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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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 information 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.

Prevalence of hazardous drinking among nursing students.

AIMS: To estimate the frequency of alcohol consumption among nursing students and describe their behaviour patterns in relation to excessive consumption. BACKGROUND: Most alcohol-related problems appear in individuals who indulge in hazardous consumption, with hazardous drinkers constituting a priority in the field of preventive activities. According to previous studies, there is a high proportion of hazardous drinkers among university students. DESIGN: Descriptive cross-sectional study. METHODS: Over the course of the 2012-2013 academic year, we assessed 1060 nursing degree students, ascertaining their socio-demographic characteristics, lifestyle and alcohol consumption by means of the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcohólicos/ISCA) and Alcohol Use Disorders Inventory Test (AUDIT). RESULTS: Hazardous alcohol consumption was observed in 43·4% of students. Moreover, 14·9% of men and 18·7% of women met criteria for hazardous drinkers, without any statistically significant difference between the sexes. The frequency of hazardous drinkers was significantly higher among participants aged under 21 years, those living outside the family nucleus and smokers. CONCLUSION: A considerable proportion of students show evidence of hazardous alcohol consumption and, while there are no sex-related differences, the proportion of hazardous drinkers tends to be higher among the youngest subjects, smokers and persons living outside the family nucleus. Alcohol-prevention activities should envisage greater protection of university settings, particularly where future health professionals are involved.

Valoración de un proyecto de “triage” de urgencias por enfermería en atención primaria / Evaluation of a primary care nursing emergencies triage project

Objetivo: Conocer la valoración, por parte de enfermeras y estudiantes de enfermería, sobre cambios organizativos para la instauración de un sistema de “triage” de urgencias en atención primaria. Diseño del estudio: Estudio cualitativo, tipo grupo focal. Emplazamiento: Atención primaria. Participantes: Enfermeras de atención primaria y estudiantes de tercer curso de enfermería. Método: Se constituyeron dos grupos, uno formado por siete enfermeras, pertenecientes a centros de salud urbano, rurales y SUAP; y un segundo grupo formado por cinco estudiantes de tercer curso de enfermería. Se realizó una videograbación de las reuniones y posteriormente se llevó a cabo un proceso de análisis y síntesis de la información. Resultados: Se constató un acuerdo en ambos grupos sobre la factibilidad de esta tarea y, en general, se consideraban con suficiente cualificación para su desempeño. Se subrayó asimismo la importancia de que no recaiga sobre el área administrativa la responsabilidad de decidir quién y cuándo debe atender a un paciente que requiere atención inmediata. En el grupo de enfermeras se hizo especial hincapié en que este proyecto no sería viable con las cargas de trabajo actuales, por lo que planteaban la necesidad de aumentar las plantillas o introducir cambios organizativos. Los estudiantes se mostraban interesados por asumir este tipo de tareas, aunque desearían una mayor formación específica en su currículo académico. Consideraban fundamental delimitar tareas y protocolizar actividades. Conclusiones: Enfermeras cualificadas en el trabajo en atención primaria y estudiantes de enfermería en la fase final de su formación coinciden en la factibilidad de implantar un sistema de “triage” para pacientes que requieren atención inmediata en un centro de salud (AU)

Objective: To ascertain the evaluation of nurses and nursing students on organisational changes for the establishment of a triage system for primary care emergencies. Design: Focus group qualitative study. Location: Primary Care. Participants: Primary health care nurses and third year nursing students. Method: Two groups were formed, one of seven nurses from city, rural and SUAP healthcare centres and a second group made up of five third year nursing students. A video recording was made of the meetings and later a process of analysis and synthesis of the information was carried out. Results: There was agreement between both groups on the feasibility of this task and, in general, they considered themselves sufficiently qualified to perform it. Likewise, importance was given to the fact that responsibility for deciding who should attend to a patient needing immediate care, and when, should not fall on the administrative area. In the nursing group, special emphasis was placed on the fact that this project would not be viable with current workloads and, for this reason, they put forward the need to increase the workforce or to bring in organisational changes. The students showed interest in taking on this kind of task, although they would wish for greater specific training in their academic curriculum. They considered definition of tasks and regulation of activities to be fundamental. Conclusions: Qualified nurses at work in primary care and nursing students nearing the end of their training agree on the feasibility of implementing a triage system for patients requiring immediate attention at a healthcare centre (AU)

The attitudes of primary care providers towards screening for colorectal cancer.

BACKGROUND AND OBJECTIVE: the scientific community supports the appropriateness of colorectal cancer screening, and there is consensus on the need to raise awareness about the significance of prevention among both health care professionals and the population. The goal was to record the attitude of primary care providers towards colorectal cancer screening, as well as the main barriers to both patient and provider participation. METHODS: a cross-sectional, observational study was performed of 511 professionals in Albacete Health District. Variables included views on screening effectiveness and cost-effectiveness, acceptance by providers and patients, barriers to participation, frequency of prevention recommendations, and education needs. RESULTS: most (76 %) considered screening was effective; 85 % said acceptance of fecal occult blood testing was intermediate or high, and 68.2 % this is also the case for colonoscopy when needed; 71.9 % would recommend screening should a population-based program be implemented (currently only 9.7 % recommends this). Correspondence analysis revealed that recommendation is more common when assigned populations are smaller. CONCLUSIONS: most providers consider screening is both effective and acceptable for patients. In today´s situation, where screening is only performed in an opportunistic manner, the proportion of professionals who commonly recommend screening for the mid-risk population is low, especially when assigned populations are huge.

El estado de salud de las personas mayores que sufren insomnio / The health status of older people with insomnia

Objetivos: Evaluar el estado de salud percibido por los mayores que sufren insomnio, tanto primario comosecundario a una enfermedad médica o asociado a otro trastorno mental.Métodos: Estudio observacional transversal realizado en una muestra representativa de 926 mayores de65 anos. Mediante una entrevista psiquiátrica se verificó la presencia de insomnio (DSM-IV-TR, Manual ˜diagnóstico y estadístico de los trastornos mentales, 4.aed., texto revisado), y con una entrevista realizadapor personal sanitario se evaluó el estado de salud percibido (EuroQol-5D), los problemas de salud y lasituación sociodemográfica.Resultados: La prevalencia de insomnio primario fue del 8,9% (intervalo de confianza del 95% [IC95%]: 7,1-11,0), la de insomnio relacionado con otro trastorno mental del 9,3% (IC95%: 7,5-11,4) y la de insomniodebido a una enfermedad médica del 7,0% (IC95%: 5,4-8,9). En los pacientes con insomnio que consumíanhipnóticos/sedantes se observó una puntuación menor en la autovaloración del estado de salud (57,6;IC95%: 53,7-61,4) significativamente inferior (p < 0,05) a la de los sujetos con insomnio no consumidores(65,1; IC95%: 53,7-61,4). El valor medio del estado de salud en los individuos sin insomnio fue de 0,87, yen cualquier tipo de insomnio fue significativamente inferior (p < 0,05): 0,80 en insomnio primario, 0,73en insomnio relacionado con otro trastorno mental y 0,76 en insomnio debido a enfermedad médica.Conclusiones: Comprobamos un peor estado de salud en los mayores con insomnio, ya sea primario osecundario a otras enfermedadesmentales u orgánicas, y también cuando consumen hipnóticos/sedantes.La gravedad de las limitaciones es inferior en el insomnio primario (AU)

Objectives: To evaluate the perceived health status of elderly patients with insomnia, whether primary,secondary to a medical illness, or associated with another mental disorder.Methods: We conducted a cross-sectional study in a representative sample of 926 persons aged over65 years. A psychiatric interview was used to verify the presence of insomnia (DSM-IV-TR, Diagnosticand Statistical Manual of Mental Disorders, fourth ed., revised text). Interviews were conducted by healthprofessionals to assess perceived health status (EuroQol-5D), health problems, and socio-demographiccharacteristics.Results: The prevalence of primary insomnia was 8.9% (95% CI: 7.1-11.0), that of insomnia associated withanother mental disorder was 9.3% (95% CI: 7.5-11.4) and that of insomnia secondary to medical illnesswas 7.0% (95% CI: 5.4-8.9). Patients with insomnia who used hypnotics/sedatives scored lower in selfreported health (57.6; 95% CI: 53.7-61.4), significantly lower (p < 0.05) than participants with insomnianot taking these drugs (65.1; 95% CI: 53.7-61.4). The mean health status score in individuals withoutinsomnia was 0.87 and was significantly lower (p < 0.05) in persons with any type of insomnia: 0.80 inprimary insomnia, 0.73 in insomnia secondary to a mental disorder and 0.76 in insomnia associated withmedical illness.Conclusions: Health status was worse in older people with insomnia, whether primary, secondary to othermental illnesses or organic, and when the elderly patients consumed hypnotics/sedatives. Limitationswere less severe in primary insomnia (AU)

[The health status of older people with insomnia]. / El estado de salud de las personas mayores que sufren insomnio.

OBJECTIVES: To evaluate the perceived health status of elderly patients with insomnia, whether primary, secondary to a medical illness, or associated with another mental disorder. METHODS: We conducted a cross-sectional study in a representative sample of 926 persons aged over 65 years. A psychiatric interview was used to verify the presence of insomnia (DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, fourth ed., revised text). Interviews were conducted by health professionals to assess perceived health status (EuroQol-5D), health problems, and socio-demographic characteristics. RESULTS: The prevalence of primary insomnia was 8.9% (95% CI: 7.1-11.0), that of insomnia associated with another mental disorder was 9.3% (95% CI: 7.5-11.4) and that of insomnia secondary to medical illness was 7.0% (95% CI: 5.4-8.9). Patients with insomnia who used hypnotics/sedatives scored lower in self-reported health (57.6; 95% CI: 53.7-61.4), significantly lower (p<0.05) than participants with insomnia not taking these drugs (65.1; 95% CI: 53.7-61.4). The mean health status score in individuals without insomnia was 0.87 and was significantly lower (p<0.05) in persons with any type of insomnia: 0.80 in primary insomnia, 0.73 in insomnia secondary to a mental disorder and 0.76 in insomnia associated with medical illness. CONCLUSIONS: Health status was worse in older people with insomnia, whether primary, secondary to other mental illnesses or organic, and when the elderly patients consumed hypnotics/sedatives. Limitations were less severe in primary insomnia.