Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

[Satisfaction with the breast cancer screening program in Barcelona: a comparison between 2006 and 2016.] / Satisfacción hacia el programa de cribado de cáncer de mama de Barcelona por parte de las mujeres: Comparativa entre 2006 y 2016.

OBJECTIVE: Satisfaction represents the subjective experience derived from the fulfillment or non-fulfillment of the expectations that the subject has regarding assistance. The debate generated by the screening programs requires studying satisfaction as one more element in the evaluation. In 2006, a study was carried out in Barcelona on the satisfaction and expectations generated around screening. Ten years later another was carried out in order to study evolution during this time. The objective of the current study is to investigate the satisfaction with the Breast Cancer Screening Program (BCSP) in Barcelona and to compare with the results obtained in a previous study carried out 10 years ago. METHODS: This was a cross-sectional study, whose study population was women participating in the BCSM. We conducted random sampling. The questionnaire asked for opinion about the informative materials and the information sessions, their level of participation (regular or irregular) and their overall satisfaction with the program. Women who had been referred for further examinations were asked specific questions about their satisfaction with the follow-up process. We conducted a descriptive analysis and compare the results to those obtained in the 2006 survey. We assessed the correlation between satisfaction and importance using the Pearson's correlation coefficient, and we also performed logistic regression analyses. All statistical analyses were conducted using SPSS. RESULTS: Participants were generally satisfied with the program, the professionalism and treatment received from the medical professionals. There was a significant positive correlation with the importance given to each of these dimensions. Women who stated that they did not feel nervous while waiting for the results of the mammography reported that they felt very satisfied with the information received [OR=1.86 (95% CI 1.03-3.36)] and with the equipment used [OR=1.97 (1.02-3.85)]. Non-working women were more satisfied with the information obtained [OR=1.86 (CI 1.06-2.9)]. Most of the results showed improvement with respect to those of the 2006 survey. CONCLUSIONS: It's necessary to continue working towards providing the best possible information, and paying special attention to the most vulnerable groups.

OBJETIVO: La satisfacción representa la vivencia subjetiva derivada del cumplimiento o incumplimiento de las expectativas que el sujeto tiene respecto a la asistencia. El debate generado por los programas de cribado, requiere estudiar la satisfacción como un elemento más en la evaluación. En el año 2006 se llevó a cabo en Barcelona un estudio sobre la satisfacción y las expectativas generadas alrededor del cribado. Diez años después se realizó otra con el fin de poder estudiar la evolución durante este tiempo. El objetivo del presente estudio es investigar la satisfacción con el Programa de Cribado del Cáncer de Mama (BCSP) de Barcelona y compararlo con los resultados obtenidos en un estudio previo realizado hace 10 años. METODOS: Estudio transversal. La población de estudio fueron las mujeres de 50 a 69 años participantes en el PDPCM (105.528 mujeres). El muestreo fue aleatorio y estratificado por distritos; las fuentes de información fueron el padrón de habitantes y los registros de cada oficina técnica. Se llevó a cabo un análisis descriptivo y estratificado por edad y clase social. Se compararon los resultados con los del 2006. La correlación entre la satisfacción y la importancia mediante el coeficiente de relación de Pearson. Se ajustaron modelos de regresión logística. RESULTADOS: Destaca la satisfacción hacia la profesionalidad y el trato recibido. Las mujeres que declararon no sentirse nerviosas durante la espera de resultados, presentaron una OR=1,86 (IC95% 1,03-3.36) de sentirse muy satisfechas respecto a la información y OR=1,97 (IC95% 1,02-3,85) respecto a los equipamientos. Las no trabajadoras en activo se sintieron más satisfechas con la información OR=1,86 (IC95% 1,06-2,9). Las de clase media fueron las más satisfechas con la profesionalidad, OR=2.26 (IC95% 1,08-4,73) respecto clase alta. CONCLUSIONES: Es importante seguir trabajando la información que se facilita prestando especial atención a los grupos que se muestran menos satisfechos en el estudio llevado a cabo.

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]. / ¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa.

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

The association between breast cancer and consumption of dairy products: a systematic review.

INTRODUCTION: Introduction: breast cancer is the most common cancer in women and its relationship with dietary factors particularly dairy products, has been investigated trough several studies but up to now there are still not enough results to confirm the association between breast cancer and dairy products. Objective: the purpose of this systematic review was to expand the number of systematic reviews that to date exist on the relationship between dairy products consumption and risk of breast cancer. A comprehensive search of the PubMed, Scopus and Embase was performed from September 2005 to September 2018 in which one case control and cohorts' studies were included. Results: Eighteen studies were finally selected for the review (10 case-control and 8 cohorts' studies). These studies reported several statistically significant associations (OR, HR, RR) between dairy product consumption and the risk of breast cancer. Seven case-control and four cohorts' studies showed that dairy product consumption was inversely associated with the risk of breast cancer, on the other hand, a positive association was found in two case-control and non- significant association was found between dairy product consumption and the risk of breast cancer in the remaining studies (one case-control and four cohorts' studies) Conclusion: Although an inverse association was observed in most studies, it's difficult to draw conclusions when the methodology methods to collect the dairy product intake and the servings or portions measurements were different in each study. On the other hand, not all studies used the same confounding variable to estimate risk.

INTRODUCCIÓN: Introducción: el cáncer de mama es de los más comunes en mujeres, y su relación con los factores dietéticos y, en particular, con los productos lácteos, ha sido investigada a través de varios estudios, pero hasta ahora no hay resultados suficientes que confirmen la asociación entre cáncer de mama y productos lácteos. Objetivo: ampliar y actualizar el número de revisiones sistemáticas que hasta día de hoy existen sobre la relación entre el consumo de productos lácteos y el cáncer de mama. Metodología: se realizó una búsqueda exhaustiva en las bases de datos PubMed, Scopus y Embase entre septiembre de 2005 y septiembre de 2018 en la que se incluyeron estudios de casos y controles y estudios de cohortes. Resultados: se seleccionaron 18 estudios (10 estudios de casos-controles y 8 estudios de cohorte). Siete casos-controles y cuatro estudios de cohorte mostraron que el consumo de productos lácteos tenía una asociación inversa con el riesgo de cáncer de mama y, por otro lado, en dos estudios de casos-controles se observó una asociación positiva. No se encontró una asociación significativa entre el consumo de productos lácteos y el cáncer de mama en los restantes estudios (1 caso-control y 4 cohortes). Conclusión: aunque se observó una asociación inversa en la mayoría de los estudios, es difícil sacar conclusiones cuando los métodos metodológicos para recolectar la ingesta de lácteos y las porciones o las mediciones de las porciones fueron diferentes en cada estudio. Por otro lado, no todos los estudios tienen en cuenta las mismas variables de confusión.

[Influence of diagnostic pathway on clinical and non-conventional therapies use in women with breast cancer of the cohort DAMA]. / Influencia de la vía diagnóstica en la clínica y el uso de terapias no convencionales en mujeres con cáncer de mama de la cohorte DAMA.

OBJECTIVE: To describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway. We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them. METHOD: Descriptive design nested in a mixed cohort (Cohort DAMA). The dependent variable was the route to diagnosis of breast cancer. The independent variables were age, body mass index, social class, disposable family income, type of tumour, histological degree, tumour stage, recurrences, treatment, adverse effects derived from treatments and unconventional therapies. Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted; and graphic representations of the unconventional therapies. RESULTS: There are differences in the characteristics of the tumours, and the impact of the adverse effects derived from the treatments. The patients diagnosed by screening were older, from a high social class, had a higher percentage of tumours of grade I differentiation, initial stages, fewer recurrences and fewer adverse effects due to treatment, although this was not different in the screening group compared to the rest. There was also less use of unconventional therapies. CONCLUSIONS: The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects. As a result, there is less need to resort to unconventional therapies.

[Social and clinical determinants of the use of health services in women with breast cancer (Cohort DAMA)]. / Determinantes sociales y clínicos del uso de servicios sanitarios en mujeres con cáncer de mama (Cohorte DAMA).

OBJECTIVE: To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project. METHOD: Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals. RESULTS: The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions. CONCLUSIONS: The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this.

Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort).

BACKGROUND: Breast cancer is a challenge for women's health-related quality of life (QoL), compromising their physical health and emotional well-being. QoL is equally distributed among different social groups. The aim of this study to analyze the impact of clinical characteristics and social determinants of health on the QoL of a cohort of women diagnosed and/or treated for breast cancer between 2003 and 2013 in one of the main hospitals in Barcelona's public health network. METHODS: We performed a descriptive cross-sectional study in a cohort of 2235 women with various stages of breast cancer at different stages of their disease. Data were obtained using questionnaires QLQ-C30 and QLQ-BR23 from the European Organization for Research and Treatment of Cancer (EORTC), which include a set of functional and symptomatic scales. We conducted descriptive and bivariate analysis using the Chi-Square test and adjusted for relevant variables using logistic regression. The dependent variables were the functional scales of QoL and the independent variables were sociodemographic and clinical variables. RESULTS: We observed significant differences for most QoL functions. Women from the most disadvantaged class, those in social isolation, or those who had suffered relapses showed the poorest results for most of the function scales. In contrast, age had differential effects depending on the function studied. CONCLUSIONS: The QoL of women diagnosed with breast cancer is closely linked to both their social and economic status, and to their stage of disease progression. It is necessary to explore interventions that focus on the social determinants of health in order to mitigate their effects on breast cancer survivors' QoL.

Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort.

BACKGROUND: Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). OBJECTIVE: We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. METHODS: We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study's objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women's social profile based on descriptive data obtained from the telephone interview (welcome survey). RESULTS: Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. CONCLUSIONS: We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer.

Country of origin and prevention of breast cancer: beliefs, knowledge and barriers.

This study describes the concept of prevention and identifies the knowledge, perceived benefits and barriers, as well as the practices of early detection of breast cancer among women from different cultural backgrounds and socioeconomic levels. A socioconstructivist qualitative study was conducted in Barcelona. The study population consisted of women who were either native (Spanish) or immigrants from low income countries, aged 40 to 69 years. Narrations of the 68 informants were subjected to sociological discourse analysis. Place and culture of origin, social class and the migratory process can either facilitate or constitute barriers to breast cancer prevention.

Knowledge, attitude and perceptions of breast cancer screening among native and immigrant women in Barcelona, Spain.

OBJECTIVE: Inequalities between immigrant and native populations in terms of access and use of health services have been described. The objective is to compare knowledge, attitudes, vulnerabilities, benefits and barriers related to breast cancer (BC) and screening mammography among women from different countries resident in Barcelona. METHODS: A cross-sectional survey carried out in Barcelona in 2009. The study population consisted of female residents in Barcelona between 45 and 69 years of age; participants were Spanish nationals or immigrants from low-income countries. 960 participants were asked 72 questions, mainly with Likert responses. The dependent variables were five quantitative scales: (1) knowledge of BC and early detection, (2) attitude towards health and BC, (3) vulnerability to BC, (4) barriers to mammography, (5) benefits of mammography. The independent variables were country of origin, social class, setting, cohabitation, age, mammography use, length of residence and fluency of the language. Analyses compared scale scores stratified by the independent variables. Multivariable linear regression models were fitted to determine the relationship between the scales and the independent variables. RESULTS: We observed inequalities according to country of origin on all scales after adjustment for independent variables. Chinese women presented the greatest differences with respect to native women, followed by Maghrebi and Filipino women. Inequalities exist on the vulnerability and barriers scales according to social class and urban/rural setting, and on the attitude scale according to social class. CONCLUSIONS: Country of origin, social class and urban/rural setting are key contributors to inequality in these scales.

Preventive control of breast and cervical cancer in immigrant and native women in Spain: the role of country of origin and social class.

The study describes the periodic use of cervical and breast cancer screening by women residing in Spain, according to their country of origin, and analyzes whether the observed associations are modified by social class. A cross-sectional design was used, with the study population consisting of women residing in Spain in 2006, ages 25-65 years (N = 10,093) and 40-69 years (N = 6674) in the cervical and breast cancer screening groups, respectively. The information source was Spain's National Health Survey of 2006. The dependent variables were: undergoing periodic cervical cancer screening (every 5 years or less) and breast cancer screening (every 2 years or less). The independent variables were: country of origin, social class, health care coverage, cohabitation, and age. A descriptive analysis was carried out, and robust Poisson regression models were fitted. Women from low-income countries underwent fewer periodic screening exams for cervical cancer and breast cancer. Independent of country of origin, women from the manual classes underwent fewer screening exams than those from the non-manual classes. In the 50-69 years age group, it was mainly women from the manual classes from low-income countries who underwent fewer periodic mammograms. Having only public health care coverage and not cohabiting with a partner were also associated with lower prevalences of use.

Evolution of inequalities in breast and cervical cancer screening in Barcelona: population surveys 1992, 2001, and 2006.

OBJECTIVE: To describe and compare breast and cervical cancer screening among women in Barcelona in 1992, 2001, and 2006 by social class, age, and screening approach. METHODS: This was a study of trends based on analysis of Barcelona health interview surveys for the years 1992 (n=5,003), 2001 (n=10,030), and 2006 (n=6,050). Dependent variables were having regular mammographies (at least every 2 years) and having regular cytologic testing (at least every 3 years). Independent variables were age, social class, and survey year. A descriptive analysis was carried out. To compare prevalence in terms of social class and the years studied, we calculated prevalence differences (PD) and prevalence ratios (PR) by fitting robust Poisson regression models. RESULTS: In 1992, women aged 40?49 had more regular mammographies than those aged 50?69, with social class inequalities in both age groups. Having cervical cancer screening was more common than having breast cancer screening, with prevalence varying from 46.4% in the low social classes to 59.2% in the high classes. In 2001, breast cancer screening had risen, particularly in women aged 50?69, a tendency that had stabilized by 2006. Inequalities diminished over the period, more markedly in women aged 50?69; PRs of 1.22 and 1.58, respectively, for high and middle social classes with respect to the lowest class in 1992 fell to PRs of 1.07 and 1.08, respectively, in 2006. In the case of cervical cancer screening, inequalities also diminished but not to the same extent. CONCLUSIONS: Preventive screening for breast and cervical cancer has increased, and the population screening program for breast cancer among women aged 50?69 years appears to contribute more than opportunistic screening for cervical cancer in reducing social class inequalities.

Socio-economic inequalities in mortality due to injuries in small areas of ten cities in Spain (MEDEA Project).

OBJECTIVES: To analyse socio-economic inequalities in mortality due to injuries among census tracts of ten Spanish cities by sex and age in the period 1996-2003. METHODS: This is a cross-sectional ecological study where the units of analysis are census tracts. The study population consisted of people residing in the cities during the period 1996-2003. For each census tract we obtained an index of socio-economic deprivation, and estimated standardized mortality ratios using hierarchical Bayesian models which take into account the spatial structure of the data. RESULTS: In the majority of the cities, the geographical pattern of total mortality from injuries is similar to that of the socio-economic deprivation index. There is an association between mortality due to injuries and the deprivation index in the majority of the cities which is more important among men and among those younger than 45 years. In these groups, traffic injuries and overdoses are the causes most often associated with deprivation in the cities. The percentage of excess mortality from injuries related to socio-economic deprivation is higher than 20% in the majority of the cities, the cause with the highest percentage being drug overdose. CONCLUSIONS: In most cities, there are socio-economic inequalities in mortality due to overdose and traffic injuries. In contrast, few cities have found association between suicide mortality and deprivation. Finally, no association was found between deprivation and deaths due to falls. Inequalities are higher in men and those under 45 years of age. These results highlight the importance of intra-urban inequalities in mortality due to injuries.

Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities.

BACKGROUND: Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. METHODS: It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. RESULTS: In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. CONCLUSION: This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment.