Trends and Predictors for the Uptake of Colon Cancer Screening Using the Fecal Occult Blood Test in Spain from 2011 to 2017.

Background: In Spain, colorectal cancer screening using the fecal occult blood test, targeted towards the 50-69 age bracket, was implemented on different dates. We aim to assess the temporal trend of colorectal cancer (CRC) screening uptake according to the year of screening implementation in each region and to identify predictors for the uptake of CRC screening. Methods: A cross-sectional study with 12,657 participants from the Spanish National Health Surveys 2011 and 2017 was used. Uptake rates were analyzed according to the date that the screening program was implemented. Results: For regions with programs implemented before 2011, the uptake rate increased 3.34-fold from 2011 to 2017 (9.8% vs. 32.7%; p < 0.001). For regions that implemented screening within the 2011-2016 period, the uptake rose from 4.3% to 13.2% (3.07-fold; p < 0.001), and for regions that implemented screening after 2016, the uptake increased from 3.4% to 8.8% (2.59-fold; p < 0.001). For the entire Spanish population, the uptake increased 3.21-fold (6.8% vs. 21.8%; p < 0.001). Positive predictors for uptake were older age, Spanish nationality, middle-to-high educational level, suffering chronic diseases, non-smoking and living in regions where screening programs were implemented earlier. Conclusions: The different periods for the implementation of CRC screening as well as sociodemographic and health inequalities may have limited the improvement in the screening uptake from 2011 to 2017 in Spain.

Reduction from 2011 to 2017 in adherence to breast cancer screening and non-improvement in the uptake of cervical cancer screening among women living in Spain.

OBJECTIVES: To analyze the uptake of breast and cervical cancer screening according to the 2017 Spanish National Health Survey (SNHS), to compare uptake rates with those obtained in the previous SNHS 2011 and to identify predictors for the uptake for these two screening tests. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: Uptake rates of breast cancer and cervical cancer screening were analyzed for women aged 40-69 and aged 25-65 years, respectively. Independent variables included sociodemographic characteristics and factors related to health status and lifestyle. RESULTS: We found that 66.8 % of women aged 40-69 years had undergone mammography in the previous two years. Positive predictors for mammography uptake were age (50-69 years); marital status (married); Spanish nationality; university education; one or more chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. We observed that 73.0 % of women aged 25-65 years had undergone cervical cytology screening in the previous three years. Positive predictors for uptake were age (25-52 years); marital status (married); Spanish nationality; middle-high educational level; no chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. There was a significant decrease in the uptake rate for breast cancer screening from the previous SNHS 2011 (OR 0.89; 95 % CI 0.83-0.94). CONCLUSIONS: The adherence rate for mammography in Spain in 2017 was below the recommended 70 % and was significantly lower than in 2011. The figures for cervical cancer screening were over 70 % and stable over time.

Heart Failure Is a Risk Factor for Suffering and Dying of Clostridium difficile Infection. Results of a 15-Year Nationwide Study in Spain.

BACKGROUND: We aimed to (1) analyze time trends in the incidence and in-hospital outcomes of heart failure (HF) patients suffering Clostridioides difficile infection (CDI); (2) compare clinical characteristics of CDI patients between those with HF and matched non-HF patients; and (3) identify predictors of in-hospital mortality (IHM) among HF patients suffering CDI. METHODS: Retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. Patients of age ≥40 years with CDI were included. For each HF patient, we selected a year, age, sex, and readmission status-matched non-HF patient. RESULTS: We found 44,695 patients hospitalized with CDI (15.46% with HF). HF patients had a higher incidence of CDI (202.05 vs. 145.09 per 100,000 hospitalizations) than patients without HF (adjusted IRR 1.35; 95%CI 1.31-1.40). IHM was significantly higher in patients with HF when CDI was coded as primary (18.39% vs. 7.63%; p < 0.001) and secondary diagnosis (21.12% vs. 14.76%; p < 0.001). Among HF patient's predictor of IHM were older age (OR 8.80; 95%CI 2.55-20.33 for ≥85 years old), those with more comorbidities (OR 1.68; 95%CI 1.12-2.53 for those with Charlson Comorbidity index ≥2), and in those with severe CDI (OR 6.19; 95%CI 3.80-10.02). CONCLUSIONS: This research showed that incidence of CDI was higher in HF than non-HF patients. HF is a risk factor for IHM after suffering CDI.

Effectiveness of the physical therapy Godelive Denys-Struyf method for nonspecific low back pain: primary care randomized control trial.

STUDY DESIGN: A simple blind, random controlled clinical trial. OBJECTIVE: To assess the effectiveness of physiotherapy treatment based on the muscular and articular chains Godelive Denys-Struyf (GDS) method for nonspecific low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: Despite a systematic review by the European COST ACTION B13 "Low back pain: guidelines for its management," there are still many unresolved questions regarding the effectiveness of the different physical therapy treatments used for LBP. SETTING: 21 physicians and physiotherapists in 7 Primary Care Centers and 6 researches in the Complutense University of Madrid (Spain). PARTICIPANTS: 137 patients diagnosed with nonspecific LBP. METHODS: The control group underwent 15 sessions of conventional physiotherapy in Primary Care Centers, and the experimental group received 15 GDS treatment sessions. Pain was evaluated by Visual Analogical Scale (VAS), functional disability by Oswestry questionnaire, and quality of life by the physical and mental components of SF-36 questionnaire. Outcome measures were assessed before treatment (A1), at the end of treatment (A2), and at 3 months (A3), and 6 months (A4) of follow-up. RESULTS: Repeated measures analysis of variance revealed that at the end of treatment and 3 months later, subjects in both groups showed less pain, reduced functional disability, and an improved quality of life, though improvements were greater in the GDS group.Six months after treatment, patients in the GDS group continued to show reduced pain (VAS(A4-A1) = -3.54, 95% CI: -4.18 to -2.90) while VAS scores in the control group returned to initial values (VAS(A4-A1) = 0.15, 95% CI: -0.36 to 0.67). CONCLUSION: Treatment of nonspecific LBP using the GDS method provides greater improvements in the midterm (6 months) in terms of the pain, functional ability, and quality of life perceived by patients than the conventional treatment based administered in primary care.

[Diagnostic value of myocardial perfusion scintigraphy with (99m)Tc-tetrofosmin in women with suspected ischemic heart disease]. / Valor diagnóstico de la gammagrafía de perfusión miocárdica con (99m)Tc-tetrofosmina en mujeres con sospecha de cardiopatía isquémica.

BACKGROUND AND OBJECTIVE: This was a cross-sectional study in which the values of sensitivity and specificity of myocardial perfusion study with (99)mTc-Tetrofosmina protocol in a day after stimulation with dipyridamole were determined in a population of women. We also assessed the relationship with coronary vascular territories, based on coronary angiography. PATIENTS AND METHOD: We studied retrospective medical records of 202 women with suspected ischemic heart disease tested on myocardial perfusion who also underwent coronary angiography. RESULTS: The values of sensitivity and specificity for the population were 87.16% and 81.48% respectively. For the coronary artery territory, the values of sensitivity and specificity for the DA artery were 68.75% and 77.78% respectively, while these were 60.0% and 81.51% for the Cx. Finally, the values for the CD were 69.88 and 72.27%, respectively. CONCLUSIONS: The myocardial perfusion test stimulation/rest has a high diagnostic validity for the disease in women with suspected ischemic heart disease.

[Cold chain maintenance in vaccines: a systematic review]. / Mantenimiento de la cadena del frío para las vacunas: una revisión sistemática.

OBJECTIVE: Systematic immunization programmes mostly depend on the correct maintenance and manipulation of the vaccines to be used, i.e. perfect maintenance of the cold chain. Therefore, we decided to carry out a systematic review of the literature on the cold chain and vaccines, to identify daily practices in vaccine sites. METHODS: A literature search was performed in the main medical databases for documents published between 1990 and 2005, including those performed by means of a survey and/or inspection of vaccine sites that provided the following data: a designated health officer, availability of a thermometer with maximums and minimums, refrigerator temperature at the time of the visit, and temperature control and registration. For all the variables, the mean prevalence was calculated with a 95% confidence interval. RESULTS: Three hundred seventy-seven articles were found; 31 were initially selected and 13 were finally included. In 72.21% of the vaccine points, there was an officer responsible for the vaccines, but only 61.43% knew the optimal temperature range. Fifty-five percent of these points had a thermometer with maximums and minimums and only 26.88% carried out temperature controls and registrations at least once per day. CONCLUSION: Important shortfalls were detected in cold chain maintenance in all selected articles, jeopardizing the effectiveness and efficiency of immunization programs.

[Vaccine storage cold chain at primary care centers in one area of Madrid: keeping the chain intact and degree of knowledge]. / Cadena del frío para la conservación de las vacunas en los centros de atención primaria de un area de Madrid: mantenimiento y nivel de conocimientos.

BACKGROUND: Vaccines are heat-labile medications, and to guarantee their immunogenicity and safeguarding effectiveness as part of immunization programs, it is absolutely essential that the "Cold Chain" go unbroken. Fundamental thereto is the personnel responsible for the vaccines, who must know the stability-related characteristics of each preparation so as to prevent handling errors. The purpose of this study was that of ascertaining how the cold chain is kept intact in primary care systems in one healthcare area of the Autonomous Community of Madrid, as well as determining the degree of information possessed by those responsible for vaccines as far as their heat-stability is concerned. METHODS: A cross-sectional study has been made at 46 primary care vaccination points. The data was gathered by means of a personal interview by one single researcher. RESULTS: The participation rate was 93.5% (43/46). In all cases, there was a maximum and minimum thermometer and monthly temperature record. An unsuitable temperature was found in three cases (6.97%). The percentage of professionals who were aware of the effect freezing has on vaccines varied greatly: 53.5%, 51.2%, 44.2% and 53.5% for diphtheria-tetanus-pertussis (DTP), hepatitis B (HBV), oral polio (OPV) and measles-mumps-rubella (MMR) respectively. And only 32% were familiar with the shake test. CONCLUSION: The professionals were found to be properly trained regarding the effect which high temperatures have on vaccines, but it is necessary for their training with regard to the instability of adsorbed preparations when frozen must be further strengthened.