[Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]

Intersectional analysis of inequalities in self-reported breast cancer screening attendance using supervised machine learning and PROGRESS-Plus framework

Background

Breast cancer is a critical public health concern in Spain, and organized screening programs have been in place since the 1990s to reduce its incidence. However, despite the bi-annual invitation for breast cancer screening (BCS) for women aged 45-69, significant attendance inequalities persist among different population groups. This study employs a quantitative intersectional perspective to identify intersectional positions at risk of not undergoing breast cancer screening in Spain.

Methods

Women were selected from the 2020 European Health Interview Survey in Spain, which surveyed the adult population (> 15 years old) living in private households (N = 22,072; 59% response rate). Inequality indicators based on the PROGRESS-Plus framework were used to disentangle existing social intersections. To identify intersectional groups, decision tree models, including classification and regression trees (CARTs), chi-squared automatic interaction detector (CHAID), conditional inference rees (CITs), and C5.0, along with an ensemble algorithm, extreme gradient boosting (XGBoost), were applied.

Results

XGBoost (AUC 78.8%) identified regional differences (Autonomous Community) as the most important factor for classifying BCS attendance, followed by education, age, and marital status. The C5.0 model (balanced accuracy 81.1%) highlighted that the relative importance of individual characteristics, such as education, marital status, or age, for attendance differs based on women's place of residence and their degree of interaction. The highest risk of not attending BCS was observed among illiterate older women in lower social classes who were born in Spain, were residing in Asturias, Cantabria, Basque Country, Castile and León, Extremadura, Galicia, Madrid, Murcia, La Rioja, or Valencian Community, and were married, divorced, or widowed. Subsequently, the risk of not attending BCS extends to three other groups of women: women living in Ceuta and Melilla; single or legally separated women living in the rest of Spain; and women not born in Spain who were married, divorced, or widowed and not residing in Ceuta or Melilla.

Conclusion

The combined use of decision trees and ensemble algorithms can be a valuable tool in identifying intersectional positions at a higher risk of not utilizing public resources and, thus, can aid substantially in developing targeted interventions to increase BCS attendance.

Behind bars: the burden of being a woman in Brazilian prisons

Background

Brazil has the third largest prison population in the world. In 2016, the female prison population totaled 42,000, an increase of 656% over the population recorded in the early 2000s. The objective of this study was to describe the socialeconomic and reproductive health of women in Brazilian prisons, and the specific assistance received within the prison system.

Methods

This is a first of its kind national survey conducted in 15 female prisons in eight Brazilian states between 2014 and 2015. The sample consisted of 1327 women in closed or semi-open prison regimes. Data collection used Audio Computer-Assisted Self-Interviewing (ACASI). STATA v.15. Was use in analysis. The study was submitted to the Research Ethics Committee of the Federal University of Ceará, under CEP protocol No. 1,024,053.

Results

The population was overwhelmingly Black or Brown, poor and little educated. When women worked previously, they had worked as domestic servants and were the sole source of income for their families. Most were mothers, with 39% having children less than 10 years old, now in the care of others. Most were in jail for drug-related crimes. Prisons were crowded, with more than 2/3rds of the inmates sharing a cell with 6 or more inmates. Services were provide, but women had not had a cervical cancer screening within the past 3 years and breast cancer screening was not conducted.

Conclusions

Overall, given their backround and prison conditions they are unlikely to change the circumstances that brought them to prison in the first place.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12914-020-00247-7.

[Knowledge, conduct and attitude before the European Code against Cancer by health professionals of primary care]

OBJECTIVE

To decide if Primary Care (PC) professionals know the European Code against Cancer (CECC) and if this relates to practice the recommendations with themselves and with their patients.

DESIGN

descriptive, observational study.

SETTING

Spanish Health Centers.

PARTICIPANTS

Health professionals.

INTERVENTIONS

self-administered questionnaire.

MAIN MEASUREMENTS

cancer protective and risk factors, screening for colorectal, breast, cervix and prostate cancer, level of knowledge of the ECAC.

RESULTS

1734 participants (10.5%), mean age 47.4 years (SD: 8.6), 71.5% female. 50.0% do not know the CECC; tutors (OR=1.61), assigned to the PAPPS (OR=1.51) and who have been working in AP for more time (OR=2.62) are the ones who know it most. 7.2% smoke and 79.1% drink alcohol. 64.1% presented normal weight and 19% performed physical activity. They avoid exposing themselves to the sun 52.7% and use protectors 53.8%. 85.2% have never had a colorectal screening, 11% never had a cytology, and 12% had a mammogram. There is a relationship between knowing the CECC and smoking (P<.001), overweight/obesity (P=.024), physical activity (P=.003), meat intake (P<.001), mammography (P<.001), cytology (P=.022), PSA (P=.045), as well as the promotion of their advice among patients.

CONCLUSIONS

The CECC is unknown by half of the AP professionals. The practice of its recommendations is uneven, with the prevalence of low smoking, and sun protection a little extended behavior. Those who know him are the ones who most practice his recommendations.

Temporal Trends in Fecal Occult Blood Test: Associated Factors (2009-2017)

A cross-sectional study with 27,821 records of non-institutionalized people in Spain aged between 50–69 years old (59.94 ± 5.8 years), who participated in the European Health Survey in Spain (2009, 2014) and National Health Survey (2011/12, 2017). Fecal occult testing, the reason for performing the test, age, sex, nationality, social status, marital status, education level, body mass index (BMI), and place of residence. Overall, 54% were women, 93.9% were Spanish, 47.8% had a secondary study, and 66.4% were married. Across the years, the rate of the fecal occult blood test (FOBT) increased significantly (p < 0.001). This increase can be accounted for a letter campaign advising testing (45%, p < 0.001). FOBT was associated with more age (odds ratio—OR 1.04, 95% confidence interval—CI 1.04–1.05, p < 0.001), Spanish nationality (OR 1.91, 95% CI 1.25–2.93, p = 0.003), being married (OR 1.13, 95% CI 1.02–1.25, p = 0.025), having a higher level of education (OR 2.46, 95% CI 2.17–2.81, p < 0.001), belonging to high social classes (OR 1.35, 95% CI 1.12–1.64, p = 0.001), and BMI <25 (OR 1.72, 95% CI 1.25–2.37). Frequency of FOBT has increased in recent years. Performing FOBT is associated with age, nationality, marital status, higher education level, and social class.

Sexual dysfunction in Spanish women with breast cancer

Purpose

To determine whether there are changes in sexuality after breast cancer, to better understand the sexual function of women with breast cancer, and to investigate the potential relationship between sexual dysfunction and socio-demographic and clinical variables.

Methods

A cross-sectional study. This study included 514 women with breast cancer between 21- and 66-years-old. The cases were gathered between June 2016 and January 2017. The instruments used were the questionnaire on Women’s Sexual Function and a questionnaire to collect socio-demographic and clinical data.

Results

The average age (± standard deviation, SD) of participants was 46.34 ± 8.28 years. Their average age at date of diagnosis was 42.26 ± 8.56 years, and the average time suffering from cancer was 4.05 ± 5.23 years. There were significant differences (p = 0.002) in the presence of sexual dysfunction before (32.1%) and after (91.2%) cancer. The primary sexual dysfunctions were due to penetration pain (50.6%), lubrication (50.6%), dysfunctional desire (44.6%), and dysfunctional excitement (44.6%). Two-thirds of participants were satisfied with their sexual relations. The women who presented most sexual dysfunction were those that had a bilateral mastectomy (p = 0.009) and those who received chemotherapy, radiotherapy and hormonal-therapy (p < 0.001).

Conclusion

Sexual function was changed in women with breast cancer. The main problems included penetration pain, desire, lubrication, and dysfunctional excitement. It is important that Health professionals recognize which circumstances influence the sexual function of women with breast cancer and to make interventions that facilitate sexual adjustment.