing and utilising vital antenatal and obstetric care (Boerleider, Wiegers, Mannien, Francke, & Deville, 2013).

Traditional Birth Attendance (TBA) and their Experiences

To strengthen maternal health care, emphasis is placed on pregnant women accessing health facilities for supervised care and deliveries from Skilled Birth Attendants (SBAs). These are qualified health professionals (such as; midwives, nurses and doctors) who are able to manage pregnancies and childbirths, and detect possible obstetric complications threatening to the mother and her unborn baby (Uzt, Siddiqui, Adegoke, & Broeke, 2013).

In many societies, Traditional Birth Attendants (TBAs) are available, usually old women who are considered skilful and knowledgeable in managing childbirths. Their competency of practice has become women’s first choice of contact when in labour. Also, their respectful approach toward mothers, irrespective of their social status, age, parity, and reasonable labour fees, have continued to influence women’s perception of positive childbirth experiences under their care (Akpabio, Edet, Etifit, & Bassey, 2014).

Unfortunately, TBAs still require essential evidence-based knowledge; they need adequate emergency obstetric skills and kits to manage during labour and birth emergencies. Their performing (birthing) roles were observed, and acquired only through other experienced TBAs. Yet, pregnant women still forgo formal deliveries to seek assistance from TBAs. Even some who often attend antenatal clinics still prefer TBAs during labour. Such care outside the scope of professional practice results in high rates of preventable maternal deaths (Akpabio, Edet, Etifit, & Bassey, 2014). Pregnancy and childbirth experiences can be life-threatening without the presence of SBAs. Hence, it is necessary for pregnant mothers to seek formal support, and care in health care settings where health care providers, and essential life-saving equipment are available.

Health Care Providers’ Attitudes and Approaches

Health Care Providers have primary responsibilities in providing health care effectively to their patients (women) without favouritism, injustice, harassment, and discrimination due to their socio-cultural attributes. One of the reason that affects pregnant women in relation to seeking a health centre birth is the “maltreatment” they receive from health care providers. Such unethical treatment in general includes professional negligence, abusive language, discrimination, and interventions without granting permission (Moyer, Adongo, Aborigo, Hodgson, & Engmann, 2014). They feel that the environment is not conducive for them. Thus, the fear of ill treatment from health care providers (especially, midwives and other female health workers) often discourages women from accessing health care to deliver their babies (Essendi, Mills, & Fotso, 2010). The attitudes and approaches of health care providers must be facilitated in such a friendly manner so as to encourage midwife/nurse-to-mother relationships to achieve optimal maternal outcomes.

Another reason that often prevents pregnant women opting for hospital births is their fear of health workers’ keeping their placentas for disposal (without giving the placentas to them). Some women often use placentas to execute traditional ceremonials, and are concerned it will be difficult for them to take their placentas home. Such deprivation becomes a hindrance for some of them to access supervised delivery where appropriate and essential (Moyer, Adongo, Aborigo, Hodgson, & Engmann, 2014). For that reason, establishing rapport and providing empathetic care and a compassionate attitude is expected. Transcultural conflicts in health are precluded when care is integrated harmoniously without cultural interference.

Conclusion

In conclusion, the emphasis on facilitating obstetric services for pregnant women performs an essential role in strengthening maternal and child health. Improving accessibility and reinforcement at all levels of the health care system is of paramount importance for obstetric services to function effectively. Professional conduct during the care is needed while as much as possible, accommodating socio-cultural attributes to attain best possible outcomes. Also, comprehensive community-based programs by health care providers relating to maternal health, has the potential to connect any existing socio-cultural barriers, and allow women to freely utilize obstetric care when necessary.

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McKenzie Maviso1

Atraumatic restorative treatment for the management of dental caries: A Review

Abstract:

Atraumatic restorative treatment is a method of minimal caries intervention that uses only hand instruments. Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment and it is over three decades ART has been introduced, so this was considered an appropriate time for a systematic review on ART. Objective of this review article was to assess the effectiveness of ART in management of dental caries. All randomized or quasi-randomized control trials on ART were included. Intervention with adhesive restorative material such as GIC with different viscosity was evaluated. Primary outcomes measures such as pain relief, patient discomfort, anxiety and durability of restoration was assessed. Studies showed survival rates ranging from 66% to 76% at 6 year for single surface restorations ART approach provided higher survival percentages for single surface restorations and it causes less pain and discomfort.

Key words

: Atraumatic restorative treatment, Survival, Deciduous teeth, Permanent teeth

Introduction:

Dental caries is one of the most prevalent oral diseases of public health concern. It affects almost all individuals irrespective of age, sex, occupation, religion, castes etc in developed as well as developing countries. It varies greatly among countries, even within a country and from region to region and there are several reasons for this problem like changes in food habits, poverty, lack of facilities especially to underprivileged section of the society, etc. WHO objective of “Health for All” still remains a dream, particularly in the underprivileged population of the world. Also, there has been a radical change in the methods of treatment of dental disease. We have seen a change in approach of treatment by the dentist, starting with extraction, then conservation of tooth structure and now stress is being laid on preventive dentistry. But the underprivileged population have not benefited from these developments that have brought about improved oral health in the industrialized world. Realizing the magnitude of this problem, particularly lack of oral health care in below poverty line segment of society, JE Frencken embarked on simplistic approach of removing caries with hand instruments and filling up the ‘cavity’. This approach is termed as Atraumatic Restorative Treatment.

^[1]

ART was first discovered in Tanzania in mid 1980s to suit the needs of the developing countries by JE Frencken Later, in Zimbabwe, the experiment was repeated by his team in larger school population group. WHO endorsed the ART procedure for the underprivileged population on world health day in April 7, 1994.

^[2]
The idea of ART is strongly supported by the modern scientific approach to controlling caries maximal prevention, minimal invasiveness and minimal cavity preparation.

^[3]

Different studies have been investigating the various aspects of ART approach in the past and still continue to increase. Most of the studies have investigated the survival of ART restoration and sealants. As ART approach is being utilized all over the world since more than 25 years, there is a need to carry out a systematic investigation about the survival and effectiveness of ART restorations. So the present systematic review focuses on the effectiveness of ART in management of dental caries in deciduous and permanent teeth.

Materials and Methods

We attempted to identify all relevant studies. Detailed search strategies were developed for each database to be searched and it was carried out in the Medline, Embase, Hinari, k-hub. All randomized controlled trials or quasi-randomized controlled trials were included. Non-randomized controlled trials were excluded. Studies with Dentate participants, regardless of the age and sex, with a history of dental (coronal) caries who have undergone restorative treatment using either conventional restorative or ART approaches were included. Studies in which evaluators were calibrated and independent, Survival result more than 1 year were included. Interventions were adhesive restorative materials, such as GICs with different viscosities, placed with the ’true’ Atraumatic Restorative Treatment (ART) approach, including Interim therapeutic restoration (ITR) with hand instruments, compared with different restorative materials, such as amalgam, placed with conventional cavity preparation methods. Studies on modified ART approaches, Survival results <1 year, Incorrect statistical survival analysis, Cavity restoration with rotary instruments were excluded.

Selection of Studies

All records identified by the searches printed off and checked on the basis of title first, then by abstract or keywords or both. Records that obviously irrelevant were discarded and the full text of all remaining records were obtained. The full reports obtained from all the electronic and other methods of searching assessed independently by two review authors to establish whether the studies meet the inclusion criteria or not, using an inclusion criteria form, which previously prepared and pilot tested. Where resolution was not possible, a third review author consulted. If more than one publication of a trial was identified, all publications were reviewed and the paper with the first publication date included as a primary version. All studies meeting the inclusion criteria then underwent data extraction and a quality assessment.

Types of Outcome Measures

Primary Outcome Measure

1. Pain relief, i.e. freedom from symptoms of pain and sensitivity as reported and experienced by the patient.
2. Patient discomfort during the procedure measured by physiological measurement or behavioral observation.
3. Patient’s anxiety and stress after treatment.
4. Durability of restoration – survival time of restoration (in months) from the time of placement.

Secondary outcome measures

1. Defects of restorative materials such as wear, fracture and staining (color changes) of restoration.
2. Restoration failure, e.g. replaced restorations.
3. Marginal integrity of restoration.
4. Secondary caries.

Results

Pain, Anxiety and Discomfort:

Five studies were reported on pain out of which three studies suggested that ART was found to be less painful.

^[4,5,6]
In a study conducted by Rahimtoola S et al

^[7]
pain was reported when ART technique was used but was significantly less than the conventional restorative technique. While in one study there was no significant difference in the pain levels of children treated using conventional restorative treatment, atraumatic restorative treatment or ultraconservative treatment but it was observed that when conventional restorative treatment was used, more children neededlocal anesthesia.

^[8]

One study showed that the levels of dental anxiety were less in patients treated with ART as compared to conventional restorative treatment.

^[9]
The studies from Topaloglu et al

^[10]
and de Menezes Abreu et al

^[11]
reported no difference in the levels of dental anxiety.

ART technique has a potential to cause less discomfort to the patient and to less invasive to the dental tissue than conventional approach. The patient’s acceptance of ART was verified by Mickenautsch et al

^[12]
who observed that both children and adults receiving ART restorations responded positively to the treatment. Study conducted by Schriks MC

^[13]
and Van Amerongen WE

^[14]
stated that children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instrument. Similar findings were reported by ECM Lo & CJ Holmgren also.

^[5]
A summary of these studies outcomes is presented in Table1.

TABLE 1



: Overview of studies having assessed dental pain, anxiety and discomfort between the ART and the traditional treatment approach

Comparison	Age	Operator background	Variable measured	Conclusion
ART vs rotary Instruments [7]	6–16 years old	Dentists	Pain: -Questions: Did you feel any pain during treatment?	ART caused less pain
ART vs rotary Instruments [8]	4–7 years old	Pedodontist specialist	Pain: -Wong–Baker FACES Pain Rating Scale	ART caused less pain
ART vs rotary instruments vs ultraconservative treatment [4]	6–7 years old	Pedodontist specialist	Pain: – -Wong–Baker FACES Pain Rating Scale	-No difference in levels of pain among treatments -Local anaesthesia was more frequent given in the rotary instrument group
ART vs rotary instruments ART vs ART with Carisolv [10]	6–7 years old	Pedodontist specialist	Anxiety: -Venham Picture Test	No difference in levels of anxiety between treatments
ART vs rotary Instruments [9]	Children and adults	Dentists and dental therapists	Anxiety: -Children’s fear survey schedule -Corah’s dental anxiety scale	Both children and adults treated with the ART were less dental-anxious
ART vs rotary instruments vs ultraconservative treatment [11]	6–7 years old	Pedodontist specialist	Anxiety: -Facial Image Scale	No difference in levels of anxiety among treatments
ART vs rotary Instruments [13]	6-year-old children	Dental students and dentists	Discomfort: -Heart rate and modified Venham index (observations)	ART caused less discomfort

Durability of Restoration

Various studies showed that survival rates were lower with increasing period of time.

^[15,16]
Frencken JE

^[15]
assessed the survival of ART restoration after first, second and third year evaluation interval and found that the survival rate of one surface ART restoration were higher in first year compared to second and third year.

Lo ECM

^[16]
Suggested that cumulative survival rates of the large restoration were lower, being 77% and 46% after 3 and 6 year respectively.

There were no statistically significant differences in cumulative survival percentages of the evaluated ART restorations between single and multiple-surface restorations at 1-year (p=0.137) and 2-year (p=0.377) evaluations. But at the 10-year evaluation, the survival rate for single-surface restorations (65.2%) was 2.1 times higher than that for the multiple surface restorations (30.6%). This difference was statistically significant (p=0.009).

^[17]

Secondary Outcome Measures:

Defects of restorative materials wear and fracture of restoration:

Studies conducted by Lo ECM

^[16]
and Frencken JE

^[18]
showed that most of the restoration were in good condition and had only minor defects and wear which did not warrant further treatment.

Secondary caries

Increment of secondary caries was found to be maximum in a study conducted by Zanata RL

^[17]
while other studies showed no statically significant difference.

^[18,19]

Operator effect.

Frencken JE

^[18]
et al observed an operator effect for single surface ART restorations.

It was observed in one study that experienced operators place better ART restoration than inexperienced operators.

^[15]

Marginal Integrity of Restoration:

In a study the restorations that were evaluated with the USPHS criteria at the 5-year examination, unacceptable marginal integrity, either a crevice extending to the enamel–dentine junction or the restoration being fractured was found in 9% of the small and 21% of the large restorations.

^[18]
While in another study, 63.6% of the ART restorations were assessed as ‘good’, 15% as having a ‘slight marginal defect’ at 3years.

^[19]

Restoration Failure

Failure occurred in 24% of the small restorations and 41% of the large restorations. The large restorations had a higher relative risk of failure, 5.87, compared with the small restorations.

^[16]
Failures were related to unacceptable marginal defects and total loss of restoration. Frencken JE

^[18]
reported failure of total 28 ART restorations placed in 25 students during the 3 year period. While same author in another study reported 106 ART restoration failures from total of 487 ART single surface posterior restorations.

^[15]

Discussion:

The ART approach seems to be an economic and effective method for improving the oral health not only of people in developing but also of those in industrialized countries (Frencken and Holmgren 2004).

^[1]
It may be considered as a safe and conservative alternative for conventional restorative dental treatment, particularly for Class I (occlusal) dental cavities.

Pr imary outcome measures:

Pain, Discomfort and Anxiety:

The originators of the ART approach noticed that the technique had a potential to cause less discomfort to the patient and to be less invasive to the dental tissues than the conventional approach. The patient’s acceptance of ART was verified by Mickenautsch and Rudolph

^[12]
, who observed that both children and adults receiving ART restorations responded very positively to the treatment. Dentists also seemed to approve the “new” approach. Among the main reasons given were those related to the patient’s comfort: the reduced use of local anesthetic and absence of the noisy drill and suction.

^[20]

Some suggested that ART as found to be less painful and cause less dental anxiety. The reasons could be contributed to the operator’s level of specialization and /or skills in handling anxious children. The studies from Topaloglu et al

^[10]
and de Menezes Abreu et al

^[4,11]
in which no difference in levels of dental anxiety and dental pain were observed, were performed by pediatric dentists. In the studies that favored ART

^[7,8,13]
all operators, but the one from de Menezes Abreu et al,

^[8]
were non-pediatric dentists (general practitioners, dental therapists or dental students). However, the latter study had included children younger than 6 years, and all those given the conventional treatment received local anesthesia and the restorations were performed under rubber dam isolation. It is not unrealistic to argue that age and the use of the needle and that of rubber dam might have influenced children’s perception of pain. In light of all these aspects, it can be hypothesized that the behavior management provided by a pediatric dentist may overcome much of the discomfort that a child can feel independent of the restorative treatment approach.

Durability of Restoration:

The survival percentages of single surface non occlusal posterior ART restoration were significantly higher than for comparable amalgam restoration 4.4, 5.3 and 6.3 years. Although it is known that non occlusal glass ionomer restoration survive long but significant lower survival results for non occlusal amalgam than for comparable ART glass ionomer restorations were observed.

^[15]

The cumulative survival rate of ART single surface restoration remained high throughout the study 92.7% (SE 3.0%) over 2 years and65.2%(SE 7.3%) up to 10 years. These rates are in the line with the results of other investigations, which reported survival rates ranging from 66% to 76% at 6 year for single surface restorations. The cumulative success of 65.2% observed in this study could be considered even better due to the longer period of clinical service. The survival rates of multiple surface restorations (class II) decreased significantly from 2 to 10 years. After 2 years, the survival rates between single and multiple surface restorations were similar. These results are consistent with those of Cefaly and Farag which observed similar survival rates for class 1 and class II restoration after 1 and 5 years, respectively. However, a statistical difference was apparent over the 10 year evaluation period (65.2×30.6% success rates for single and multiple surface restorations, respectively).

^[17]

Secondary outcome measures:

Defects of restorative material such as Wear, Fracture and Staining of Restoration:

The annual wear rate of the high strength glass–ionomer material used in their study was rather stable at around 20-25 m after the first year and this did not increase much with time or size of the restoration. This rate is very satisfactory and may help to alleviate some of the concerns of earlier reviews on ART. The use of an adhesive material in ART restorations also makes repair of restorations with gross defects and wear possible and total replacement may not be necessary.

^[15]
Reasons for minor defects and wear can be explained by the fact that firm finger pressure was applied over the restorative material to ensure good penetration of glass ionomer into the pits and fissures, as recently demonstrated.

^[18]

Secondary caries:

It has been shown that caries left in occlusal enamel lesions had either not progressed at all or only progressed slightly under clinically ‘intact’ as well as ‘sometimes intact’ sealants after 3 years. In contrast, caries had progressed under sealants that were ‘never intact’.

^[18]

No ART restoration failed because of carious lesion development only. Restorations failed because of a combination of dentine carious lesions and mechanical defects.

^[17]
This pattern of failure was also observed by Frencken et al

^[15]
but contrasts with the study of Prakki et al

^[21]
which observed no caries even in those teeth whose ART restorations were missing.

Operator effect:

An operator effect has been cited in a number of ART studies.

^[18,22,23]
Although all operators (dentists and dental therapists) in the studies referred to above had followed a training course on ART, the operator effect seems to indicate that in order to perform quality ART restorations, the operating dental personnel requires skill, diligence and comprehension. An ART training course of a couple of days may be too short for some qualified dentists and dental therapists.

^[15]
The operators’ greater experience in applying ART and the use of a high-viscous glass ionomer in the study may explain the higher results.

^[18]

Failure of Restoration:

The finding that failures of ART restorations placed in the same child were correlated suggests that some factors related to the individual subjects such as diet, occlusion, and caries risk may influence restoration survival.

^[16]
The predominant reasons for ART restorations to fail were unacceptable defects at the margin and re restoration.

^[15]

Almost half of the failures were related both to the physical characteristics of the glass ionomer used and to the operators’ handling of the material. Few failures were due to excessive wear. The other half of the failures were considered to be operator related. The exact reasons for the unacceptable marginal defects were unknown. However, it can be speculated that improper mixing of glass ionomer, providing a mixture that was either too dry or too wet, was one of the reasons. Another reason could be the difficulty in inserting the material into the depths of deep and small preparations. Subsurface voids produced during insertion may have resulted in later fracture of the surface layer under pressure.

^[18]

Compared to conventional treatment approaches, ART is still very young. Despite this, much progress has been made in researching various aspects of the ART approach. More experience in the actual technique of cleaning carious cavities with hand instruments has been gained and newer, physically stronger glass ionomers have been marketed as a result of its existence. These developments have most probably led to the higher survival results of ART restorations in permanent teeth in the more recent compared to the early studies.

Conclusion:

ART technique has proved to be less painful and causes less discomfort to the patients with high survival rate in both in primary and permanent teeth. This technique has the potential to make oral health care more available to a larger part of the world’s population than before. The greater part of the world’s population has no access to restorative dental care. ART should be taken seriously by the dental profession and educational courses should be organized before the approach is used in the clinic.

INTRODUCTION

Through years, many movies have been released for public viewing regarding cancers of all types. Depictions might include the nature of cancers, patients’ response, care-givers’ response, and the clinical outcomes. Since movies may affect thoughts of the viewers, outcomes in movies may affect decision making of the patient or caregiver and may affect care-seeking behavior, the way they react to the situation and their compliance to treatment.

At present, films featuring cancer patients are no longer a rare scenario, as stated in a press release at the ESMO 2012 Congress of the European Society for Medical Oncology. Many cancer movies were released for viewing, however, the portrayal of the patient’s chances of survival are rarely accurate. In 82 movies that focused on cancer patients, Dr Luciano De Fiorre et al, found that descriptions on cancer experience in the films were not reflective of cancer in its scientific meaning.

In the Philippines, there are only few movies that feature a person/persons with cancer. And in most of the Filipino movies that depict cancer, cancer patients are diagnosed late and hospitalization with other therapeutic modalities are not clearly seen. Cancer patients’ experiences described in the movie were so different from the truth. Davaoenos, like most Filipinos, see that cancer is always worse in the movies. The illness is usually depicted as death sentence.

To our knowledge, no previous descriptive reviews of movies about cancers in children, adolescents, and young adults have been documented, hence this research.

Review of Related Literature

Medical portrayals in the media, including depictions of clinical outcomes, may impact public perceptions and health decision-making. Media greatly affects people’s behavior toward a certain event and the said response varies in each individual, depending on how they perceive or understand. What we see affects what we think, and thoughts may become action. We act upon what we see thru imitation (Koordeman et al 2011) Both market research and anecdotal case reports have long claimed that the general public learn and form reactions regarding health conditions based on what is seen on television (Eisenman et al., 2005) (Tayal, 2003). Increasingly, media has not only been an entertainment tool, but has been applied deliberately as a health educational source, as “entertainment education” in different countries (Hether H.J et al, December 2008.) Some people do not only rely to medical professionals regarding their health. According to one study, (Kowalczyk et al, 2012)older generations greatly depend on internet in gaining information about cancer, hence it must be ensured that they are gaining information from a reliable source. Cinema had also been used for medical-educational purposes (Akram et al, 2009). More recently, entertainment education has been attempted on the topic of cancer as well, for instance promoting breast cancer awareness in adults. The extent and nature of depictions of cancers in children, adolescents and young adults, however, remain less clear.

Negative perceptions result from negative portrayals and negative outcomes. In one research, it was noted that there had already been lots of motion pictures with negative portrayals of the medical profession (Thibodeau et al, 2007). In another research with 131movies as sample size, it was pointed out that physicians were portrayed negatively in 44% of movies and that 27% of the sample size had medical inaccuracies. (Flores et al, 2002).

There may be a wide disparity between public perceptions and scientific findings. This usually happens when we are convinced by what we saw or hear on the news and not relying on the scientifically documented events. Movies like “Erin Brokovich” let the people think that cancer in New Jersey and Long Island, New York trigger the cancer clusters (Robinson D,2002). In reality, it is not only the purely environmental exposures that may lead to cancer.

After carefully studying 82 movies that centre on a person with cancer, Dr Luciano De Fiore et al, found experiences pertaining to cancer as described in the films were not reflective of the truth. In the movies the researchers studied, 40 characters with cancer were women, and 35 men. In 21 films the type of cancer was not mentioned. Symptoms were considered in 72% of the movies, while diagnostic tests were mentioned in 65%. The most frequent treatment mentioned in the movies was chemotherapy followed by pain-relief. Death occurred in 63% of all movies). Doctors and nurses turned up in 58 films (77%). (De Fiore, 2012)

If we are exposed to wrong information, we will be living in wrong direction. If cancer patients in movies die without a fight, diagnosed cancer patients may also choose to die without a fight. It is the government’s role to protect the viewers from what they see. Some research had already pointed good representations about cancer in movies. Some movies are informative and the role of medical research in overcoming the disease is already highlighted ( Lederer SE,2007).

A positive outlook about cancer is very possible if people will see realistic portrayals in movies. Movies especially those containing health issues will give hope if those will not only show death and hopelessness of cure.

At present, there are movies with scenes pertaining to health and death issues which contain inappropriate portrayals although it is worth mentioning that some movies remind audiences that not all scenes are based on real events but are reflective of the writer’s view.

In a bigger perspective, it is not only cancer prevention consciousness is the major barrier in fighting against cancer. Poor language skills, low income and low education are contributory barriers (Loughridge, 2012). There must be a collaborative effort in our fight against cancer. Cancer patients, medical practitioners, health allies and the government must move to destroy against these barriers.

In a press conference made during World Cancer Day, it was pointed out by Dr Lucio Lecciones that leukemia accounts 40-60% of cancer among patients in the Philippine setting. And that in Philippine Medical Center Hospital alone, the case rate is increasing by 30% annually. Deaths from leukemia accounts greater than the number of dengue shock syndrome, sepsis and prematurity combined. It was also stated that 70% of the newly diagnosed childhood cancer cases in the country were recognized in the late stages of the disease. Diagnosis was made when the cancer is no longer curable , even with the use of the most aggressive and expensive treatment. Socioeconomic status is also a great contributory factor to the abandonment to treatment. High cost of diagnostics and treatment affects survival rate and there is barely 2 in ten children surviving cancer.

(

Jet Villa, 2014)

The Department of Health is active in the campaign for the fight against cancer. Educating people not only on how to prevent cancer, but also, how to survive it. Most doctors encourage prevention, as the saying goes “An ounce of prevention is better than a pound of cure”- Benjamin Franklin.

Cancer cases were increasing in number. There were more than 82, 000 new cancer cases, affecting both males and females in 2010 in a census from the Department of Health, Philippines. With the increasing trend in cases, it is estimated to reach 85, 000 new cases annually. According to Dr Ona, the number of cases is expected to double within the next decade.

Cancer ranks third as the leading cause of death in the Philippines, according to PSMO president Felycette Gay Lapus. The risk factors in developing cancer include smoking, viral infections, sedentary lifestyle, alcohol and radiation. With the great number of people affected, vigilance to its warning signs, a healthy lifestyle and early treatment will shield the people against the disease.

How can we expect cancer patients submitting themselves to doctors if most of the cancer movies show no hope for cure, portrayals of non compliance to treatment and death immediately after diagnosis. How can we expect people to gain true information when media has its own flaws in its portrayals. Much freedom is given for entertainment but not much is given to qualify information. Even if we have the most potent medicine or cure for patients, if we are directed by misleading information, science will still fail. In the end, it is not the therapy that will have a great influence to people but it us how they help themselves not to be victims of misleading information. There are only few movies that contribute or portray facts about cancer and even other health issues. With its double edge sword, vigilance to its content can prevent future deaths and maladies.

Research Questions

1.What are the most common movie depictions of cancer in childhood, adolescents, and young adults? Are the depictions relevant and/or appropriately show the true nature of cancer- regarding its detection, treatment and outcomes? Do movies show the common symptoms of cancer?

2.Do movies discuss the care-givers’ and patients’ options to treatment? Do movies promote hospitalization among cancer patients?

3.What are the most common outcomes of cancer as depicted on movies?

4.What are the patients’ and caregivers’ response or coping mechanisms in dealing about cancer?

5.How do movies portray cancer in children, adolescents and young adults (AYA), including outcomes?

Significance of the Study

In our fight for cancer, we need to address problems about economy, problems arising from bad health habits and addressing the country’s education. Media is a double-edged sword promoting entertainment to people and depicting pictures which can be perceived as facts. Media can be merely entertaining or may be source of information. These informations may twist a myth into a fact, and wrong decisions may be produced.

This study aims to explore movie depictions in children, adolescents and young adults through a review of cancer movies for the last twenty five years. Media becoming an entertainment-educational tool portrays a role in information dissemination thus may help in prediction of viewer’s attitudes towards cancer. This is an exploratory study of movies which aims to describe cancer depictions and portrayals. Our result will guide future research to better understand movies, including their effect on viewing public. Furthermore, this research specifically describes movies depictions as how they may affect viewers who are themselves patients and caregivers.

Accurate result of this study will provide awareness to medical practitioners of the dismal movie depictions which will guide them on how to correct each. It will also help them understand why patients have feeling of fear and opted not to be treated medically. Practitioners may educate the public by showing the data in the hospitals

Hospital administrators will be able to identify the dismal portrayals of cancer and promote scientifically based scenario thru health programs and by disseminating information thru all forms of media. It will also serve as an important tool in their advocacy in the fight of cancer.

If we are exposed to wrong information, we will be living in wrong direction. If cancer patients in movies die without a fight, diagnosed cancer patients may also choose to die without a fight. It is the government’s role to protect the viewers from what they see. But the burden of correcting the moviemakers’ wrong portrayal of diseases specifically cancer lies on us physicians. It is hoped that this study will provide the figures of the disparity between fact and myth.

Should the results of this study show significant dismal portrayals of cancer in movies, health allies will be obliged to warn public about the disparities in movies, especially those pertaining health. It is not only empathy that is elicited when viewing movies. Some persons may imitate whatever they saw, good or bad. Absolute correction of wrong portrayals may be impossible, however public warning will still help the viewing audience not to be misguided.

Objectives

1.To characterize the depiction of cancers in children, adolescents and young adults (AYA) in English-language or –subtitled movies.

2.To gather data about the most common signs, symptoms and outcomes of cancer as depicted on movies

3.

To gather data about behaviors and coping mechanisms of patients in response to cancer, as depicted on movies.

4.

To gather data about behaviors and coping mechanisms of families, caregivers and/or significant others of cancer patients, as depicted on movies.

5. To gather data about where treatment is initiated on movies, and estimated time to live of cancer patients from time of detection.

Design/Method

A qualitative type of research will be used in this study. A preliminary list of mainstream, independent, and made-for-television movies produced from 1975 to 2010 will be independently identified by two authors through manual searches of the internet and movie databases, for English-speaking or English subtitled films. This will be made possible by searching from websites namely:

www.google.com

and

www.youtube.com

. Abstracts of movies will then be viewed thru

www.imdb.com

and will be decided whether they fit the inclusion criteria.

Qualifying movies will then be viewed by the two authors. Included movies will be those movies containing individuals aged 29 and below whose signs and symptoms of cancer are noticeable by the audience

. Data gathering about the variables regarding cancer, most common signs and symptoms of cancers, behavior of patients and families and the most common outcomes will then be gathered and tabulated.

Setting

Data gathering were done by the two researchers independently at home by viewing the movies included in the criteria. The outcomes of the data gathering are to be collaborated

Inclusion Criteria

Each of these criteria must be met for inclusion:

1.The cancer movies are released on public during the year 1975 to 2010.

2.

The character of the movie, particularly the patient with cancer must be aged 29 and below and these characters clearly manifested signs and symptoms of cancer noticeable to the audience.

Exclusion Criteria

Either of these criteria being met will lead to exclusion:

1.

Cancer movies released before year 1975 and beyond 2010 are excluded in the study, including those with cancer characters with age 30 years and above.

2.


Cancer movies filmed between the year 1975-2010 which contains languages not clearly understood by the proponents of this research.

3.


Movies which involve cancer patients who are not the main subjects of the film or cancer manifestations not highlighted in the film.

Data Gathering

Main outcome measures

1.The Variables of Cancer in an individual affected as reflected on movies

1.1.Age

1.2. Sex

1.3.Type of cancer

Table2. The Most Common Signs and Symptoms, Treatment Options, Outcomes of Different Types of Cancer and Estimated Time to Live among Cancer Patients as Reflected on Movies

2.1.Physical effects

2.2.Treatment Options

2.3. Outcome of cancer

2.4. Estimated time to live among cancer patients

Table 3.Behavioral Reactions of people toward cancer

1. Behavioral reaction of patients toward the sickness
2. Behavioral reaction of families/caregivers toward cancer

3.3.Where treatment is initiated

Data Handling and Analysis

The co-authors will review cancer movies based on the inclusion and exclusion criteria. The data from the movies included will be tabulated in a table. All of the movies viewed independently by the co-authors will be collaborated at the end of the 10-month study period. The data on age, sex, type of cancer, physical manifestation of different types of cancer, treatment options, outcomes and estimated time to live will be presented as frequency and percentage. Typical emotional process that most people with a terminal illness and families go through namely: denial, anger, bargaining, depression and acceptance will be presented in frequency and percentage.

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