Facilitators and barriers to participation in population-based colorectal cancer screening programme from the perspective of healthcare professionals: Qualitative research study

Objective High participation determines the success of colorectal cancer screening programmes in reducing incidence and mortality. The factors that determine participation must be studied from the perspective of professionals that implement the programme. The aim was to identify factors that facilitate or hinder the participation of the invited people in the bowel cancer screening programme of the Basque Country (Spain) from professional's perspective. Methods Qualitative design based on individual interviews and focus groups. Thirty-eight primary care professionals who implement the programme participated (administrative staff, nurses and general practitioners). Thematic analysis was performed. Results Professionals show high satisfaction with the programme, and they believe firmly in its benefits. Facilitators for participation include professionals' commitment to the programme, their previous positive experiences, their optimistic attitude towards the prognosis of cancer and their trust in the health system and accessibility. Barriers include invitees' lack of independence to make decisions, fear of a positive test result and patient vulnerability and labour mobility of the health professionals. Conclusions Professionals show a high degree of involvement and identify primary care is an appropriate place to carry out disease prevention. They identify the closeness to patients, the personal attitude and the characteristics of the health system as key factors that influence participation.Euskal Herriko Unibertsitatea; Spanish Ministry of Science, Innovation and Universities, Grant/Award Number: SEV-2017-0718; Spanish Ministry of Economy and Competitiveness MINECO and FEDER, Grant/Award Number: MTM2016-74931-P; Department of Education, Language Policy and Culture from the Basque Government, Grant/Award Numbers: BERC 2018-2021, IT620-1

Inequalities and Risk Factors Related to Non-Participation in Colorectal Cancer Screening Programmes: a Systematic Review

Background Colorectal cancer (CRC) screening programmes require high levels of participation in order to reduce mortality. To improve participation rates, it is necessary to identify the health risk factors and social inequalities associated with non-participation. Methods A systematic review was conducted between June and September of 2019 in six databases: CINHAL, Medline, Scopus, Social Sciences Citation Index, Embase and PsycINFO. Studies assessing the relationship between health risk factors, participation in preventive activities and participation in CRC screening were included. Methodological assessment was carried out according to the Quality Assessment Tools of the National Heart, Lung and Blood Institute. Results A total of nine studies that analyze participation in both organized and opportunistic screening programmes using any type of screening method were finally selected. Data were mainly self-reported although in two studies medical records were also studied. We identified several variables: gender, body mass index, consultation with a doctor or a specialist, educational level, employment, health insurance, residence, ethnicity, age, marital status, income, other preventive activities, obesity, physical activity, smoking, family history of CRC and general health status. Conclusion The scarcity of studies linking risk factors, social inequalities and participation in preventive activities for participation in screening in the same study makes it difficult to reach definitive patterns related to non-participation in CRC screening programmes. Nevertheless, being under 60, obese, smoker and sedentary have shown an association with non-participation as well as not visiting a doctor.This study was financed by the Health Department of the Basque Government (Spain) (internal code: 2017111126).SUA have received funding from the Department of Education of the Basque Government through the Consolidated Research Group MATHMODE (IT1294-19)

Analysis of Post-Colonoscopy Colorectal Cancer and Its Subtypes in a Screening Programme

Using the algorithm of the World Endoscopy Organisation (WEO), we have studied retrospectively all colorectal cancers, both detected and non-detected by the Basque Country screening programme from 2009 to 2017. In the screening programme 61,335 colonoscopies were performed following a positive Faecal Immunochemical test (FIT) (≥20 µg Hb/g faeces) and the 128 cases of post-colonoscopy colorectal cancer (PCCRC) detected were analysed. Among them, 50 interval type PCCRCs were diagnosed (before the recommended surveillance), 0.8 cases per 1000 colonoscopies performed, and 78 non-interval type PCCRCs (in the surveillance carried out at the recommended time or delayed), 1.3 per 1000 colonoscopies. Among the non-interval type PCCRCs, 61 cases were detected in the surveillance carried out at the recommended time (type A) and 17 when the surveillance was delayed (type B), 1 case per 1000 colonoscopies performed and 0.28 cases per 1000 colonoscopies performed, respectively. Interval type PCCRC is less frequent than non-interval type PCCRC. In interval type PCCRCs, CRCs detected in advanced stages (stages III–IV) were significantly more frequent than those detected in early stages, compared to those of non-interval type PCCRCs (OR = 3.057; 95% CI, 1.410–6.625; p < 0.005). Non-interval type B PCCRCs are less frequent than non-interval type A PCCRCs, but the frequency of advanced stages is higher in interval type B PCCRCs.S.U.-A. have received funding from the Department of Education of the Basque Government through the Consolidated Research Group MATHMODE (IT1294-19)

Implicacion de los profesionales de atencion primaria en el programa de deteccion precoz de cancer colorrectal del Pais Vasco

OBJETIVO: El Gobierno Vasco (Espana) aprobo en 2008 un programa de deteccion del cancer colorrectal de base poblacional en Atencion Primaria. Se ha logrado una cobertura del 100% con una tasa de participacion media del 68,4%. Los profesionales de medicina y enfermeria desempenan un papel fundamental en su implementacion. El objetivo fue describir las caracteristicas, implicacion y actitudes de los profesionales de la salud que implementan el programa.METODOS: Estudio descriptivo transversal a personal de medicina y enfermeria entre mayo y junio de 2016. Se diseno un cuestionario en linea ad-hoc. Los datos incluian informacion sociodemografica y preguntas relativas a su implicacion en el programa.RESULTADOS: 1.216 profesionales de la salud respondieron al cuestionario (50,7% medicina y 49,3% enfermeria). El 78% eran mujeres. El 75,8% considero que el programa era muy importante, aunque se encontraron diferencias entre profesionales de medicina y de enfermeria. El 89% asistio a formacion y el 34% a jornadas cientificas sobre el cribado por lo menos una vez. Se observaron diferencias entre medicos y profesionales de la enfermeria en cuanto a la asistencia a formacion y jornadas y en la importancia que daban al programa.CONCLUSIONES: Existe un alto nivel de participacion de los profesionales de la atencion primaria de la salud en el programa y lo consideran muy importante. Las diferencias entre los profesionales en cuanto a su opinion y experiencia deben ser tenidas en cuenta en el diseno de los programas, ya que son ellos los que tienen un contacto mas estrecho con la poblacionOBJECTIVE: The Basque Government (Spain) approved a population based Colorectal Cancer Screening Programme in 2008 with its base on Primary Healthcare. Since then, a coverage of 100% of the population and an average participation rate of 68.4% have been achieved. General Practitioners and nurses play a central role on its implementation. The aim of this work was to describe the characteristics, involvement and attitudes of the health professionals that implement the programme. METHODS: A cross-sectional descriptive study was conducted in Primary Healthcare to general practitioners and nurses between May and June of 2016. An ad-hoc online questionnaire was designed. The data included socio-demographic information and questions regarding their involvement on the programme. RESULTS: 1,216 health professionals answered the questionnaire, 50.7% were general practitioners and 49.3% nurses. 78% of the responders were women. The 75.8% considered the programme very important although differences were found between general practitioners and nurses. The 89% of the professionals attended training and 34% scientific workshops about screening at least once. There were differences between general practitioners and nurses on the attendance to the training and importance they give to the programme, and on their participation on workshops. CONCLUSIONS: There is a high level of involvement of Primary Healthcare professionals in the programme as they consider it very important; this could be one of the keys for its success. The differences between professionals on their opinion and experience should be taken into account on its design, as they are the ones with a closer contact with the population

Implicacion de los profesionales de atencion primaria en el programa de deteccion precoz de cancer colorrectal del Pais Vasco

OBJETIVO: El Gobierno Vasco (Espana) aprobo en 2008 un programa de deteccion del cancer colorrectal de base poblacional en Atencion Primaria. Se ha logrado una cobertura del 100% con una tasa de participacion media del 68,4%. Los profesionales de medicina y enfermeria desempenan un papel fundamental en su implementacion. El objetivo fue describir las caracteristicas, implicacion y actitudes de los profesionales de la salud que implementan el programa.METODOS: Estudio descriptivo transversal a personal de medicina y enfermeria entre mayo y junio de 2016. Se diseno un cuestionario en linea ad-hoc. Los datos incluian informacion sociodemografica y preguntas relativas a su implicacion en el programa.RESULTADOS: 1.216 profesionales de la salud respondieron al cuestionario (50,7% medicina y 49,3% enfermeria). El 78% eran mujeres. El 75,8% considero que el programa era muy importante, aunque se encontraron diferencias entre profesionales de medicina y de enfermeria. El 89% asistio a formacion y el 34% a jornadas cientificas sobre el cribado por lo menos una vez. Se observaron diferencias entre medicos y profesionales de la enfermeria en cuanto a la asistencia a formacion y jornadas y en la importancia que daban al programa.CONCLUSIONES: Existe un alto nivel de participacion de los profesionales de la atencion primaria de la salud en el programa y lo consideran muy importante. Las diferencias entre los profesionales en cuanto a su opinion y experiencia deben ser tenidas en cuenta en el diseno de los programas, ya que son ellos los que tienen un contacto mas estrecho con la poblacionOBJECTIVE: The Basque Government (Spain) approved a population based Colorectal Cancer Screening Programme in 2008 with its base on Primary Healthcare. Since then, a coverage of 100% of the population and an average participation rate of 68.4% have been achieved. General Practitioners and nurses play a central role on its implementation. The aim of this work was to describe the characteristics, involvement and attitudes of the health professionals that implement the programme. METHODS: A cross-sectional descriptive study was conducted in Primary Healthcare to general practitioners and nurses between May and June of 2016. An ad-hoc online questionnaire was designed. The data included socio-demographic information and questions regarding their involvement on the programme. RESULTS: 1,216 health professionals answered the questionnaire, 50.7% were general practitioners and 49.3% nurses. 78% of the responders were women. The 75.8% considered the programme very important although differences were found between general practitioners and nurses. The 89% of the professionals attended training and 34% scientific workshops about screening at least once. There were differences between general practitioners and nurses on the attendance to the training and importance they give to the programme, and on their participation on workshops. CONCLUSIONS: There is a high level of involvement of Primary Healthcare professionals in the programme as they consider it very important; this could be one of the keys for its success. The differences between professionals on their opinion and experience should be taken into account on its design, as they are the ones with a closer contact with the population

Age of menarche and its relationship with body mass index and socioeconomic status

Artículo de publicación ISIBackground: A decline in the age of menarche was observed from early 1900s to the 1970s. However, it is not known if a further decline ocurred thereafter. Aim: To evaluate the age of menarche in girls from Santiago, Chile and its relationship with body mass index (BMI) and socioeconomic status. Material and Methods: We studied 1302 healthy girls aged 7 to 19 years. Age of menarche was evaluated through a questionnaire to the patient and her parents. Kaplan-Meier curves were used to determine age of menarche and Cox regression analysis was employed to evaluate the effect of the type of school and BMI on the age of menarche. Results: The mean age at menarche was 12.7±0.04 years. Girls from public and private schools had their period at 12.5±0.1 and 13.05±0.05 years respectively. A negative correlation between z scores for BMI and age of menarche was observed (r-0.3: p =0.001). Girls whose menarche occurred before 11.5 years had higher z scores for BMI and a larger proportion were overweight, compared to girls who had menarche later. Cox regression analysis showed that after adjusment for BMI, age of menarche was similar in both types of schools. Conclusions: Age of menarche is ocurring three months earlier in girls from public schools, which is associated with higher z scores for BMI. Type of school, a marker of socio-economic status in Chile, affects timing of menarche due to differences in body mass index

Molecular characterization of Chilean patients with a clinical diagnosis of Noonan syndrome

Artículo de publicación ISIBackground: Noonan syndrome (NS) is an autosomal dominant syndrome characterized by typical dysmorphic features, cardiac anomalies as well as postnatal growth retardation, and is associated with Ras-MAPK pathway gene mutations. The purpose of this study was to improve the diagnosis of Chilean patients with suspected NS through molecular analysis. Methods: We screened 18 Chilean patients with a clinical diagnosis of NS for mutations in PTPN11 by high resolution melting (HRM) and subsequent sequencing. Results: Three PTPN11 missense mutations were detected in 22% of analyzed patients. Of these, two (c.181G > A and c.1510A > G) were previously reported and one was the novel substitution c.328G > A (p.E110K) affecting the linker stretch between the N-SH2 and C-SH2 domains of SHP-2 protein. Conclusion: Molecular studies confirmed the clinical diagnosis of NS in 4 of 18 patients, which provided support for therapeutic decisions and improved genetic counseling for their families

Clinical and molecular characterization of Chilean patients with Léri-Weill dyschondrosteosis

Artículo de publicación ISIAim: L é ri-Weill dyschondrosteosis (LWD) is a mesomelic dysplasia with disproportionate short stature associated with short stature homeobox-containing gene (SHOX) haploinsufficiency. The objective of this study was to improve the diagnosis of patients with suspected LWD through molecular analysis. Methods: Twelve patients from 11 families with a clinical diagnosis of LWD were analyzed with multiplex ligationdependent probe amplification to detect deletions and duplications of SHOX and its enhancer regions. High resolution melting and sequencing was employed to screen for mutations in SHOX coding exons. Results: The molecular-based screening strategy applied in these patients allowed detection of five SHOX deletions and two previously unreported SHOX missense mutations. Conclusion: Molecular studies confirmed the clinical diagnosis of LWD in seven out of 12 patients, which provided support for therapeutic decisions and improved genetic counseling in their families

Comparison of three doses of leuprolide acetate in the treatment of central precocious puberty: Preliminary results

Objective Depot luteinizing-hormone releasing hormone (LHRH) agonist have been widely used for the treatment of central precocious puberty (CPP), but the optimal doses to obtain hormonal suppression are still unknown, especially in patients with higher weights. The goal of our study was to compare the efficacy of three leuprolide acetate (LA) preparations, suppressing gonadotropin secretion in patients with CPP. Design In an open 12-month protocol, we evaluated LA 7·5 mg/month, 11·25 and 22·5 every 3 months. Patients Fourteen girls with CPP and weights over 30 kg. Measurements: Clinical, radiological and laboratory follow-up: GnRH test plus LH, FSH 40 min post analogue was performed periodically. Results Pretreatment basal and LHRH stimulated LH levels between groups were not different. Basal and LHRH stimulated LH levels decreased significantly between baseline and from 3 up to 12 months of therapy in all groups (P = 0·001). GnRH stimulated LH peak &lt;2 IU/l, the main efficacy criterio