Social inequalities in the use of physiotherapy in women diagnosed with breast cancer in Barcelona: DAMA cohort.

PURPOSE: This study aimed to analyze social inequalities in the use and access of physiotherapy service and its clinical and socio-economic determinants in women diagnosed with breast cancer in the hospital network of Barcelona. METHODS: Data from 2235 women belonging to the mixed (prospective and retrospective) DAMA Cohort were analyzed, including demographic, socio-economic, clinical, and breast cancer treatment outcomes. To determine the influence of such variables on access to physiotherapy, different Poisson regression models with robust variance (obtaining Prevalence Ratios and confidence intervals) were estimated. RESULTS: Although when experiencing different chronic and acute symptoms, only between 20 and 35% of women visited physiotherapist. Two out of 3 women reported to have received insufficient information about medical care and rehabilitation. Age of women, job occupation, education level, having a mutual or private insurance, as well as outcomes related to breast cancer, appear to be factors influencing the access to physiotherapy. CONCLUSIONS: Social and economic inequalities exist on the access to physiotherapy by women diagnosed with breast cancer, which is generally low, and may clearly impact on their functional recovery. Promoting strategies to reduce social bias, as well as improve communication and patient information regarding physiotherapy may be of interest for a better health care in breast cancer diagnosed women.

¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa / How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe

OBJETIVO: Analizar cómo se mide el estatus migratorio en la población infantil y juvenil en la literatura científica sobre salud y desigualdades sociales en salud en Europa. MÉTODO: Se realizó una búsqueda sistemática de publicaciones entre 2007 y 2017 en PubMed y Social Sciences Citation Index, en español, inglés y francés. Se incluyeron artículos realizados en Europa en los que se analizaran la salud o las desigualdades sociales en salud de la población menor de 18 años según su origen migratorio. Se realizó una descripción de las variables usadas para la medición del estatus migratorio. RESULTADOS: Se incluyeron 50 artículos. Veinte estudios analizaban alguna variable de salud perinatal, once de salud mental, nueve de salud dental y diez de otras variables. Las principales variables para definir el estatus migratorio fueron el país de nacimiento (32 estudios), tanto del niño o la niña como de la madre o de alguno de los progenitores, y en ocasiones de forma complementaria. Menos frecuente fue la utilización de la nacionalidad (15 estudios) del niño o la niña, o de los progenitores, especialmente la materna. El estatus migratorio se denomina de muy diferentes maneras, no siempre equiparables, y en ocasiones no se explicita claramente la variable utilizada. CONCLUSIONES: Existe una gran diversidad de formas de medir el estatus migratorio en la población infantil y juvenil. Son necesarios una mejor definición y un consenso para mejorar la comparabilidad temporal y geográfica del conocimiento en esta área, que ayude al diseño de políticas públicas encaminadas a reducir las desigualdades sociales en salud desde la infancia

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood

[Satisfaction with the breast cancer screening program in Barcelona: a comparison between 2006 and 2016.] / Satisfacción hacia el programa de cribado de cáncer de mama de Barcelona por parte de las mujeres: Comparativa entre 2006 y 2016.

OBJECTIVE: Satisfaction represents the subjective experience derived from the fulfillment or non-fulfillment of the expectations that the subject has regarding assistance. The debate generated by the screening programs requires studying satisfaction as one more element in the evaluation. In 2006, a study was carried out in Barcelona on the satisfaction and expectations generated around screening. Ten years later another was carried out in order to study evolution during this time. The objective of the current study is to investigate the satisfaction with the Breast Cancer Screening Program (BCSP) in Barcelona and to compare with the results obtained in a previous study carried out 10 years ago. METHODS: This was a cross-sectional study, whose study population was women participating in the BCSM. We conducted random sampling. The questionnaire asked for opinion about the informative materials and the information sessions, their level of participation (regular or irregular) and their overall satisfaction with the program. Women who had been referred for further examinations were asked specific questions about their satisfaction with the follow-up process. We conducted a descriptive analysis and compare the results to those obtained in the 2006 survey. We assessed the correlation between satisfaction and importance using the Pearson's correlation coefficient, and we also performed logistic regression analyses. All statistical analyses were conducted using SPSS. RESULTS: Participants were generally satisfied with the program, the professionalism and treatment received from the medical professionals. There was a significant positive correlation with the importance given to each of these dimensions. Women who stated that they did not feel nervous while waiting for the results of the mammography reported that they felt very satisfied with the information received [OR=1.86 (95% CI 1.03-3.36)] and with the equipment used [OR=1.97 (1.02-3.85)]. Non-working women were more satisfied with the information obtained [OR=1.86 (CI 1.06-2.9)]. Most of the results showed improvement with respect to those of the 2006 survey. CONCLUSIONS: It's necessary to continue working towards providing the best possible information, and paying special attention to the most vulnerable groups.

OBJETIVO: La satisfacción representa la vivencia subjetiva derivada del cumplimiento o incumplimiento de las expectativas que el sujeto tiene respecto a la asistencia. El debate generado por los programas de cribado, requiere estudiar la satisfacción como un elemento más en la evaluación. En el año 2006 se llevó a cabo en Barcelona un estudio sobre la satisfacción y las expectativas generadas alrededor del cribado. Diez años después se realizó otra con el fin de poder estudiar la evolución durante este tiempo. El objetivo del presente estudio es investigar la satisfacción con el Programa de Cribado del Cáncer de Mama (BCSP) de Barcelona y compararlo con los resultados obtenidos en un estudio previo realizado hace 10 años. METODOS: Estudio transversal. La población de estudio fueron las mujeres de 50 a 69 años participantes en el PDPCM (105.528 mujeres). El muestreo fue aleatorio y estratificado por distritos; las fuentes de información fueron el padrón de habitantes y los registros de cada oficina técnica. Se llevó a cabo un análisis descriptivo y estratificado por edad y clase social. Se compararon los resultados con los del 2006. La correlación entre la satisfacción y la importancia mediante el coeficiente de relación de Pearson. Se ajustaron modelos de regresión logística. RESULTADOS: Destaca la satisfacción hacia la profesionalidad y el trato recibido. Las mujeres que declararon no sentirse nerviosas durante la espera de resultados, presentaron una OR=1,86 (IC95% 1,03-3.36) de sentirse muy satisfechas respecto a la información y OR=1,97 (IC95% 1,02-3,85) respecto a los equipamientos. Las no trabajadoras en activo se sintieron más satisfechas con la información OR=1,86 (IC95% 1,06-2,9). Las de clase media fueron las más satisfechas con la profesionalidad, OR=2.26 (IC95% 1,08-4,73) respecto clase alta. CONCLUSIONES: Es importante seguir trabajando la información que se facilita prestando especial atención a los grupos que se muestran menos satisfechos en el estudio llevado a cabo.

[How to measure the migration status of the child and young population? Studies on health and inequalities in health in Europe]. / ¿Cómo medir el estatus migratorio de la población infantil y juvenil? Estudios sobre salud y desigualdades en salud en Europa.

OBJECTIVE: To analyse how the migration status of the child and young population is measured in the scientific literature on health and social inequalities in health in Europe. METHOD: A systematic search of the literature published in Spanish, English and French between 2007 and 2017 in PubMed and Social Sciences Citation Index was carried out. The included studies analysed health and social inequalities in health of a population under 18 years old according to its migration origin in Europe. The variables used to measure the migration status were described. RESULTS: 50 articles were included. Twenty studies analysed perinatal health, eleven mental health, nine dental health, and ten studies other variables. The main variables to define migration status were the country of birth (32 studies), either of the child, the mother, or one of the parents, and sometimes in a complementary way. Less frequent was the use of nationality (15 studies), of the child, or of the parents, especially the mother. Migration status is referred to in very different ways, not always comparable and sometimes the variable used is not clearly explained. CONCLUSIONS: There is a great diversity of ways to measure migration status in the child and young population. A better definition and consensus is needed to improve the temporal and geographical comparability of knowledge in this area, which will help to design public policies aimed at reducing social inequalities in health from childhood.

The association between breast cancer and consumption of dairy products: a systematic review / La asociación entre cáncer de mama y el consumo de productos lácteos: una revisión sistemática

INTRODUCTION: breast cancer (BC) is the most common cancer in women and its relationship with dietary factors particularly dairy products, has been investigated trough several studies but up to now there are still not enough results to confirm the association between breast cancer and dairy products. OBJECTIVE: the purpose of this systematic review was to expand the number of systematic reviews that to date exist on the relationship between dairy products consumption and risk of breast cancer. A comprehensive search of the PubMed, Scopus and Embase was performed from September 2005 to September 2018 in which one case control and cohorts' studies were included. RESULTS: eighteen studies were finally selected for the review (10 case-control and 8 cohorts' studies). These studies reported several statistically significant associations (OR, HR, RR) between dairy product consumption and the risk of breast cancer. Seven case-control and four cohorts' studies showed that dairy product consumption was inversely associated with the risk of breast cancer, on the other hand, a positive association was found in two case-control and non- significant association was found between dairy product consumption and the risk of breast cancer in the remaining studies (one case-control and four cohorts' studies). CONCLUSION: although an inverse association was observed in most studies, it's difficult to draw conclusions when the methodology methods to collect the dairy product intake and the servings or portions measurements were different in each study. On the other hand, not all studies used the same confounding variable to estimate risk

INTRODUCCIÓN: el cáncer de mama (BC) es de los cánceres más comunes en mujeres, y su relación con los factores dietéticos y, en particular, con los productos lácteos, ha sido investigada a través de varios estudios, pero hasta ahora no hay resultados suficientes que confirmen la asociación entre cáncer de mama y productos lácteos. OBJETIVO: el objetivo de esta revisión fue ampliar y actualizar el número de revisiones sistemáticas que hasta día de hoy existen sobre la relación entre el consumo de productos lácteos y el cáncer de mama. METODOLOGÍA: se realizó una búsqueda exhaustiva en las bases de datos PubMed, Scopus y Embase entre septiembre de 2005 y septiembre de 2018 en la que se incluyeron estudios de casos y controles y estudios de cohortes. RESULTADOS: se seleccionaron 18 estudios (10 estudios de casos-controles y 8 estudios de cohorte). Siete casos-controles y cuatro estudios de cohorte mostraron que el consumo de productos lácteos tenía una asociación inversa con el riesgo de cáncer de mama y, por otro lado, en dos estudios de casos-controles se observó una asociación positiva. No se encontró una asociación significativa entre el consumo de productos lácteos y el cáncer de mama en los restantes estudios (1 caso-control y 4 cohortes). CONCLUSIÓN: aunque se observó una asociación inversa en la mayoría de los estudios, es difícil sacar conclusiones cuando los métodos metodológicos para recolectar la ingesta de lácteos y las porciones o las mediciones de las porciones fueron diferentes en cada estudio. Por otro lado, no todos los estudios tienen en cuenta las mismas variables de confusión

The association between breast cancer and consumption of dairy products: a systematic review.

INTRODUCTION: Introduction: breast cancer is the most common cancer in women and its relationship with dietary factors particularly dairy products, has been investigated trough several studies but up to now there are still not enough results to confirm the association between breast cancer and dairy products. Objective: the purpose of this systematic review was to expand the number of systematic reviews that to date exist on the relationship between dairy products consumption and risk of breast cancer. A comprehensive search of the PubMed, Scopus and Embase was performed from September 2005 to September 2018 in which one case control and cohorts' studies were included. Results: Eighteen studies were finally selected for the review (10 case-control and 8 cohorts' studies). These studies reported several statistically significant associations (OR, HR, RR) between dairy product consumption and the risk of breast cancer. Seven case-control and four cohorts' studies showed that dairy product consumption was inversely associated with the risk of breast cancer, on the other hand, a positive association was found in two case-control and non- significant association was found between dairy product consumption and the risk of breast cancer in the remaining studies (one case-control and four cohorts' studies) Conclusion: Although an inverse association was observed in most studies, it's difficult to draw conclusions when the methodology methods to collect the dairy product intake and the servings or portions measurements were different in each study. On the other hand, not all studies used the same confounding variable to estimate risk.

INTRODUCCIÓN: Introducción: el cáncer de mama es de los más comunes en mujeres, y su relación con los factores dietéticos y, en particular, con los productos lácteos, ha sido investigada a través de varios estudios, pero hasta ahora no hay resultados suficientes que confirmen la asociación entre cáncer de mama y productos lácteos. Objetivo: ampliar y actualizar el número de revisiones sistemáticas que hasta día de hoy existen sobre la relación entre el consumo de productos lácteos y el cáncer de mama. Metodología: se realizó una búsqueda exhaustiva en las bases de datos PubMed, Scopus y Embase entre septiembre de 2005 y septiembre de 2018 en la que se incluyeron estudios de casos y controles y estudios de cohortes. Resultados: se seleccionaron 18 estudios (10 estudios de casos-controles y 8 estudios de cohorte). Siete casos-controles y cuatro estudios de cohorte mostraron que el consumo de productos lácteos tenía una asociación inversa con el riesgo de cáncer de mama y, por otro lado, en dos estudios de casos-controles se observó una asociación positiva. No se encontró una asociación significativa entre el consumo de productos lácteos y el cáncer de mama en los restantes estudios (1 caso-control y 4 cohortes). Conclusión: aunque se observó una asociación inversa en la mayoría de los estudios, es difícil sacar conclusiones cuando los métodos metodológicos para recolectar la ingesta de lácteos y las porciones o las mediciones de las porciones fueron diferentes en cada estudio. Por otro lado, no todos los estudios tienen en cuenta las mismas variables de confusión.

Influencia de la vía diagnóstica en la clínica y el uso de terapias no convencionales en mujeres con cáncer de mama de la cohorte DAMA / Influence of diagnostic pathway on clinical and non-conventional therapies use in women with breast cancer of the cohort DAMA

OBJETIVO: Describir y analizar, según la vía diagnóstica, las características de los tumores de cáncer de mama. Se analizan los efectos adversos de los tratamientos recibidos y la utilización de terapias no convencionales para paliarlos. MÉTODO: Diseño descriptivo anidado en cohorte mixta (Cohorte DAMA). La variable dependiente fue la vía diagnóstica del cáncer de mama. Las variables independientes fueron la edad, el índice de masa corporal, la clase social, con renta familiar disponible, el tipo de tumor, el grado histológico, el estadio tumoral, las recidivas, el tratamiento, los efectos adversos de los tratamientos y las terapias no convencionales. Se realizaron análisis descriptivos bivariados y se ajustaron modelos de regresión univariados y multivariados, y se hicieron representaciones gráficas de la frecuentación de terapias no convencionales. RESULTADOS: Existen diferencias en las características de los tumores y en el impacto de los efectos adversos derivados de los tratamientos. Las pacientes diagnosticadas por cribado fueron de mayor edad y de clase social alta, presentaron un mayor porcentaje de tumores de grado I histológico, estadios iniciales, menos recidivas y efectos adversos debidos al tratamiento, aunque este no fuera distinto en el grupo de cribado respecto al resto. También hubo un menor uso de terapias no convencionales. CONCLUSIONES: Los resultados indican que la implantación de programas de cribado aumenta la posibilidad de detectar tumores en etapas iniciales y con terapias con menos efectos adversos; en consecuencia, con menor necesidad de recurrir a terapias no convencionales

OBJECTIVE: To describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway. We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them. METHOD: Descriptive design nested in a mixed cohort (Cohort DAMA). The dependent variable was the route to diagnosis of breast cancer. The independent variables were age, body mass index, social class, disposable family income, type of tumour, histological degree, tumour stage, recurrences, treatment, adverse effects derived from treatments and unconventional therapies. Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted; and graphic representations of the unconventional therapies. RESULTS: There are differences in the characteristics of the tumours, and the impact of the adverse effects derived from the treatments. The patients diagnosed by screening were older, from a high social class, had a higher percentage of tumours of grade I differentiation, initial stages, fewer recurrences and fewer adverse effects due to treatment, although this was not different in the screening group compared to the rest. There was also less use of unconventional therapies. CONCLUSIONS: The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects. As a result, there is less need to resort to unconventional therapies

[Influence of diagnostic pathway on clinical and non-conventional therapies use in women with breast cancer of the cohort DAMA]. / Influencia de la vía diagnóstica en la clínica y el uso de terapias no convencionales en mujeres con cáncer de mama de la cohorte DAMA.

OBJECTIVE: To describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway. We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them. METHOD: Descriptive design nested in a mixed cohort (Cohort DAMA). The dependent variable was the route to diagnosis of breast cancer. The independent variables were age, body mass index, social class, disposable family income, type of tumour, histological degree, tumour stage, recurrences, treatment, adverse effects derived from treatments and unconventional therapies. Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted; and graphic representations of the unconventional therapies. RESULTS: There are differences in the characteristics of the tumours, and the impact of the adverse effects derived from the treatments. The patients diagnosed by screening were older, from a high social class, had a higher percentage of tumours of grade I differentiation, initial stages, fewer recurrences and fewer adverse effects due to treatment, although this was not different in the screening group compared to the rest. There was also less use of unconventional therapies. CONCLUSIONS: The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects. As a result, there is less need to resort to unconventional therapies.

Determinantes sociales y clínicos del uso de servicios sanitarios en mujeres con cáncer de mama (Cohorte DAMA) / Social and clinical determinants of the use of health services in women with breast cancer (Cohort DAMA)

Objetivo: Describir y analizar los factores asociados al uso de los servicios sanitarios (urgencias, ingresos y atención primaria) en mujeres supervivientes de cáncer de mama diagnosticadas o tratadas en cuatro hospitales universitarios de Barcelona entre 2003 y 2013, en el marco del proyecto Cohorte DAMA. Método: Diseño descriptivo anidado en una cohorte mixta (Cohorte Dama). Se obtuvo la información sociodemográfica y del uso de servicios sanitarios a través de cuestionario, y del tumor a partir de la historia clínica. Se efectuaron modelos de regresión logística, calculando la odds ratio del uso de servicios sanitarios (urgencias, ingresos hospitalarios y atención primaria) cruda y ajustada (ORa) por método diagnóstico, características del tumor y de la mujer, y sus intervalos de confianza del 95%. Resultados: La presencia de enfermedades crónicas se asoció a mayor uso de los tres niveles asistenciales (ORa: 3,53 urgencias, 1,67 ingresos, 3,89 atención primaria) y a complicaciones derivadas del tratamiento (ORa: 1,35 urgencias, 1,43 atención primaria). Un nivel económico desfavorecido incrementó el riesgo de uso de urgencias y de atención primaria, pero no el de los ingresos hospitalarios. Un estadio tumoral avanzado se asoció a un mayor riesgo de ingreso. Por edad, las menores de 50 años presentaron más riesgo de uso de urgencias e ingresos. Conclusiones: Los factores asociados al uso de servicios de salud difieren según el nivel asistencial. La presencia de trastornos crónicos, la menor edad y la clase social desfavorecida incrementan el riesgo del uso de servicios más que el estadio tumoral y las complicaciones derivadas del tratamiento. El método diagnóstico, el tiempo de supervivencia y el uso de terapias no convencionales no influyeron en ello

Objective: To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project. Method: Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals. Results: The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions. Conclusions: The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this

[Social and clinical determinants of the use of health services in women with breast cancer (Cohort DAMA)]. / Determinantes sociales y clínicos del uso de servicios sanitarios en mujeres con cáncer de mama (Cohorte DAMA).

OBJECTIVE: To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project. METHOD: Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals. RESULTS: The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions. CONCLUSIONS: The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this.

Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort).

BACKGROUND: Breast cancer is a challenge for women's health-related quality of life (QoL), compromising their physical health and emotional well-being. QoL is equally distributed among different social groups. The aim of this study to analyze the impact of clinical characteristics and social determinants of health on the QoL of a cohort of women diagnosed and/or treated for breast cancer between 2003 and 2013 in one of the main hospitals in Barcelona's public health network. METHODS: We performed a descriptive cross-sectional study in a cohort of 2235 women with various stages of breast cancer at different stages of their disease. Data were obtained using questionnaires QLQ-C30 and QLQ-BR23 from the European Organization for Research and Treatment of Cancer (EORTC), which include a set of functional and symptomatic scales. We conducted descriptive and bivariate analysis using the Chi-Square test and adjusted for relevant variables using logistic regression. The dependent variables were the functional scales of QoL and the independent variables were sociodemographic and clinical variables. RESULTS: We observed significant differences for most QoL functions. Women from the most disadvantaged class, those in social isolation, or those who had suffered relapses showed the poorest results for most of the function scales. In contrast, age had differential effects depending on the function studied. CONCLUSIONS: The QoL of women diagnosed with breast cancer is closely linked to both their social and economic status, and to their stage of disease progression. It is necessary to explore interventions that focus on the social determinants of health in order to mitigate their effects on breast cancer survivors' QoL.

Cribado mamográfico, ¿qué nos depara el futuro? / Mammography screening, what does the future hold?

No disponible

Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort.

BACKGROUND: Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). OBJECTIVE: We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. METHODS: We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study's objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women's social profile based on descriptive data obtained from the telephone interview (welcome survey). RESULTS: Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. CONCLUSIONS: We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer.

Desigualdades en la realización de mamografías y citologías cervicales en las mujeres españolas según las encuestas nacionales de salud / Inequalities in mammographic and cervical screening in Spanish women according to national health surveys

Objetivo. Analizar la frecuencia del control mamográfico, del control mamográfico a través del programa poblacional y del control citológico según comunidad autónoma y clase social en mujeres españolas de 25 a 69 años. Métodos. Estudio observacional. La fuente de información fue la Encuesta Nacional de Salud (ENS) correspondiente a los años 2003, 2006 y 2011. La población de estudio fueron las mujeres de 25 a 69 años (N=7.844 ENS-2003, N=12.845 ENS-2006 y N=7.695 ENS-2011). Las variables dependientes: control mamográfico periódico, control mamográfico periódico vía programa poblacional y control citológico periódico. Variables independientes: edad, clase social (manual/no manual), comunidad autónoma, años de inicio del programa y ENS. Se calculó la razón de prevalencia con su intervalo de confianza al 95% (IC 95%). Resultados. En el año 2006, el 49,2% de las mujeres de clase no manual realizaron un control mamográfico periódico vía programa poblacional frente al 61,5% de clase manual (razón de prevalencia ENS-2006: 0,81; IC 95% 0,75-0,88). En la ENS-2011, el 53,6% de las mujeres de clase social no manual realizaron un control mamográfico periódico vía programa poblacional frente al 68,0% de las de clase manual. Para la ENS-2003, las mujeres de clase social no manual realizaron un 90,2% de controles citológicos periódicos respecto al 86,7% de las clases manuales (razón de prevalencia ENS-2003: 1,04; IC 95% 1,01-1,06). Conclusiones. No se observan diferencias por clase social en la realización de controles mamográficos periódicos. Los programas poblacionales de cáncer de mama compensan las diferencias de clase en la práctica del control mamográfico. En el control citológico son las mujeres de clase social no manual las que realizan una mayor proporción (AU)

Objective. To analyse the frequencies of mammographic screening, mammographic follow-up through a population-based screening programme, and cytological screening by autonomous community and social class in Spanish women aged 25 to 69 years. Methods. Observational study. The information source was the National Health Surveys (NHS) for 2003, 2006 and 2011. The study population consisted of women aged 25 to 69 years (N=7,844 for NHS-2003, N=12,845 for NHS-2006 and N=7,695 for NHS-2011). The dependent variables were periodic mammographic screening, periodic mammographic screening through a population-based programme, and periodic cervical screening. The independent variables were age, social class (manual/non-manual), autonomous community, the number of years since the start of the programme, and year of the NHS. Prevalence ratios with their 95% confidence intervals (95% CI) were calculated. Results. In 2006, participation in periodic population-based mammographic screening was 49.2% among women from a non-manual social class versus 61.5% among those from a manual social class (prevalence ratios NHS-2006: 0.81; 95% CI 0.75-0.88). In NHS-2011, participation was 53.6% among women from a non-manual social class versus 68.0% among those from a manual social class. For NHS-2003, participation in periodic cytological screening was 90.2% among women from a non-manual social class versus 86.7% among those from a manual social class (prevalence ratios NHS-2003: 1.04; 95% CI 1.01-1.06). Conclusions. No differences were observed by social class in periodic mammographic screening. Population-based breast cancer screening programmes compensate for differences in social class in mammographic follow-up. Cytological screening was more frequent among women from a non-manual social class (AU)

A favor del lazo rosa y la prevención del cáncer de mama: diferentes puntos de vista / In favour of the pink ribbon and breast cancer prevention: various points of view

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Country of origin and prevention of breast cancer: beliefs, knowledge and barriers.

This study describes the concept of prevention and identifies the knowledge, perceived benefits and barriers, as well as the practices of early detection of breast cancer among women from different cultural backgrounds and socioeconomic levels. A socioconstructivist qualitative study was conducted in Barcelona. The study population consisted of women who were either native (Spanish) or immigrants from low income countries, aged 40 to 69 years. Narrations of the 68 informants were subjected to sociological discourse analysis. Place and culture of origin, social class and the migratory process can either facilitate or constitute barriers to breast cancer prevention.

Tengo intención de hacerme una mamografía: estadios de adopción para realizar control mamográfico en mujeres de distinto origen cultural y social / No disponible

Objetivo: Describir el estadio de adopción en cuanto a la toma de decisión de hacerse controles regulares de cáncer de mama en mujeres de distinto origen sociocultural residentes en Barcelona en el año 2009. Métodos: Encuesta transversal realizada a una muestra de 960 mujeres de 45 a 69 años residentes en Barcelona en el año 2009 autóctonas e inmigrantes de países en vías de desarrollo. Se desarrolló un cuestionario telefónico. Las variables dependientes fueron los estadios de adopción en que se encontraban las mujeres según el Modelo Transteórico de las etapas de cambio: precontemplación, contemplación, acción, mantenimiento y recaída. Las variables independientes fueron: país de origen, clase social, edad, tiempo de estancia en el país de acogida, conocimiento del idioma, tener hijos, antecedentes familiares de cáncer y nivel de estudios. Se realizó un análisis descriptivo y se estimaron modelos de regresión de Poisson robusta para cada estadio con el fin de obtener las razones de prevalencia según las variables independientes y modelos multivariados para comparar losdistintos estadios versus el de mantenimiento. Resultados: El 90% de las mujeres autóctonas se sitúan en el estadio de mantenimiento, 3% de las Latinoamericanas, 41% de las de Europa del Este, 47% de las chinas (47%), 58% de las filipinas, 70% de las magrebíes y 80% de las indopakistaníes. Conclusiones: Es necesario mejorar el conocimiento del cáncer de mama y su prevención trabajando conjuntamente con personas del propio colectivo sobretodo en el caso de las mujeres chinas, filipinas y de Europa del Este (AU)

Objective: To describe the stage of adoption in terms of decision making regular checkups for breast cancer in women of different sociocultural backgrounds living in Barcelona in 2009. Methods: A cross-sectional survey of a sample of 960 women aged 45 to 69 years living in Barcelona in 2009, native and immigrants from developing countries. We developed a telephone questionnaire. The dependent variables were the stages of adoption in which women were under the Transtheoretical Model: precontemplation, contemplation, action, maintenance and relapse. The independent variables were: Country of origin, social class, age, length of stay in the host country, language skills, have children, family history of cancer and educational level. We performed a descriptive analysis and regression models were estimated robust Poisson each stage in order to obtain the prevalence ratios as independent variables and multivariate models to compare the different stages versus maintenance. Results: Ninety percent of native women are in the maintenance stage, 73% of Latin American, 41% of Eastern Europe, 47% of Chinese (47%), 58% of the Philippines, 70% of Maghrebi and 80% of Pakistani-Indian. Conclusions: To improve knowledge of breast cancer and its prevention by working with people from the community itself especially in the case of Chinese women, Filipino and Eastern European women (AU)

Knowledge, attitude and perceptions of breast cancer screening among native and immigrant women in Barcelona, Spain.

OBJECTIVE: Inequalities between immigrant and native populations in terms of access and use of health services have been described. The objective is to compare knowledge, attitudes, vulnerabilities, benefits and barriers related to breast cancer (BC) and screening mammography among women from different countries resident in Barcelona. METHODS: A cross-sectional survey carried out in Barcelona in 2009. The study population consisted of female residents in Barcelona between 45 and 69 years of age; participants were Spanish nationals or immigrants from low-income countries. 960 participants were asked 72 questions, mainly with Likert responses. The dependent variables were five quantitative scales: (1) knowledge of BC and early detection, (2) attitude towards health and BC, (3) vulnerability to BC, (4) barriers to mammography, (5) benefits of mammography. The independent variables were country of origin, social class, setting, cohabitation, age, mammography use, length of residence and fluency of the language. Analyses compared scale scores stratified by the independent variables. Multivariable linear regression models were fitted to determine the relationship between the scales and the independent variables. RESULTS: We observed inequalities according to country of origin on all scales after adjustment for independent variables. Chinese women presented the greatest differences with respect to native women, followed by Maghrebi and Filipino women. Inequalities exist on the vulnerability and barriers scales according to social class and urban/rural setting, and on the attitude scale according to social class. CONCLUSIONS: Country of origin, social class and urban/rural setting are key contributors to inequality in these scales.