Observational study to evaluate the impact of internet reminders for GPs on colorectal cancer screening uptake in Northern Italy in 2013.

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer worldwide and CRC-related mortality can be effectively reduced by population-based screening. Screening uptake is a key indicator of performance, susceptible of several implementation methods. Participation in ASL Milano 1 area (northern Italy) is increasing thanks to reminder invitation sent to non-responders. Here we evaluate the implementation of another strategy among those proved to be effective. METHODS: In the years 2013-2014 we conducted an observational study in patients non-responder to first invitation and subsequent mailed reminder. A list of them was sent to their own GP, who had the task to evaluate possible exclusion criteria and make a reminder, either by personal interview, telephone call or via e-mail. Intervention could be conducted either by the GP himself or by an assistant. Primary outcomes were to assess the overall efficacy of the intervention and the efficacy of its single features (type of intervention and provider), measuring the consequent uptake of CRC screening. RESULTS: Participation in CRC screening was significantly higher (33,5%) in patients who received a reminder from GP, regardless of the type, vs those who did not (19,0%, p < 0.01). No statistically significant difference was detected either by method or by provider of the intervention. DISCUSSION: The results of our study demonstrate that even a modest intervention can have a significant effect in improving compliance to screening for CRC, one of the cancers with highest incidence in developed countries, for which an effective treatment is available in case of early diagnosis.

Some comments on the process of counterurbanization in Europe.

PIP: The process of counter-urbanization in Western Europe is analyzed using the rank-size rule. Three major groups of countries are identified: those in which the decentralization of population began in the 1960s, those in which decentralization began in the 1970s, and those that still showed urban concentration in the 1970s. Comparisons are made among different types of counter-urbanization patterns.^ieng