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Background: Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate., Methods/design: Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed., Discussion: This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.

Background: Longer life expectancy has led to a progressive aging of the population and to growing sociosanitary homecare. This study is aimed at describing the population of patients suffering from chronic diseases having been provided with homecare throughout the first ten years that homecare was available by a primary care team at an urban Healthcare Center, to study how often this type of care was used and to analyze the survival of those individuals having been provided with this care., Methods: A descriptive study. The subjects under study were 1,357 chronically-ill patients included from the very start of a homecare program (May 1994-December 2002). Firstly, a descriptive analysis was made the main characteristics of this population. Afterward, using Cox's proportional hazards model, the factors linked to survival were assessed, as well as having plotted the corresponding cumulative survival probability curves using the Kaplan-Meier method., Results: Predominant female population (68%), and an average age of 82 (DE: 11 years). Worth of special note were the lack of elevators (76%) and loneliness (18%). Eleven percent (11%) of the patients were totally dependent for all of their daily living activities, whilst approximately 20% revealed severe cognitive disorders. With regard to the homecare, the program target of 2-3 visits/patient/year for the medical staff and off 4-6 visits/patient/year for the nursing staff were surpassed. The flu vaccine injections were always above the 70% target, whilst the tetanus vaccine injections increased yearly., Conclusions: The population cared for under this program is characterized by being greatly aged, with a high death rate and requiring continuous homecare. During the ten years studied, most of the objectives previously set were achieved.

Objective: To assess the consumption of psychiatric drugs by chronic homebound patients., Design: Descriptive, longitudinal study., Setting: Raval Nord Health District, Barcelona., Patients and Other Participants: All 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active., Measurements and Main Results: Of the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmacological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01)., Conclusions: There is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity.

Objective: To assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring., Design: Descriptive, longitudinal study., Setting: "Raval Nord" Health District, Barcelona., Patients and Other Participants: All the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84)., Measurements and Main Results: After three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May 99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05)., Conclusions: It is important to assess the autonomy, cognitive capacity and comorbidity of home-bound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient.

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.

Objective: To analyse the repercussions that caring for chronically sick patients at home can have on the health of the main carers., Design: A descriptive crossover study., Setting: "Raval Nord" Health District, Barcelona., Patients and Other Participants: All the 336 chronically sick at home recorded in the home-care programme during January to March 1996. All the 236 carers identified during the same period., Measurements and Main Results: 75% of the patients and 72% of those considered the main carers answered a home questionnaire. Most of the chronically ill at home were women (67%), with an average age of 81 (SD, 11). 18% presented severe disorders in the Short Portable Mental Status Questionnaire (SPMSQ), test which showed a significant relationship (p < 0.0001) with less autonomy according to the Katz index. 36% of carers remarked physical problems such as repeated back-aches and lumbago., Conclusions: The most important disorders affecting the autonomy and mental health of chronic patients at home lead to increased psychological malaise in the career, especially if he/she is a family member.

Objectives: To describe the group of chronic patients cared for at home and the frequency of visits, and to analyse their survival at two years., Design: A longitudinal, descriptive study., Setting: Raval Nord Health District, Barcelona., Patients and Other Participants: All the 646 patients registered as chronically ill at home during the first two years of a programme of home care (May 1994 to 1996)., Measurements and Main Results: First, a descriptive analysis of the main characteristics of this population group was made, which showed that 66.6% were women and that its average age was 81 (SD, 11 years). Less autonomy meant a greater number of visits (p < 0.0001), both by the doctor and nursing staff. Nursing visits were mainly to attend bed-sores and Diabetes Mellitus. Loneliness was the greatest underlying reason for social workers' visits., Conclusions: This was a very aged population group, with high mortality and requiring on-going home care. Autonomy was a good predictor both of the frequency of visits and of these patients' survival time.

Objective: To find a predictive model for the geographical distribution of the homebound chronically ill in function of variables corresponding to censal areas., Design: A study of an ecological type., Setting: Raval Nord Health District, Barcelona., Patients and Other Participants: The study units are the 30 censal areas of Raval Nord. In each area researchers counted the number of homebound chronically ill recorded during the first three months of a home care programme (May 1994)., Measurements and Main Results: A multiple regression analysis was performed, with selection of the variables by the stepwise method of the SPSS-PC+ statistical package, taking as dependent variable "y" the number of homebound chronically ill per 1,000 inhabitants. The prognostic variables were taken from the 1991 municipal roll, and evaluated along with the distance in metres from each censal area to the primary care centre (PCC). The distribution of the homebound chronically ill in the different censal areas of Raval Nord was connected to 3 variables which, in order of analysis, were: distance to the PCC, the relationship with senile dependency and the index of family socio-economic capacity., Conclusions: Distance, senile dependence and economic resources are factors which condition the number and distribution of the homebound chronically ill.