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Background: The objective was to analyze sociodemographic, organizational and health care-related factors associated to level of enrollment in a breast cancer screening program developed in one area of Barcelona (Spain)., Material and Methods: Three types of indicators were used: coverage, response and participation. The influence of age, educational level, previous clinical contacts, the person who received the citation and the reason for not attending after the first citation were studied. The odds ratio (OR) was used to estimate the magnitude of the association between variables. The OR were adjusted by age and education through unconditional logistic regression., Results: The rates were: coverage 79.2%, response 74.6%, and participation 61%. The response after the first citation was influenced by the recipient of the letter (p < 0.001); when it was the target-woman, the response was 75%. The response after the successive citations was 50.5% if the reason for not attending previously was circumstantial, and 11.5% when it was lack of interest. Having had previous clinical contacts in the primary care centre or in the reference hospital multiplied by 4 to 7 times the response. Coverage decreased with age, and it presented a curvilinear pattern with respect to educational level. Multivariate analyses emphasized the importance of previous clinical contacts (ORs between 3.5 and 8.1; p < 0.001)., Conclusions: Previous contacts with the health system, the method of citation and the reason for not attending after the initial phase were factors clearly associated with participation in a breast cancer screening program. Research on factors influencing participation would contribute to improve the results of screening programs currently underway in Spain.

Background: Clinical practice shows that certain patients may underestimate and others overestimate some initial symptoms of their disease. In studies on the interval between first symptoms and treatment onset, estimating the date in which symptoms first appeared is crucial. The study analyzed patient-physician agreement in assessing first symptom attributable to cancer., Methods: During two years, two physicians personally interviewed, through a structured questionnaire, all symptomatic patients with a neoplasm of the digestive tract admitted to Hospital del Mar (Barcelona, Spain). Patients had a mid-low sociocultural profile and most had been admitted through the Emergency Department., Results: Absolute agreement (symptom and date) occurred in 85% of the 183 subjects. In most discordant cases, patients had overlooked some component of the "toxic syndrome", and the date of symptom onset was, based on physician's assessment, chronologically prior to the date elicited from the patient. Disagreement was directly related to the patient's health status (p < 0.05) and to the number of reported symptoms until hospital admittance (p = 0.002), but not to tumour stage. Agreement increased with the importance attributed by the patient to the first symptom (p < 0.05)., Conclusions: In spite of difficulties inherent to measuring symptomatic onset of diseases, structured patient interviews appear to be a reasonably valid method and deserve further development in this and other areas of research.

Background: Investigation in health care services by data bases (DB) is undergoing an important increase in numerous countries. Several of the most relevant epidemiologic studies on the postsurgical morbidity and mortality of benign hypertrophy of the prostate (BHP) have used DB. The aim of this study was to prepare and optimize the DB of a health cooperative (Asistencia Sanitaria Colegial)., Methods: Since 1981 the DB contains sociodemographic variables, data concerning visits to general practitioners and specialists, complementary examinations and hospitalizations. The coding system was specifically developed by the cooperative. The study base was made up of all the policies of the members between January 1981 and December 1988 (101,400 males). To identify the policies 14 codes potentially related with BHP were initially chosen and all the policies containing any of these codes were selected, with the manual analysis of 204 policies being thereby performed., Results: The total number of policies initially selected for the study was 3,157. Manual revision discarded the use of 9 of the 14 codes used in the first selection. In agreement with the 5 codes able to define diseases of prostatic gland and to the file in which they appeared the policies were classified as probable diseases of prostatic gland (n = 1,007, 31.9%), possible (n = 805, 25.5%) and improbable (n = 1,345, 42.5%). Likewise, the strategy to follow for the selection of a cohort of BHP cases was defined., Conclusions: The manual analysis of policies evidenced a remarkable coherence and exhaustiveness of the information registered. The principal difficulties found with the data base used were the lack of a sole diagnosis and the coding system used in addition to the impossibility of automatically controlling the assistance received by the patients outside the cooperative system. The availability of a data base such as that herein described with a well defined large population and with accessible sociodemographic and health care information justifies collaborative efforts among health care administrators, clinicians, computer scientists and epidemiologists.

After buprenorphine was introduced as an analgesic, several clinical observations have stimulated the investigation of its potential abuse by heroin addicts. To evaluate the prevalence of buprenorphine use by a group of heroin abusers being treated on an outpatient basis, a cross-sectional study was carried out where the information given by the 188 subjects was verified by urine drug analyses. The patients had three different therapeutic modalities: methadone maintenance program (MMP), antagonist maintenance program (AMP), and drug-free program (DFP). The urine samples were analyzed with an enzyme immunoassay technique for the detection of heroin, methadone, dextropropoxyphene, cannabis and benzodiazepines. Buprenorphine was investigated with a radioimmunoassay technique. Overall 66% of the patients admitted having used buprenorphine throughout their toxicologic history (period prevalence) and 6.7% had positive urine controls for this drug (5% in the MMP group, 0% in the AMP group and 12% in the DFP group) (point prevalence). In 72% of the cases the drug was administered intravenously. In addition, a clinically statistically significant association was found between positivity for heroin and buprenorphine. The possible tolerance to the latter is suggested by the fact that the mean current dose was higher than the mean initial dose. In the study population, the use of cannabis and benzodiazepines was also very high. The results suggest that most patients had a previous history of buprenorphine use. This drug could have a higher potential for abuse than that found in previous experimental studies.