María Luisa López

Impact of a web-based intervention supplemented with text messages to improve cancer prevention behaviors among adolescents: Results from a randomized controlled trial

OBJECTIVE To assess the impact of a web-based intervention supplemented with text messages to reduce cancer risk linked with smoking, unhealthy diet, alcohol consumption, obesity, sedentary lifestyle and sun exposure. METHODS A total of 2001 voluntary adolescents from Spain and Mexico were recruited between 2009 and 2012 and randomly assigned to: one control group and two experimental groups, which received exclusively the online intervention (experimental group 1) or the intervention supplemented with encouraging text messages (experimental group 2). The educational intervention was based on both: successful psychosocial models (i.e. A.S.E. and Transtheoretical model) and the school curriculum. RESULTS After a 9-month follow-up, the prevalence of students who did not eat fruit was reduced significantly in all groups: experimental group 1 (-62.6%), experimental group 2 (-71.5%) and even the control group (-66.8%). Being overweight was only reduced in the experimental group 2 (-19.6%). The total cancer behavioral risk score, which ranged from 0 to 100 points (highest risk), was significantly reduced in the experimental group 1 (-3.5 points) and in the experimental group 2 (-5.3 points). The text-supplemented online intervention increased the probability of improving the post-test total cancer behavioral risk (OR=1.62). CONCLUSION The web-based intervention supplemented with text messages had a positive global impact, but it lead to only minimal changes in risky behaviors. This intervention appears useful in controlling overweight adolescents. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN27988779.

Risk factors for second primary tumours in breast cancer survivors

Breast cancer (BC) survivors have an increased risk of developing second primary cancer (SPC). The aim of this study was to detect and compare SPC predictors linked to the host, the first BC and its treatment. Two hundred and seventeen patients with a nonbreast SPC and 465 matched controls, nested in the cohort of BC patients diagnosed in a Spanish region between 1975 and 2003, were involved in a case–control study. The Tumour Registry database provided information about the host, BC and its treatment factors. Their contribution to the risk of developing SPC was measured by means of a conditional logistic regression. After controlling for differences between cases and controls at baseline, obesity [odds ratio (OR): 7.48; 95% confidence interval (CI): 1.25–44.88], smoking (OR: 3.16; 95% CI: 1.23–8.15), high blood pressure (OR: 1.68; 95% CI: 1.04–2.71) and having first-degree relatives suffering from cancer (OR: 1.69; 95% CI: 1.05–2.72) were the best SPC predictors. The risk of SPC increases by 1% per month of survival from BC (OR: 1.01; 95% CI: 1.007–1.012), while having metastases (OR: 0.23; 95% CI: 0.14–0.37) and being premenopausal at diagnosis of the BC (OR: 0.44; 95% CI: 0.247–0.792) diminish the risk, probably decreasing survival. The treatments were the regression models worst predictors. Controlling modifiable factors linked to lifestyle such as obesity and smoking is essential to prevent SPC in survivors of BC. Health education to remove persistent risk factors should be included in the treatment protocol of BC patients, because they are important predictors of SPC.

Smoking Prevention and Young People: using research to identify out‐of‐school intervention sites in three countries

ABSTRACT This paper presents data from the first phase of a proposed 4 year smoking prevention project. In recognising a need to develop out‐of‐school interventions to complement school‐based initiatives, the pilot year of this study has been used to survey young peoples participation in different activities in the three study countries. The main part of this paper reports data from Great Britain, The Netherlands and Spain showing by country, age group and smoking status participation in out‐of‐school activities. The concluding discussion examines the commonalities of findings across the three countries and implications for the selection of intervention sites.

Emotional Intelligence and Health Risk Behaviors in Nursing Students

BACKGROUND To explore the association between emotional intelligence (EI) and risky health behaviors in nursing students at the University of Oviedo (Spain). METHOD This cross-sectional study of 275 students used a validated questionnaire to measure EI level, nine risky behaviors (smoking, excessive alcohol consumption, illicit drug use, unhealthy diet, being overweight, sedentarism, risky sun exposure, occupational risk, and unsafe sex), and other factors that may influence EI. RESULTS Students with the highest EI score had a lower probability of drinking too much alcohol (odds ratio [OR], 0.31; 95% confidence interval [CI] [0.19, 0.67]), eating too few fruits and vegetables (OR, 0.60; 95% CI [0.34, 0.99]), and having unsafe sex (OR, 0.10; 95% CI [0.01, 0.74]). A dose-response effect was found for those three behaviors (p for trend <0.02). CONCLUSION Poor EI is associated with excessive alcohol consumption, unhealthy diet, and unsafe sex. Training nursing students about EI could improve health behaviors, and thus the role of nurses as health promoters.

Behavioural cancer risk factors in women diagnosed with primary breast cancer

AIMS To investigate behavioural risk factors and self-efficacy among women diagnosed with breast cancer. BACKGROUND The appearance of new tumours in breast cancer survivors is influenced by risk behaviours. Knowing their prevalence and womens perceived ability to adopt a healthy lifestyle would allow designing educational interventions aimed at modifying these behaviours. DESIGN An observational cross-sectional study of women diagnosed with breast cancer. METHODS The study was carried out in Asturias (Spain). A total of 2407 breast cancer patients diagnosed between 1998-2008 were selected and 492 women agreed to participate. Self-reported data on risk factors self-efficacy were gathered through a telephone interview based on the European Code against Cancer conducted between February-June 2010. RESULTS A total of 16·1% of women in this study were regular smokers, 5% drank alcohol excessively, 49% were overweight, 54% reported a lower level of physical activity than recommended and 7·5% did not use sun protection. The Total Cancer Behavioural Risk indicator was calculated by adding up the results of all modifiable risks contained in the European Code against Cancer, with an average score of 21·6 in a scale from 0-78 points (0 = null cancer risk, 78 = maximum cancer risk). Self-efficacy levels were very high among our participants. CONCLUSION The results suggest that there is a need to design programmes to promote a healthy lifestyle among women diagnosed with breast cancer. Nurses have an important role to play in planning and implementing these programmes, using the most efficient educational techniques.

Diagnóstico de sospecha del cáncer en los servicios de urgencia hospitalarios

Background . To measure the frequency, trends and distribution of cancers with suspected diagnosis in the Hospital Emergency Services (HES) in Asturias during 2006-12. To describe the clinical characteristics of these cancers and to determine if they differ from those whose diagnosis is made in other services. Methods . Population based descriptive study of cancers registered in the Hospital Tumour Registry of Asturias (Spain), which provided data of patient characteristics, cancer variables (site, histology, stage, metastasis and delay), the hospital and service of diagnosis. Patients with confirmed diagnosis of cancer (non-melanoma of skin excluded) in the study period were included (N=26,020). Differences of cancer cases according to the service that had performed the suspected diagnosis were analyzed. We performed regression analysis of the time between the first symptom and the suspected diagnosis, the definitive diagnosis and treatment, controlling main confounders. Results . Seven point nine percent (n=2,056) of all cancer cases were suspected in a HES (annual minimum of 5.3% and maximum 10.4%, with an upward trend). These patients were mainly men (60.6%), with a mean age of 67.7 years, and with lung (21.0%) and colon cancer (15.5%). The HES ranks 6th place in the list of services which diagnosed cancer. There was more diagnosis of advanced tumours (33.0%) and metastasis (29.5%) in the HES. The HES halved the time between the first symptom and the SD (-63.3 days; p<0.001), and between definitive diagnosis and initiation of treatment (-15.9 days; p<0.001) compared to the other services. Conclusions . The HES contribute significantly to suspected cancer diagnosis, mainly advanced and metastatic tumours in the respiratory and digestive system, whose symptoms escape accidental diagnosis conducted in primary care, and they start abruptly.