Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity.

Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease.

Effect of the use of prediagnosis hormones on breast cancer prognosis: MCC-Spain study.

OBJECTIVE: To extend knowledge about the long-term use of hormones in hormone therapy or oral contraception as prognostic factors in breast cancer. METHODS: The MCC-Spain project is a cohort of 1,685 women with incident breast cancer recruited in Spain. Recruitment was carried out between 2007 and 2010, and the follow-up finished in December 2017. The impact of hormone therapy or oral contraception on breast cancer prognosis was analyzed considering year of birth and menopausal status (1,095 women [65%] were postmenopausal). Hazard ratios (HRs) were estimated using Cox regression models. Death by any cause was considered as the event, and hormone therapy or oral contraception were analyzed as regressors. RESULTS: Oral contraception use for less than 5 years shows an HR of 1.10 (95% CI, 0.75 to 1.62), whereas use for 5 or more years shows an HR of 1.46 (95% CI, 0.95 to 2.25), with a P trend of 0.01, showing a dose-dependent response. Regarding hormone therapy and restricting the analysis to postmenopausal women born between1940 and 1959, where most hormone therapy (consumption) is concentrated, the results did not show any trend. CONCLUSION: Concerning oral contraception use, our results demonstrate that their use is related to poor prognosis in breast cancer. However, research in this field is limited and controversial, indicating the need for more research in this area. Regarding hormone therapy consumption, our results indicate no association with better prognosis, which contradicts what has previously been published.

Alcohol use and family-related factors among Spanish university students: the unHicos project.

BACKGROUND: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. METHODS: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association. RESULTS: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2-17.6), and that of BD was 48.8% (95% CI = 47.9-48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. CONCLUSIONS: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.

[Declared experiences of risky sexual behaviors in relation to alcohol consumption in the first year of college.] / Experiencias declaradas de conductas sexuales de riesgo en relación con el consumo de alcohol en el primer año de universidad.

OBJECTIVE: In college students, higher risk alcohol consumption (drunkenness and binge drinking-BD) has negative consequences on their development and and probably facilitates risk sexual behaviors. The objective was to study if risky sexual behaviors when consuming alcohol (RSBA) are associated with higher risk consumption. METHODS: Cross-sectional multicenter study with UniHcos Project, 1st year university students from 11 universities in Spain, academic years 2011-2012 to 2017-2018 data. This data were collected by self-administered questionnaire. A uni and bivariate analysis was performed, evaluated the statistical significance of the differences in prevalence with chi-square. Mean and standard deviation were used for quantitative variables and Student's t test statistic was used. RESULTS: 9,862 subjects (72.2% women). 90.3% reported having consumed alcohol and 60.9% had drunk the last year, 49% BD in last month. It was deteded in men, significantly higher consumption in the last month and drunkenness. Last month consumption and drunkenness were significantly higher in men and in <21 years. The RSBA were significantly higher among who were drunk (15.7% unprotected sex, 1.9% sexual abuse and 0.7% taking sexual advantage) and had BD (17.1%, 1.9% and 0.7 %). Women with both risk consumptions had more sexual abuse (2.2%), and men had greater behaviors of taking sexual advantage of someone (drunk: 1.2%; BD: 1.3%). CONCLUSIONS: Alcohol consumption was above similar groups. BD consumption was similar by gender and age. Risk sexual behaviors appear mainly in problematic consumption. Gender differences are not detected in alcohol consumers in unprotected sex but deteded in the rest.

OBJETIVO: En universitarios, el consumo de alcohol de mayor riesgo (borracheras y binge drinking (BD), tiene consecuencias negativas sobre su desarrollo y probablemente facilita conductas sexuales de riesgo. El objetivo de este trabajo fue estudiar si las conductas sexuales de riesgo al consumir alcohol (CSRA) se asocian a los consumos de mayor riesgo. METODOS: Estudio multicéntrico transversal con datos del Proyecto uniHcos, de universitarios de 1er año de 11 universidades españolas, entre los cursos 2011-2012 y 2017-2018. Datos recogidos mediante cuestionario autoadministrado. Se realizó un análisis uni y bivariable, evaluando la significación estadística de las diferencias de prevalencia con chi-cuadrado. Se utilizó media y desviación típica para variables cuantitativas y como estadístico de contraste t de Student. RESULTADOS: 9.862 participantes (72,2% mujeres). El 90,3% consumió alcohol y el 60,9% tuvo borracheras en último año; el 49% tuvo BD en el último mes. El consumo en el último mes y las borracheras fueron mayores en hombres y <21 años. Las CSRA fueron superiores entre los que se emborracharon (15,7% sexo sin protección, 1,9% abuso sexual y 0,7% aprovecharse sexualmente) y consumieron en BD (17,1%, 1,9% y 0,7%). Las mujeres con ambos consumos de riesgo presentaron más abusos sexuales (2,2%), y los hombres fueron quienes más se aprovecharon sexualmente de otros (borracheras:1,2%; BD: 1,3%). CONCLUSIONES: El consumo de alcohol está por encima de grupos similares. El BD tiene un patrón similar por género y edad. Las CSRA se asocian a los consumos de mayor riesgo, no detectándose en este grupo diferencias por género en sexo sin protección, sí en otras CSRA.

Health advice on alcohol consumption in pregnant women in Seville (Spain) / Consejo sanitario sobre el consumo de alcohol en embarazadas de Sevilla (España)

OBJECTIVE: To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD: A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS: 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION: The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed

OBJETIVO: Analizar en qué medida las gestantes recuerdan haber recibido asesoramiento sanitario sobre el consumo de alcohol durante el embarazo, cuál es el mensaje percibido y si existe desigualdad social al respecto. MÉTODO: Se realizó un estudio transversal descriptivo con 426 mujeres en su semana 20 de embarazo en las consultas externas de un hospital universitario de Sevilla (España). Los datos se recopilaron mediante entrevistas estructuradas cara a cara realizadas por profesionales sanitarias entrenadas. RESULTADOS: El 43% de las entrevistadas afirmaron no haber recibido consejo sanitario alguno al respecto. Solo el 43,5% dijeron que habían recibido el mensaje correcto (no beber absolutamente nada de alcohol durante el embarazo) por parte de la matrona, el 25% por el obstetra y el 20,3% por el médico de atención primaria. Las embarazadas con menor nivel educativo fueron las que menos refirieron haber recibido asesoramiento sanitario sobre el tema. CONCLUSIÓN: El consejo sanitario adecuado (evitar todo consumo de alcohol durante el embarazo) no llega de manera efectiva a una amplia proporción de las gestantes. Es necesario desarrollar programas institucionales que posibiliten que los profesionales sanitarios puedan llevar a cabo con eficacia actividades preventivas de los trastornos del espectro alcohólico fetal

"It's Important but, on What Level?": Healthy Cooking Meanings and Barriers to Healthy Eating among University Students.

The negative impact of a sedentary lifestyle and poor diet on health is evident across the lifespan, but particularly during the university period. Usually, the diet of university students is rich in sweetened drinks and processed foods and low in fruits, vegetables and legumes. Although there is an association between maintaining a healthy diet and the frequency of cooking at home, the time currently spent on cooking or learning how to cook is decreasing globally. The main aim of this study was to explore university students' perceptions about healthy cooking and barriers to eating healthily. A group of 26 students participated in four focus groups. Content analysis was conducted using Atlas.ti v.8. Students perceived cooking healthily as a more complicated and time-consuming process than cooking in general. Individual and environmental factors were the most reported barriers. Costs and time, among others, were the main barriers pointed out by students with regard to healthy eating. This study highlights the need to develop interventions that modify these false perceptions about cooking healthily, and to train students so that they are able to cook healthy meals in a quick, easy, and cost-effective way. Further, specific actions are required in the university setting to minimize access to unhealthy options and to promote those linked to healthy eating.

Health advice on alcohol consumption in pregnant women in Seville (Spain).

OBJECTIVE: To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD: A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS: 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION: The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed.

Oportunidades de mejora del servicio de metadona en atención primaria, desde el punto de vista profesional / Opportunities for the improvement of the methadone service in primary health care, from the professionals’ point of view

Objetivo: Identificar y priorizar las oportunidades de mejora, según el modelo European Foundation for Quality Management (EFQM), del servicio de dispensación de metadona en los Centros de Atención Primaria (CAP) en Andalucía desde la perspectiva de los/as profesionales. Metodología: Método de consenso Delphi, a través de tres rondas de entrevistas con cuestionario administrado por correo electrónico a 39profesionales durante septiembre de 2007 a marzo de 2008. Se configuró un panel de expertos/as formado por: Dispensadores/as y Prescriptores/as de metadona así como Coordinadores/as de dispositivos asistenciales del Programa de Tratamiento con Metadona (PTM). Criterios de selección: Estar activo laboralmente y tener una experiencia de al menos 3 años. Variables de diversificación muestral en la composición del panel: Rol profesional, ámbito geográfico y tipo de hábitat. Captación: A través de profesionales claves de distintas instituciones. Resultados: En total se identificaron 48 oportunidades de mejoras. Trece oportunidades obtuvieron un nivel de acuerdo alto en la última ronda. Los criterios, según el modelo EFQM, que obtuvieron un mayor consenso para mejorar la atención fueron: Liderazgo, Alianzas y Recursos. Y la dimensión que obtuvo un mayor desacuerdo fue Procesos. Conclusiones: A pesar de su implementación desde 1997 en los CAP en Andalucía, el servicio de dispensación de metadona se encuentra en una fase de despliegue más que de perfeccionamiento (AU)

Objective: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM)model, of the methadone dispensing service in Andalusian Primary HealthCare, from the point of view of professionals. Method: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with aminimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. Results: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. Conclusions: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is atan implementation phase, rather than what could be classed as a fully deployed stage (AU)

[Opportunities for the improvement of the methadone service in primary health care, from the professionals' point of view]. / Oportunidades de mejora del servicio de metadona en atención primaria, desde el punto de vista profesional.

OBJECTIVE: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM) model, of the methadone dispensing service in Andalusian Primary Health Care, from the point of view of professionals. METHOD: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with a minimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. RESULTS: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. CONCLUSIONS: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is at an implementation phase, rather than what could be classed as a fully deployed stage.

Acciones para mejorar el servicio de dispensación de metadona en atención primaria / No disponible

No disponible

Percepción de usuarios de los Programas de Tratamiento con Metadona sobre la accesibilidad y atención recibida de los equipos terapéuticos / Methadone treatment programme users perception of the accesibility and care received from the therapetuci teams

Fundamento: SE explora la atención y cobertura terapéutica prestada desde los Centros de atención al Tratamiento de las toxicomanías de dos ciudades españolas desde la perspectiva de sus usuarios de los Tratamientos con Metadona (TM). Se pretenden ofrecer claves de cómo orientar el TM para su mejora en la prevención de recaídas y abandonos prematuros, y facilitar la reinserción de sus pacientes. Métodos: Estudio exploratorio, cualitativo, que recoge información a través de una entrevista semi-estructurada a 30 usuarios de los TM en Barcelona y Granada. Resultados: La atención prestada por los equipos terapéuticos queda articulada sobre 3 pilares: médico, psicológico y social. La centralidad de la figura de los médicos en los discursos de los pacientes, refleja el papel principal de la metadona y su prescripción. Casi el 60% ha visitado en los últimos 3 meses al profesional de medicina, reduciéndose esta cifra al 22% para el caso de la psicología y un 6% con trabajo social. Los usuarios expresan la falta de una evaluación global e individual de la integraciónsocial, la escasez de recursos (vivienda, empleo y formación, necesidades básicas) adaptados a las necesidades particulares y la falta de implicación de las familias, donde el papel de psicólogos y trabajadores sociales podrían ser mayor al actual. Conclusiones: A pesar de los resultados positivos obtenidos de los TM, su principal limitación es la falta de una intervención integral de las necesidades individuales de los pacientes. Fortalecer el papel de la intervención psicológica y social, se convierte en requisitos imprescindibles para avanzar en la rehabilitación y reinserción

Background: This study explores the type of care and the therapeutic treatment at drug treatment centres located in two Spanish cities, as perceived by methadone treatment (MT) users. It provides key aspects to improve the ability of MT programmes to prevent relapses and premature discharges from treatment, and to facilitate users´ social reintegration. Methods: Exploratory qualitative study based on semi-structured interviews among 30 MT programme users in the cities of Barcelona and Granada. Results: The care provided by therapeutic teams relies on 3 main intervention areas: medical, psychological and social care. The central role attributed to the physicians in user´s discourses reflects the relevance assigned to the methadone and its medical prescription. Almost 60% of users had visited their prescribing doctor a least once in the previous three-months 22% their psychologist, and only 6% their social worker. Users interviewed mentioned the absence of a comprehensive and individualized assessment of their social integration, the lack of resource adapted to their individual needs (housing, employment, training and basic needs), and the lack to family implication where they felt that psychologist and social workers could play a much more relevant role than at present. Conclusions: Despite the generally positive outcomes of the MT, its main limitation lies in the lack of a comprehensive approach to users´ individual needs. Strengthening biopsychological intervention emerges as an essential prerequisite to progress towards users´ rehabilitation and reinsertion