¿Qué piensan las mujeres sobre la mamografía de cribado? Encuesta en el programa de diagnóstico precoz de cáncer de mama / What do women think about screening mammography? Survey in a breast cancer screening programme

Objetivos. En España las mujeres no toman una decisión informada sobre su participación en el programa de cribado mamográfico. Se analizó si proporcionar información individualizada y precisa sobre los beneficios y riesgos del programa de cribado mamográfico incrementaba su grado de conocimiento. Pacientes y método. Se realizó un ensayo clínico aleatorizado y controlado en el que participaron 434 mujeres de entre 45 y 69 años, convocadas a la mamografía de cribado. Doscientas dieciocho fueron aleatorizadas al grupo control y 216 al de intervención. Se evaluó el grado de conocimiento sobre beneficios y riesgos del cribado mamográfico mediante un cuestionario específico, en la segunda entrevista, al mes. Secundariamente se analizaron la actitud, la ansiedad y la depresión, así como la preocupación por el cáncer de las participantes. Resultados. Adquirieron un buen conocimiento 15 de 178 mujeres (8,4%) en el grupo control y 32 de 177 (18,1%) en el de intervención (p=0,008). Las mujeres del grupo de intervención tienen un riesgo relativo 2,39 veces mayor de adquirir un buen conocimiento que las del grupo control (IC 95% 1,24-4,60). No se hallaron diferencias en ninguno de los objetivos secundarios evaluados. Conclusiones. Las mujeres poseen un nivel de conocimientos muy pobre sobre el programa de cribado con mamografía, siendo la televisión su principal fuente de información. La información individualizada incrementó significativamente el grado de buen conocimiento, aunque persistió en porcentajes muy bajos. Tienen una actitud muy positiva sobre el mismo y no se aprecia un impacto negativo en la esfera psicosocial por su participación en este tipo de procedimientos

Objectives. Spanish women do not make an informed choice about their participation in breast cancer screening. Our study hypothesised that providing individualised and accurate information about the benefits and risks of the mammography screening programme in Spain would increase their knowledge. Patients and method. A randomised controlled clinical trial was conducted in 434 women aged between 45 and 69 years: 216 were assigned to the intervention group and 218 to the control group. The degree of knowledge about the benefits and risks of mammography screening was determined from questionnaires administered at baseline and after one month. Secondarily, the participants’ attitudes, anxiety and depression and cancer worry were analysed. Results. Good knowledge was acquired by 15 of 178 women (8.4%) in the control group and 32 of 177 (18.1%) in the intervention group (P=.008). The relative risk of acquiring a good level of knowledge about the programme was 2.39 times higher in women in the intervention group than in those in the control group (95% CI 1.24-4.60). No differences were found in the secondary endpoints. Conclusions. Women have a very poor level of knowledge about mammography screening, with their main information source being television. Individualized information significantly increased the proportion of women with good knowledge but the percentages remained very low. Women had a very positive attitude to screening and a negative impact in the psychosocial sphere due to their participation was not observed

Using an informed consent in mammography screening: a randomized trial.

Spanish women do not make an informed choice regarding breast cancer screening (BCS). Our aim was to evaluate the impact of receiving information regarding real BCS benefits and risks on knowledge, attitude, decision, feelings, and worries about cancer. Randomized controlled clinical trial of 355 women aged between 45 and 67 years, 177 and 178 assigned to the intervention group (IG) and control group (CG), respectively. After breast screening, women received either Nordic Cochrane Centre information on BCS or standard information. The primary outcome (knowledge) was determined from questionnaire administered at baseline and after a month. Answers were scored from 0 to 10 and scores of 5 or more indicated that women were well informed (had "good knowledge"). Questionnaires regarding attitudes, future screening intentions, and psychosocial impact were also administered. The Chi-squared and Student's t-tests were used to compare qualitative and quantitative variables, respectively. Good knowledge was acquired by 32 (18.10%) IG women and 15 (8.40%) CG women (P = 0.008). Mean scores from first to second interview increased from 2.97 (SD 1.16) to 3.43 (SD 1.39) in the CG and from and from 2.96 (SD 1.23) to 3.95 (SD 1.78) (P = 0.002) in the IG. No differences were found in the secondary endpoints. Women receiving information based on the Nordic Cochrane Centre document were better informed. This means of providing information is not very efficacious, nor does it modify attitude, decision, feelings, or worries about cancer.

Women's perceptions of breast cancer screening. Spanish screening programme survey.

OBJECTIVES: Participants in breast cancer screening programmes may benefit from early detection but may also be exposed to the risks of overdiagnosis and false positives. We surveyed a sample of Spanish women to assess knowledge, information sources, attitudes and psychosocial impact. MATERIALS AND METHODS: A total of 434 breast cancer screening programme participants aged 45-69 years were administered questionnaires regarding knowledge, information sources, attitudes and psychosocial impact. Scores of 5 or more (out of 10) and 12 or less (out of 24) were established as indicating adequate knowledge and a positive attitude, respectively. Psychosocial impact was measured using the Hospital Anxiety and Depression Scale and the Cancer Worry Scale. RESULTS: Only 42 women (9.7%) had adequate knowledge. The mean (SD) knowledge score was 2.97 (1.16). Better educated women and women without previous false positives had higher scores. The main sources of information were television, press, Andalusian Health Service documentation and family and friends. Most participants (99.1%) had a positive attitude, with a mean (SD) score of 3.21 (2.66). Mean (SD) scores for anxiety, depression and cancer worry were 1.86 (3.26), 0.72 (1.99) and 9.4 (3.04), respectively. CONCLUSION: Women have a very positive attitude to breast cancer screening, but are poorly informed and use television as their main information source. They experience no negative psychosocial impact from participation in such programmes.

Follow-up of long-term survivors of breast cancer in primary care versus specialist attention.

BACKGROUND: Hospitals have traditionally been the place where the follow-up of breast cancer patients occurs in Spain. OBJECTIVE: To describe the evolution of long-term survivors of breast cancer according to type of follow-up received (in primary or specialist/hospital care), measuring impact of care type on health, cost, health-related quality of life (HRQL) and satisfaction results. METHOD: Retrospective study of cohorts with disease-free patients followed up for at least 5 years in Oncology. Using personal questionnaires, the type and cost of the follow-up, events, HRQL and satisfaction were analysed. RESULTS: Ninety-eight women were surveyed, 60 in primary and 38 in specialist care. There were no differences between groups in diagnosis of metastasis or new primary tumours. The number of annual visits per patient was 0.98 (0.48) in primary and 1.11 (0.38) in specialist care (P = 0.19). In primary, 44.6% were programmed and 55.4% on demand; in specialist, 94.6% were programmed and 5.4% on demand (P = 0.0001). The costs of follow-up in primary care were lower--€112.86 (77.54) versus €184.61 (85.87) per patient and year (P = 0.0001). No differences were reported in HRQL. Preference for specialist care was expressed by 80%, versus 10% for primary, with 10% indifferent. Patients showed greater satisfaction with specialist care in all questionnaire dimensions. CONCLUSIONS: Compliance with follow-up protocol was high in both groups. In specialist care nearly all the visits were programmed and in primary almost half were on demand. In our locality, primary is more cost-effective than specialist care, but patients express greater satisfaction with specialist follow-up and hence prefer it.

Brote de faringoamigdalitis de origen alimentario por estreptococo betahemolítico A / Tonsillopharyngitis outbreak caused by foodborne group A beta-hemolytic streptococcus

Fundamento: Aunque no son frecuentes, algunos autores han comunicado brotes de faringoamigdalitis de origen alimentario. El 11 de mayo de 2010 se notificó a la Red de Vigilancia Epidemiológica de Andalucía (SVEA) que había personas con cuadro de faringoamigdalitis que tenían en común haber asistido a una comunión celebrada el día 8. El objetivo de este trabajo es la caracterización epidemiológica del brote Método: Estudio observacional descriptivo de casos notificados y análisis de casos control por exposición a los alimentos implicados. Se analizaron las variables edad, sexo, sintomatología y fecha de inicio de síntomas. Fuentes de información fueron los registros del SVEA e historia digital individual (DIRAYA). Se calcularon frecuencias, tasas de ataque, y análisis bayesiano de comparación de diferencia de proporciones de enfermar para un intervalo de probabilidad o credibilidad (IP) del 95%. Resultados: De 130 asistentes a una celebración se detectaron 41 casos de faringoamigdalitis (tasa ataque 31,5%) y se aisló en frotis Estreptococo betahemolítico A. El grupo de edad más afectado fue el de 25-44 años: 16 (39,0%);hubo más afectación de las mujeres 24 (68,6%) mujeres. La ensaladilla de huevo presentó una probabilidad mayor del 80% P(Delta>0,10 y Delta>0,15) para un IP del 95% de enfermar tras su consumo y la probabilidad de tener menos riesgo de no enfermar. Conclusiones: Se trató de un brote por estreptococo betahemolítico A. El análisis epidemiológico evidenció exposición a fuente única y común, siendo plausible la hipótesis del origen alimentario, posiblemente por la ensaladilla de huevo contaminada por algún manipulador de alimentos. Como factores contribuyentes se identificaron inadecuadas medidas higiénico-sanitarias en la manipulación y conservación de los alimentos(AU)

Background: Although infrequent, some authors have reported outbreaks of foodborne tonsillopharyngitis. On May 11, 2010 a series of cases of tonsillopharyngitis among those attending a fellowship meeting on 8 March was notified to the Epidemiological Surveillance Network in Andalusia (SVEA). The aim of this study is to epidemiologically characterise the outbreak . Methods: Descriptive analysis of reported cases and case -control exposure to the implicated food. The variables taken into account were age, sex, symptoms and start date. Sources of information used were the records of the SVEA and individual digital report (DIRAYA). Frequencies and attack rates were calculated, and a Bayesian analysis for the comparison of difference in proportions of disease was carried out for a 95% probability or credibility range (IP). Results: Among the 130 attendees at a communion 41 cases of tonsillopharyngitis (attack rate 31.5%) were detected, and in smears Group A Beta-Hemolytic Streptococcus was isolated. The most affected age group was the 25-44 year-olds, 16 (39,0%); 68.6% (24) female. The egg salad showed a probability greater than 80% P(Delta>0.10 and Delta>0.15) for a 95% IP of risk of disease after intake and a probability of having a lower risk of no disease. Conclusions: It was a Group A Beta-Hemolytic Streptococcal outbreak, the epidemiological evidence indicates exposure to common single source, hence the hypothesis of dietary origin, the implicated food was egg salad. Contributing factors could be cross-contamination after preparation favoured by the bad practice and the conditions of the place(AU)

[Tonsillopharyngitis outbreak caused by foodborne group A beta-hemolytic Streptococcus]. / Brote de faringoamigdalitis de origen alimentario por estreptococo betahemolítico A.

BACKGROUND: Although infrequent, some authors have reported outbreaks of foodborne tonsillopharyngitis. On May 11, 2010 a series of cases of tonsillopharyngitis among those attending a fellowship meeting on 8 March was notified to the Epidemiological Surveillance Network in Andalusia (SVEA). The aim of this study is to epidemiologically characterise the outbreak. METHODS: Descriptive analysis of reported cases and case - control exposure to the implicated food. The variables taken into account were age, sex, symptoms and start date. Sources of information used were the records of the SVEA and individual digital report (DIRAYA). Frequencies and attack rates were calculated, and a Bayesian analysis for the comparison of difference in proportions of disease was carried out for a 95% probability or credibility range (IP). RESULTS: Among the 130 attendees at a communion 41 cases of tonsillopharyngitis (attack rate 31.5%) were detected, and in smears Group A Beta-Hemolytic Streptococcus was isolated. The most affected age group was the 25-44 year-olds, 16 (39,0%); 68.6% (24) female. The egg salad showed a probability greater than 80% P(Δ>0.10 and Δ>0.15) for a 95% IP of risk of disease after intake and a probability of having a lower risk of no disease. CONCLUSIONS: It was a Group A Beta-Hemolytic Streptococcal outbreak, the epidemiological evidence indicates exposure to common single source, hence the hypothesis of dietary origin, the implicated food was egg salad. Contributing factors could be cross-contamination after preparation favoured by the bad practice and the conditions of the place.

[Measles outbreak in Campo de Gibraltar, Cádiz, Spain, during the Period February-July 2008]. / Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero-julio 2008.

BACKGROUND: On the 4th of February 2008, 2 cases of measles, epidemiologically linked (2 members of the crew of the Fast-Ferry Jaime I from the company Balearia, which performs the route Algeciras-Tangier), were notified to the Epidemiological Surveillance Network in Andalusia (SVEA). The aim of this paper is to epidemiologically characterize this population level outbreak detected in the area of Campo de Gibraltar, the vaccine effectiveness and the control measures implemented. METHODS: Descriptive observational study of reported cases. We have analysed the following variables: age, sex, municipality of residence, onset date, virus genotype, groups involved, previous immunization status, interventions, vaccine effectiveness. Information sources are SVEA records, vaccination program and individual digital story (Diraya). Rates 10(5) were calculated according to age group and frequency measurements. To compare vaccine effectiveness, the Chi(2) test was used. RESULTS: We confirmed 155 cases of measles, 88.4% by laboratory techniques. Most affected age groups under 2 years (19%) and from 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated. Virus was isolated from imported measles genotype D4. The vaccine efficacy was greater than 99%. CONCLUSIONS: The outbreak of the imported measles virus was confirmed. More than half of the cases were not vaccinated. The decrease in the incidence in vaccinated individuals recommends the necessity of carrying out Catch-Up campaigns to increase the coverage therefore avoiding the appearance of these outbreaks.

Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero- julio 2008 / Measles outbreak in Campo de Gibraltar, Cadiz, Spain, during the period February-July 2008

Fundamento: El 4 de febrero de 2008 se notificó a la Red de VigilanciaEpidemiológica de Andalucía (SVEA), 2 casos de sarampiónvinculados epidemiológicamente, 2 tripulantes del Fast-Ferry Jaime Ide la Compañía Balearia, que realiza la línea de Algeciras - Tánger. Elobjetivo de este trabajo es caracterizar epidemiológicamente el brote deámbito poblacional detectado en la Comarca Campo de Gibraltar, lasmedidas de control implementadas y la efectividad vacunal.Método: Estudio observacional descriptivo de casos notificados.Se analizan las variables edad, sexo, municipio de residencia,sintomatología, fecha de inicio, colectivos implicados, estado vacunalprevio, intervenciones realizadas, genotipo del virus, y efectividadvacunal. Fuentes de información los registros del SVEA, programade vacunas e historia digital individual (Diraya). Se calcularontasas x 105 por grupo de edad y medidas de frecuencia. Para comparaciónde efectividad vacunal se utilizó test Chi2.Resultados: Se confirmaron 155 casos de sarampión, 88.4%por laboratorio. Grupos de edad mas afectados menores de 2 años(19%) y de 21 a 40 (51%). El 54.2% varones. El 72,14% no estabanvacunados. Se aisló virus sarampión Genotipo D4 importado. Laefectividad vacunal era superior al 99%.Conclusiones: Se confirma un brote por virus del sarampiónimportado. Mas de la mitad de los casos no estaban vacunados. Ladisminución de la incidencia en vacunados hace necesario recomendarcampañas de Cacht - Up que aumenten las coberturas para evitarla aparición de estos brotes vacunales(AU)

Background: On the 4th of February 2008, 2 cases of measles,epidemiologically linked (2 members of the crew of the Fast-FerryJaime I from the company Balearia, which performs the route Algeciras- Tangier), were notified to the Epidemiological SurveillanceNetwork in Andalusia (SVEA). The aim of this paper is to epidemiologicallycharacterize this population level outbreak detected inthe area of Campo de Gibraltar, the vaccine effectiveness and thecontrol measures implemented.Methods: Descriptive observational study of reported cases.We have analysed the following variables: age, sex, municipality ofresidence, onset date, virus genotype, groups involved, previousimmunization status, interventions, vaccine effectiveness. Informationsources are SVEA records, vaccination program and individualdigital story (Diraya). Rates 105 were calculated according to agegroup and frequency measurements. To compare vaccine effectiveness,the Chi2 test was used.Results: We confirmed 155 cases of measles, 88.4% by laboratorytechniques. Most affected age groups under 2 years (19%) andfrom 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated.Virus was isolated from imported measles genotype D4. Thevaccine efficacy was greater than 99%.Conclusions: The outbreak of the imported measles virus wasconfirmed. More than half of the cases were not vaccinated. Thedecrease in the incidence in vaccinated individuals recommends thenecessity of carrying out Catch-Up campaigns to increase the coveragetherefore avoiding the appearance of these outbreaks(AU)

Enfermedad meningocócica e impacto de la vacunación sistemática con la vacuna conjugada antimeningocócica C en un área sanitaria de Andalucía / Impact of systematic vaccination with the antimeningococcal C conjugated vaccine in a health area in Andalusia

Fundamento: En la Comunidad Autónoma de Andalucía,comenzó en julio de 2000 la vacunación con vacuna conjugada antimeningocócicaC de todos los niños nacidos con posterioridad al 1 deenero de 1995, y en septiembre de 2001 se amplíó a los nacidos a partirdel 1 de enero de 1991, esto es, hasta los 10 años de edad. El objetivode este trabajo es valorar la efectividad de esta vacuna tras suintroducción masiva en los niños del área geográfica de un distritosanitario, midiendo su impacto.Métodos: Mediante un estudio longitudinal retrospectivo deincidencia poblacional se calculan las coberturas vacunales de losniños nacidos entre los años 1991 y 2001 y las tasas de incidencia delos casos declarados de enfermedad meningocócica en siete temporadasepidemiológicas (1997/98 a 2003/04). El impacto de la vacunaciónfrente a la meningitis del serogrupo C se calcula comparandolas tasas promedios anuales de las temporadas previas y posterioresa las campañas de vacunación en la población menor y mayor de 10años, utilizando el test exacto de Fisher.Resultados: En el periodo de estudio se declararon 109 casos deenfermedad meningocócica, de los que 50 eran de meningitis C. Apartir de la temporada 2000-2001 descendió la incidencia de meningitisC en los niños menores de 10 años. En este grupo de edad seencuentran diferencias significativas entre las tasas promedio anualde las temporadas prevacunales y postvacunales (de 8,2 a 2,0 por100.000 habitantes). En la población mayor de 10 años no se observaeste descenso en la incidencia. En el periodo de estudio no se hadeclarado ningún caso de fallo vacunal.Conclusiones: La ausencia de fallos vacunales y la disminuciónde la incidencia de enfermedad meningocócica C en los niños menoresde 10 años sugiere la buena efectividad de esta nueva vacuna conjugadafrente al meningococo C

Background: A retrospective longitudinal study of populationincidence was made to assess the effectiveness of meningococcalserogroup C conjugate vaccine, after its mass introduction in childrenin the geographic area of a health district, measuring its populationimpact, and we have studied the state of the meningococcaldisease.Methods: Vaccine coverage in children born between 1991 and2001, and rates of incidence in declared cases of meningococcaldisease in seven epidemiological seasons (1997/98 to 2003/04) werecalculated. The impact of vaccination against serogroup C meningitiswas assessed comparing the average annual rates of previous andlater seasons to the vaccination campaigns in population youngerand older than 10, using the Fisher exact test.Results: In all the study period, 109 cases of meningococcaldisease were declared, of which 50 were of serogroup C meningococcaldisease. Starting from 2000/2001 season the incidence ofserogroup C disease decreased in the population below 10. In thisage group, the annual average rate of post-vaccine seasons decreasesin respect to pre-vaccine (from 8.2 to 2.0 per 100,000 inhabitants)showing a statistically significant difference. In the population above10 years, this incidence reduction was not observed. In the studyperiod, no case of vaccine failure was declared.Conclusions: The absence of vaccine failure and the impactobserved on the incidence of serogroup C meningococcal disease inchildren under 10 suggests the effectiveness of this new conjugatevaccine, together with suitable vaccination conditions (vaccinationschedule, high catch-up, etc.) which are developing in our health district

[Impact of systematic vaccination with the antimeningococcal C conjugated vaccine in a health area in Andalusia]. / Enfermedad meningocócica e impacto de la vacunación sistemática con la vacuna conjugada antimeningocócica C en un área sanitaria de andalucía.

BACKGROUND: A retrospective longitudinal study of population incidence was made to assess the effectiveness of meningococcal serogroup C conjugate vaccine, after its mass introduction in children in the geographic area of a health district, measuring its population impact, and we have studied the state of the meningococcal disease. METHODS: Vaccine coverage in children born between 1991 and 2001, and rates of incidence in declared cases of meningococcal disease in seven epidemiological seasons (1997/98 to 2003/04) were calculated. The impact of vaccination against serogroup C meningitis was assessed comparing the average annual rates of previous and later seasons to the vaccination campaigns in population younger and older than 10, using the Fisher exact test. RESULTS: In all the study period, 109 cases of meningococcal disease were declared, of which 50 were of serogroup C meningococcal disease. Starting from 2000/2001 season the incidence of serogroup C disease decreased in the population below 10. In this age group, the annual average rate of post-vaccine seasons decreases in respect to pre-vaccine (from 8.2 to 2.0 per 100,000 inhabitants) showing a statistically significant difference. In the population above 10 years, this incidence reduction was not observed. In the study period, no case of vaccine failure was declared. CONCLUSIONS: The absence of vaccine failure and the impact observed on the incidence of serogroup C meningococcal disease in children under 10 suggests the effectiveness of this new conjugate vaccine, together with suitable vaccination conditions (vaccination schedule, high catch-up, etc.) which are developing in our health district.