Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review.

BACKGROUND: Inequalities in cancer incidence and mortality can be partly explained by unequal access to high-quality health services, including cancer screening. Several interventions have been described to increase access to cancer screening, among them patient navigation (PN), a barrier-focused intervention. This systematic review aimed to identify the reported components of PN and to assess the effectiveness of PN to promote breast, cervical and colorectal cancer screening. METHODS: We searched Embase, PubMed and Web of Science Core Collection databases. The components of PN programmes were identified, including the types of barriers addressed by navigators. The percentage change in screening participation was calculated. RESULTS: The 44 studies included were mainly on colorectal cancer and were conducted in the USA. All described their goals and community characteristics, and the majority reported the setting (97.7%), monitoring and evaluation (97.7%), navigator background and qualifications (81.4%) and training (79.1%). Supervision was only referred to in 16 studies (36.4%). Programmes addressed mainly barriers at the educational (63.6%) and health system level (61.4%), while only 25.0% reported providing social and emotional support. PN increased cancer screening participation when compared with usual care (0.4% to 250.6% higher) and educational interventions (3.3% to 3558.0% higher). CONCLUSION: Patient navigation programmes are effective at increasing participation to breast, cervical and colorectal cancer screening. A standardized reporting of the components of PN programmes would allow their replication and a better measure of their impact. Understanding the local context and needs is essential to design a successful PN programme.

Changes in life expectancy and disease burden in Norway, 1990-2019: an analysis of the Global Burden of Disease Study 2019.

BACKGROUND: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties. METHODS: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient. FINDINGS: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors. INTERPRETATION: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors. FUNDING: Bill & Melinda Gates Foundation, Research Council of Norway, and Norwegian Institute of Public Health.

Fruit and vegetable consumption in Europe according to gender, educational attainment and regional affiliation-A cross-sectional study in 21 European countries.

OBJECTIVE: The purpose of the present study was to examine fruit and vegetable consumption according to gender, educational attainment and regional affiliation in Europe. DESIGN: Cross-sectional study. SETTING: 21 European countries. PARTICIPANTS: 37 672 adults participating in the 7th round of the European Social Survey. MAIN OUTCOME MEASURES: Fruit and vegetable consumption was measured using two single frequency questions. Responses were dichotomized into low (

Physical activity in long-term breast cancer survivors - A mixed-methods approach.

OBJECTIVES: Traditional methods measuring physical activity (PA) may misrepresent breast cancer survivors (BCSs) and low-socioeconomic status (SES) groups. This study identifies PA-levels, routines and experiences among BCSs, in general and by SES, and explores whether a mixed-methods approach might unveil diversities of PA in BCS across SES. MATERIALS AND METHODS: 250 BCSs referred to postoperative radiation therapy in 2007-2008 participated in a longitudinal follow-up study examining health-related quality-of-life and late-effects. Subsample-data on SES and PA were collected by questionnaires (n = 52), activity-logs (n = 52) and interviews (n = 37). Parallel mixed analyses were conducted, in combination with sequential, full-sample analyses of questionnaires and contrasting case analyses of logs and interviews. RESULTS: Dependent on which measurement used, 23%, 35%, 54% and 63% of BCSs met PA guidelines. Questionnaire-data revealed no significant differences in PA levels between SES groups. Log-data showed more PA bouts in high-SES BCSs, but no difference in min/week across SES. Neighbourhood walking was preferred, while scheduled exercise was rare. Interview-data added that PA was medicating, normatively described and accompanied by unfulfilled ambitions, particularly in low-SES BCSs. Balancing duties and activities was demanding. PA constraints were similar across groups. Domestic PA was important in low-SES, while high-SES BCSs described more energy. CONCLUSION: Although PA levels among BCSs were similar across SES and equal to PA in the general population, SES differences became evident when measured by activity-logs and as stated in interviews. Future follow-up programs for BCSs could benefit from expanding the PA perspectives, thus better meet the needs of different SES groups.

The potential impact of a social redistribution of specific risk factors on socioeconomic inequalities in mortality: illustration of a method based on population attributable fractions.

BACKGROUND: Socioeconomic differences in health are a major challenge for public health. However, realistic estimates to what extent they are modifiable are scarce. This problem can be met through the systematic application of the population attributable fraction (PAF) to socioeconomic health inequalities. METHODS: The authors used cause-specific mortality data by educational level from Belgium, Norway and Czech Republic and data on the prevalence of smoking, alcohol, lack of physical activity and high body mass index from national health surveys. Information on the impact of these risk factors on mortality comes from the epidemiological literature. The authors calculated PAFs to quantify the impact on socioeconomic health inequalities of a social redistribution of risk factors. The authors developed an Excel tool covering a wide range of possible scenarios and the authors compare the results of the PAF approach with a conventional regression. RESULTS: In a scenario where the whole population gets the risk factor prevalence currently seen among the highly educated inequalities in mortality can be reduced substantially. According to the illustrative results, the reduction of inequality for all risk factors combined varies between 26% among Czech men and 94% among Norwegian men. Smoking has the highest impact for both genders, and physical activity has more impact among women. CONCLUSIONS: After discussing the underlying assumptions of the PAF, the authors concluded that the approach is promising for estimating the extent to which health inequalities can be potentially reduced by interventions on specific risk factors. This reduction is likely to differ substantially between countries, risk factors and genders.