Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries

There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user-provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user-directed interventions to increase demand, user-directed interventions to increase access, provider-directed interventions, and policy and system-level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider-directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives.

The prevalence of substance use disorders among people in Norwegian, Danish and Swedish prisons: A multi-national cohort study, 2010-19

AIMS

We estimated the prevalence of substance use disorders (SUDs) in the Norwegian, Danish and Swedish prison populations and compared the prevalence of SUDs in the national prison populations with country-specific general population prevalence rates.

DESIGN

A multi-national cohort study using data from the National Prison Registries linked to the National Patient Registries in Norway, Denmark and Sweden.

SETTING AND PARTICIPANTS

We used data from the PriSUD-Nordic study, including national prison populations aged 19 years and older in Norway (2010-19), Denmark (2010-18) and Sweden (2010-13). A total of 119 507 Individuals (108 971 men and 10 536 women) contributing to 191 507 incarcerations were included in the study (Norway: 45432 men; 5429 women, Denmark: 42 162 men; 3370 women, Sweden: 21 377 men; 1737 women).

MEASUREMENT

We calculated a study prevalence and prevalence at entry to prison for all types of SUDs before imprisonment each consecutive year of observation in each prison population. We also extracted country-specific 1-year prevalence rates from the Global Burden of Diseases database to calculate comparative national prevalence ratios.

FINDINGS

The study prevalence of any SUD was approximately 40% [Norway: 44.0%, 95% confidence interval (CI) = 43.6-44.5%; Denmark: 39.9%, CI = 39.5-40.4%; Sweden: 39.1%, CI = 38.4-39.7%] in all three countries. Women had a significantly higher study prevalence of any SUD compared with men (Norway: 55.8 versus 42.6%, P < 0.001; Denmark 43.1 versus 39.7%, P = 0.004; Sweden: 51.7 versus 38.0%, P < 0.001). Prevalence estimates were higher for SUDs among people in prison than in the general population. We observed an increasing proportion of people with SUDs entering prison in Norway (P = 0.003), while the proportion was more stable in Denmark and Sweden.

CONCLUSIONS

Substance use disorders (SUDs) appear to be highly prevalent among the Scandinavian prison populations compared with the general population, especially among women. In Norway, there was a relative increase in SUDs from 2010 to 2019.

Emotion regulation and its relation to symptoms of anxiety and depression in children aged 8-12 years: does parental gender play a differentiating role?

BACKGROUND

Symptoms of anxiety and depression are prevalent and highly comorbid in children, contributing to considerable impairment even at a subclinical level. Difficulties with emotion regulation are potentially related to both anxious and depressive symptoms. Research looking at maternal contributions to children's mental health dominates the literature but ignores the potentially important contributions of fathers.

METHOD

The present study is part of the Coping Kids study in Norway, a randomized controlled study of a new indicated preventive intervention for children, EMOTION. EMOTION aims to reduce levels of anxious and depressive symptoms in children aged 8-12 years. Using cross sectional data and multiple regression analyses, we investigated the relations between anxious and depressive symptoms and emotion regulation in n = 602 children. Symptoms were reported by the child, mothers and fathers. Emotion regulation was reported by mothers and fathers.

RESULTS

Symptoms of anxiety, as reported by parents, were associated with poorer emotion regulation. This association was also demonstrated for depressive symptoms as reported by both parents and children. When analyzing same gender reports, parental gender did not differentiate the relationship between anxiety symptoms and emotion regulation. For depressive symptoms, we did find a differentiating effect of parental gender, as the association with dysregulation of emotion was stronger in paternal reports, and the association with adaptive emotion regulation was stronger in maternal reports. When using reports from the opposite parent, the emotion regulation difficulties were still associated with depressive and anxiety symptoms, however exhibiting somewhat different emotional regulation profiles.

CONCLUSION

Problems with emotion regulation probably coexists with elevated levels of internalizing symptoms in children. In future research, both caregivers should be included.

TRIAL REGISTRATION

The regional ethics committee (REC) of Norway approved the study. Registration number: 2013/1909; Project title: Coping Kids: a randomized controlled study of a new indicated preventive intervention for children with symptoms of anxiety and depression. ClinicalTrials.gov; Protocol ID 228846/H10 .