RESUMO
Faecal occult blood (FOB) - based screening programmes for colorectal cancer detect about half of all cancers. Little is known about individual health behavioural characteristics which may be associated with screen-detected and interval cancers. Electronic linkage between the UK National Health Service Bowel Cancer Screening Programme (BCSP) in England, cancer registration and other national health records, and a large on-going UK cohort, the Million Women Study, provided data on 628,976 women screened using a guaiac-FOB test (gFOBt) between 2006 and 2012. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated by logistic and Cox regression for associations between individual lifestyle factors and risk of colorectal tumours. Among screened women, 766 were diagnosed with screen-detected colorectal cancer registered within 2 years after a positive gFOBt result, and 749 with interval colorectal cancers registered within 2 years after a negative gFOBt result. Current smoking was significantly associated with risk of interval cancer (RR 1.64, 95%CI 1.35-1.99) but not with risk of screen-detected cancer (RR 1.03, 0.84-1.28), and was the only factor of eight examined to show a significant difference in risk between interval and screen-detected cancers (p for difference, 0.003). Compared to screen-detected cancers, interval cancers tended to be sited in the proximal colon or rectum, to be of non-adenocarcinoma morphology, and to be of higher stage.
Assuntos
Neoplasias Colorretais/epidemiologia , Estilo de Vida , Idoso , Estudos de Coortes , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Sangue Oculto , Estudos Prospectivos , Medicina Estatal , Inquéritos e QuestionáriosRESUMO
Inadequate emergency visits, which could be resolved in primary care, are an unnecessary expense for the healthcare service. We did a review of all gynaecology and obstetrics emergency visits by pregnant or postpartum women during 2010 and 2011 in order to describe the adequacy of the visits by pregnant women to the emergency service. We defined three levels of adequacy: adequate, moderately adequate, and inadequate. One thousand seven hundred and forty-three visits to the emergency room of gynaecology and obstetrics were studied. These consultation motivations were adequate in 38.9%, moderately adequate in 46.7% and inadequate in 14.4%. This shows that the amount of inadequate and moderately adequate visits to the emergency department could be reduced by 61% by implementing different interventions, and also reducing health spending for emergencies. Impact statement What is already known on this subject: Visits to the emergency room constitute a basic pillar in the hospital structure, and it generates great health expense. Other authors have reported high rates of inadequacy of these visits to the emergency services. They find inadequate visits are associated with young age and female gender among other factors. What the results of this study add: Knowing the adequacy of the visits generated by pregnant young women is a starting point for implementing health policies that could reduce these inadequate visits and consequently health expenditure could be reduced. What the implications are of these findings for clinical practice and/or further research: These health policies could consequently reduce health expenditure.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Distribuição por Idade , Distribuição de Qui-Quadrado , Emergências/classificação , Serviço Hospitalar de Emergência/economia , Feminino , Idade Gestacional , Humanos , Gravidez , Gestantes , História Reprodutiva , Estudos Retrospectivos , EspanhaRESUMO
Associations between behavioural and other personal factors and colorectal cancer risk have been reported to vary by tumour characteristics, but evidence is inconsistent. In a large UK-based prospective study we examined associations of 14 postulated risk factors with colorectal cancer risk overall, and across three anatomical sites and four morphological subtypes. Among 1.3 million women, 18,518 incident colorectal cancers were identified during 13.8 (SD 3.4) years follow-up via record linkage to national cancer registry data. Cox regression yielded adjusted relative risks. Statistical significance was assessed using correction for multiple testing. Overall, colorectal cancer risk was significantly associated with height, body mass index (BMI), smoking, alcohol intake, physical activity, parity and menopausal hormone therapy use. For smoking there was substantial heterogeneity across morphological types; relative risks around two or greater were seen in current smokers both for signet ring cell and for neuroendocrine tumours. Obese women were also at higher risk for signet ring cell tumours. For adenocarcinomas, the large majority of colorectal cancers in the cohort, all risk factor associations were weak. There was little or no heterogeneity in risk between tumours of the right colon, left colon and rectum for any of the 14 factors examined. These epidemiological findings complement an emerging picture from molecular studies of possible different developmental pathways for different tumour types.
Assuntos
Neoplasias Colorretais/epidemiologia , Adenocarcinoma/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Carcinoma/classificação , Carcinoma/epidemiologia , Neoplasias Colorretais/patologia , Anticoncepcionais Orais Hormonais/efeitos adversos , Exercício Físico , Feminino , Seguimentos , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Menopausa , Pessoa de Meia-Idade , Tumores Neuroendócrinos/epidemiologia , Obesidade/epidemiologia , Especificidade de Órgãos , Modelos de Riscos Proporcionais , Estudos Prospectivos , História Reprodutiva , Risco , Fumar/epidemiologia , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
HYPOTHESIS: The new hysteroscopic system with mechanical energy is an effective outpatient technique for diagnosis and treatment that has certain advantages over conventional hysteroscopy in the management of endometrial polyps. OBJECTIVES: Our primary objective was to assess the total duration of hysteroscopy and polypectomy performed in an outpatient setting comparing the new mechanical energy hysteroscopy to the bipolar energy system. Our secondary objective was to compare the level of safety of both hysteroscopic techniques using the procedure success rate, the need for subsequent referral to surgery, existing complications, and comfort experienced by the patient during the procedure. PATIENTS AND METHODS: This randomized controlled trial included the first 90 patients with an ultrasound diagnosis of endometrial polyp (>1 cm) who underwent an outpatient diagnostic and operative hysteroscopy at the Igualada Hospital (Barcelona) and agreed to be included in the study by signing an informed consent. RESULTS: We obtained a 91% success rate with the TRUCLEAR System® compared to a 69% success rate with the Versapoint® system. Total operating time was 6.36 min in the TRUCLEAR System group versus 10.82 min in the Versapoint system group (p < 0.05), with a polypectomy time of 3.06 and 7.91 min, respectively (p < 0.05). There were no significant differences between the two techniques when analyzing pain using the visual analogue scale. No complications were recorded for either technique. CONCLUSION: The mechanical energy system presents a significant decrease in the total duration of polypectomy and hysteroscopy when performed both by experienced staff and by staff in training, resulting in higher success rates without complications with respect to conventional hysteroscopy with bipolar energy.
Assuntos
Histeroscopia/métodos , Pólipos/cirurgia , Doenças Uterinas/cirurgia , Procedimentos Cirúrgicos Ambulatórios/métodos , Feminino , Humanos , Histeroscopia/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Pólipos/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia , Doenças Uterinas/diagnóstico por imagemRESUMO
BACKGROUND: Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population's reasons for refusing to take part in the screening programme and to find out the health professionals' opinion about the official programme implementation and on the new computerised tool. METHODS/DESIGN: This is a parallel randomised trial with a cross-sectional second stage. PARTICIPANTS: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50-69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient's electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. DISCUSSION: We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. TRIAL REGISTRATION: Clinical Trials.gov identifier NCT01877018.
Assuntos
Neoplasias Colorretais/diagnóstico , Registros Eletrônicos de Saúde , Programas de Rastreamento/métodos , Idoso , Atitude do Pessoal de Saúde , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Registros Eletrônicos de Saúde/economia , Feminino , Humanos , Masculino , Sistemas de Registro de Ordens Médicas , Pessoa de Meia-Idade , Sangue Oculto , Médicos de Atenção Primária , EspanhaRESUMO
BACKGROUND: In terms of tobacco consumption, health workers have been considered as reference group, however smoking prevalence in this group is higher than in general population. This study aimed to estimate the prevalence of tobacco consumption among workers of a health institution in Catalonia during a period of 10 years (2001-2011), and to describe their characteristics. METHODS: The questionnaire on tobacco consumption prevalence was validated, and was administered in 2001, 2004, 2008 and 2011. A random sampling was carried out in two acute care institutions. The characteristics of the study sample and the differences between smokers were analyzed using the chi-square test for linear trend. A logistic regression model was performed including all the surveys. RESULTS: The smoking prevalence among health care workers for 2001, 2004, 2008 and 2011, was 30.00%, 34.42%, 36.21% and 29.42%, respectively. Women had the highest consumption prevalence (33,40%). Tobacco smoking decreased in medical staff, from 25.97% in 2001, to 18.88% in 2011 (p=0.005), and in nurses from 35,15% in 2001 to 25.61% in 2011 (p=0.007), but not among the administrative staff. CONCLUSION: Overall and for the first time, smoking prevalence in health workers begins to decrease. However, it does not decrease in the same way among all types of healthcare workers and the prevalence remains high when compared with the population prevalence. This consumption reduction coincides with the measures introduced by the program after the legislative changes.
Assuntos
Recursos Humanos em Hospital/tendências , Fumar/tendências , Uso de Tabaco/tendências , Adulto , Coleta de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Prevalência , Distribuição por Sexo , Fumar/epidemiologia , Espanha/epidemiologia , Inquéritos e Questionários , Uso de Tabaco/epidemiologiaRESUMO
BACKGROUND: Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate. METHODS/DESIGN: Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed. DISCUSSION: This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.
Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/terapia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Oncologia/métodos , Invasividade Neoplásica , Metástase Neoplásica , Prognóstico , Estudos Prospectivos , Recidiva , Espanha , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The birth rate in Spain has increased due to the continuous rise in the number of immigrants. Ethnic origin and socioeconomic position can be determining factors in differences in maternal and child health. The aim of the present study was to determine the possible existence of differences in neonatal diagnoses according to parental ethnic origin. METHODS: We performed a retrospective, cross-sectional study of all live newborns delivered in Hospital del Mar (Barcelona) between 2003 and 2005. The variables studied were risk of admission, diagnostic classes, and parental ethnic group. RESULTS: Of the 2118 newborns included in this study, 46.7% were of immigrant origin (mainly from Central and South America) and 6.4% were gypsies. More than 60% of the 1445 admitted newborns were included in the diagnostic class of risk or suspicion of infection. The risk of pregnancy with little or no prenatal care was higher in non-native and gypsy newborns (OR = 2.58; 95%CI: 1.76-3.77, and OR = 5.84; 95%CI: 3.45-9.90, respectively). The risk of low birth weight and maternal drug use were lower in non-native newborns (OR = 0.17; 95%CI: 0.03-0.90, and OR = 0.12; 95%CI: 0.03-0.44, respectively). CONCLUSIONS: Differences in non-native and gypsy newborns compared with native newborns are not due to imported or genetic diseases but are probably due to differences in the social and cultural environment during pregnancy. Preventive measures should be promoted and reinforced and access to and the quality of primary care should be improved in these mothers and their infants.