6-Year Risk of Developing Lung Cancer in Spain: Analysis by Autonomous Communities / Riesgo a 6 años de desarrollar cáncer de pulmón en España: análisis por comunidades autónomas

Introduction: Lung cancer screening with low-dose computed tomography (LDCT) has been proposed as a strategy to reduce lung cancer mortality. Since LDCT has side effects there is a need to carefully select the target population for screening programmes. Because in Spain health competences are transferred to the seventeen Autonomous Communities (ACs), the present paper aims to identify individuals at high risk of developing lung cancer in the different ACs. Methods: We used the 2011–2012 data of the Spanish National Interview Health Survey (n=21,006) to estimate the proportion of individuals at high risk of developing lung cancer using a 6-year prediction model (PLCOm2012). This proportion was then extrapolated into absolute figures for the Spanish population, using the population census data of 2018 from the National Institute of Statistics. Results: The proportion of individuals aged 50–74 with a risk of lung cancer ≥2% was 9.5% (15.9% in men, 3.5% in women). This proportion ranged from 6.6% in Región de Murcia to 12.7% in Andalucía and 13.0% in Extremadura. When extrapolated to the Spanish population, it was estimated that a total of 1,341,483 individuals may have a 6-year risk of lung cancer ≥2%. Conclusions: The present study is the first one that evaluated the number of individuals at high risk of developing lung cancer in the different Spanish ACs using a prediction model and selecting people with a 6-year risk ≥2%. Further studies should assess the cost and effectiveness associated to the implementation of a lung cancer screening programme to such population. (AU)

Introducción: La detección del cáncer de pulmón con tomografía computarizada de baja dosis se ha propuesto como una estrategia para reducir la mortalidad por dicho cáncer. Como la tomografía computarizada de baja dosis tiene efectos secundarios, es necesario seleccionar cuidadosamente la población objetivo para los programas de cribado. Debido a que en España las competencias de salud están transferidas a las 17 comunidades autónomas, el presente trabajo tiene como objetivo identificar a las personas con alto riesgo de desarrollar cáncer de pulmón en las diferentes comunidades autónomas. Métodos: Utilizamos los datos de 2011-2012 de la Encuesta Nacional de Salud de España (n=21.006) para estimar la proporción de individuos con alto riesgo de desarrollar cáncer de pulmón utilizando un modelo de predicción a 6 años (PLCOm2012). Esta proporción se extrapoló en cifras absolutas para la población española, utilizando los datos del censo de población de 2018 del Instituto Nacional de Estadística. Resultados: La proporción de individuos de 50 a 74 años con riesgo de cáncer de pulmón≥2% fue del 9,5% (15,9% en hombres, 3,5% en mujeres). Esta proporción osciló entre el 6,6% en la Región de Murcia, el 12,7% en Andalucía y el 13,0% en Extremadura. Cuando se extrapoló a la población española, se estimó que un total de 1.341.483 individuos podrían tener un riesgo de cáncer de pulmón a los 6 años≥2%. Conclusiones: El presente estudio es el primero que evaluó el número de individuos con alto riesgo de desarrollar cáncer de pulmón en las diferentes comunidades autónomas españolas utilizando un modelo predictivo y seleccionando personas con un riesgo a los 6 años≥2%. Se deberían realizar estudios adicionales para evaluar el coste y la efectividad asociados a la implementación de un programa de cribado de cáncer de pulmón para dicha población. (AU)

6-Year Risk of Developing Lung Cancer in Spain: Analysis by Autonomous Communities.

INTRODUCTION: Lung cancer screening with low-dose computed tomography (LDCT) has been proposed as a strategy to reduce lung cancer mortality. Since LDCT has side effects there is a need to carefully select the target population for screening programmes. Because in Spain health competences are transferred to the seventeen Autonomous Communities (ACs), the present paper aims to identify individuals at high risk of developing lung cancer in the different ACs. METHODS: We used the 2011-2012 data of the Spanish National Interview Health Survey (n=21,006) to estimate the proportion of individuals at high risk of developing lung cancer using a 6-year prediction model (PLCOm2012). This proportion was then extrapolated into absolute figures for the Spanish population, using the population census data of 2018 from the National Institute of Statistics. RESULTS: The proportion of individuals aged 50-74 with a risk of lung cancer ≥2% was 9.5% (15.9% in men, 3.5% in women). This proportion ranged from 6.6% in Región de Murcia to 12.7% in Andalucía and 13.0% in Extremadura. When extrapolated to the Spanish population, it was estimated that a total of 1,341,483 individuals may have a 6-year risk of lung cancer ≥2%. CONCLUSIONS: The present study is the first one that evaluated the number of individuals at high risk of developing lung cancer in the different Spanish ACs using a prediction model and selecting people with a 6-year risk ≥2%. Further studies should assess the cost and effectiveness associated to the implementation of a lung cancer screening programme to such population.

6-Year Risk of Developing Lung Cancer in Spain: Analysis by Autonomous Communities.

INTRODUCTION: Lung cancer screening with low-dose computed tomography (LDCT) has been proposed as a strategy to reduce lung cancer mortality. Since LDCT has side effects there is a need to carefully select the target population for screening programmes. Because in Spain health competences are transferred to the seventeen Autonomous Communities (ACs), the present paper aims to identify individuals at high risk of developing lung cancer in the different ACs. METHODS: We used the 2011-2012 data of the Spanish National Interview Health Survey (n=21,006) to estimate the proportion of individuals at high risk of developing lung cancer using a 6-year prediction model (PLCOm2012). This proportion was then extrapolated into absolute figures for the Spanish population, using the population census data of 2018 from the National Institute of Statistics. RESULTS: The proportion of individuals aged 50-74 with a risk of lung cancer ≥2% was 9.5% (15.9% in men, 3.5% in women). This proportion ranged from 6.6% in Región de Murcia to 12.7% in Andalucía and 13.0% in Extremadura. When extrapolated to the Spanish population, it was estimated that a total of 1,341,483 individuals may have a 6-year risk of lung cancer ≥2%. CONCLUSIONS: The present study is the first one that evaluated the number of individuals at high risk of developing lung cancer in the different Spanish ACs using a prediction model and selecting people with a 6-year risk ≥2%. Further studies should assess the cost and effectiveness associated to the implementation of a lung cancer screening programme to such population.

Core indicators evaluation of effectiveness of HIV-AIDS preventive-control programmes carried out by nongovernmental organizations. A mixed method study.

BACKGROUND: The number of nongovernmental organizations working on AIDS has grown. There is great diversity in the type of activities and population groups that have been targeted. The purposes of this study are: to describe and analyze the objectives and HIV-AIDS preventive activities that are carried out by the AIDS-NGOs that work with AIDS in Catalonia and that receive subsidies from the Department of Health; and to develop a comprehensive proposal for measurable and agreed upon core quality evaluation indicators to monitor and assess those objectives and activities that can have an impact on the fight against inequalities and stigmatization, and incorporate the perspectives of the service providers and users. METHODS: A mixed method study has been carried out with professionals from the 36 NGOs that work with HIV/AIDS in Catalonia, as well as their users. This study achieved the completeness model using the following phases:1. A systematic review of AIDS-NGOs annual reports and preparation of a catalogue of activities grouped by objectives, level of prevention and AIDS-NGOs target population; 2. A transversal study through an ad-hoc questionnaire administered to the AIDS-NGOs representatives; 3. A qualitative study with a phenomenological approach through focus groups, individual interviews and observations; 4. Consensus meetings between AIDS-NGOs professionals and the research team using Haddon matrices in order to establish a proposal of evaluation indicators. RESULTS: The information was classified according to level of prevention and level of intervention. A total of 248 objectives and 258 prevention activities were identified. 1564 evaluation indicators, addressed to 7 target population groups, were produced. Thirty core activities were selected. The evaluation indicators proposed for these activities were: 76 indicators for 15 primary prevention activities, 43 for 5 secondary prevention activities and 68 for 10 tertiary prevention activities. CONCLUSIONS: The results could help to homogeneously assess the preventive-control activities carried out of AIDS-NGOs. The proposed indicators could help the professionals to improve the evaluation of the preventive-control AIDS-NGOs activities. Furthermore, the Haddon matrix enables us to identify deficiencies of activities at intervention levels and strategies to bear in mind in order to enhance the future AIDS prevention programs.

Experiences about HIV-AIDS preventive-control activities. Discourses fromnon-governmental organizations professionals and users

Objectives: The main aim of this study was to identify the experiences of professionals in nongovernmental organizations (NGO) in Catalonia (Spain) working in HIV/AIDS prevention and control activities and potential areas of improvement of these activities and their evaluation. A further aim was to characterize the experiences, knowledge and practices of users of these organizations with regard to HIV infection and its prevention. Methods: A phenomenological qualitative study was conducted with the participation of both professionals and users of Catalan nongovernmental organizations (NGO) working in HIV/AIDS. Theoretical sampling (professional) and opportunistic sampling (users) were performed. To collect information,the following techniques were used: four focus groups and one triangular group (professionals), 22 semi-structured interviews, and two observations (users). A thematic interpretive content analysis was conducted by three analysts. Results: The professionals of nongovernmental organizations working in HIV/AIDS adopted a holisticapproach in their activities, maintained confidentiality, had cultural and professional competence and followed the principles of equality and empathy. The users of these organizations had knowledge of HIV/AIDS and understood the risk of infection. However, a gap was found between knowledge, attitudes and behavior. Conclusions: NGO offer distinct activities adapted to users’ needs. Professionals emphasize the need for support and improvement of planning and implementation of current assessment. The preventive activities of these HIV/AIDS organizations are based on a participatory health education model adjusted to people’s needs and focused on empowerment (AU)

Objetivos: Identificar las experiencias y actividades de las organizaciones no gubernamentales (ONG) que trabajan en la prevención y control del VIH/sida, las posibles áreas de mejora de las actividades y de su evaluación, e identificar las experiencias, conocimientos y prácticas de sus usuarios sobre el VIH y suprevención. Métodos: Estudio cualitativo fenomeno lógico en el que participan los profesionales y usuarios de las ONG que trabajan en VIH. Se realizó un muestreo teórico (profesionales) y un muestreo opinático (usuarios). Se utilizaron cuatro grupos focales y uno triangular (profesionales), 22 entrevistas semi-estructuradas y dos observaciones (usuarios). Se realizó un análisis de contenido temático realizado por tres analistas. Resultados: Los profesionales de las ONG ofrecen un enfoque holístico, confidencialidad, competencia cultural y profesional, y aplican los principios de igualdad y empatía. Los usuarios tienen conocimientos sobre el VIH/sida y comprenden el riesgo de infección. Existe una separación entre conocimiento, actitud y conducta. Conclusiones: Las ONG ofrecen diversas actividades adaptadas a las necesidades de los usuarios. Los profesionales destacan la necesidad de apoyo y mejora de la planificación y ejecución del proceso de evaluación actual. Las actividades preventivas de las ONG que trabajan en VIH/sida se basan en un modelo de educación sanitaria participativa ajustado a las necesidades de la población, basada en el empoderamiento (AU)

Experiences about HIV-AIDS preventive-control activities. Discourses from non-governmental organizations professionals and users.

OBJECTIVES: The main aim of this study was to identify the experiences of professionals in nongovernmental organizations (NGO) in Catalonia (Spain) working in HIV/AIDS prevention and control activities and potential areas of improvement of these activities and their evaluation. A further aim was to characterize the experiences, knowledge and practices of users of these organizations with regard to HIV infection and its prevention. METHODS: A phenomenological qualitative study was conducted with the participation of both professionals and users of Catalan nongovernmental organizations (NGO) working in HIV/AIDS. Theoretical sampling (professional) and opportunistic sampling (users) were performed. To collect information, the following techniques were used: four focus groups and one triangular group (professionals), 22 semi-structured interviews, and two observations (users). A thematic interpretive content analysis was conducted by three analysts. RESULTS: The professionals of nongovernmental organizations working in HIV/AIDS adopted a holistic approach in their activities, maintained confidentiality, had cultural and professional competence and followed the principles of equality and empathy. The users of these organizations had knowledge of HIV/AIDS and understood the risk of infection. However, a gap was found between knowledge, attitudes and behavior. CONCLUSIONS: NGO offer distinct activities adapted to users' needs. Professionals emphasize the need for support and improvement of planning and implementation of current assessment. The preventive activities of these HIV/AIDS organizations are based on a participatory health education model adjusted to people's needs and focused on empowerment.

Cancer incidence in AIDS patients in Catalonia, Spain.

HIV infected people and AIDS patients develop cancer more frequently than the general population. The objective of this study was to evaluate the risk of developing cancer among 15 to 69 year old AIDS patients from two geographic areas: Tarragona and Girona provinces, in north-eastern Spain. We have studied invasive and in situ cancers (for all sites) among 1659 AIDS patients from +/-5 years around the date of their AIDS diagnosis by matching the population-based Cancer Registries with the AIDS Registry covering these populations. The periods used in the linkage were 1981-1998 for Tarragona and 1994-1999 for Girona. Sex and age-standardised incidence ratios (SIRs) of observed-to-expected cancers were calculated by type of cancer as a measure of risk. For selected types of cancers, SIRs were also calculated for HIV exposure category. Compared with the general population, incidence of cancer among AIDS patients (invasive and in situ) increased 22.9 fold in men (n=142) and 21.0 fold in women (n=45). High statistically significant SIRs were found for Kaposi's sarcoma (KS) (male, 486.4; female, 1030.0), non-Hodgkin's lymphoma (NHL) (male, 126.1; female, 192.8) and invasive cervical cancer (41.8). High risks were also found for Hodgkin's lymphoma (31.1), liver cancer (29.4) and lung cancer (9.4) in men, and in situ cervical cancer (24.4) in women. For all non-AIDS defining malignant neoplasms as a group SIRs were 3.4 in men and 2.5 in women. Among men, homo/bisexuality was strongly related to risk of KS and NHL. The rates of cervical cancer, Hodgkin's lymphoma, liver cancer and lung cancer were among the highest ever reported linked to HIV infection. For the cervical cancer this could be attributable to the low incidence of this cancer in the general population and to the high prevalence of intravenous drug users among HIV women and probably due to poor preventive strategies in this population.

[Reporting of newly diagnosed HIV infections in Catalonia, Barcelona, Spain. Implementation and results]. / Declaración de los nuevos diagnósticos de infección por el VIH en Cataluña. Implementación y resultados.

OBJECTIVES: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. METHODS: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. RESULTS: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. CONCLUSIONS: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification.

Declaración de los nuevos diagnósticos de infección por el VIH en Cataluña. Implementación y resultados / Reporting of newly diagnosed HIV infections in Catalonia. Barcelona. Spain. Implementation and results

Objetivos: Describir los resultados de la notificación de nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (NDIVIH) en Cataluña (2001-2003), y comparar las características de la epidemia como resultado de la utilización de este nuevo sistema de información junto con el Registro de casos de sida de Cataluña, con las halladas únicamente en el Registro de casos de sida. Métodos: Datos de las notificaciones de NDIVIH y de casos de sida entre 2001 y 2003 en Cataluña. Resultados: Entre los NDIVIH (n = 1.765), la vía de transmisión más frecuente fue las relaciones heterosexuales (46,8%), seguida de las relaciones homosexuales entre varones (26,7%) y el uso de drogas por vía parenteral (19,9%). Entre los 1.210 casos de sida, la forma de transmisión más frecuente fue el uso de drogas por vía parenteral (42,2%), seguida de relaciones heterosexuales (34,5%) y de las relaciones homosexuales entre varones (18,0%). La diferencia de utilizar una o 2 fuentes de información respecto a la variable vía de transmisión de la infección fue estadísticamente significativa. Conclusiones: El sistema de información basado en los datos sobre NDIVIH es viable, ha sido útil para conseguir los objetivos previstos en el sistema de vigilancia epidemiológica del VIH y proporciona información más precisa que el Registro de sida para describir los actuales patrones de transmisión del virus. La exhaustividad del nuevo sistema de información podría mejorar mediante la incorporación del diagnóstico de infección al sistema de enfermedades de declaración obligatoria

Objectives: To describe newly diagnosed HIV infections from the HIV Reporting System in Catalonia (2001-2003), and to compare the characteristics of the epidemic based on the use of the HIV Reporting System and the Catalonian AIDS Registry versus those based on the Catalonian AIDS Registry alone. Methods: Data were collected from newly diagnosed HIV infections and AIDS cases between 2001 and 2003 in Catalonia. Results: Among the newly diagnosed HIV infections (1,765) the most frequent route of HIV infection was heterosexual transmission (46.8%), followed by men who had sex with men (26.7%), and injecting drug use (19.9%). Out of the 1,210 AIDS cases, the most common route of HIV transmission was injecting drug used (42.2%), followed by (heterosexual transmission 34.5%) and MSM (18.0%). Comparison of routes of HIV transmission in the two reporting systems (HIV/AIDS versus AIDS) revealed statistically significant differences. Conclusions: The HIV/AIDS Reporting System based on reporting of newly diagnosed HIV infections is feasible, since it has been useful in achieving the objectives of epidemiological HIV infection surveillance. It also provides more accurate information than does the AIDS Registry, which can be used to describe recent patterns of HIV transmission. The completeness of the new reporting system may be enhanced by including the diagnosis of HIV infection among the diseases of mandatory notification

Sida. Evolución de los objetivos del Plan de Salud de Cataluña para el año 2000 / AIDS. Evaluation of the objectives of the Health Plan for Catalonia for the year 2000

Fundamento y objetivo: El propósito de este trabajo es identificar y evaluar los indicadores sanitarios relacionados con los objetivos de salud establecidos por el Departament de Sanitat y Seguretat Social en el Plan de Salud de Cataluña para el año 2000, referentes al virus de la inmunodeficiencia humana (VIH): disminuir la incidencia, retrasar la aparición de casos de sida e incrementar la supervivencia, disminuir la transmisión vertical y las prácticas de riesgo, y mejorar el marco asistencial. Población y método: Los indicadores utilizados provienen de diversos sistemas de información, como el Registro de Sida de Cataluña, el seguimiento de la prevalencia en poblaciones centinela y el Registro de Mortalidad, así como de estudios de: cribado anónimo no relacionado en recién nacidos, frecuencia de prácticas de riesgo en series transversales de varones homosexuales y en usuarios de drogas por vía parenteral (UDVP), pacientes infectados en tratamiento, cobertura de pruebas de detección de anticuerpos y retraso en el diagnóstico de la infección. Resultados: Los indicadores epidemiológicos reflejan el impacto de las terapias de alta efectividad introducidas en 1996, disminuyendo drásticamente los casos de sida e incrementando la supervivencia. Por otra parte, destaca un incremento en la transmisión heterosexual y un aumento en las conductas de riesgo entre los varones homosexuales. A pesar del acceso universal y gratuito de las pruebas diagnósticas, el 45% de los casos de sida conocen su estado seropositivo en el año previo al diagnóstico de sida. Conclusiones: Los objetivos generales se han cumplido y los indicadores corroboran la respuesta observada en los países occidentales ante la epidemia. Pero los resultados también expresan una relajación en las conductas entre los varones homosexuales y la necesidad de incrementar la percepción de riesgo entre la población con prácticas heterosexuales, así como de potenciar el diagnóstico precoz y las intervenciones preventivas en general. Para evaluar mejor la asistencia a las personas afectadas es necesaria la inclusión de nuevos indicadores (AU)

Background and objective: The purpose of this paper is to identify and evaluate the health indicators related to the AIDS objectives fixed by Department of Health and Social Security in the Health Plan for Catalonia for the year 2000: diminish the incidence, delay the appearance of new cases and increase the survival, diminish vertical transmission and risk practices and finally improve assistencial framework. Subjects and method: The indicators have been obtained from several information systems like the AIDS Registry of Catalonia, the Mortality Registry, the monitorized prevalence of sentinel populations and studies like unlinked anonymous screening in newborns, risk practices frequency in transversal series of homosexual men and addicted to parenteral drugs, infected patients undergoing treatment, coverage of antibody detection tests and delay in the diagnosis of infection. Results: The epidemiologic indicators reflect the impact of high efectivity therapies introduced in 1996. We have noticed a dramatic decrease of aids cases with a parallel rise of survival rates. It is remarkable how the heterosexual transmission have increased. Moreover, risk behaviours among homosexual men have experimented a notable enlargement. Despite the universal and free access to AIDS diagnostic tests, only 45% of cases know their seropositive status in the previous year to AIDS diagnosis. Conclusions: General objectives have been achieved and the indicators confirm the western countries response against the epidemy. However, results also express a relaxation in homosexual men sexual habits and the need to increase risk perception among heterosexual population. In order to evaluate better the affected people assistance, it is necessary to include new indicators (AU)