Interaction of sedentary behaviour and educational level in breast cancer risk

Objective This cross-sectional study aims to analyse the relationship between sedentary behaviour and breast cancer (BC) risk from a social perspective. Methods Women aged 45–70 who participated in the Valencia Region Breast Cancer Screening Programme (2018–2019) were included, with a total of 121,359 women analysed, including 506 with cancer and 120,853 without cancer. The response variable was BC (screen-detected) and the main explanatory variable was sedentary behaviour (≤2 / >2-≤3 / >3-≤5 / >5 hours/day, h/d). Nested logistic regression models (M) were estimated: M1: sedentary behaviour adjusted for age and family history of BC; M2: M1 + hormonal/reproductive variables (menopausal status, number of pregnancies, hormone replacement therapy; in addition, months of breastfeeding was added for a subsample of women with one or more live births); M3: M2 + lifestyle variables (body mass index, smoking habits); M4: M3 + socioeconomic variables (educational level, occupation); Final model: M4 + gender variables (childcare responsibilities, family size). Interaction between sedentary behaviour and educational level was analysed in the Final model. Moreover, for the whole sample, postmenopausal women and HR+ BC, the Final model was stratified by educational level. Results Sedentary behaviour was associated with an increased risk of BC with a nearly statistically significant effect in the Final model (>2-≤3 h/d: OR = 1.22 (0.93–1.61); >3-≤5 h/d: OR = 1.14 (0.86–1.52); >5: OR = 1.19 (0.89–1.60)). For women with a low educational level, sitting more than 2 h/d was associated with an increased risk of BC in the whole sample (>2-≤3 h/d OR = 1.93 (1.19–3.21); in postmenopausal women (>2-≤3 h/d, OR = 2.12 (1.18–2.96), >5h/d OR = 1.75 (1.01–3.11)) and in HR+ BC (>2-≤3h/d, OR = 2.15 (1.22–3.99)). Similar results were observed for women with one or more live births. Conclusions Sitting >2 h/d is associated with BC risk in women with low educational level, especially in postmenopausal women and those with live births.M.P-C: This work was supported by the Generalitat Valenciana and the European Social Fund [grant number ACIF/2019/085]

Construction of an individual socioeconomic status index for analysing inequalities in colorectal cancer screening

Objective: To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP). Methods: Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models. Results: The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757–0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347–1.390) and Q3 OR = 1.156 (1.137–1.175). Conclusions: An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.AMB, DS: PI18/01669, the Instituto de Salud Carlos III, co-founded by the European Regional Development Fund (ERDF). https://www.isciii.es

Evaluation of physical activity programmes for the elderly - exploring the lessons from other sectors and examining the general characteristics of the programmes

<p>Abstract</p> <p>Background</p> <p>In Portugal, there are several physical activity (PA) programmes for elderly people developed by the local government. The importance of these programmes has been increasing since the evidence has shown that this type of health promotion interventions may reduce the deleterious effects of the ageing process. However, no study has already identified the general characteristics of these programmes nor if they use any scheme to assess the quality of the service provided. A widely-used scheme is the EFQM Excellence Model, which will be in the core of our present work. Thus, the main aims of this preliminary study were 1) to identify the general characteristics of the PA programmes developed by the Portuguese Local Public Administration 2) to determine the extent of implementation of quality initiatives in these programmes.</p> <p>Methods</p> <p>Data were collected by an on-line questionnaire sent to all Continental Municipalities (n = 278). Categorical data were expressed as absolute counts and percentages. Continuous data were expressed as the mean and SD. An open-ended question was analysed using qualitative content analysis with QSR NVivo software. Associations between categorical variables were tested by the use of contingency tables and the calculation of chi-square tests. Significance level was set at p ≤ 0.05.</p> <p>Results</p> <p>Results showed: i) a total of 125 PA programmes were identified in the 18 districts of the Portugal mainland; ii) the main goal of the majority (95.2%) was the participants' health promotion; iii) different characteristics of the programmes were found according to different regions of the country; iv) certain characteristics of the programmes were associated to the existence of other features; v) only one PA programme developed quality initiatives.</p> <p>Conclusions</p> <p>In conclusion, although there are many PA programmes for elderly people spread throughout the country, aiming at improving the health of participants, the overwhelming majority does not adopt quality control initiatives. Considering that the quality of a service increases customer satisfaction, the continuous quality improvement of the PA programmes for elderly people should therefore be implemented since they can be useful and critical for elderly satisfaction and adherence.</p

Reasons for participating in the Valencian Community Colorectal Cancer Screening Programme by gender, age, and social class

Objective: To know the reasons to participate or not in a colorectal cancer (CCR) screening programme and to analyze the differences by sex, age and social class. Methods: Cross-sectional study by a telephone survey directed to a sample of men and women aged between 50-74 year old, participants (n = 383) and non participants (n = 383) in the CCR screening programme of Valencian Community. Descriptive analysis and logistic regression models estimating the Odds Ratio (p < 0.05). Results: The main reasons to participate are "it is important for health" (97.9 %) and "the test is easy" (97.6 %); and to non participate are "no CCR symptoms" (49.7 %) and "didn't receive invitation letter" (48.3 %). Women are more likely not to participate if the reason was to consider the "test unpleasant" (OR: 1.82; IC: 1.00-3.28), and men if the reason was "lack of time" (OR 0.51; IC: 0.27-0.97); persons 60 or more years old if the reason was "diagnostic fear" (OR: 2.31; IC: 1.11-4.80), and persons 50-59 years old if was "lack of time" (OR 0.44; IC: 0.23-0.85); non manual social class persons if the reason was "lack of time" (OR: 2.66; IC: 1.40-5.10); manual women if the reason was "embarrassment to perform the test" (OR: 0.37; IC: 0.14-0.97); and non manual men if was "lack of time" (OR: 4.78; IC: 1.96-11.66). Conclusions: There are inequalities in the reasons for not participating in CCR screening programmes by sex, age and social class. It would be advisable to design actions that incorporate specific social group needs in order to reduce inequalities in participation

Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was Ptas. 8.547bn in 1995. Expenditure on selected anti-infective drugs was Ptas. 522 million (6.1% of the total). The overall saving estimated was 7.63% (Ptas. 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.FUNDAMENTO: El gasto farmacéutico es la principal partida de gasto en las áreas de atención primaria. La necesidad de contener el gasto sanitario ha supuesto la búsqueda de alternativas en este campo, una de las cuales sería potenciar una política de prescripción que utilizara la presentación más barata de cada principio activo. El objetivo de este trabajo es evaluar la cantidad que se ahorraría si se optara por prescribir la alternativa más barata en una selección de fármacos antiinfecciosos. MÉTODOS: Se analizó la prescripción farmacéutica de dos áreas sanitarias a través de la base de datos de facturación de productos farmacéuticos de 1995. Se seleccionaron los monofármacos de acción antiinfecciosa y se buscó para cada principio activo y presentación la alternativa más económica, según el registro facilitado por el Ministerio de Sanidad; realizando un análisis de minimización de costes. No se consideraron los costes de implementación de dicha política de prescripción. RESULTADOS: El gasto farmacéutico total en las áreas fue de 8.547 millones en 1995. El gasto en los antiinfecciosos seleccionados fue de 522 millones (6,1% del total). El ahorro global estimado fue del 7,63% (39.901.778 ptas.). Dicho ahorro se concentró en los subgrupos: penicilinas, quinolonas, cefalosporinas y macrólidos. El 75% del ahorro potencial identificado se hubiera conseguido con la prescripción de la alternativa más barata de 2 principios activos: amoxicilina y ciprofloxacino. CONCLUSIONES: El estudio muestra las posibilidades de contención del gasto en nuestro medio y ofrece una base para la actuación en este sentido. Sería conveniente impulsar la información y formación de prescriptores y dispensadores para potenciar el uso de la alternativa más económica de cada medicamento que se prescriba, especialmente en aquellos casos en que haya importantes márgenes para el ahorro

Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria

FUNDAMENTO: El gasto farmacéutico es la principal partida de gasto en las áreas de atención primaria. La necesidad de contener el gasto sanitario ha supuesto la búsqueda de alternativas en este campo, una de las cuales sería potenciar una política de prescripción que utilizara la presentación más barata de cada principio activo. El objetivo de este trabajo es evaluar la cantidad que se ahorraría si se optara por prescribir la alternativa más barata en una selección de fármacos antiinfecciosos. MÉTODOS: Se analizó la prescripción farmacéutica de dos áreas sanitarias a través de la base de datos de facturación de productos farmacéuticos de 1995. Se seleccionaron los monofármacos de acción antiinfecciosa y se buscó para cada principio activo y presentación la alternativa más económica, según el registro facilitado por el Ministerio de Sanidad; realizando un análisis de minimización de costes. No se consideraron los costes de implementación de dicha política de prescripción. RESULTADOS: El gasto farmacéutico total en las áreas fue de 8.547 millones en 1995. El gasto en los antiinfecciosos seleccionados fue de 522 millones (6,1% del total). El ahorro global estimado fue del 7,63% (39.901.778 ptas.). Dicho ahorro se concentró en los subgrupos: penicilinas, quinolonas, cefalosporinas y macrólidos. El 75% del ahorro potencial identificado se hubiera conseguido con la prescripción de la alternativa más barata de 2 principios activos: amoxicilina y ciprofloxacino. CONCLUSIONES: El estudio muestra las posibilidades de contención del gasto en nuestro medio y ofrece una base para la actuación en este sentido. Sería conveniente impulsar la información y formación de prescriptores y dispensadores para potenciar el uso de la alternativa más económica de cada medicamento que se prescriba, especialmente en aquellos casos en que haya importantes márgenes para el ahorro

Interval Cancer in Population-Based Colorectal Screening Programmes: Incidence and Characteristics of Tumours

The objective of this study is to evaluate interval cancer (IC) in colorectal cancer (CRC) screening, which is CRC diagnosed in an individual after having received a negative faecal occult blood test and before the next invitation to participate in screening. A follow-up study was conducted on a cohort of participants in the first three screening rounds of four colorectal cancer screening programmes in Spain, n = 664,993. A total of 321 ICs and 2120 screen-detected cancers (SCs) were found. The IC and SC rates were calculated for each guaiac (gFOBT) or immunochemical (FIT) test. A Cox regression model was used to estimate the hazard ratios (HR) of IC risk factors. A nested case–control study was carried out to compare IC and SC tumour characteristics. The IC rate was 1.16‰ with the gFOBT and 0.35‰ with the FIT. Men and people aged 60–69 showed an increased probability of IC (HR = 1.81 and HR = 1.95, respectively). There was a decreased probability of IC in individuals who regularly participated in screening, HR = 0.62 (0.47–0.82). IC risk gradually rose as the amount of Hb detected in the FIT increased. IC tumours were in more advanced stages and of a larger size than SC tumours, and they were mostly located in the cecum. These results may play a key role in future strategies for screening programmes, reducing IC incidence

Proyecto de Convivencia IES Sierra de San Quílez

Seleccionado en la convocatoria: Ayudas para desarrollar proyectos de convivencia, Gobierno de Aragón 2007-08El proyecto tiene como finalidad la mejora de la convivencia escolar en un centro de Educación Secundaria. Para ello se plantean varios objetivos que afectan a toda la comunidad educativa, abarcando todos los centros educativos de la localidad y los servicios sociales del Ayuntamiento. Se promueve la mejora del plan de acción tutorial, incluyendo actividades para trabajar habilidades sociales, educación de las emociones y el trabajo cooperativo. La dinamización de la asamblea de delegados y la creación de una escuela de padres, son otros de los objetivos planteados.Gobierno de Aragón. Departamento de Educación, Cultura y DeporteAragónDirección General de Política Educativa; Avda. Gómez Laguna, 25, planta 2; Zaragoza; Tel. +34976715416; Fax +34976715496ES

Proyecto de Convivencia IES Sierra de San Quílez

Seleccionado en la convocatoria: Ayudas para desarrollar proyectos de convivencia, Gobierno de Aragón 2008-09El proyecto tiene como finalidad la mejora de la convivencia escolar en el Instituto Sierra de San Quílez. Para ello se pone en marcha de un programa de mediación entre iguales y en la prevención del maltrato escolar. Se intenta introducir progresivamente la educación emocional a través de las tutorías, además de otras acciones como la creación de una escuela de padres y la formación de un grupo de trabajo de profesores para intercambiar estrategias frente a la disrupción en el aula. Entre las actividades realizadas para la consecución de los objetivos destacan: taller de mediación, creación de carteles, actividades recreativas y sesiones conjuntas de convivencia.Gobierno de Aragón. Departamento de Educación, Cultura y DeporteAragónDirección General de Política Educativa; Avda. Gómez Laguna, 25, planta 2; 50009 Zaragoza; Tel. +34976715416; Fax +34976715496ES