Invitation strategies for colorectal cancer screening programmes: The impact of an advance notification letter

AimTo estimate the impact of an advance notification letter on participation in sigmoidoscopy (FS) and fecal immunochemical test (FIT) screening.MethodsEligible subjects, invited in 3 Italian population based programmes using FS and in 5 using FIT, were randomised (1:1:1), within GP, to: A) standard invitation letter; B) advance notification followed after 1 month by the standard invitation; and C) B + indication to contact the general practitioner (GP) to get advice about the decision to be screened. We calculated the 9-month attendance and the incremental cost of each strategy. We conducted a phone survey to assess GP's utilization and predictors of participation.ResultsThe advance notification was associated with a 20% increase in the attendance among 15,655 people invited for FS (B vs A — RR: 1.17, 95% CI: 1.10–1.25; C vs A — RR: 1.19, 95% CI: 1.12–1.27); the incremental cost ranged between 10 and 9 Euros. Participation in FIT screening (N = 23,543) was increased only with simple pre-notification (B vs A — RR: 1.06, 95% CI: 1.02–1.10); the incremental cost was 22.5 Euros. GP consultation rate was not increased in group C.ConclusionsAn advance notification represents a cost-effective strategy to increase participation in FS screening; its impact on the response to FIT screening was limited.     

Impact of invitation and reminder letters on cervical cancer screening participation rates in an organized screening program

Study's Objective was to explore the impact of invitation and reminder letters on cervical cancer screening participation among eligible Ontario women 30 to 69 years of age. A cross-sectional study was used to describe factors and screening patterns for 1,150,783 eligible women. A cohort design was used to compare the impact of invitation and reminder letters on Pap uptake comparing women who received the intervention (n = 99,278) with a historical non-intervention group (n = 130,181). Factors that might influence screening participation were included as covariates in a multivariable logistic regression models. Overall, 26.7% of women who had a Pap test 3 to 5 years prior and 9.8% of women with no Pap test in the previous 5 years were screened within 9 months after the intervention. On cohort analysis, 14.1% of women in the intervention group and 8.5% of women in the non-intervention group were screened within 9 months. Being mailed an invitation letter was associated with greater likelihood of screening (OR = 1.8, CI 1.7–1.8). Controlling for covariates, the letter intervention was associated with 9 month screening for both women with a Pap test 3 to 5 years prior (AOR = 1.7, CI 1.6–1.8) and those with no Pap test in the previous 5 years (AOR = 1.8, CI 1.7–1.9). There was a significant effect of all covariates on the participation. The invitation and reminder letter strategy increased cervical cancer screening participation. Additional strategies that could encourage eligible women to participate and/or removing barriers to screening for eligible women may be necessary.     

Development of a predictive prognostic rule for early assessment of COVID-19 patients in primary care settings

ObjectiveTo investigate possible early prognostic factors among middle-aged and older adult and explore prognostic rules stratifying risk of patients.DesignCommunity-based retrospective cohort.SettingPrimary Health Care Tarragona region.Participants282 community-dwelling symptomatic patients ≥50 years with laboratory-confirmed COVID-19 (hospitalised and/or outpatient) during March-June 2020 in Tarragona (Southern Catalonia, Spain).Main outcome measurementsRelationship between demographics, pre-existing comorbidities and early symptomatology (first 5-days) and risk of suffering critical outcome (ICU-admission/death) across clinical course was evaluated by logistic regression analyses, and simple predictive models were developed.ResultsOf the 282 cases (mean age: 65.9 years; 140 men), 154 (54.6%) were hospitalised (30 ICU-admitted) and 45 (16%) deceased. Median time follow-up in clinical course was 31 days (range: 30–150) for survivors and 14 days (range: 1–81) for deceased patients. In crude analyses, increasing age, male sex, some comorbidities (renal, respiratory or cardiac disease, diabetes and hypertension) and symptoms (confusion, dyspnoea) were associated with an increased risk to suffer critical outcome, whereas other symptoms (rinorrhea, myalgias, headache, anosmia/disgeusia) were related with reduced risk. After multivariable-adjustment only age/years (OR: 1.04; 95% CI: 1.01–1.07; p = 0.004), confusion (OR: 5.33; 95% CI: 1.54–18.48; p = 0.008), dyspnoea (OR: 5.41; 95% CI: 2.74–10.69; p < 0.001) and myalgias (OR: 0.30; 95% CI: 0.10–0.93; p = 0.038) remained significantly associated with increased or reduced risk. A proposed CD65-M prognostic rule (acronym of above mentioned 4 variables) showed a good correlation with the risk of suffering critical outcome (area under ROC curve: 0.828; 95% CI: 0.774–0.882).ConclusionClinical course of COVID-19 is early unpredictable, but simple clinical tools as the proposed CD65-M rule (pending external validation) may be helpful assessing these patients in primary care settings.     

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.     

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.     

Recent relocation and decreased survival following a cancer diagnosis

ObjectiveTo determine the impact of recent relocation prior to a cancer diagnosis on cancer-specific outcomes.MethodsWe identified 272,718 patients with two different entries in the Surveillance, Epidemiology, and End Results database within 3 years of each other. Those who had relocated to a different county between entries were identified and we determined the risk of stage IV disease or cancer-specific mortality among relocators and non-relocators after adjusting for other patient-specific demographic and clinical factors.ResultsA total of 4639 (1.7%) patients relocated to a new county within 3 years prior to a second cancer diagnosis and 268,079 (98.3%) patients did not. Patients who had relocated to a new area were more likely to be diagnosed with stage IV cancer (25.2% vs. 20.8%; adjusted odds ratio = 1.27; 95% confidence interval [CI], 1.18–1.37; P < 0.001), and had an increased risk of 10-year cancer-specific mortality (20.9% vs. 17.9%; adjusted hazard ratio 1.26; 95% CI, 1.17–1.36; P < 0.001).ConclusionThese results suggest that recent relocation to a new county prior to a cancer diagnosis is associated with an increased risk of late-stage presentation and worse cancer-specific mortality.     

Where can they play? Outdoor spaces and physical activity among adolescents in U.S. urbanized areas

ObjectiveTo estimate behavior-specific effects of several objectively measured outdoor spaces on different types of moderate to vigorous physical activity (MVPA) in a large, diverse sample of U.S. adolescents.MethodsUsing data from Wave I (1994–1995) of the National Longitudinal Study of Adolescent Health (U.S., n = 10,359) and a linked geographic information system, we calculated percent greenspace coverage and distance to the nearest neighborhood and major parks. Using sex-stratified multivariable logistic regression, we modeled reported participation in wheel-based activities, active sports, exercise, and ≥ 5 MVPA bouts/week as a function of each outdoor space variable, controlling for individual- and neighborhood-level sociodemographics.ResultsAvailability of major or neighborhood parks was associated with higher participation in active sports and, in females, wheel-based activity and reporting ≥ 5 MVPA bouts/week [OR (95% CI): up to 1.71 (1.29, 2.27)]. Greater greenspace coverage was associated with reporting ≥ 5 MVPA bouts/week in males and females [OR (95% CI): up to 1.62 (1.10, 2.39) for 10.1 to 20% versus ≤ 10% greenspace] and exercise participation in females [OR (95% CI): up to 1.73 (1.21, 2.49)].ConclusionsProvision of outdoor spaces may promote different types of physical activities, with potentially greater benefits in female adolescents, who have particularly low physical activity levels.     

Comparative effectiveness of two outreach strategies for cervical cancer screening

ObjectiveTest-specific reminder letters can improve cancer screening adherence. Little is known about the effectiveness of a reminder system that targets the whole person by including multiple screening recommendations per letter.MethodsWe compared the effectiveness of a Pap-specific reminder letter sent 27 months after a woman's last Pap, to a reminder letter that included up to seven preventive service recommendations sent before a woman's birthday (“birthday letter”) on Pap smear adherence from a natural experiment occurring in routine clinical care. Participants included 82,016 women from Washington State who received 72,615 Pap-specific letters between 2003 and 2007 and 100,218 birthday letters between 2009 and 2012. We defined adherence as having a Pap test within a six month window around the Pap test due date. Using logistic regression, we calculated adjusted odds ratios (OR) for adherence with 95% confidence intervals (CI) following the birthday letter with 1–2 recommendations, 3–5 recommendations, and 6–7 recommendations compared to the Pap-specific letter. All analyses were stratified by whether a woman was up-to-date or overdue for screening at the time she received a letter.ResultsAdjusted ORs showed reduced adherence following the birthday letter compared with the Pap-specific letter for up-to-date women whether the letter had 1–2 recommendations (OR = 0.37, 95%CI = 0.36–0.39), 3–5 recommendations (OR = 0.44, 95%CI = 0.42–0.45), or 6–7 recommendations (OR = 0.36, 95%CI = 0.32–0.40). We noted no difference in Pap-test adherence between letter types for overdue women.ConclusionsIn conclusion, for women regularly adherent to screening, an annual birthday letter containing reminders for multiple preventive services was less effective at promoting cervical cancer screening compared with a Pap-specific letter.     

Association of IPS1 polymorphisms with peginterferon efficacy in chronic hepatitis B with HBeAg-positive in the Chinese population

AimsTo investigate whether IPS1 polymorphisms affect peginterferon alpha (PEG-IFN) efficacy in chronic hepatitis B (CHB) patients using a tag- single nucleotide polymorphism (SNP) approach.MethodsA total of 212 hepatitis B e antigen (HBeAg)-positive patients treated with a 48 weeks of PEG-IFN monotherapy were enrolled initially and 127 patients were followed for 48 weeks posttreatment. Genotype analysis was performed for 10 tag-SNPs in IPS1.ResultsThe end of virological response (EVR) rate was 45.8% (97/212) and the sustained virological response (SVR) rate was 45.7% (58/127). Meanwhile, 35.4% (75/212) achieved HBeAg seroconversion at the end of treatment. In a multivariate analysis, the rs2464 CC genotype was independently associated with EVR (OR 2.21, 95% CI 1.23–3.98, P = 0.008) and SVR (OR 2.34, 95% CI 1.05–5.20, P = 0.037) after adjustment for sex, age, HBV genotype, baseline levels of HBV DNA and ALT. Meanwhile, rs2464 CC genotype were also independently associated with decline of HBsAg levels below 1500 IU/mL at 12 weeks of treatment (OR 2.52, 95% CI 1.01–6.29, P = 0.047). Furthermore, three SNPs were found to be independently associated with HBeAg seroconversion at the end of treatment. (1) The rs2326369 CC genotype was independently associated with no HBeAg seroconversion (OR 0.52, 95% CI 0.29–0.95, P = 0.034); (2) The rs6515831 TT genotype was independently associated with HBeAg seroconversion (OR 2.11, 95% CI 1.14–3.90, P = 0.017); (3) The rs2464 CC genotype was independently associated with HBeAg seroconversion (OR 2.36, 95% CI 1.26–4.42, P = 0.007).ConclusionsPolymorphisms in IPS1 are independently associated with treatment response to PEG-IFN among Chinese HBeAg-positive CHB patients.     

Association between obesity and helicobacter pylori infection

ObjectivesThe relationship between obesity and helicobacter pylori infection has been extensively reported; however, evidence from existing literature showing conflicting data. This current meta-analysis sought to assess the association between obesity and the risk of helicobacter pylori infection by summarizing all available data.MethodsPubMed, Embase, Web of Science, Cochrane databases were screened to identify relevant literature that assessed the association between obesity and helicobacter pylori infection in participants before the end of May, 2022. Data extraction and quality assessment were performed. The odds ratio (OR) and 95% confidence interval (95% CI) were used to estimate the association between obesity and helicobacter pylori infection by using a random-effects model. In addition, sensitivity analysis and publication bias were conducted.ResultsA total of twenty-one studies with 307,462 participants were included in this meta-analysis. Pooled estimates showed that obesity is associated with an increased risk of helicobacter pylori infection compared to non-obese counterparts (21 studies; OR:1.34; 95% CI: 1.17–1.52; I² = 91%). We also conducted subgroup analysis according to sex and study design, respectively. We found that males were more likely to have helicobacter pylori infection than females (OR: 1.59; 95% CI: 1.28–1.97; I² = 94.7% for male percent > 50%; OR:1.14; 95% CI: 0.94–1.38; I² = 75.2% for male percent < 50%). Furthermore, pooled studies of case-control study (OR: 1.20; 95% CI:1.05, 1.37; I² = 82.4%) showed that the people with obesity had a significantly higher prevalence of helicobacter pylori infection.ConclusionThis comprehensive quantitative analysis provides an affirmation that obesity is associated with an increased risk of helicobacter pylori infection. From this point of view, the prevention of obesity is important in the treatment of helicobacter pylori infection.     

Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders,Belgium

BackgroundMammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified.MethodsMultivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30 months after a t0 mammogram, using a random sample of women 50–67 years (Belgium 2010–2013).ResultsA false positive result at the most recent past mammogram (Odds Ratio = 5.0, 95% Confidence Interval 3.6–6.8), an interval until new invitation greater than 25 months (Odds Ratio = 4.8 for > 29 months, 95% Confidence Interval 2.9–8.1), waiting times in the mammography unit > 1 h (Odds Ratio = 2.1, 95% Confidence Interval 1.2–3.7) and difficulties in reaching the unit (Odds Ratio = 2.5, 95% Confidence Interval 1.4–4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good.ConclusionsMaintaining an invitation cycle of maximum 25 months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.     

Telephone follow-up was more expensive but more efficient than postal in a national stroke registry

ObjectiveTo compare the efficiency and differential costs of telephone- vs. mail-based assessments of outcome in patients registered in a national clinical quality of care registry, the Australian Stroke Clinical Registry (AuSCR).Study Design and SettingThe participants admitted to hospital with stroke or transient ischemic attack were randomly assigned to complete a health questionnaire by mail or telephone interview at 3–6 months postevent. Response rate, researcher burden, and costs of each method were compared.ResultsCompared with the participants in the mail questionnaire arm (n = 277; 50% female; mean age: 70 years), those in the telephone arm (n = 282; 45% female; mean age: 68 years) required a shorter time to complete the follow-up (mean difference: 24.2 days; 95% confidence interval [CI]: 15.0, 33.5 days). However, the average cost of completing a telephone follow-up was greater (US$20.87 vs. US$13.86) and had a similar overall response to the mail method (absolute difference: 0.57%; 95% CI: ?4.8%, 6%).ConclusionPosthospital stroke outcome data were slower to collect by mail, but the method achieved a similar completion rate and was significantly cheaper to conduct than follow-up telephone interview. Findings are informative for planning outcome data collection in large numbers of patients with acute stroke.     

Factors associated with not receiving homecare,end-of-life homecare,or early homecare referral among cancer decedents: A population-based cohort study

Publicly funded homecare has been shown to reduce acute care use and improve quality of life for those nearing end-of-life (EOL). Yet despite the known benefits of homecare, many EOL cancer patients never receive these services. We used administrative data on all cancer decedents in Ontario, Canada in 2006 to determine predictive factors of not receiving homecare, not receiving EOL homecare, and late initiation of EOL homecare. 22,262 decedents met the eligibly criteria, 25% of whom never received homecare in the last six months of life. A logistic regression found that cancer disease site, having a comorbidity (OR: 1.15, 95% CI: 1.1–1.2), region of residence, shorter cancer survival (OR: 2.09, 95% CI: 1.8–2.4), being male (OR: 1.25, 95% CI: 1.2–1.3), lower income (OR: 1.06, 95% CI: 1.03–1.08), older age (OR: 1.03, 95% CI: 1.02–1.05), and less prior emergency department use were significant factors associated with not receiving homecare (p < 0.001). Individuals with hematological cancer (OR: 1.57, 95% CI: 1.3–1.8) were less likely to receive homecare in their final months. Some of these covariates also predicted not receiving EOL homecare and late referral to these services (p < 0.05). The systematic differences in homecare use that we identified can help to guide strategies for improving access to these important services.     

Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women

ObjectiveResearch on emotional distress and mortality has largely focused on depression in men and in elderly populations. We examined the relation between anxiety and mortality in women at midlife, adjusting for depression.Study Design and SettingAt baseline, 5,073 healthy Dutch women aged 46–54 years (mean = 50.4 ± 2.1) and living in Eindhoven, completed a three-item anxiety scale (“being anxious/worried,” “feeling scared/panicky,” “ruminating about things that went wrong;” Cronbach's α = 0.77). The primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death.ResultsAt follow-up, 114 (2.2%) women had died at the mean age of 56.4 ± 3.1 years. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. Smoking, living alone, and lower education were related to mortality, but depression was not. Adjusting for these variables, anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR] = 1.77, 95% confidence interval [CI]: 1.14–2.74, P = 0.011). Anxiety was related to cardiovascular death (HR = 2.77, 95% CI: 1.17–6.58, P = 0.021); there was also a trend for lung cancer death (HR = 1.91, 95% CI: 0.90–4.06, P = 0.095) but not for breast cancer death.ConclusionAnxiety predicted premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.     

Risk factors for tuberculosis among health care workers in South India: a nested case–control study

ObjectiveThe epidemiology of tuberculosis (TB) among health care workers (HCWs) in India remains under-researched. This study is a nested case–control design assessing the risk factors for acquiring TB among HCWs in India.Study Design and SettingsIt is a nested case–control study conducted at a tertiary teaching hospital in India. Cases (n = 101) were HCWs with active TB. Controls (n = 101) were HCWs who did not have TB, randomly selected from the 6,003 subjects employed at the facility. Cases and controls were compared with respect to clinical and demographic variables.ResultsThe cases and controls were of similar age. Logistic regression analysis showed that body mass index (BMI) <19 kg/m² (odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.49–5.87), having frequent contact with patients (OR: 2.83, 95% CI: 1.47–5.45) and being employed in medical wards (OR: 12.37, 95% CI: 1.38–110.17) or microbiology laboratories (OR: 5.65, 95% CI: 1.74–18.36) were independently associated with increased risk of acquiring TB.ConclusionHCWs with frequent patient contact and those with BMI <19 kg/m² were at high risk of acquiring active TB. Nosocomial transmission of TB was pronounced in locations, such as medical wards and microbiology laboratories. Surveillance of high-risk HCWs and appropriate infrastructure modifications may be important to prevent interpersonal TB transmission in health care facilities.     

Salud autopercibida en ancianos jóvenes españoles y portugueses tras la recesión según la Encuesta Europea de Salud: un estudio transversal

ObjectiveThe aim of this study is to describe self-perceived health (SPH) in Spanish and Portuguese population aged between 65 and 74 years old and to analyze other associated factors measured in the European Health Interview Survey (EHIS) in 2014.DesignRetrospective secondary data analysis from EHIS 2014.SettingCommunity based.ParticipantsYoung seniors, people aged 65-74 years old surveyed and with available data from two countries.Main measurementsFor each country and sex, SPH, sociodemographic variables, clinical chronic conditions, lifestyles and utilization of health care resources were described. A multiple logistic regression (very good or good SPH versus remaining levels) with robust estimators was used to assess the country effect adjusted by sociodemographic factors, clinical factors and/or lifestyles.ResultsGood SPH showed variation by country (52.9% Spain vs. 19% Portugal; P < .001) and gender (44% men vs. 31.3% women; P < .001). Both countries had high prevalence of multimorbidity (64.7% Spain vs. 76.3% Portugal; P < .001) and the distribution of chronic diseases was similar with the only exception of depression (13.2% Spain vs. 20.3% Portugal; P < .001). Regarding individual factors related with good SPH we found Spanish nationality (OR: 4.52; 95% CI: 4.05-5.04), male gender (OR: 1.10; 95% CI: 1.101-2.21), education level, completing primary school (OR: 1.28; 95% CI: 1.24-1.31) or achieving tertiary level (OR: 2.43; 95% CI: 1.14-5.17) and physical activity of two or more days per week (OR: 1.87; 95% CI: 1.39-2.5). Factors with a negative impact on SPH were multimorbidity (OR: 0.19; 95% CI: 0.12-0.31) and depression (OR: 0.32; 95% CI: 0.25-0.41).DiscussionGood SPH is higher in Spanish young seniors compared to Portuguese. Having higher level of education achieved and practicing regular physical exercise were two most important factors increasing good SPH.     

Symptoms of specific anxiety disorders may relate differentially to different physical activity modalities in young adults

BackgroundAnxiety symptoms may be a barrier to physical activity (PA) such that persons who experience anxiety engage in less PA. The purpose of this study was to assess if symptoms of panic disorder, social phobia, generalized anxiety disorder (GAD) or agoraphobia are associated with frequency, intensity or type of PA in young adults.MethodsData on lifetime anxiety symptoms and current PA levels were collected in self-report questionnaires in 2007–2008 from 880 persons aged 18–24 years participating in the Nicotine Dependence in Teens (NDIT) study. The associations between anxiety symptom subtypes and different PA modalities were investigated in five multivariable logistic regression models, one for each of five PA indicators (i.e., meeting moderate-to vigorous PA (MVPA) guidelines, meeting strength training guidelines, meeting both MVPA and strength training guidelines, participating in team sports, frequent walking) as outcomes.Results37%, 47%, 40% and 21% of participants reported lifetime symptoms of panic disorder, social phobia, GAD, and agoraphobia, respectively. In multivariable logistic regression, participants who endorsed lifetime GAD symptoms were statistically significantly less likely to meet MVPA guidelines (OR 0.5, 95% CI 0.4–0.8, p < 0.05), and MVPA and strength training guidelines (OR 0.7, 95% CI 0.5–1.0, p < 0.05). Those with agoraphobia symptoms were more likely to walk frequently [OR (95% CI) = 1.6 (1.1, 2.3)].ConclusionPA interventions may need to be tailored to people who have experienced specific anxiety symptoms to maximize adherence to PA recommendations, and increase the potential for health benefits from PA participation.     

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes

ObjectiveTo identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes.DesignCross-sectional analytical study.SiteClinics of the Mexican Institute of Social Security (IMSS), Mexico.ParticipantsPatients with type 2 diabetes.Main measurementsGlycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained.ResultsA total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p = 0.016), lower percentage of fat (p = 0.008), and lower fat mass (p = 0.018); followed a diet (p = 0.004) and had received diabetes education (p = 0.002), and to obtain information about their illness (p = 0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c ≥ 7% (OR: 4.68; 95% CI: 1.48,14.86; p = 0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21–3.90; p = 0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p = 0.046).ConclusionInadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.