Trends in colorectal cancer surgical resection rates during the screening era: a retrospective study in Italy.

BACKGROUND: Faecal immunochemical test (FIT)-based screening is effective in reducing colorectal cancer (CRC) incidence, but its sensitivity for proximal lesions remains low. OBJECTIVES: We compared age-adjusted CRC surgical resection rates across anatomic sites (proximal colon, distal colon, rectum), age groups and sex over 20 years in a large Italian population. We particularly focused on changes in trends following FIT-screening implementation in the target population (50-69 years). DESIGN: This retrospective study analysed data from the Veneto Region's administrative Hospital Discharge Dataset, involving over 54 000 patients aged 40-89 (43.4% female) who underwent CRC surgery between 2002 and 2021. RESULTS: Overall, surgery rates increased until 2007 (annual percentage changes: 2.5% in males, 2.9% in females) and then declined (-4.2% in males, -3.4% in females). This decline was steeper for distal and rectal cancers compared with proximal cancer, suggesting a shift towards more right-sided CRC surgery.In males, the prescreening increase in proximal surgery was reversed after screening implementation (slope change: -6%) while the prescreening decline accelerated for distal (-4%) and rectal (-3%) surgeries. In females, stable prescreening trends shifted downward for all sites (-5% for proximal, -8% for distal and -7% for rectal surgery). However, the change in trends between prescreening and postscreening periods was not different across anatomic sites for either sex (all slope change differences in pairwise comparisons were not statistically significant). CONCLUSION: The shift towards proximal surgery may not be entirely due to the FIT's low sensitivity but may reflect an underlying upward trend in proximal cancers independent of screening.

Associations between news coverage, social media discussions, and search trends about celebrity deaths, screening, and other colorectal cancer-related events.

OBJECTIVE: Colorectal cancer (CRC) is the third leading cause of cancer death among both men and women in the United States. CRC-related events may increase media coverage and public attention, boosting awareness and prevention. This study examined associations between several types of CRC events (including unplanned celebrity cancer deaths and planned events like national CRC awareness months, celebrity screening behavior, and screening guideline changes) and news coverage, Twitter discussions, and Google search trends about CRC and CRC screening. METHODS: We analyzed data from U.S. national news media outlets, posts scraped from Twitter, and Google Trends on CRC and CRC screening during a three-year period from 2020 to 2022. We used burst detection methods to identify temporal spikes in the volume of news, tweets, and search after each CRC-related event. RESULTS: There is a high level of heterogeneity in the impact of celebrity CRC events. Celebrity CRC deaths were more likely to precede spikes in news and tweets about CRC overall than CRC screening. Celebrity screening preceded spikes in news and tweets about screening but not searches. Awareness months and screening guideline changes did precede spikes in news, tweets, and searches about screening, but these spikes were inconsistent, not simultaneous, and not as large as those events concerning most prominent public figures. CONCLUSIONS: CRC events provide opportunities to increase attention to CRC. Media and public health professionals should actively intervene during CRC events to increase emphasis on CRC screening and evidence-based recommendations.

Trends in Colorectal Cancer Screening from the National Health Interview Survey: Analysis of the Impact of Different Modalities on Overall Screening Rates.

Colorectal cancer is the second leading cause of cancer-related mortality in adults in the United States. Despite compelling evidence of improved outcomes in colorectal cancer, screening rates are not optimal. This study aimed to characterize colorectal cancer screening trends over the last two decades and assess the impact of various screening modalities on overall colorectal cancer screening rates. Using National Health Interview Survey data from 2005 to 2021, we examined colorectal cancer screening [colonoscopy, multitarget stool DNA (mt-sDNA), fecal occult blood test (FOBT)/fecal immunochemical test, sigmoidoscopy, CT colonography] rates among adults ages 50-75 years (n = 85,571). A pseudo-time-series cross-sectional (pseudo-TSCS) analysis was conducted including a random effects generalized least squares regression model to estimate the relative impact of each modality on changes in colorectal cancer screening rates. Among 50 to 75 year olds, the estimated colorectal cancer screening rate increased from 47.7% in 2005 to 69.9% in 2021, with the largest increase between 2005 and 2010 (47.7%-60.7%). Rates subsequently plateaued until 2015 but increased from 63.5% in 2015 to 69.9% in 2018. This was primarily driven by the increased use of mt-sDNA (2.5% in 2018 to 6.6% in 2021). Pseudo-TSCS analysis results showed that mt-sDNA contributed substantially to the increase in overall screening rates (77.3%; P < 0.0001) between 2018 and 2021. While colorectal cancer screening rates increased from 2005 to 2021, they remain below the 80% goal. The introduction of mt-sDNA, a noninvasive screening test may have improved overall rates. Sustained efforts are required to further increase screening rates to improve patient outcomes and offering a range of screening options is likely to contribute to achieving this goal. PREVENTION RELEVANCE: This retrospective study highlights the importance of convenient stool-based colorectal cancer screening options to achieve the national goal of 80% for overall colorectal cancer screening rates. Empowering screening-eligible individuals with a choice for their colorectal cancer screening tests is imperative.

Quantified trends in provider reimbursement and utilization volume in colorectal cancer screenings: analysis of Medicare claims from 2000 to 2019.

AIM: Colorectal cancer (CRC) screening rates in the United States remain persistently below guideline targets, partly due to suboptimal patient utilization and provider reimbursement. To guide long-term national utilization estimates and set reasonable screening adherence targets, this study aimed to quantify trends in utilization of and reimbursement for CRC screenings using Medicare claims. METHOD: Inflation-adjusted reimbursements and utilization volume associated with each CRC screening code were abstracted from Medicare claims between 2000 and 2019. Screenings, screenings/100 000 enrolees and reimbursement/screening were analysed with linear regression and compared with the equality of slopes tests. Average reimbursement per screening was compared using analysis of variance with Dunnett's T3 multiple comparisons test. RESULTS: The growth rate of multitarget stool DNA tests (mt-sDNA)/100 000 was the highest at 170.4 screenings/year (R2 = 0.99, p ≤ 0.001), while that of faecal occult blood tests/100 000 was the lowest at -446.4 screenings/year (R2 = 0.90, p ≤ 0.001) (p ≤ 0.001). Provider reimbursements averaged $546.95 (95% CI $520.12-$573.78) per mt-sDNA screening, significantly higher than reimbursements for all invasive screenings. Only FOBTs significantly increased in reimbursement per screening at $0.62/year (R2 = 0.91, p ≤ 0.001). CONCLUSION: We derived forecastable trend numbers for utilization and provider reimbursement. Faecal immunochemical tests/100 000 and mt-sDNA screenings/100 000 increased most rapidly during the entire study period. The number of nearly all invasive screenings/100 000 decreased rapidly; the number of colonoscopies/100 000 increased slightly, probably due to superior diagnostic strength. These trends indicate the that replacement of other invasive modalities with accessible noninvasive screenings will account for much of future screening behaviour and thus reductions in CRC incidence and mortality, especially given providers' reimbursement incentive to screen average-risk patients with stool-based tests.

Origen y evolución del control de salud / Origin and evolution of periodic health check-ups

Los controles periódicos de salud son aquellos cuidados médicos realizados a intervalos regulares, motivados por la necesidad de evaluar la salud en general y prevenir enfermedades a futuro. Se presume que comenzaron a ponerse en práctica durante el siglo XIX para la detección precoz de la tuberculosis y otras enfermedades contagiosas. A principios del siglo XX fueron difundidos los programas de examinación médica en el contexto de la estimación del riesgo de enfermedad y/o muerte previo a la contratación de seguros de vida. El desarrollo tecnológico posterior a la Segunda Guerra mundial fomentó el interés en estas examinaciones periódicas con la implementación de pruebas masivas de rastreo, lo que aumentó de manera considerable de la mano de los servicios de medicina prepaga. En los últimos años se han realizado múltiples esfuerzos por cuantificar los beneficios de estos controles. Si bien existen diversas opiniones respecto a su utilidad, pareciera ser que el enfoque actual del control periódico de salud implica tener en cuenta las necesidades de las personas, el riesgo individual y la relación médico-paciente como eje de la discusión. (AU)

Periodic health check-ups are medical care performed at regular intervals, motivated by the need to assess general health and prevent future diseases. It is presumed that they began to be implemented in the 19thcentury for the early detection of tuberculosis and other contagious diseases, and later spread in the early 20thcentury in the context of estimating the risk of illness and/or death prior to taking out life insurance. The technological development after the World War II encouraged interest in these periodic examinations with the implementation of mass screening tests, which increased considerably with the introductionof prepaid medical services. In recent years, multiple efforts have been made to quantify the benefits of such controls. While there are varying opinionsas to their usefulness, it appears that the current approach to periodic health check-ups is to take into account the needs of individuals, their individual risk, and the doctor-patient relationship at the core of the discussion. (AU)

Prevalencia y factores asociados a incontinencia urinaria en el área de salud este de Valladolid / Prevalence and factors associated with urinary incontinence in the east area of health of Valladolid

INTRODUCCIÓN: La incontinencia urinaria (IU) es la pérdida involuntaria de orina que constituye un problema social o higiénico importante y es demostrable de forma objetiva. Es un síntoma común que aparece en muchas enfermedades, afectando a todos los grupos de edad y a ambos sexos. En España se estima una prevalencia global de 24% en la mujer y 7% en el hombre, aumentando con la edad hasta el 50% y 29% respectivamente. A pesar de su repercusión en la calidad de vida se encuentra infradiagnosticada por diversos motivos. OBJETIVO: Determinar la prevalencia de la IU y sus factores asociados. MATERIAL Y MÉTODO: En este estudio epidemiológico observacional retrospectivo se recogieron datos de las historias clínicas de pacientes con IU de la Unidad de Suelo Pélvico del Área de Salud Este de Valladolid. RESULTADOS: Los tipos de incontinencia más frecuentes fueron: de esfuerzo (43,13%) y mixta (39,21%). Los factores de riesgo y patología asociada más importantes fueron episiotomía (57,1%) y cistocele (32,6%) en las mujeres y adenocarcinoma de próstata (60%) en los hombres. Tras tratamiento rehabilitador en un intervalo de 2 a 3 meses mejoraron las respuestas en los cuestionarios de incontinencia urinaria (ICIQ-SF). CONCLUSIONES: Los datos recopilados están en consonancia con estudios revisados, y viendo los avances en prevención y tratamiento de IU resulta coherente su abordaje multidisciplinar

INTRODUCTION: Urinary incontinence (UI) is the involuntary loss of urine that is a major social or hygienic problem and is objectively provable. It is a common symptom that appears in many diseases, affecting all age groups and both sexes. In Spain it is estimated a prevalence of 24% in women and 7% in men, increasing with age up to 50% and 29% respectively. Despite its impact on quality of life, it is under-diagnosed for various reasons. OBJECTIVE: To determine the prevalence of UI and its associated factors. MATERIAL AND METHOD: In this retrospective longitudinal epidemiological study data were collected from the medical histories of patients with UI belonging to the Pelvic Floor Unit of the East Health Area in Valladolid. RESULTS: The most frequent types of incontinence were: effort (43,13%) and mixed (39,21%). The most important risk factors and associated diseases were episiotomy (57.1%) and cystocele (32.6%) in women and adenocarcinoma of prostate (60%) in men. Responses in the questionnaires of urinary incontinence (ICIQ-SF) improved after 2-3 months of rehabilitation treatment. CONCLUSIONS: The collected data are consistent with studies reviewed, and seeing the progress in prevention and treatment of UI, multidisciplinary approach is coherent

El primer contacto hospitalario a través del Servicio de Urgencias es un predictor independiente de supervivencia global y de supervivencia libre de enfermedad en pacientes con cáncer colorrectal / First hospital contact via the Emergency Department is an independent predictor of overall survival and disease-free survival in patients with colorectal cancer

Objeto: el objetivo del presente estudio es examinar la asociación entre el tipo de admisión hospitalaria, la supervivencia y las características patológicas de una amplia población de pacientes con cáncer colorrectal. Métodos: realizamos un estudio en 1.079 pacientes diagnosticados en el Hospital Costa del Sol de Marbella con cáncer colorrectal y evaluamos la relación entre su tasa de supervivencia y la vía por la que realizaron el primer contacto con el hospital (admisión programada o de urgencias). Las variables incluidas en nuestro estudio fueron las siguientes: edad, género, localización del tumor, estadio patológico, grado de diferenciación, quimioterapia previa a la cirugía y supervivencia. Resultados: los pacientes admitidos por primera vez al hospital a través del Servicio de Urgencias fueron diagnosticados con mayor frecuencia de cáncer de colon (63,7%) y con tumores pobremente diferenciados (64,2%) y metastásicos (70%). En el análisis de regresión de Cox la supervivencia libre de enfermedad produjo una razón de riesgo (RR) de 1,36 (intervalo de confianza [IC] 95%: 1,11-1,66) para los pacientes del Servicio de Urgencias y para la supervivencia global de 1,41 (IC 95%: 1,14-1-76). Conclusiones: La admisión hospitalaria a través del Servicio de Urgencias es un indicador de agresividad y de peor pronóstico frente a los pacientes que ingresan por vía programada

Aims: the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer. Methods: the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival. Results: colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival. Conclusions: hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes

Factors associated with delay in seeking care by tuberculosis patients / Factores asociados a demoras en la búsqueda de atención del enfermo de tuberculosis / Fatores associados ao atraso na procura por atendimento pelo doente de tuberculose

ABSTRACT Objective: To identify social, clinical and behavioral factors of tuberculosis patients that are associated with delay in the search for primary health care. Method: This is a cross-sectional, quantitative study conducted with 56 people on treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio Grande do Norte, Brazil. The data were collected through a structured instrument. The Chi-square and Fisher tests were applied to test the association between independent and dependent variables (search time). A value of p <0.05 was set as statistically significant. Results: No social or clinical variables were statistically associated with patient delays in the search for primary health care. Among the behavioral variables, self-medication and the first health service sought had a statistically significant association with the time for seeking care (p = 0.020, and p = 0.033, respectively). Conclusion: Self-medication contributes to the delay in the search for primary health care by tuberculosis patients.

RESUMEN Objetivo: Identificar factores sociales, clínicos y conductuales de enfermos de tuberculosis, asociados a la demora por buscar la primera atención de salud. Método: Estudio transversal, cuantitativo, realizado con 56 personas en tratamiento de tuberculosis pulmonar, en Natal/RN, Brasil. Datos recolectados mediante instrumento estructurado. Se aplicaron los tests de Chi-cuadrado y de Fisher para probar la asociación entre las variables dependientes e independientes (tiempo de búsqueda). Se estableció un valor de p < 0,05 como estadísticamente significativo. Resultados: Ninguna variable social o clínica mostró asociación estadística a la demora del enfermo en la búsqueda de la primera atención de salud. Entre las variables conductuales, la automedicación y el primer servicio de salud buscado presentaron asociación estadísticamente significativa con el tiempo de búsqueda (p = 0,020 y p = 0,033, respectivamente). Conclusión: La automedicación contribuye a la demora en la búsqueda de la primera atención de salud en el enfermo de tuberculosis.

RESUMO Objetivo: Identificar fatores sociais, clínicos e comportamentais dos doentes de tuberculose que estejam associados ao atraso na procura pelo primeiro atendimento à saúde. Método: Estudo transversal, quantitativo, conduzido com 56 pessoas em tratamento da tuberculose pulmonar em Natal/RN, Brasil. Os dados foram coletados por meio de instrumento estruturado. Aplicaram-se os testes de Qui-quadrado e Fisher para testar a associação entre as variáveis independentes e dependentes (tempo de procura). Fixou-se valor de p < 0,05 como estatisticamente significativo. Resultados: Nenhuma variável social ou clínica se mostrou estatisticamente associada ao atraso do doente na procura pelo primeiro serviço de saúde. Dentre as variáveis comportamentais, a automedicação e o primeiro serviço de saúde procurado apresentaram associação estatística significativa com o tempo de procura (p = 0,020 e p = 0,033, respectivamente). Conclusão: A automedicação contribui para o atraso na procura pelo primeiro atendimento à saúde pelo doente de tuberculose.

A community pharmacy-based cardiovascular risk screening service implemented in Iran

Background: Cardiovascular disease is a major health concern around the world. Objective: To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. Methods: A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. Results: Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. Conclusion: A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required (AU)

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Estrategia para aumentar el cribado de los factores de riesgo cardiovascular en la población joven / Strategy to increase screening for cardiovascular risk factors among young people

Objetivo. Evaluar la efectividad de una intervención para aumentar la participación entre la población joven en el Programa de Actividades Preventivas y Promoción de la Salud (PAPPS) y el registro de sus variables. Evaluar diferencias de registro por edad y sexo. Método Diseño: ensayo clínico controlado y aleatorizado. Ámbito: centro de atención primaria de Palamós. Sujetos: 828 personas entre 25 y 40 años asignadas a una enfermera con alguna variable del PAPPS indebidamente cumplimentada: 415 en grupo control y 413 en grupo intervención. Intervención: carta para realizar el PAPPS y llamada si tras 3 semanas responden menos del 10%. Variables: edad, sexo, nacionalidad, acudir a consulta, número de variables del PAPPS bien registradas y registro adecuado de cada una inicial y final. Análisis estadístico: descriptivo univariable y bivariable, intervalo de confianza del 95%, RRR y NNT. Resultados Grupos heterogéneos respecto a acudir a la consulta: 5 (1,2%) del grupo control y 85 (20,6%) del grupo de intervención (p<0,001), NNT=5 (IC del 95%, 4-7) y registro completo adecuado del PAPPS: 5 (1,2%) del grupo control y 73 (17,7%) del grupo intervención (p<0,001), NNT=6 (IC del 95%, 5-8). Se encontraron diferencias en la edad y el sexo en relación con el número de variables bien registradas y el registro del colesterol (p<0,001) y entre la edad y el índice de masa corporal (p=0,005). Conclusiones. La estrategia consiguió aumentar significativamente el número de personas que realizaron el PAPPS y su registro, influyendo la edad y el sexo (AU)

Objective. To evaluate the effectiveness of an intervention to increase the participation among young people in the Health Prevention and Promotion Activities Programme (PAPPS) and the register of their variables. To evaluate differences in registering based on age and sex. Method Design: randomized, controlled clinical trial. Setting: Palamós primary care centre. Participants: A total of 828 people between the ages of 25 and 40 assigned to a nurse with one of the PAPPS variables improperly completed: 415 in control group and 413 in intervention group. Intervention: letter to complete the PAPPS and phone call if the response after three weeks was less than 10%. Variables: age, sex, nationality, clinic attendance, number of variables of PAPPS variables properly completed and the correct registration of each one at the beginning and end of the period. Statistical analysis: univariate and bivariate analysis, 95% confidence interval, RRR and NNT. Results. Heterogeneous groups as regards clinic attendance: 5 (1.2%) of control and 85 (20.6%) of intervention group, NNT=5 (95% CI, 4-7); and properly completed registration of PAPPS (P<.001): 5 (1.2%) of control and 73 (17.7%) of intervention, NNT=6 (95% CI, 5-8). At the end, there were differences with regard to age and sex in the number of variables completed and in the registration of cholesterol (P<.001), and only in regard to age in body mass index (P=.005). Conclusions. The strategy significantly increased the number of people who completed the PAPPS and their registration. Sex and age influenced the completion (AU)

Rastreamento e diagnóstico do câncer de ovário / Screening and diagnosis of ovarian cancer

O câncer de ovário apresenta a maior taxa de mortalidade entre as neoplasias ginecológicas, sendo a maioria dos casos diagnosticados em estágio avançado. O diagnóstico precoce é passo fundamental no manejo e controle da doença. No entanto, estratégias de rastreamento populacional não têm se mostrado efetivas para a redução de mortalidade. O rastreamento em população de alto risco (história familiar), por outro lado, é recomendado por comitês especializados. A associação entre a dosagem sérica de CA 125 e a US transvaginal, feita de forma periódica e sequencial, é o método mais utilizado em programas de rastreamento.

Ovarian cancer has the highest mortality rate among gynecological neoplasias, most of the cases being diagnosed at advanced stage. Early diagnosis is crucial for management and control of the disease. Population screening strategies, however, have not been effective in reducing mortality. On the other hand, the screening in high risk populations (family history) is recommended by expert committees. The combination of serum CA 125 measurement and transvaginal ultrasound, performed in periodical and sequential fashion, is the most common method used in screening programs.

Screening for lead exposure in children in Belize

OBJECTIVES: The objectives of this pilot study were to determine the blood lead levels in children in Belize and to try to relate these findings to demographic variables. METHODS: With permission from parents, capillary blood was collected from the fingers of 164 children with an age range of 2 to 8 years, living and attending school in the spring of 2002 in four towns: Belize City, San Pedro, Orange Walk, and Benque Viejo. The sample represents 0.4 percent of all children in Belize in that age range. Lead levels were analyzed by the method of anodic stripping voltammetry using the ESA LeadCare analyzer. RESULTS: The mean blood lead level for the children in the sample was 4.94 micrograms per deciliter (mg/dL) with a standard deviation of 2.46. However, 11 children (7 percent) had blood lead in the range of 10.1-13.8 mg/dL, which is the level of concern according to guidelines of the Centers for Disease Control and Prevention. Children living in the large urban centers of Belize City and Orange Walk town had higher lead levels (mean 5.80 and 5.74 mg/dL) than children living in the smaller towns of Benque Viejo and San Pedro (mean 4.17 and 4.63 mg/dL). There were no statistically significant differences between male and female children. CONCLUSIONS: These data indicate that children in Belize are being exposed to lead and suggest that this pilot study be followed up with a comprehensive study with a larger sample and correlation of the findings to socioeconomic characteristics, to children's behavior, and to the home and school environment.

Screening and chemoprevention in lung cancer

Lung cancer is a major health problem due to its incidence and mortality. The risk factors, the existence of a preclinical phase, and the relationship between stage at diagnosis and survival are known. A number of strategies that aim to diagnose lung cancer in its earliest stages, based principally on imaging studies, are therefore being tested. Several drugs aimed at reducing the probability of developing lung cancer in the at-risk population are also under study. At the present time, the results obtained have not been encouraging and we do not have a clear strategy either for early diagnosis or for the use of chemopreventive agents (AU)

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Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005 / 예방의학회지

OBJECTIVES: This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. ontinued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

Trends in the uptake of antenatal voluntary counselling and testing for HIV and HIV prevalence among childbearing women in Barbados, 1993-2004: evidence to gauge the effectiveness of HIV prevention measures / Tendencias en el interés por el asesoramiento y prueba voluntarios prenatales para el vih, y prevalencia del vih entre las embarazadas de barbados, 1993­2004: evidencia para evaluar la efectividad de las medidas para prevenir el vih

OBJECTIVES: To describe the long term trends on the uptake of antenatal voluntary counselling and testing (VCT) for Human Immunodeficiency Virus (HIV) and on the HIV prevalence among pregnant women. These data were used to gauge the impact of the National Acquired Immunodeficiency Syndrome (AIDS) Intervention Programme on preventing mother-to-child transmission (PMTCT) in Barbados. METHODS: This was a population based study. Data for this report were drawn from the HIV Surveillance Programme for the mother-to-child transmission of HIV The study population comprised all pregnant women who attended the various antenatal care clinics throughout Barbados during the period between 1993 and 2004. RESULT: The uptake of the VCT for HIV among the pregnant women in Barbados has increased from 39.9in 1993 to over 89.7in 2004 (p < 0.0001). Mean annual HIV prevalence decreased from 10.53 per thousand women screened in 1993-1996 to 8.23 during 2001-2004 (p = 0.121). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women declined from 8.83 per thousand women screened during 1993-1996 to 4.53 per thousand pregnant women screened during 2001-2004 (p = 0.004). Mean annual incidence rate of newly diagnosed HIV infection among the pregnant women aged less than 25 years during the corresponding period declined from 10.17 per thousand women aged less than 25 years screened to 4.75 per thousand women screened (p = 0.003). CONCLUSION: There has been a significant decline in the prevalence and incidence of HIV since the late-1990s. Although new infections are still occurring, the numbers are small. The decline may partly be explained by the impact of PMTCT and the general preventive measures on the spread of HIV among this population.

Objetivos. Describir las tendencias a largo plazo en relación con el interés en el asesoramiento y prueba voluntarios (APV) prenatales para el virus de la inmunodeficiencia humana VIH, así como en relación con la prevalencia del VIH entre las embarazadas. Estos datos fueron usados para evaluar el impacto del Programa Nacional de Intervención del Síndrome de Inmunodeficiencia Adquirida (SIDA) en la prevención de la transmisión de madre a hijo (PTMH) en Barbados. Métodos. Se trató de un estudio poblacional. Los datos para este reporte fueron tomados del Programa de Vigilancia del VIH para la transmisión madre a hijo del VIH. El estudio poblacional abarcó a todas las embarazadas que asistieron a las distintas clínicas de atención prenatal en todo Barbados durante el período comprendido entre 1993 y 2004. Resultado. El interés mostrado por el APV del VIH entre las embarazadas de Barbados, ha aumentado de 39.9% en 1993 a más de 89.7% en 2004 (p < 0.0001). La media anual de prevalencia del VIH disminuyó de 10.53 por cada mil mujeres sometidas a pesquisaje en 1993­1996 a 8.23 durante 2001­2004 (p = 0.121). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas descendió de 8.83 por cada mil mujeres embarazadas sometidas a pesquisaje durante 1993­1999 a 4.53 por cada mil mujeres sometidas a pesquisaje durante 2001­2004 (p = 0.004). La tasa de incidencia anual media de infección por VIH de diagnóstico reciente entre las embarazadas menores de 25 años de edad durante el periodo correspondiente disminuyó de 10.17 por cada mil mujeres menores de 25 años de edad sometidas a pesquisaje, a 4.75 por cada mil mujeres sometidas a pesquisaje (p = 0.003). Conclusión. Ha habido un descenso significativo en la prevalencia e incidencia del VIH desde los finales de 1990. Aunque todavía se están produciendo nuevas infecciones, su número es pequeño. El descenso puede explicarse en parte por el impacto del PTMH y las medidas generales de prevención de la difusión del VIH entre esta población