Social inequalities in a population based colorectal cancer screening programme in the Basque Country.

BACKGROUND: While it is known that a variety of factors (biological, behavioural and interventional) play a major role in the health of individuals and populations, the importance of the role of social determinants is less clear. The effect of social inequality on population-based screening for colorectal cancer (CRC) could limit the value of such programmes. The present study aims to determine whether such inequalities exist. METHODS: Data was obtained from the population-based screening programme administered in the Autonomous Community of the Basque Country, Spain, with a target population aged 50 to 69, first invited to participate between 2009 and 2011. The magnitude of inequality was analysed using the odds ratio (taking the least disadvantaged socioeconomic quintile as the reference population), the population attributable risk and the relative index of inequality, based on the regression, which is the ratio of the rates in the most and least disadvantaged socioeconomic groups. RESULTS: The target population comprised 242,394 people, with the test kit successfully sent to 95.1 % (230,510). The overall response rate was 64.3 % (67.1 in women and 61.4 % men). Among women, the highest participation was in the third quintile (71.5 %) and the lowest in the first - the least disadvantaged (65.7 %). The lowest and highest rates of people with identified lesions were in the second and fourth quintiles (14.7/1000 and 17.0/1000 respectively). Among men, the response rate was lowest in the fifth - most disadvantaged - quintile (60.2 %). The highest rate of identified lesions was in the fifth quintile; 38 % higher than the first (55.7/1000 compared to 41.0/1000). CONCLUSIONS: Sex and socioeconomic group influence the rate of participation in the CRC programme and the rate of lesions found in the participants. Any public health programme is morally and ethically obliged to strive for equity and effectiveness. Improving participation of men and socially disadvantaged groups should be taken in account.

Fish muscle processing into seafood products reduces ß-parvalbumin allergenicity.

Fish is one of the eight major foods causing type-I food allergy, and the prevalence of its allergy is increasing in part due to changes in consumption habits. One of the main drivers for these changes has been the processing developments transforming the fish muscle into seafood products. Most fish allergic patients react to the Ca2+-binding protein ß-parvalbumin (ß-PV) abundant in muscle. Here we have analyzed the effect of processing in the content and allergenic properties of the ß-PV. We found that the transformation process decreases the ß-PV content (4.7 ± 0.3 mg/g muscle, 0.24 ± 0.03 mg/g surimi, ≤0.003 ± 0.001 mg/g in seafood products), reduces the specific-IgE binding and prevents allergy relevant properties such the protease resistance and amyloid aggregation. These results suggest seafood products as potentially tolerable foods for fish allergic patients, but milk and egg allergic patients should be aware of the presence relevant additives.

Association between animal welfare indicators and microbiological quality of beef carcasses, including Salmonella spp., from a slaughterhouse in Ecuador.

BACKGROUND AND AIM: Pre-slaughter management and slaughter operations are considered critical factors for animal welfare and meat quality. Previous studies have found poor animal welfare management at municipal slaughterhouses in Ecuador, and little is known about how this affects the microbiological quality of the meat. Therefore, the aim of the study was to analyze the association of the microbiological quality of beef carcasses and animal welfare indicators in a municipal slaughterhouse in Ecuador. MATERIALS AND METHODS: Data for 6 months were collected from a municipal slaughterhouse in Ecuador. Five trained researchers were strategically located along the slaughter process. A total of 351 animals were observed with regard to welfare indicators, and their carcasses were sampled to evaluate microbiological quality. Antemortem (slipping, falling, and vocalization) and postmortem animal welfare indicators (bleed interval, pH, temperature, and bruises) were measured. To determine the total aerobic bacteria (TAB) and Escherichia coli counts and the presence of Salmonella spp., we collected samples by swabbing four different points of each carcass. The association between microbiological quality and animal welfare indicators was studied using univariate and multivariate logistic regressions. RESULTS: The mean TAB count was 5.3 log CFU/cm2, and the mean total count of E. coli was 2.4 log CFU/cm2. Salmonella spp. were isolated in 3.1% of the carcasses. An electric goad was used in all animals, 19.1% slipped at least once, and 19.9% vocalized. The mean pH of the carcasses was 7.2, and 79.2% of carcasses had bruises. Multivariate analysis showed that Salmonella spp. and the TAB count were associated with pH and the number of bruises (p = 0.01 in both cases). CONCLUSION: Although there was non-significant association between the majority of animal welfare indicators and microbiological quality, the poor management affecting animal welfare and carcass hygiene are worrisome.

Colorectal cancer screening program using FIT: quality of colonoscopy varies according to hospital type.

Background and study aims To compare the quality of colonoscopy in a population-based coordinated program of colorectal cancer screening according to type of hospital (academic or non-academic). Patients and methods Consecutive patients undergoing colonoscopy after positive FIT (≥ 20 ug Hb/g feces) between January 2009 and September 2016 were prospectively included at five academic and seven non-academic public hospitals. Screening colonoscopy quality indicators considered were adenoma detection rate, cecal intubation rate, complications and bowel preparation quality. Results A total of 48,759 patients underwent colonoscopy, 34,616 (80 %) in academic hospitals and 14,143 in non-academic hospitals. Among these cases, 19,942 (37.1 %) advanced adenomas and 2,607 (5.3 %) colorectal cancers (CRCs) were detected, representing a total of 22,549 (46.2 %) cases of advanced neoplasia. The adenoma detection rate was 64 %, 63.1 % in academic hospitals and 66.4 % in non-academic hospitals ( P  < 0.001). Rates of advanced adenoma detection, cecal intubation and adequate colonic preparation were 45.8 %, 96.2 % and 88.3 %, respectively, and in all cases were lower (implying worse quality care) in academic hospitals (45.3 % vs 48.7 %; odds ratio [OR] 0.87, 95 % confidence interval [CI] 0.84 - 0.91; 95.9 % vs 97 %; OR 0.48, 95 % CI 0.38 - 0.69; and 86.4 % vs 93 %; OR 0.48, 95 % CI 0.45 - 0.5; respectively; P  < 0.001 in all cases). In 13 patients, all in the academic hospital group, CRC was diagnosed after colonoscopy (0.26 cases × 1000 colonoscopies). Rates of CRC treated by endoscopy were similar in both types of hospital (30 %). The rate of severe complication was 1.2 % (602 patients), with no significant differences by hospital type: bleeding occurred in 1/147 colonoscopies and perforation in 1/329. One patient died within 30 days after screening colonoscopy. Conclusions The quality of colonoscopy was better in non-academic hospitals. The rate of detection of advanced neoplasia was higher in non-academic hospitals and correlated with the rate of post-colonoscopy CRC.

Descriptive, Longitudinal Study Results Applied to Statistical Models to Assess the Impact of Early Microbiological Cultures on the Economic Burden of Treatment for Infected Diabetic Foot Ulcers at a Mexican Public Health Facility.

Infection plays a critical role in health care and impacts the cost of the treatment of diabetic foot ulcers (DFU). To examine the cost reduction associated with the multidisciplinary treatment of infected DFU (IDFU) by obtaining early (ie, within 48 hours of admission) microbiological culture results, a descriptive, longitudinal study was conducted. Data were collected prospectively from patient medical charts of a cohort of 67 patients (mean age, 56.14 ± 12.3 years; mean duration of diabetes, 14.95 ± 8 years) with IDFU treated at a Mexican public health facility from January 1 to April 30, 2010. Information included demographic data (age, gender, marital status, time elapsed since first diagnosis of diabetes mellitus type 2 [DM2]), and the following clinical records: Wagner classification, bacterium type, antimicrobial resistance, length of hospital stay, and the antibiotic schedule utilized, as well as number and type of laboratory tests, medications, intravenous therapy, surgical and supportive treatment, type and number of specialists, and clinical outcome. Microcosting was used to calculate the unit cost of each medical treatment element. Using the Monte Carlo and Markov predictive simulation economical models, cost reduction associated with early identification of the specific microorganism through bacterial culture in IDFU was estimated. Based on the statistical results, differences between real and estimated costs when including early microbiological culture were identified and the number and type of most common species of infectious bacteria were detected. The total cost observed in the patient cohort was $502 438.04 USD, mean cost per patient was $7177.69 ± $5043.51 USD, and 72.75% of the total cost was associated with the hospital stay length. The cost of the entire treatment including antibiotics was $359 196.16 USD; based on the simulation of early microbiological culture, the model results showed cost could be reduced by 10% to 25% (in this study, the cost could be as low as $304 624.63 USD). The use of early microbiological cultures on IDFU to determine the appropriate antibiotic can reduce treatment costs by >30% if hospital stay is part of the consideration.

Factores de riesgo para infección por VIH en indígenas de la etnia warao del Municipio Antonio Díaz, Estado Delta Amacuro, Venezuela. Octubre ­ diciembre 2015

Delta Amacuro asienta la mayor población indígena de la etnia Warao en comunidades de difícil acceso y limitadas condiciones de vida. En 2007, la Cruz Roja venezolana diagnosticó los primeros casos de infección por VIH en este estado; posteriormente, diversas publicaciones han reportado que la prevalencia de infección por VIH en comunidades de la etnia Warao es 10 veces mayor a la prevalencia mundial. El objetivo de la investigación fue evaluar factores de riesgo para infección por VIH en indígenas del municipio Antonio Díaz, Estado Delta Amacuro durante octubre ­ diciembre 2015. Los factores de riesgo fueron agrupados en: características socioeconómicas, estatus migratorio, hábitos psicobiológicos y conocimiento sobre la enfermedad. Se realizó un estudio analítico de tipo casos y controles. Se evaluaron 50 pacientes VIH positivo de 7 comunidades y 100 controles del mismo sexo, comunidad y edad. A todos se les realizó una entrevista directa. Se compararon los resultados utilizando pruebas Chi cuadrado y se determinaron los Odds Ratio. La inestabilidad en la pareja sexual, las prácticas de hombres que tienen sexo con hombres, las relaciones sexuales fortuitas y durante viajes, el inicio precoz de relaciones sexuales, el sexo oral, sexo anal y el no uso de métodos de barrera constituyeron factores de riesgo para infección por VIH en la población estudiada. El desconocimiento de la forma de trasmisión y prevención resultaron también estadísticamente significativos. La falta de conocimiento, movimientos migratorios frecuentes y las prácticas sexuales de riesgo pueden explicar la elevada prevalencia de infección por VIH en esta población.

In Delta Amacuro state is established the biggest Amerindian community belonging to the Warao ethnic. This people live in difficult access communities with precarious life conditions. In 2007 the Venezuelan Red Cross diagnosed the first HIV infection cases in the state. Later, many publications have reported HIV prevalence in Waraos communities ten times higher than worldwide prevalence. The main objective was to evaluate risk factors for HIV infection in Waraos Amerindians who live in Antonio Diaz municipality, Delta Amacuro state between October and December 2015. Risk factors were grouped in: socioeconomic conditions, migratory status, sexual and psychobiologic habits and disease knowledge. An analytic case-control study was conducted. Fifty HIV patients from seven communities and 100 controls were evaluated. The information from cases and controls was collected through a direct interview. The results were compared using chi square test, odds ratios were calculated. No stability in sexual partners, men who have sex with other men, casual sex, sex during trips, early sexual initiation, oral sex and anal sex and lacking in use of barrier contraceptive methods were risk factors for HIV infection in the study group. Lack of knowledge about transmission and prevention of the disease were also statistically significant risk factors. Lack of knowledge, frequent migratory movements and risk sexual behavior may explain the high prevalence of HIV infection in this population.

Exceso ponderal y variables socioeconómicas en trabajadores del sector salud en la ciudad de Caracas / Weight excess and socioeconomic variables in health workers in Caracas

El desarrollo de obesidad y sobrepeso están influenciados por diversos factores. Se evalúa la relación entre exceso ponderal y algunas variables socio-económicas en trabajadores del sector salud. Se realizó un estudio diagnóstico, retrospectivo con una muestra no probabilística de 337 trabajadores de un centro de salud quienes fueron atendidos en una consulta de medicina preventiva. El promedio de edad fue 34,6 años, peso promedio 69,11 Kilogramos (Kg), estatura promedio 1,6 metros (m), Índice de Masa Corporal (IMC) promedio 26,66 Kg/m2. Treinta y seis por ciento de los trabajadores presentaban un IMC normal, 40,06% sobrepeso y 23,44% obesidad. No se encontraron diferencias significativas de peso entre géneros. El IMC promedio más alto lo tuvo el grupo entre 35-40 años (28,88 Kg/m2). El IMC promedio más alto lo tuvieron los trabajadores del horario nocturno (27,84 Kg/m2) y el más bajo los de fines de semana (24,14 Kg/m2). La mayor frecuencia de sobrepeso la presentaron los trabajadores matutinos (53,41%), y de obesidad los del nocturno (32,81%). El grupo de obreros no especializados tuvo el IMC promedio más alto (31,36 kg/m2); el grupo de gerentes tuvo un IMC promedio menor (26,73 Kg/m2). El exceso de peso afecta dos terceras partes de la muestra estudiada. Existe relación entre algunos factores socio-económicos y la frecuencia de exceso ponderal en el grupo estudiado(AU)

The development of obesity and overweight is influenced by several factors. The objective of this study was to assess the relationship between the frequency of overweight and obesity and various socioeconomic variables among health care workers from Caracas, Venezuela. A descriptive, retrospective study was conducted using a nonrandom sample of 337 workers seenat a local health center for preventive care. The mean age of the workers was 34.6 years, their mean weight was 69.11 Kg, their mean height was 1.6 m, and their mean body mass index (BMI) was26.66 Kg/m2. Among them, 36% had a normal BMI, 40.06% were overweight and 23.44% were obese. No significant difference in BMI was found between men and women. The group of 35 to 40-year-olds had the highest mean BMI (28.88 Kg/m2). The highest mean BMI was found among those who worked the night shift (27.84 Kg/m2), and the lowest mean BMI among those who worked the weekend shift (24.14 Kg/m2). The highest frequency of overweight was found among those who worked the morning shift (53,41%), and the highest frequency of obesity among those working the night shift (32.81%). Unskilled workers had a mean BMI of 31.36 kg/m2, and those who worked in the most senior positions had a mean BMI of 26.73 kg/m2. Overall, excess weight affected two-thirds of the study sample. There is a relation ship between socioeconomic factors and frequency of excess weight in the study population(AU)