RESUMO
BACKGROUND: The objective of this study was to assess the effectiveness of a Patient Navigation Intervention targeting deprived patients for Colo-Rectal Cancer (CRC) screening participation. METHODS: A cluster randomized controlled trial was conducted in 5 districts. Peer Lay Patient Navigators were recruited to operate in deprived areas. Eligible participants had to be between 50 and 74 years old, live in these deprived areas and receive an invitation to the nationally organized Colo-Rectal Cancer (CRC) screening during the study period. The theory-driven navigation intervention was deployed for 18 months. A population Health Intervention Research assessment method was used to assess effectiveness and context interaction. The primary criterion was screening participation at 12 months. RESULTS: Twenty-four thousand two hundred eighty-one individuals were included inside 40 clusters. The increase in participation in the intervention group was estimated at 23%, (ORa = 1.23, CI95% [1.07-1.41], p = 0.003). For the subgroup of individuals who participated, the time delay to participating was reduced by 26% (ORa = 0.74, CI95% [0.57-0.96], p = 0.021). Main factors modulating the effect of the intervention were: closeness of navigator profiles to the targeted population, navigators' abilities to adapt their modus operandi, and facilitating attachment structure. CONCLUSION: The ColoNav Intervention succeeded in demonstrating its effectiveness, for CRC screening. Patient Navigation should be disseminate with broader health promotion goals in order to achieve equity in health care. TRIAL REGISTRATION: clinicaltrials.gov NCT02369757 24/02/2015.
Assuntos
Neoplasias Colorretais , Navegação de Pacientes , Neoplasias Retais , Humanos , Pessoa de Meia-Idade , Idoso , Navegação de Pacientes/métodos , Detecção Precoce de Câncer/métodos , Projetos de Pesquisa , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/prevenção & controle , Programas de RastreamentoRESUMO
BACKGROUND: To assess the efficacy of a patient educational program built according to guidelines that aims at reducing cancer-related fatigue (CRF). METHODS: Randomised controlled trial, multicentre, comparing a patient education program, vs the standard of care. Patients were adult cancer outpatients with any tumour site. The primary outcome was fatigue severity assessed with a visual analogical scale (VAS), between the day of randomisation and week 7. Secondary outcomes were fatigue assessed with other scales, health-related quality of life, anxiety and depression. The time to fatigue severity deterioration was assessed. Analyses were performed in a modified intent-to-treat way, that is, including all patients with at least one baseline and 1 week 7 score. RESULTS: A total of 212 patients were included. Fatigue severity assessment was made on 79 patients in the experimental group and 65 in the control group. Between randomisation and week 7, the fatigue (VAS) improved by 0.96 (2.85) points in the experimental group vs 1.63 (2.63) points in the control group (P=0.15). No differences with the secondary outcomes were highlighted between two groups. No other factors were found to be associated with fatigue severity deterioration. CONCLUSIONS: Despite rigorous methodology, this study failed to highlight the program efficacy in fatigue reduction for cancer patients. Other assessment tools should be developed to measure the effect of the program on CRF and behaviour. The implementation of the program should also be explored in order to identify its mechanisms and longer-term impact.
Assuntos
Ansiedade/prevenção & controle , Depressão/prevenção & controle , Fadiga/prevenção & controle , Neoplasias/complicações , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Atividades Cotidianas , Adulto , Ansiedade/etiologia , Estudos de Casos e Controles , Depressão/etiologia , Gerenciamento Clínico , Fadiga/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Neoplasias/terapia , Medição da Dor , Prognóstico , Reforço Psicológico , Taxa de SobrevidaRESUMO
BACKGROUND: The mass colorectal cancer screening program was implemented in 2008 in France, targeting 16 million French people aged between 50 and 74. The current adhesion is insufficient and the participation rate is even lower among the underserved population, increasing health inequalities within our health care system. Patient Navigation programs have proved their efficiency to promote the access to cancer screening and diagnosis. METHODS/DESIGN: The purpose of the study is to assess the implementation of a patient navigation intervention that has been described in another cultural environment and another health care system. The main objective of the program is to increase the colorectal cancer screening participation rate among the deprived population through the intervention of a navigator to promote the Fecal Occult Blood Test (FOBT) and complementary exams. We performed a multisite cluster randomized controlled trial, with three groups (one experimental group and two control groups) for 18 months. DISCUSSION: The study attempts to give a better understanding of the adhesion barriers to colorectal cancer screening among underserved populations. If this project is cost-effective, it could create a dynamic based on peer approaches that could be developed for other cancer screening programs and other chronic diseases. TRIAL REGISTRATION: NCT02369757.
Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/tendências , Acessibilidade aos Serviços de Saúde/tendências , Programas de Rastreamento/métodos , Navegação de Pacientes/métodos , Idoso , Análise Custo-Benefício , Detecção Precoce de Câncer/métodos , Feminino , França , Humanos , Masculino , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Populações VulneráveisRESUMO
From a population-based cohort of cases of first cancers diagnosed between 1987 and 2004, before the patient's age of 15 years, the authors conducted a nested case-control study, matching 64 patients who experienced a second malignant neoplasm (SMN) with 190 controls. SMNs comprised 10 leukemia or myelodysplastic syndromes, 5 lymphomas induced by Epstein-Barr virus after allograft, and 49 solid tumors, including mainly 25 carcinomas (17 of the thyroid), 9 bone sarcomas, and 7 central nervous system (CNS) tumors. The median latency occurrence was 6.5 years, and that of thyroid carcinomas induced by 12 Gy fractioned total body irradiation (TBI) was 7.6 years. The relative risk (RR) of an SMN was increased by genetic and family factors and increased 17 to 69 times according to the dose of radiotherapy administered in the region for the first cancer. Age younger than 4 years at the time of radiotherapy increased the risk of SMN. Chemotherapy adjusted according to the dose of radiotherapy administered in the field yielded a greater RR of an SMN only for cumulative doses exceeding 2 g/m2 of epipodophyllotoxin but not for alkylating agents or platinum compounds. The RR of secondary leukemia increased 10-fold following high doses of epipodophyllotoxin >2 g/m2 but was not affected by alkylating agents or anthracyclines. The crude RR of a solid SMN developing after radiotherapy was very high at 18 and reached 90.7 for thyroid carcinoma after TBI, whereas the authors observed no increased risk associated with chemotherapy. These results confirm the risk of secondary leukemia after epipodophyllotoxin and of solid tumor after radiotherapy.
Assuntos
Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/terapia , Podofilotoxina/administração & dosagem , Sistema de Registros , Irradiação Corporal Total , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , França/epidemiologia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Although the benefits of physical activity (PA) on health are recognised, prostate cancer patients do not follow PA recommendations. The barriers to PA, whether physical, environmental or organisational, are known. Furthermore, even when such barriers are overcome, this achievement is not systematically accompanied by a change in lifestyle habits. The proposal of a programme enabling the integration of PA in the patient's everyday life represents a new challenge in the personalized management of cancer patients. Peer-mentoring interventions have demonstrated their effectiveness in increasing adherence to PA by patients. This study aimed (1) to assess the feasibility of a peer-mentoring intervention: the Acti-Pair program in a local context and (2) to assess the effectiveness of the intervention in this context. METHODS AND ANALYSIS: A pre-post design pilot study will be used to evaluate feasibility, potential effectiveness and implementation outcomes overs in prostate cancer patients. We performed a mixed quantitative and qualitative prospective study to assess means and process indicators and the implementation of the Acti-Pair program. This study will be performed in cancer centres of Loire district and will be comprised of three successive stages (1) diagnosis of the target population, (2) recruitment and training of peers, and (3) implementation of this intervention in the Loire department. DISCUSSION: This study will allow us to extend the peer-mentoring intervention to other contexts and assess the effectiveness of this intervention and its generalisability.
RESUMO
The producing strain Streptomyces sp. 1010 was isolated from a shallow sea sediment from the region of Livingston Island, Antarctica. From the culture broth of this strain naturally active secondary metabolites were isolated identical to phthalic acid diethyl ester (C12H14O4, MW. 222); 1, 3-bis (3-phenoxyphenoxy)benzene (C30H22O4, MW.446); hexanedioic acid dioctyl ester (C22H42O4, MW.370) and the new substance 2-amino- 9, 13 -dimethyl heptadecanoic acid (C19H39NO2, MW.313). These compounds represent diverse classes of chemical structures and provide evidence for the untapped biosynthetic potential of marine bacteria from Antarctica.
Assuntos
Aminoácidos/isolamento & purificação , Ácidos Dicarboxílicos/isolamento & purificação , Ésteres/isolamento & purificação , Sedimentos Geológicos/microbiologia , Éteres Fenílicos/isolamento & purificação , Ácidos Ftálicos/metabolismo , Água do Mar/microbiologia , Streptomyces/metabolismo , Aminoácidos/metabolismo , Regiões Antárticas , Ácidos Dicarboxílicos/metabolismo , Ésteres/metabolismo , Cromatografia Gasosa-Espectrometria de Massas/métodos , Hexanos , Éteres Fenílicos/metabolismo , Ácidos Ftálicos/isolamento & purificação , Espectrometria de Massas por Ionização por Electrospray/métodos , Streptomyces/isolamento & purificaçãoRESUMO
Specialty teams are said to be an innovative solution for providing the coordinated, cost-effective care sought by managed care companies. This article describes one home health agency's systematic process for development of disease management and specialized skills teams.
Assuntos
Administração de Caso/organização & administração , Gerenciamento Clínico , Agências de Assistência Domiciliar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Competência Clínica , Humanos , Modelos de Enfermagem , Avaliação de Programas e Projetos de Saúde , Gestão da Qualidade TotalRESUMO
This article will explore food preparation and faith healing practices of contemporary Cajun culture. Decades of exile and oppression required the early Cajuns to make use of scarce resources as a means of survival. Although modern society offers technological advances and information that can lead to more positive health outcomes, this close-knit group of hearty individuals frequently chooses to leave many traditional practices unchanged. Health care practitioners must understand the beliefs and practices of the Cajun people in order to meet their health needs.
Assuntos
Atitude Frente a Saúde/etnologia , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde , Enfermagem Transcultural/métodos , Canadá/etnologia , Currículo , Bacharelado em Enfermagem , Humanos , Louisiana , Enfermagem Transcultural/educaçãoAssuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/uso terapêutico , Hematínicos/uso terapêutico , Metaloproteínas/uso terapêutico , Succinatos/uso terapêutico , Idoso , Feminino , Compostos Férricos/efeitos adversos , Hematínicos/efeitos adversos , Humanos , Masculino , Metaloproteínas/efeitos adversos , Pessoa de Meia-Idade , Succinatos/efeitos adversosRESUMO
An statistical analysis is reported on specific problems of the infant of diabetic mother during the period 1980-1985, with a total of 287 newborns. Complications in this sample are exposed, and significant differences demonstrated in gestational age, fetal distress, hypocalcemia, polycythemia, jaundice, respiratory distress syndrome and associated problems according to clinical type of diabetes mellitus. High percentage of congenital malformations is pointed-out with a predominance of cardiac septal defects. Diabetological control was closer in insulin-dependent group, therefore, its effect has been studied separately. A lower rate of hypoglycemia was found in those under control, while infant of insulin-dependent diabetic mother showed a better compliance between weight and gestational age and a lower rate of respiratory distress syndrome.