Factors Related to Non-participation in the Basque Country Colorectal Cancer Screening Programme.

Background: Despite the high participation rates in the Basque Country, colorectal cancer screening programme (Spain), there is still a part of the population that has never participated. Since it is essential to ensure equal access to health services, it is necessary to identify the determinants of health and socio-economic factors related to non-participation in the screening programme. Methods: Cross sectional descriptive study including all invited population in a complete round between 2015 and the first trimester of 2017. Health risk factors available in medical records and their control have been analyzed using univariate and multivariate analyses. Results: 515,388 people were invited at the programme with a 71.9% of fecal immunochemical test participation rate. Factors that increase the risk of non-participation are: being men (OR = 1.10, 95% CI 1.09-1.12); younger than 60 (OR = 1.18, 95% CI 1.17-1.20); smoker (OR = 1.20, 95% CI 1.18-1.22); hypertensive (OR = 1.14, 95% CI 1.12-1.15) and diabetic (OR = 1.40, 95% CI 1.36-1.43); having severe comorbidity (OR = 2.09, 95% CI 2.00-2.19) and very high deprivation (OR = 1.15, 95% CI 1.12-1.17), as well as making <6 appointments to Primary Care in 3 years (OR = 2.39, 95% CI 2.33-2.45). Still, the area under the curve (AUC) indicates that there are more factors related to non-participation. Conclusions: The participation in the Basque Country colorectal cancer-screening Programme is related to some risk factors controlled by Primary Care among others. Therefore, the involvement of these professionals could improve, not only the adherence to the CRC screening, but also other health styles and preventive interventions.

Exposure to Radioactive Emanations of Medical Personnel in Percutaneous Nephrolithotomy.

The use of radioactive emanations has been of great importance for the performance of endourology procedures, such as percutaneous nephrolithotomy (NLP). The damage to health caused by radiation has been a sensitive issue. The objective of this work was to determine the dose received by the surgeon during NLP and the total dose generated by the fluoroscope. A cross-sectional study was conducted with data from a cohort study with a duration of 18 months that included 101 patients. Radiation was measured with dosimeter during the last 6 months. During the last 6 months of the study, 34 patients were submitted to surgery. The average age was 47 years. Average fluoroscopy time was 58.3 second (24-122 seconds) in both male and female groups, with 57.16 seconds and 58.95 seconds per case, respectively (P = .6). Radiation emitted during 6 months for the 34 patients was 330.5 mGy. The total radiation measured by the dosimeter was 1 mSv, which is equivalent to 0.3% of the total radiation applied during the procedures. Doses measured by the dosimeter on the surgeon were within the recommended annual doses although dose received by the hands exceeds the authorized limits (500 mSv/y).

Evaluation of the colorectal cancer screening Programme in the Basque Country (Spain) and its effectiveness based on the Miscan-colon model.

The population-based Basque Colorectal Cancer (CRC) Screening Programme started in 2009 with a biennial immunochemical quantitative test (FIT) biennial and colonoscopy under sedation in positive cases. The population target of 586,700 residents was from 50 to 69 years old and the total coverage was reached at the beginning of 2014. The aim of our study was to determine possible scenarios in terms of incidence, mortality and reduction of Life-years-Lost (L-y-L) in the medium and long term of CRC. METHODS: Invitations were sent out by the Programme from 2009 to 2014, with combined organizational strategies. Simulation was done by MISCAN-colon (Microsimulation Screening Analysis) over 30 years comparing the results of screening vs no-screening, taking the population-based Cancer Registry into account. Lifetime population and real data from the Programme were used from 2008 to 2012. The model was run differentially for men and women. RESULTS: 924,416 invitations were sent out from 2009 to 2014. The average participation rate was 68.4%, CRC detection rate was 3.4% and the Advanced Adenoma detection rate was 24.0‰, with differences observed in sex and age. Future scenarios showed a higher decrease of incidence (17.2% vs 14.7%), mortality (28.1% vs 22.4%) and L-y-L (22.6% vs 18.4%) in men than women in 2030. CONCLUSIONS: The Basque Country CRC Programme results are aligned to its strategy and comparable to other programmes. MISCAN model was found to be a useful tool to predict the benefits of the programme in the future. The effectiveness of the Programme has not been formally established as case control studies are required to determine long term benefits from the screening strategy.

Patients with cancer in the intensive monitoring unit. New perspectives. / El paciente con cáncer en la unidad de vigilancia intensiva. Nuevas perspectivas.

In recent years, there has been a significant improvement in the survival of patients with cancer in intensive care units (ICUs). Advances in medical and surgical treatments and better selection of patients has helped improve the life expectancy of this type of patient. An appropriate and early resuscitation in the ICU, without initial limitations on the life support techniques, has been shown to also decrease the mortality of patients with cancer. At present, we should not deny admission to the ICU based only on the underlying neoplastic disease. However, the mortality rate for patients with cancer in the ICU, especially those with hematologic disease, remains high. In some cases, an ICU admission test (ICU test) is required for at least 3 days to identify patients who can benefit from intensive treatment. We would like to propose a decision algorithm for ICU admission that will help in making decisions in an often complex situation.

Effect of oral anticoagulants on the outcome of faecal immunochemical test.

BACKGROUND: We aimed to evaluate whether oral anticoagulants (OACs) alter faecal immunochemical test (FIT) performance in average-risk colorectal cancer (CRC) screening. METHODS: Individuals aged 50-69 years were invited to receive one FIT sample (cutoff 75 ng ml(-1)) between November 2008 and June 2011. RESULTS: Faecal immunochemical test was positive in 9.3% (21 out of 224) of users of OAC and 6.2% (365 out of 5821) of non-users (P-trend=0.07). The positive predictive value (PPV) for advanced neoplasia (AN) in non-users was 50.4% vs 47.6% in users (odds ratio, 0.70; 95% CI, 0.3-1.8; P=0.5). The PPV for AN in OAC more antiplatelets (aspirin or clopidogrel) was 75% (odds ratio, 2; 95% CI, 0.4-10.8; P=0.4). CONCLUSIONS: Oral anticoagulant did not significantly modify the PPV for AN in this population-based colorectal screening program. The detection rate of advanced adenoma was higher in the combination OAC more antiplatelets.

Traumatismo ocular infantil con afectación de la agudeza visual en pacientes del Hospital de Clínicas: frecuencia, manejo y resultado visual final / Child ocular trauma affecting visual acuity in patients of the Hospital de Clínicas: frequency, management and final visual result

El objetivo de este trabajo es determinar la frecuencia del traumatismo ocular infantil con afectación de la agudeza visual (AV), manejo de urgencia y relación entre la AV al momento de la consulta y luego de un mes de evolución. Se realizó un estudio observacional, descriptivo, con 318 pacientes menores de 16 años, de ambos sexos, que acudieron al servicio de Oftalmología del Hospital de Clínicas, entre setiembre de 2006 y julio de 2007. De los pacientes que consultaron por traumatismo ocular con afectación de la agudeza visual se analizaron datos demográficos, agente causante del trauma, circunstancia, lugar donde se produjo el accidente, tiempo de evolución, AV, tipo de trauma, zona afecta y tratamiento de urgencia. De los 318 niños que consultaron al departamento de urgencias del servicio durante el periodo de estudio, 101 (31,7%) lo hicieron por traumatismo ocular. De éstos, 55 (54,5%) presentó disminución de la agudeza visual. El trauma fue cerrado en el 85,5% de los pacientes y abierto en el 14,5%. Los principales agentes causantes del trauma fueron rama de plantas, palo, piedra, explosivos, alambre y varilla de hierro. La AV al mes de la primera consulta mejoró en el 83,5% de los casos, permaneció igual en el 14,5% y empeoró en el 2%. Existe una relación directa entre AV inicial y AV al mes de la primera consulta (p= 0,01), y una relación inversa entre el tiempo de evolución y la AV al mes (p= 0,013).El traumatismo ocular infantil es un motivo de consulta frecuente en los servicios de urgencia oftalmológica. La AV inicial y el tiempo de evolución constituyen factores pronósticos de la AV final en estos pacientes.

The objective of this work was to determine the frequency of child ocular trauma affecting visual acuity (VA), management of urgencies and relation between the VA at the time of the consultation and after one month of evolution. This was an observational descriptive study of 318 patients, girls and boys under 16 years who attended the Ophthalmology Service of the Hospital de Clínicas from September, 2006 to July, 2007. The following data of the patients that consulted for eye trauma affecting their visual acuity were analyzed: demographic data, causative agent of the trauma, circumstances, place of accident, time of evolution, VA, trauma type, affected zone and urgency treatment. A total of 318 children consulted the urgency department of the service and 101 (31.7%) of them consulted for eye trauma. Of these, 55 (54.5%) showed a decrease of the visual acuity. The trauma was closed in 85.5% patients and open in 14.5%. The main causative agents of trauma were tree branches, sticks, stones, explosives, wires and iron rods. After one month of consultation, VA improved in 83.5% of the cases, remains equal in 14.5% and worsened in 2%. There was a direct relation between the initial VA and the VA at one month (p = 0.01) and an inverse relation between time of evolution and the VA at one month (p = 0.013). The child eye traumatism is a frequent reason of consultation in the ophthalmic urgency services. The initial VA and the time of evolution are prognosis factors of the final VA of these patients.