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Menéndez Rodríguez M, García-Morales N, Seoane Pillado T, Garau Ramírez J, Traver Salvador A, Hervás Jiménez Y, Fernández-Domínguez MJ, Menéndez Villalva C, Cubiella J. Influence of social support and stressful life events on adherence to colorectal cancer screening using faecal occult blood test in Spanish medium risk population. Gastroenterol Hepatol 2024; 47:14-23. [PMID: 36842551 DOI: 10.1016/j.gastrohep.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the second cause of cancer-related deaths worldwide. Five-year survival rate in Spain is 57%. The most important prognostic factor is the stage of the tumor at the diagnosis. CRC can be early diagnosed, but the adherence to screening programs is low (<50%). This study aims to ascertain the influence of social support and stressful life events on the adherence to the population screening of CRC with fecal occult blood test in Spanish average risk population. METHODS Multicenter case-control study. We conducted a simple random sampling among individuals invited to participate in the colorectal cancer screening program. We analyzed epidemiological and social variables associated with lifestyle and behavioral factors. We performed a descriptive and a bivariant analyses and a logistic regression analysis. RESULTS Four hundred and eight patients (237 cases and 171 controls) were included. Multivariant analyses showed independent association between higher adherence to the screening program and older age (OR: 1.06; 95% CI: 1.01-1.10), stable partner (OR: 1.77, 95% CI: 1.08-2.89) and wide social network (OR: 1.68; 95% CI: 1.07-2.66). Otherwise, lower adherence was associated to perceiving barriers to participate in the program (OR: 0.92; 95% CI: 0.88-0.96). We find a statistically significant association between lower adherence and high impact stressful life events in the bivariant analyses, and the tendency was maintained (OR: 0.63, 95% CI: 0.37-1.08) in the multivariant. CONCLUSION Social variables decisively influence the adherence to colorectal cancer screening. The implementation of social interventions that improve social support, reduce impact of stressful life events and the design of screening programs that decrease the perceived barriers, will contribute to increase the participation on these programs. Secondary, the colorectal cancer diagnosis will be made in early-stages with the consequent mortality reduction.
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Affiliation(s)
- Martín Menéndez Rodríguez
- Primary Health Center Salceda de Caselas, Gerencia de Gestión Integrada de Vigo, SERGAS, Vigo, Spain; Area of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; South Galicia Health Research Institute, Vigo, Spain.
| | - Natalia García-Morales
- South Galicia Health Research Institute, Vigo, Spain; Digestive Service, Complexo Hospitalario Universitario de Vigo Sergas, Vigo, Spain
| | - Teresa Seoane Pillado
- Unit of Preventive Medicine and Public Health, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
| | - Jorge Garau Ramírez
- Primary Health Center Chile, Área Hospital Clínic-Malvarrosa, Valencia, Spain
| | | | | | - María José Fernández-Domínguez
- South Galicia Health Research Institute, Vigo, Spain; Primary Health Center Leiro, Gerencia de Gestión Integrada de Ourense, SERGAS, Ourense, Spain
| | - Carlos Menéndez Villalva
- South Galicia Health Research Institute, Vigo, Spain; Primary Health Center Mariñamansa-A Cuña, Gerencia de Gestión Integrada de Ourense, SERGAS, Ourense, Spain
| | - Joaquín Cubiella
- South Galicia Health Research Institute, Vigo, Spain; Digestive Service, Hospital Universitario de Ourense, Ourense, Spain; Center for Biomedical Research Network for Liver and Digestive Diseases, Ourense, Spain
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Lago-Deibe FI, Valladares-Cabaleiro M, Fernández-Domínguez MJ, Fernández-Fernández I, Clavería A, Rodríguez-Pastoriza S, Roca-Pardinas J, Martín-Miguel MV. Effectiveness and safety of tetanus vaccine administration by intramuscular vs. subcutaneous route in anticoagulated patients: Randomized clinical trial in primary care. Front Med (Lausanne) 2022; 9:1054988. [PMID: 36619617 PMCID: PMC9813590 DOI: 10.3389/fmed.2022.1054988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Design Prospective, double-blind clinical trial comparing tetanus-diphtheria vaccine administration routes, intramuscular (IM) vs. subcutaneous (SC) injection, in patients with oral anticoagulants. ISRCTN69942081. Study population Patients treated with oral anticoagulants, 15 health centers, Vigo (Spain). Sample size, 117 in each group. Outcome variables Safety analysis: systemic reactions and, at the vaccine administration site, erythematic, swelling, hematoma, granuloma, pain.Effectiveness analysis: differences in tetanus toxoid antibody titers.Independent variables: route, sex, age, baseline serology, number of doses administered. Analysis Following the CONSORT guidelines, we performed an intention-to-treat analysis. We conducted a descriptive study of the variables included in both groups (117 in each group) and a bivariate analysis. Fewer than 5% of missing values. Imputation in baseline and final serology with the median was performed. Lost values were assumed to be values missing at random. We conducted a descriptive study of the variables and compared routes. For safety, multivariate logistic regression was applied, with each safety criterion as outcome and the independent variables. Odds ratios (ORs) were calculated. For effectiveness, a generalized additive mixed model, with the difference between final and initial antibody titers as outcome. Due to the bimodal distribution of the outcome, the normal mixture fitting with gamlssMX was used. All statistical analyses were performed with the gamlss.mx and texreg packages of the R free software environment. Results A previously published protocol was used across the 6-year study period. The breakdown by sex and route showed: 102 women and 132 men; and 117 IM and 117 SC, with one dose administered in over 80% of participants. There were no differences between groups in any independent variable. The second and third doses administered were not analyzed, due to the low number of cases. In terms of safety, there were no severe general reactions. Locally, significant adjusted differences were observed: in pain, by sex (male, OR: 0.39) and route (SC, OR: 0.55); in erythema, by sex (male, OR: 0.34) and route (SC, OR: 5.21); and in swelling, by sex (male, OR: 0.37) and route (SC, OR: 2.75). In terms of effectiveness, the model selected was the one adjusted for baseline serology.
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Affiliation(s)
- Fernando Isidro Lago-Deibe
- Sárdoma Health Center, Vigo Health Area, Galician Health Service, Vigo, Spain
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Mercedes Valladares-Cabaleiro
- Moaña Primary Care Emergency Center (Punto de Atención Continuada), Vigo Health Area, Galician Health Service, Moaña, Spain
| | - María José Fernández-Domínguez
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Leiro Health Center, Ourense Health Area, Galician Health Service, Ourense, Spain
| | | | - Ana Clavería
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
| | - Sara Rodríguez-Pastoriza
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
| | - Javier Roca-Pardinas
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Department of Statistics and Operations Research, University of Vigo, Vigo, Spain
- Galician Research and Mathematical Technology Center (Centro de Investigación e Tecnoloxía Matemática de Galicia/CITMAga), Santiago de Compostela, Spain
| | - María Victoria Martín-Miguel
- South Galicia Health Research Institute (Instituto de Investigación Sanitaria Galicia Sur), Vigo Health Area, Galician Health Service, Vigo, Spain
- Network for Research on Chronicity, Primary Care and Health Promotion (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), Vigo, Spain
- Vigo Family and Community Medicine and Nursing Teaching Unit, Vigo Health Area, Galician Health Service, Vigo, Spain
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Rañó-Santamaría O, Fernandez-Merino C, Castaño-Carou AI, Lado-Baleato Ó, Fernández-Domínguez MJ, Sanchez-Castro JJ, Gude F. Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study. Front Med (Lausanne) 2022; 9:1015195. [PMID: 36507495 PMCID: PMC9726913 DOI: 10.3389/fmed.2022.1015195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health. Objectives (1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality. Materials and methods In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression. Results A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33). Conclusion (1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.
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Affiliation(s)
| | | | | | - Óscar Lado-Baleato
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain,*Correspondence: Óscar Lado-Baleato,
| | | | | | - Francisco Gude
- Health Research Institute (IDIS), Santiago de Compostela, Spain,Clinical Epidemiology Unit, University Clinic Hospital, Santiago de Compostela, Spain
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González-Formoso C, Clavería A, Fernández-Domínguez MJ, Lago-Deibe FL, Hermida-Rial L, Rial A, Gude-Sampedro F, Pita-Fernández S, Martín-Miguel V. Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial. BMC Fam Pract 2019; 20:15. [PMID: 30657056 PMCID: PMC6337818 DOI: 10.1186/s12875-018-0901-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/28/2018] [Indexed: 11/10/2022]
Abstract
Background Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. Methods Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants’ demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. Results Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (− 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39–3.35), and by 13.75 (2.41–354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. Conclusion A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. Trial registration It was retrospectively registered with (ISRCTN41911128, 31/12/2010). Electronic supplementary material The online version of this article (10.1186/s12875-018-0901-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clara González-Formoso
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Ana Clavería
- Quality and Research Unit, Primary Care, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Rosalía de Castro 21-23, 36201, Vigo, Spain.
| | - M J Fernández-Domínguez
- Ourense Health Center, EOXI Ourense, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Ourense, Spain
| | - F L Lago-Deibe
- Sárdoma Health Center, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
| | - Luis Hermida-Rial
- Fontenla-Maristany Health Center, EOXI Ferrol, Galician Health Service, Ferrol, Spain
| | - Antonio Rial
- Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Gude-Sampedro
- Epidemiology Department, EOXI Santiago de Compostela, Instituto de Investigación Sanitaria Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Victoria Martín-Miguel
- Vigo Teaching Unit of Family and Community Medicine and Nursing, EOXI Vigo, Galician Health Service, RedIAPP, Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo, Spain
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