Effectiveness of three interventions to improve participation in colorectal cancer screening

Background and objective: Participation in colorectal cancer (CRC) screening varies widely among different countries and different socio-demographic groups. Our objective was to assess the effectiveness of three primary-care interventions to increase CRC screening participation among persons over the age of 50 years and to identify the health and socio-demographic-related factors that determine greater participation. Methods: We conducted a randomized experimental study with only one post-test control group. A total of 1,690 subjects were randomly distributed into four groups: written briefing; telephone briefing; an invitation to attend a group meeting; and no briefing. Subjects were evaluated 2 years post-intervention, with the outcome variable being participation in CRC screening. Results: A total of 1,129 subjects were interviewed. Within the groups, homogeneity was tested in terms of socio-demographic characteristics and health-related variables. The proportion of subjects who participated in screening was: 15.4% in the written nformation group (95% confidence interval [CI]: 11.2-19.7); 28.8% in the telephone information group (95% CI: 23.6-33.9); 8.1% in the face-to-face information group (95% CI: 4.5-11.7); and 5.9% in the control group (95% CI: 2.9-9.0), with this difference proving statistically significant (p < 0.001). Logistic regression showed that only interventions based on written or telephone briefing were effective. Apart from type of intervention, number of reported health problems and place of residence remained in the regression model. Conclusions: Both written and telephone information can serve to improve participation in CRC screening. This preventive activity could be optimized by means of simple interventions coming within the scope of primary health-care professionals (AU)

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Análisis de las variables sociosanitarias asociadas a la permanencia en incapacidad temporal / Analyses of the sociosanitary variables associated with the permanency in temporary disability

INTRODUCCIÓN: La incapacidad temporal (IT) constituye un proceso de origen multifactorial. OBJETIVO: Evaluar el proceso de IT en relación con la enfermedad, estado de salud, satisfacción laboral, perfil de locus de control y características sociodemográficas. MÉTODO: Estudio observacional de cohortes prospectivo sobre 404 pacientes en IT. Realizamos un análisis de supervivencia describiendo la evolución de los participantes en cuanto a su permanencia en IT. RESULTADOS: La permanencia media en IT fue significativamente superior (p < 0,05) en sujetos con nivel de instrucción bajo (9,4 meses), trabajadores manuales (8,5 meses), mayores de 60 años (10,0 meses), pacientes insatisfechos laboralmente (9,3 meses), con baja autopercepción de salud (10,2 meses), consumidores de medicación crónica (10,6 meses), fumadores (9,3 meses) y consumidores de drogas no institucionalizadas (10,5 meses). Tras el análisis multivariante, se asocian a una menor duración de la IT: las enfermedades del aparato locomotor, sistema cardiorrespiratorio o problemas psicológicos, un nivel de instrucción alto, una buena autopercepción de salud y la abstención en el consumo de tóxicos. CONCLUSIONES: Además de la enfermedad, otros factores relacionados con la percepción del estado de salud, características sociodemográficas y el estilo de vida, influyen de manera significativa en la reincorporación de un trabajador a su actividad laboral

INTRODUCTION: The temporary disability (IT) refers to a process of multifactorial origin. AIM: To evaluate this process in relation with the corresponding disease, health status, labor satisfaction, locus of control profile and socio-demographic characteristics. METHODS: A prospective observational cohort study was performed on 404 patients in IT. We carried out an analysis of survival describing the evolution of the participants as well as their permanency in IT. RESULTS: The permanency average in IT was significantly high (p < 0,05) in subjects with a lower level of instruction (9,4 months), manual workers (8,5 months), over 60 years old (10,0 months), labor unsatisfied patients (9,3 months), with low health self-awareness (10,2 months), consumers of chronic medication (10,6 months), smokers (9,3 months) and consumers of not institutionalized drugs (10,5 months). After the multivariate analysis, they associate the diseases of the locomotive device, the cardiorespiratory system or psychological problems, a high level of instruction, a good auto perception of health and the abstention in the consumption of toxins to a minor duration of the IT. CONCLUSIONS: Besides the disease, other factors related to the perception of the health status, sociodemographic characteristics and the way of life, influence in a significant way the reincorporation of a worker to his labor activity

Características sociosanitarias de los pacientes en incapacidad temporal en el área sanitaria de Albacete / Features healthcare of patients in temporary disability in the area of health of Albacete

FUNDAMENTOS: La incapacidad temporal (IT) constituye un importante problema sanitario, económico y social. El objetivo del estudio es describir los motivos de IT, satisfacción laboral y características sociosanitarias de los sujetos que permanecen en IT durante un periodo prolongado. MÉTODOS: Estudio descriptivo transversal, sobre 404 pacientes en IT. Se recogieron datos sobre: diagnóstico de IT, satisfacción laboral, salud autopercibida, características sociodemográficas, estado de salud y perfil de locus de control. RESULTADOS: Entre las personas en IT predominan los varones (53,2%), con edad media de 48,1 años, casados (64,1%), con bajo nivel de instrucción (36,1%) y pertenecientes a clases sociales inferiores (27,2%). Las enfermedades predominantes son las enfermedades del aparato locomotor (46,5%), seguidas de problemas psicológicos (18,6%) y enfermedades cardiovasculares (6,2%). Los pacientes muestran un nivel aceptable de satisfacción laboral, siendo ésta superior en hombres (76,5 ± 12,9DE), en pertenecientes a categorías sociales superiores (80,9 ± 14,9 DE en categorías I-II) y en trabajadores con nivel de instrucción elevado (80,5 ± 14,5 DE en personas con estudios universitarios). La mayoría califica su salud como buena (57,9%), y sin un perfil predominante de locus (37,6%). La mayoría tienen episodios previos de IT, generalmente inferiores a 6 meses (74,5%). CONCLUSIONES: Varones de mediana edad, con enfermedades del aparato locomotor, bajo nivel de instrucción, buena salud autopercibida, satisfechos con su trabajo y pertenecientes a clases sociales inferiores conforman el perfil más común del paciente que permanece en IT durante un periodo prolongado, no observándose entre ellos un perfil de locus de control predominante

FUNDANMENTALS: The temporary disability (TD) constitutes a major health, economic and social problem. The objective of the study is to describe the reasons for IT, job satisfaction, and features social and health care of subjects that remain in IT for a long time. METHODS: Descriptive study cross, about 404 patients in IT. Data were collected on: diagnosis of IT, job satisfaction, self-perceived health, features sociodemographic, health status and profile of locus of control. RESULTS: Among the people in IT dominate males (53.2%), with average age of 48.1, married (64.1%), with low level of education (36.1%) and lower social classes (27.2%). Predominant diseases are diseases of the locomotor system (46.5%), followed by psychological problems (18.6%) and cardiovascular diseases (6.2%). Patients show an acceptable level of job satisfaction, which is higher in men (76.5 ± 12, US), in belonging to higher social categories (80.9 ± 14.9 of in categories I-II) and workers with high level of instruction (80.5 ± 14.5 of in people with University studies). Most qualifies as good health (57.9%), and without a predominant profile of locus (37.6%). Most have previous episodes of IT, generally less than 6 months (74.5%). CONCLUSIONS: Men of middle age, with diseases of the musculoskeletal, low level of instruction, good health self-perceived, satisfied with his work and belonging to the lower social classes comprise the most common profile of the patient who stays in IT for an extended period, not observed including a profile of locus of control predominantly

[Therapeutic compliance in patients with cardiovascular diseases]. / Cumplimiento terapéutico en pacientes con enfermedades cardiovasculares.

BACKGROUND: Our purpose was to establish, by means of a survival analysis, the duration of therapeutic compliance and the probability of abandonment or prescription drugs in cardiovascular patients, as well as the prognostic factors that determine it. PATIENTS AND METHOD: Longitudinal observational study (1996-1998). By means of a consecutive sampling, 493 patients who initiated a cardiovascular treatment were selected. Through interviews, we obtained information on cardiovascular problems and treatment, concomitant diseases, consumption of other drugs and social and demographic variables. The consumption of prescribed drugs was established across 6 periodic observations. RESULTS: During the observational period, 39.4% of drugs prescribed by the general practitioner (GP) were abandoned, as compared to 22.4% of those prescribed by specialists (p < 0.05). The degree of abandonment was significantly higher among consumers of vasodilators and vasoprotective agents. Cardiac glycosydes and angiotensin converting enzyme inhibitors were among the therapeutic subgroups in which a longer survival time was observed (average: 19.8 and 16.5 months, respectively). By a Cox regression analysis, we noticed that the risk of abandonment was higher in patients who took two or more doses of the drug per day (OR = 2.8; 95% IC, 21-37), in consumers of medicines with a daily cost lower than ptas. 100 (OR = 1.4); 95% CI, 1.0-1.8) and in subjects younger than 65 years (OR = 1.3; 95% CI, 1.0-1.8). CONCLUSIONS: A higher degree of abandonment of cardiovascular medication occurs when it is administered in primary health-care (i.e., drugs prescribed by the GP), mainly in relation to a greater prescription of agents with a low therapeutic effectiveness. Abandonment is influenced by patients' social and demographic factors and also by the specific characteristics of the treatment.

Cumplimiento terapéutico en pacientes con enfermedades cardiovasculares / Therapeutic compliance in patients with cardiovascular diseases

FUNDAMENTO: Establecer, mediante análisis de supervivencia, la duración del cumplimiento terapéutico y la probabilidad de abandono de la medicación en pacientes con enfermedades cardiovasculares, así como los factores pronósticos que los determinan. PACIENTES Y MÉTODO: Estudio observacional longitudinal (1996-1998). Mediante muestreo consecutivo, se seleccionó a 493 pacientes que iniciaron tratamiento cardiovascular. A través de entrevista se obtuvo información sobre problemas cardiovasculares y tratamiento, enfermedades concomitantes, consumo de otros fármacos y variables sociodemográficas. A lo largo de 6 observaciones periódicas se constató el consumo o abandono de la medicación prescrita. RESULTADOS: Durante el período observado se abandonó la toma del 39,4 por ciento de los fármacos prescritos por el médico general, frente al 22,4 por ciento de los originados en el medio especializado (p < 0,05). Dichos abandonos fueron significativamente superiores entre los consumidores de vasodilatadores periféricos y vasoprotectores. Los glucósidos cardíacos e inhibidores de la enzima conversiva de la angiotensina fueron los subgrupos terapéuticos en los que se observó un mayor tiempo de continuidad de toma de medicamentos (medianas de 19,8 y 16,5 meses, respectivamente). Mediante regresión de Cox, se comprobó que el riesgo de abandono fue superior en los que tomaban dos o más dosis de fármaco al día (odds ratio [OR] = 2,8), en consumidores de medicamentos con un coste diario inferior a 100 ptas. (OR = 1,4); (IC del 95 por ciento, 1,51,9) y en sujetos de edad inferior a 65 años (OR = 1,3) (IC del 95 por ciento 1,0-1,8). CONCLUSIONES: Se produce un mayor abandono de los tratamientos cardiovasculares originados en atención primaria, en relación con una mayor prescripción en dicho nivel de fármacos de utilidad terapéutica baja. En el abandono de la medicación intervienen tanto las variables sociodemográficas de los pacientes como las características del tratamiento (AU)