Asia Pacific consensus recommendations for colorectal cancer screening.

Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.

Prevalence and predictive factors for complementary and alternative medicine use in Brunei Darussalam.

INTRODUCTION: Complementary and alternative medicine (CAM) use is common among patients with chronic disorders. CAM use is also reported to be common among the general population. This cross-sectional study assessed the prevalence, types of ingested CAM use and the factors predictive of their use in Brunei Darussalam. METHODS: 568 visitors (male 41.4 percent, mean age 40.2+/-15.1 years) to the medical wards were randomly approached and invited to participate in this study. Demographical data (gender, age and racial groups), comorbidities, smoking history, use of prescribed medications and psychosomatic symptoms of depression (anxiety, backache, depression, headache and insomnia) and CAM use were collected. RESULTS: Overall, 21.1 percent had used CAM in the last 12 months, comprising traditional remedies (35.8 percent), vitamins/minerals supplements (19.2 percent), non-vitamins/non-minerals supplements (30 percent) and herbal remedies (3.3 percent). 11.7 percent were unsure of the CAM they had taken. On univariate analysis, older age (40 years and above) and presence of psychosomatic symptoms of depression, particularly backaches, depression, headache and insomnia, were predictive for CAM use. On multivariate analysis, only the presence of any psychosomatic symptoms of depression remained significant for CAM use (odds ratio 1.7, 95 percent confidence interval 1.1-2.6). Among those using prescribed medications, 21.9 percent were also using CAM. 21 percent of subjects without any comorbidities reported using CAM. There was no report of any adverse events. CONCLUSION: CAM use is not uncommon. One-fifth of our subjects have used CAM within the past 12 months, even in those who do not have any comorbidity. Presence of any psychosomatic symptom of depression was predictive for CAM use. Most importantly, a proportion of the users were not even sure of what they had taken.