Risk factors associated with hospitalisation for influenza-associated severe acute respiratory illness in South Africa: A case-population study

BackgroundInfluenza is a common cause of severe respiratory illness, but risk factors for hospitalisation in low income settings with a high HIV prevalence are not well described. We aimed to assess risk factors associated with influenza-associated severe acute respiratory illness (SARI) hospitalisation in South Africa.MethodsWe conducted a case-population study using data on risk conditions in patients hospitalised with SARI and the national prevalence of these conditions. Data on hospitalised cases were from the national SARI surveillance program while data on the referent population were from the latest national census or health and demographic surveillance surveys.FindingsFrom 2009 to 2012, we identified 3646 (7.9%) of 46,031 enrolled cases of SARI that were associated with influenza infection. Risk factors associated with hospitalisation included previous history of smoking [case-population ratio (CPR) 3.82, 95% confidence interval (CI) 3.5–4.16], HIV infection (CPR 3.61, 95% CI 3.5–3.71), asthma (CPR 2.45, 95% CI 2.19–2.73), previous history of hospital admission in the past 12 months (CPR 2.07, 95% CI 1.92–2.23), and tuberculosis (CPR 1.85, 95% CI 1.68–2.02). When stratified by age, there is increased risk of hospitalisation in those ⩽5 years of age (CPR 3.07, 95% CI 2.93–3.21) and among those 35 years of age and above (CPR 1.23, 95% CI 1.28–1.18). Male sex (CPR 0.85, 95% CI 0.82–0.88) and completion of pneumococcal conjugate vaccination schedule in children <5 years of age (CPR 0.74, 95% CI 0.71–0.77) were associated with decreased risk of hospitalisation.ConclusionThese results identify groups at high-risk for severe influenza who should be considered potential targets for influenza vaccination in South Africa and similar settings.     

Correlates of receiving recommended adolescent vaccines among youth with special health care needs: Findings from a statewide survey

BackgroundMany youth with special health care needs (YSHCN) have not received recommended adolescent vaccines, yet data are lacking on correlates of vaccination among this population. Such information can identify subgroups of YSHCN that may be at risk for under-immunization and strategies for increasing vaccination.MethodsWe analyzed weighted data from a population-based sample of parents with an 11- to 17-year-old child with a special health care need from the 2010–2012 North Carolina Child Health Assessment and Monitoring Program (n = 604). We used ordinal logistic regression to identify correlates of how many recommended vaccines (tetanus booster, meningococcal, and HPV [at least one dose] vaccines) adolescents had received.ResultsOnly 12% of YSHCN (18% of females and 7% of males) had received all three vaccines. More YSHCN had received tetanus booster vaccine (91%) than meningococcal (28%) or HPV vaccines (32%). In multivariable analyses, YSHCN who were female (OR = 2.59, 95% CI: 1.57–4.24), ages 16–17 (OR = 2.06, 95% CI: 1.10–3.87), or who had a preventive check-up in the past year (OR = 2.98, 95% CI: 1.24–7.21) had received a greater number of the vaccines. YSHCN from households that contained a person with at least some college education had received fewer of the vaccines (OR = 0.57, 95% CI: 0.33–0.96). Vaccine coverage did not differ by type of special health care need.ConclusionsVaccine coverage among YSHCN is lacking and particularly low among those who are younger or male. Reducing missed opportunities for vaccination at medical visits and concomitant administration of adolescent vaccines may help increase vaccine coverage among YSHCN.     

Genetic variants at 18q11.2 and 8q24 identified by genome-wide association studies were not associated with pulmonary tuberculosis risk in Chinese population

ObjectiveGenome-wide association study (GWAS) recently identified several susceptibility loci in ASAP1 gene on chromosome 8q24 for tuberculosis (TB) in a Russian population, but no relevant studies have been performed to validate these findings. In addition, previous GWAS in Ghana and Gambia found that the variant rs4331426 at 18q11.2 was a susceptibility locus for TB. However, the follow-up studies reported conflicting results. Herein, we investigated the contribution of genetic variants at 8q24 and 18q11.2 to TB in Chinese population.MethodsWe genotyped four genetic variants at 8q24 (rs10956514 and rs11774633) and 18q11.2 (rs4331426 and rs6507226) in a case–control study with 355 newly bacteriologically confirmed pulmonary TB cases and 395 healthy controls using TaqMan allelic discrimination assay. Subsequently, we conducted a meta-analysis including 4 reported studies in Chinese populations and our case–control study with a total of 3118 cases and 3226 controls to further evaluate the relationship between rs4331426 at 18q11.2 and TB risk.ResultsWe did not find significant association between genetic variants at 8q24 and risk of TB (rs10956514: OR = 0.89, 95%CI: 0.72–1.09, P = 0.253; rs11774633: OR = 0.86, 95%CI: 0.69–1.08, P = 0.206). We did not observe significant association for genetic variants at 18q11.2 (rs4331426: OR = 0.62, 95%CI: 0.34–1.14, P = 0.122; and rs6507226: OR = 0.98, 95%CI: 0.80–1.20, P = 0.853). Moreover, the pooled results from the Meta-analysis further supported that rs4331426 at 18q11.2 was not associated with TB risk in Chinese population (OR = 0.90, 95% CI: 0.63–1.29).ConclusionsOur findings indicate that TB risk-associated loci at 8q24 and 18q11.2 identified by GWAS from the other populations may not contribute to TB susceptibility in Chinese population.     

Prevalence and associated factors of seasonal influenza vaccination among 24- to 59-month-old children in Hong Kong

BackgroundInfluenza results in severe complications among 24- to 59-month-old children, who are recommended by the WHO to take up influenza vaccination (IV) annually. Health promotion is warranted. Yet, there is a dearth of studies on IV prevalence and associated factors in this age group.MethodsA random population-based telephone survey interviewed 540 parents of Chinese children aged 24–59 months in Hong Kong during March through June, 2011. Constructs of the Health Belief Model (HBM) and subjective norm formed basis for assessing parental perceptions on influenza and IV. For data analysis, adjusted, and stepwise multiple logistic regression models were fit.ResultsThe prevalence of having taken up at least one dose and two doses of IV among children aged 24–59 months was 58.9 and 42.4%, respectively. Significant associated factors included family members’ IV experience (ORu = 5.37, 95% CI: 3.48, 8.29), variables related to the HBM constructs (except perceived severity) [perceived susceptibility of seasonal influenza (ORu = 2.03, 95% CI: 1.39, 2.95), perceived benefits of IV (ORu = 3.11, 95% CI: 2.05, 4.71), perceived barriers (ORu = 0.49, 95% CI: 0.25, 0.96) of IV, and cue to action (ORu = 4.79, 95% CI: 2.87, 7.99)], supportive subjective norm (ORu = 4.26, 95% CI: 2.91, 6.25), and level of fear felt during the H1N1 pandemic (ORu = 1.97, 95% CI: 1.01, 3.87). Adjusted for the child's age, the same significant factors were found. Exposure to related media messages was statistically non-significant.ConclusionThe reported IV prevalence was higher than that of 24- to 59-month-old children reported in other studies. There is room for improvement through health promotion, which should modify parental cognitions related to HBM (except perceived severity and self-efficacy) and involve family members to create subjective norm. Media campaigns may be inadequate for promotion of IV; use of the setting approach may be considered.     

Mortalité tardive après cancer des enfants survivants à cinq ans dans la région Rhône-Alpes

BackgroundThe population of survivors of childhood cancer is currently growing. Studies from other countries have shown an increased risk of late mortality. In order to measure this risk within a French cohort, the mortality of children who had survived five years from a cancer diagnosis were compared to the mortality of the general population, according to follow-up interval and cancer and treatment characteristics.MethodsThe study population consisted of 635 children diagnosed with cancer before the age of 15 who had survived at least five years, and were registered in the Rhone-Alpes region cancer registry from 1987 to 1992. Mortality was compared with general population rates of the Rhone-Alpes region to assess age and sex standardized mortality ratio (SMR) and absolute excess risk of death.ResultsThe median follow-up of children was 14.0 years. Among the 42 observed deaths, 71.4% were attributed to a recurrence of the original cancer, 9.5% to a second cancer. The 15-year cumulative risk of death, all causes, was 7.1%. The overall mortality of the cohort was 20.7 fold greater than the general population (95% CI: 14.9–27.9), and the absolute excess risk of 6.9 per 1000 persons-years. The long term excess-mortality was higher in case of recurrence of original cancer (SMR = 99.9, 95% CI: 67.9–141.9, absolute excess risk 35.4 per 1000 persons-years); it was raised during the five to nine years follow-up interval after diagnosis (SMR = 33.8, 95% CI: 23.2–47.3) mainly due to the primary malignancy, and decreased after (10–14 years follow-up interval SMR = 6.5, 95% IC 2.4–14.2).ConclusionThe late mortality of childhood cancer is significantly increased during the five to nine years following diagnosis and decreases after, but the cohort follow-up has to be extended in order to assess outcome beyond 15 years after diagnosis.     

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

BackgroundIn June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers' attention toward warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up.MethodsData were analyzed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models were estimated to assess associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30 days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects.ResultsOver the study period, reading warnings significantly decreased (p < 0.0001) while reading inserts increased (p = 0.004). More frequent reading of warnings was associated independently with stronger response efficacy (B_{often/very often vs never} = 0.28, 95% CI: 0.11–0.46) and risk perceptions at follow-up (B_{often/very often vs never} = 0.31, 95% CI: 0.06–0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (B_{twice or more vs none} = 0.30, 95% CI: 0.14–0.47), quit attempts (OR_{twice or more vs none} = 1.68, 95% CI: 1.28–2.19), and sustained quit attempts (OR_{twice or more vs none} = 1.48, 95% CI: 1.01–2.17).ConclusionsMore frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs.     

The Italian version of the Lower Extremity Functional Scale was reliable,valid, and responsive

ObjectiveTo determine the measurement properties of an Italian Version of the Lower Extremity Functional Scale (LEFS) in patients with lower extremity musculoskeletal dysfunction.Study Design and SettingThis is a prospective methodological study of repeated measures with a sample of 250 consecutive patients. Reliability, validity, and responsiveness were evaluated.ResultsThe Italian version of the LEFS showed a high degree of internal consistency with a Cronbach alpha of 0.94 (95% confidence interval [CI]: 0.91, 0.96). The test–retest reliability was high for both intra-interviewer and inter-interviewer measures with an ICC_{(2,1 and 2,k)} of 0.91 (95% CI: 0.86, 0.93) and 0.89 (95% CI: 0.83, 0.91), respectively. The LEFS showed a better correlation with the 36-Item Short-Form Health Survey (SF-36) physical component summary score rather than with the SF-36 mental component summary score both at the initial assessment (r = 0.61 and 0.26, respectively) and at the discharge (r = 0.72 and 0.22, respectively). Receiver operating characteristic curve analysis revealed a large responsiveness for the LEFS (area under the curve [AUC] = 0.97) and a moderate responsiveness for the SF-36 (AUC = 0.68).ConclusionThe Italian version of the LEFS is a valid, reliable, and responsive tool that can be used to measure function in Italian patients with lower extremity musculoskeletal dysfunction.     

Prevalence of physical activity in European adults — Compliance with the World Health Organization's physical activity guidelines

BackgroundAdults are recommended to engage in at least 150 min/week of moderate-to-vigorous physical activity (PA).PurposeThis study aimed to examine the level of compliance with PA recommendations among European adults.MethodsUsing data from European Social Survey round 6, PA self-report data was collected from 52,936 European adults from 29 countries in 2012. Meeting PA guidelines was assessed using World Health Organization criteria.Results61.47% (60.77% male, 62.05% female) of European adults reported to be engaged in moderate to vigorous PA at least 30 min on 5 or more days per week. The likelihood of achieving the PA recommended levels was higher among respondents older than 18–24. For those aged 45–64 years the likelihood increased 65% (OR = 1.65, 95% CI: 1.51–1.82, p < 0.001) and 112% (OR = 2.12, 95% CI: 1.94–2.32, p < 0.001) for males and females, respectively. Those who were high school graduates were more likely to report achieving the recommended PA levels than those with less than high school education (males: OR = 1.19, 95% CI: 1.12–1.27, p < 0.001; females: OR = 1.13, 95% CI: 1.06–1.20, p < 0.001).ConclusionAlthough about 60% of European adults reported achieving the recommended levels of PA, there is much room for improvement among European adults, particularly among relatively inactive subgroups.     

Changes in cervical cancer incidence following the introduction of organized screening in Italy

ObjectiveTo quantify the impact of organized cervical screening programs (OCSPs) on the incidence of invasive cervical cancer (ICC), comparing rates before and after activation of OCSPs.MethodsThis population-based investigation, using individual data from cancer registries and OCSPs, included 3557 women diagnosed with ICC at age 25–74 years in 1995–2008. The year of full-activation of each OCSP was defined as the year when at least 40% of target women had been invited. Incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs) were calculated as the ratios between age-standardized incidence rates observed in periods after full-activation of OCSPs vs those observed in the preceding quinquennium.ResultsICC incidence rates diminished with time since OCSPs full-activation: after 6–8 years, the IRR was 0.75 (95% CI: 0.67–0.85). The reduction was higher for stages IB–IV (IRR = 0.68, 95% CI: 0.58–0.80), squamous cell ICCs (IRR = 0.74, 95% CI: 0.64–0.84), and particularly evident among women aged 45–74 years. Conversely, incidence rates of micro-invasive (stage IA) ICCs increased, though not significantly, among women aged 25–44 years (IRR = 1.34, 95% CI: 0.91–1.96). Following full-activation of OCSPs, micro-invasive ICCs were mainly and increasingly diagnosed within OCSPs (up to 72%).Conclusion(s)Within few years from activation, organized screening positively impacted the already low ICC incidence in Italy and favored down-staging.     

Self-assessed health,perceived stress and non-participation in breast cancer screening: A Danish cohort study

ObjectivePopulation-based cancer screening is offered in many countries to detect early stages of cancer and reduce mortality. Screening efficiency and equality is susceptible due to a group of non-participants. We investigated associations between self-assessed health, perceived stress and subsequent non-participation in breast cancer screening.MethodsThis population-based cohort study included 4512 women who had participated in a Health Survey in 2006 and who were also the target group (aged 50–69 years) for the first organised breast cancer screening programme -3 years later in the Central Denmark Region in 2008–2009.ResultsA U-shaped association was observed for physical health assessment as women with the highest (PR = 1.28, 95% CI: 1.06–1.55), and the lowest (PR = 1.41, 95% CI: 1.18–1.68) physical health scores were less likely to participate in the programme than women with physical health scores in the middle range. Women with low mental health assessment were more likely not to participate than women with mental health scores in the middle range (PR = 1.44, 95% CI: 1.22–1.69). Higher non-participation propensity was also observed for women with the highest perceived stress scores (PR = 1.27, 95% CI: 1.07–1.51) compared with women scoring in the middle range.ConclusionsWomen with highest and lowest self-assessed physical health, with lowest mental health or highest perceived stress were significantly more likely not to participate in breast cancer screening 2 -3years later than women who reported average health. Interventions targeting these groups may promote equal participation in future breast cancer screening programmes.     

Association between characteristics of physical activity in leisure time and obesity in Brazilians adults and elderly

ObjectiveTo verify the association of obesity with volume, intensity and types of physical activity in leisure time among Brazilian adults and elderly.Study designCross-sectional study, with a secondary analysis of data from "Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey".MethodsThe target population comprised adults aged ≥18 years. The outcome was obesity (BMI ≥ 30.0 ??kg/m²) and the exposures were the volume, intensity, and main type of physical activity in leisure time. Binary logistic regression was used and the results were expressed as odds ratio (OR) and 95% confidence intervals (CI95%), with a significance level of 5%.ResultsCompared to inactive, the highest volume of leisure time physical activity (≥300 min/week) had a lower occurrence of obesity in adults (OR = 0.76; CI95%: 0.63, 0.92; p = 0.001) and elderly (OR = 0.62; CI95%: 0.46, 0.82; p = 0.001). In adults, vigorous activities (OR = 0.65; CI95%: 0.55, 0.78; p < 0.001) and, in the elderly, light/moderate activities (OR = 0.75; CI95%: 0.62, 0.89; p < 0.001) and vigorous (OR = 0.54; CI95%: 0.37, 0.78; p < 0.001) presented protective effect for obesity. Among the types of physical activity, running was the most strongly associated with a lower occurrence of obesity in adults (OR = 0.54; CI95%: 0.32, 0.92; p = 0.024) and elderly (OR = 0.27; CI95%: 0.10, 0.69; p = 0.006). In adults, strength training (p < 0.001), gymnastics (p = 0.032) and sports (p = 0.013) and in elderly, walking (p = 0.001) and sports (p = 0.003) also had protective effect.ConclusionA greater volume, vigorous intensity and physical activities of a structuring character and intensity progression, such as running, were associated with the lower occurrence of obesity.     

Parental perceptions of childhood seasonal influenza vaccination in Singapore: A cross-sectional survey

PurposeSeasonal influenza vaccination is recommended in children aged 6–59 months, but little is known about child vaccination coverage and determinants in Asian settings. We report the results of a survey of knowledge, attitudes, practices, and determinants of child influenza vaccination in Singapore.MethodsIn December 2015-March 2016, we conducted a survey of 332 parents of children aged 6 months to 5 years attending pre-schools. We assessed child influenza vaccine coverage and parental knowledge, attitudes, and practices of child influenza vaccination. We used multivariable regression and structural equation models to identify factors associated with child influenza vaccination.ResultsKnowledge about influenza, perceived benefit of vaccination, and willingness to vaccinate were high. However, only 32% of children had ever received influenza vaccine, and only 15% in the past year. Factors independently associated with child influenza vaccination included: being recommended influenza vaccine by a child’s doctor (prevalence ratio (PR) = 2.47, 95% CI: 1.75–3.48); receiving influenza vaccine information from a private general practitioner (PR = 1.47, 95% CI: 1.05–2.04); regularly receiving pre-travel influenza vaccine (PR = 1.64, 95% CI: 1.19–2.25); higher willingness to vaccinate (PR = 1.58, 95% CI:1.24–2.04 per unit increase in willingness score); and feeling well-informed about influenza vaccine (PR = 1.44, 95% CI: 1.04–1.99). Parents who obtained influenza vaccine information from television were less likely to have vaccinated their child (PR = 0.44, 95% CI: 0.23–0.85). Path analysis indicated that being recommended vaccination by a child's doctor increased willingness to vaccinate and self-efficacy (feeling well-informed about influenza vaccine). Median willingness-to-pay for a dose of influenza vaccine was SGD30 (interquartile range: SGD20-SGD50), and was higher in parents of vaccinated compared with unvaccinated children (SGD45 vs SGD30, p = 0.0012).ConclusionKnowledge and willingness to vaccinate was high in this parent population, but influenza vaccine uptake in children was low. Encouraging medical professionals to recommend vaccination of eligible children is key to improving uptake.     

Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors

ObjectiveTo assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics.Study Design and SettingScreening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression.ResultsHaving one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15–1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40–1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84–0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68–0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99–1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99–1.26]). There was no indication that influence of risk factors varied by radiologist characteristics.ConclusionWomen with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.     

Men with nonapnea sleep disorders have a high risk of developing subsequent epilepsy: A nationwide population-based cohort study

ObjectiveThis nationwide population-based cohort study evaluated the effects of nonapnea sleep disorders (NSDs) on the development of epilepsy.MethodsWe identified 63,865 patients aged ≥ 20 years, diagnosed with NSDs (ICD-9-CM: 307.4 or 780.5), and without coding for apnea-related sleep disorders (ICD-9-CM: 780.51, 780.53, or 780.57) during 2000–2003 as the NSD cohort. In addition, we enrolled a comparison cohort of 127,728 patients. We calculated the adjusted hazard ratio (aHR) for developing epilepsy (ICD-9-CM: 345) after adjustment for age, sex, comorbidities, and drug use. A Kaplan–Meier analysis was used to measure the cumulative incidence of epilepsy between the 2 groups until the end of 2011.ResultsThe cumulative incidence of epilepsy was significantly higher in the NSD cohort than in the comparison cohort. The aHR for developing epilepsy in the NSD cohort was 1.52 (95% CI = 1.37–1.69). The risk of developing epilepsy was higher among males (aHR = 1.41) than among females. The age-stratified effects of NSDs on developing epilepsy were the highest among patients aged ≥ 65 years. When comorbidities and NSDs coexisted, the risk of epilepsy was specifically increased in patients having an NSD and stroke (aHR: 8.61, 95% CI: 7.43–9.98) in addition to brain tumors (aHR: 7.66, 95% CI: 5.06–11.6).ConclusionThis study indicated that patients with NSDs have a higher risk of developing epilepsy and that the risk is much higher among men and older patients. These findings suggest that NSDs constitute a predisposing, possibly independent factor for developing subsequent epilepsy in adulthood.     

Social security status and mortality in Belgian and Spanish male workers

ObjectiveTo assess differences in mortality rates between social security statuses in two independent samples of Belgian and Spanish male workers.MethodsStudy of two retrospective cohorts (Belgium, n = 23,607; Spain, n = 44,385) of 50–60 year old male employees with 4 years of follow-up. Mortality rate ratios (MRR) were estimated using Poisson regression models.ResultsMortality for subjects with permanent disability was higher than for the employed, for both Belgium [MRR = 4.56 (95% CI: 2.88–7.21)] and Spain [MRR = 7.15 (95% CI: 5.37–9.51)]. For the unemployed/early retirees, mortality was higher in Spain [MRR = 1.64 (95% CI: 1.24–2.17)] than in Belgium [MRR = 0.88 (95% CI: 0.46–1.71)].ConclusionMRR differences between Belgium and Spain for unemployed workers could be partly explained because of differences between the two social security systems. Future studies should further explore mortality differences between countries with different social security systems.     

Joint effects of objectively-measured sedentary time and physical activity on all-cause mortality

ObjectiveExamine the joint effects of objectively-measured sedentary time and moderate-to-vigorous physical activity (MVPA) on all-cause mortality.MethodsThe present study included data from the 2003–2006 National Health & Nutrition Examination Survey, with mortality follow-up data (via National Death Index) through 2011 (N = 5575 U.S. adults). Sedentary time (activity counts/min between 0 and 99) and MVPA (activity counts/min ≥ 2020) were objectively measured using the ActiGraph 7164 accelerometer.ResultsThe median age of the participants was 50 yrs; proportion of men was 50.2%; proportion of whites was 53.8%, 18.7% for blacks; median follow-up was 81 months; and 511 deaths occurred over the follow-up period. After adjusting for age, gender, race-ethnicity, cotinine, weight status, poverty level, C-reactive protein and comorbid illness (summed score of 0–8 chronic diseases), and for a 1 min increase in MVPA and sedentary time, both MVPA (HR_adjusted = 0.98; 95% CI: 0.96–0.99; P = 0.04) and sedentary time (HR_adjusted = 1.001; 95% CI: 1.0003–1.002; P = 0.008) were independently associated with all-cause mortality. Further, MVPA was associated with all-cause mortality among those with greater (above median) sedentary time (HR_adjusted = 0.95; 95% CI: 0.93–0.97; P < .001). Sedentary time was not associated with all-cause mortality among those engaging in above median levels of MVPA (HR_adjusted = 0.998; 95% CI: 0.996–1.001; P = .32), but sedentary time was associated with increased mortality risk among those below median levels of MVPA (HR = 1.002; 95% CI: 1.001–1.003; P < 0.001).ConclusionsSedentary time and MVPA are independently associated with all-cause mortality. Above median sedentary time levels did not negate the beneficial effects of MVPA on all-cause mortality risk.     

How to increase uptake in oncologic screening: A systematic review of studies comparing population-based screening programs and spontaneous access

Background.Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access.Methods.Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions.Results.The invitation letter vs no intervention showed significantly more participation (RR = 1.60 95%CI 1.33–1.92; RR = 1.52 95%CI 1.28–1.82; RR = 1.15 95%CI 1.12–1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR = 1.74 95%CI 1.25–2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR = 0.99 95%CI 0.94–1.05; RR = 1.08 95%CI 0.99–1.17, for breast and cervical cancer, respectively).Conclusion.Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective.     

How to increase uptake in oncologic screening: A systematic review of studies comparing population-based screening programs and spontaneous access

Background.Cervical, breast and colorectal cancer (CRC) screenings are universally recommended interventions. High coverage of the target population represents the most important factor in determining their success. This systematic review aimed at assessing the effectiveness of population-based screening programs in increasing coverage compared to spontaneous access.Methods.Electronic databases and national and regional websites were searched. We included all studies on interventions aimed at increasing screening participation published between 1999 and 2009; for those published before, we consulted the Jepson et al. review (2000). We compared spontaneous access (including no intervention) vs population-based screening programs actively inviting the target population. Among the latter, we compared GP-based vs invitation letter-based interventions.Results.The invitation letter vs no intervention showed significantly more participation (RR = 1.60 95%CI 1.33–1.92; RR = 1.52 95%CI 1.28–1.82; RR = 1.15 95%CI 1.12–1.19, for breast, cervical and CRC screenings, respectively). GP-based interventions, although more heterogeneous, showed a significant effect when compared with no intervention for breast (RR = 1.74 95%CI 1.25–2.43), but not for cervical and CRC. No significant differences were found between invitation letter-based and GP-based organization (RR = 0.99 95%CI 0.94–1.05; RR = 1.08 95%CI 0.99–1.17, for breast and cervical cancer, respectively).Conclusion.Population-based programs are more effective than spontaneous screening in obtaining higher testing uptake. Both invitation letter-based and GP-based programs are effective.