A network perspective to the measurement of sense of coherence (SOC): an exploratory graph analysis approach

The measurement of sense of coherence (SOC) has received attention for more than three decades. Despite the extensive use of SOC-13, there is still a long debate regarding its dimensionality structure. Recently, there has been an increasing use of network modeling as a valid alternative to latent-variable modeling. This study proposes an exploratory approach to the structure of SOC-13 by adopting a network perspective. The network structure was estimated with a Gaussian Graphical Model, and Exploratory Graph Analysis (EGA) was used to inspect network dimensionality. We fit and compared the unidimensional, first- and second-order confirmatory factor analysis (CFA), bifactor-CFA, and structure derived from EGA. Our results showed unacceptable fit values for the CFA models, suggesting that SOC-13 is not unidimensional. Inspection of the estimated network suggested that the SOC-13 items emerged as a dynamic system of mutually interacting nodes that formed three distinct clusters of items (communities) that are not those defined in the literature. EGA identified three communities of items: the first community was characterized by comprehensibility and manageability items, the second community was characterized by comprehensibility and manageability items, and the third dimension was characterized by all meaningfulness items and one comprehensibility item. Our study presented a novel perspective in investigating the structure of SOC-13 that strengthens the assumption that SOC should be conceptualized as a complex system of cognitive (comprehensibility), behavioral (manageability), and motivational dimensions (meaningfulness) that are deeply linked and not necessarily distinct

Audit system on Quality of breast cancer diagnosis and Treatment (QT): Results of quality indicators on screen-detected lesions in Italy, 2011-2012

This annual survey, conducted by the Italian group for mammography screening (GISMa), collects individual data on diagnosis and treatment of about 50% of screen-detected, operated lesions in Italy. The 2011-2012 results show good overall quality and an improving trend over time. A number of critical issues have been identified, including waiting times (which have had a worsening trend over the years) and compliance with the recommendation of not performing frozen section examination on small lesions. Pre-operative diagnosis improved constantly over time, but there is still a large variation between Regions and programmes. For almost 90% of screen-detected invasive cancers a sentinel lymph node (SLN) biopsy was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN dissection for ductal carcinoma in situ, although apparently starting to decline, deserves further investigation. The detailed results have been distributed, among other ways by means of a web-based data-warehouse, to regional and local screening programmes, in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. The problem of waiting times should be assigned priority. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times

Impact of screening programme using the faecal immunochemical test on stage of colorectal cancer: Results from the IMPATTO study

To evaluate the impact of faecal immunochemical test (FIT) screening on stage distribution at diagnosis, and to estimate relative incidence rates by stage in screened at first and subsequent rounds vs. unscreened. We included all incident cases occurring in 2000–2008 in 50- to 71-year-olds residing in areas with an FIT-screening programme. Multinomial logistic models were computed to estimate the relative risk ratio (RRR) of stages I and IV, compared to stage II + III, adjusting for age, sex, geographical area, and incidence year. Proportions were then used to estimate incidence rate ratios (IRR) by stage for screened subjects at the first and at subsequent rounds vs. unscreened subjects, applying the expected changes in overall incidence during screening phases. 11,663 cancers were included: 5965 in not-invited and 5,698 in invited subjects, 3,425 of whom attendees. Compared to not-invited, invited subjects had RRR 2.04 (95% CI: 1.84; 2.46) of stage I and RRR 0.77 (95% CI: 0.69; 0.87) of stage IV. Differences were stronger comparing attendees vs. nonattendees. Interval cancers were more frequently stage I compared to non-invited (RRR 1.54; 95% CI: 1.15; 2.04), but there was no difference for stage IV. IRRs in screened at first round vs. unscreened were 4.6 (95% CI: 4.2; 5.1), 1.4 (95% CI: 1.3; 1.5) and 0.7 (95% CI: 0.6; 0.9) for stages I, II + III and IV, respectively; in the following rounds the IRRs of screened vs. unscreened were 1.4 (95% CI: 1.2; 1.6), 0.8 (95% CI: 0.7; 0.9) and 0.3 (95% CI: 0.1; 0.4) for stages I, II + III and IV, respectively. FIT screening reduces the incidence of metastatic cancers by about 70% after the first round