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Pedrós Barnils N, Schüz B. Intersectional analysis of inequalities in self-reported breast cancer screening attendance using supervised machine learning and PROGRESS-Plus framework. Front Public Health 2024; 11:1332277. [PMID: 38249401 PMCID: PMC10796495 DOI: 10.3389/fpubh.2023.1332277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Background Breast cancer is a critical public health concern in Spain, and organized screening programs have been in place since the 1990s to reduce its incidence. However, despite the bi-annual invitation for breast cancer screening (BCS) for women aged 45-69, significant attendance inequalities persist among different population groups. This study employs a quantitative intersectional perspective to identify intersectional positions at risk of not undergoing breast cancer screening in Spain. Methods Women were selected from the 2020 European Health Interview Survey in Spain, which surveyed the adult population (> 15 years old) living in private households (N = 22,072; 59% response rate). Inequality indicators based on the PROGRESS-Plus framework were used to disentangle existing social intersections. To identify intersectional groups, decision tree models, including classification and regression trees (CARTs), chi-squared automatic interaction detector (CHAID), conditional inference rees (CITs), and C5.0, along with an ensemble algorithm, extreme gradient boosting (XGBoost), were applied. Results XGBoost (AUC 78.8%) identified regional differences (Autonomous Community) as the most important factor for classifying BCS attendance, followed by education, age, and marital status. The C5.0 model (balanced accuracy 81.1%) highlighted that the relative importance of individual characteristics, such as education, marital status, or age, for attendance differs based on women's place of residence and their degree of interaction. The highest risk of not attending BCS was observed among illiterate older women in lower social classes who were born in Spain, were residing in Asturias, Cantabria, Basque Country, Castile and León, Extremadura, Galicia, Madrid, Murcia, La Rioja, or Valencian Community, and were married, divorced, or widowed. Subsequently, the risk of not attending BCS extends to three other groups of women: women living in Ceuta and Melilla; single or legally separated women living in the rest of Spain; and women not born in Spain who were married, divorced, or widowed and not residing in Ceuta or Melilla. Conclusion The combined use of decision trees and ensemble algorithms can be a valuable tool in identifying intersectional positions at a higher risk of not utilizing public resources and, thus, can aid substantially in developing targeted interventions to increase BCS attendance.
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Affiliation(s)
- Núria Pedrós Barnils
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
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2
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Medina-Perucha L, Pistillo A, Raventós B, Jacques-Aviñó C, Munrós-Feliu J, Martínez-Bueno C, Valls-Llobet C, Carmona F, López-Jiménez T, Pujolar-Díaz G, Flo Arcas E, Berenguera A, Duarte-Salles T. Endometriosis prevalence and incidence trends in a large population-based study in Catalonia (Spain) from 2009 to 2018. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221130566. [PMID: 36281527 PMCID: PMC9608029 DOI: 10.1177/17455057221130566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Endometriosis greatly impacts women’s health and quality of life. However, research on the prevalence and incidence of endometriosis remains inconclusive. This study assesses time trends in the prevalence and incidence of endometriosis diagnoses in Catalonia (Spain) from 2009 to 2018, considering differences by age and socioeconomic status. Methods: Population-based cohort study using data from the Information System for Research in Primary Care (SIDIAP) database. Data were included from over 2.4 million women aged 15–55 years between 1 January 2006 and 31 December 2018. Results: A total of 2,337,717 women were selected as the incident population; 0.7% had an endometriosis diagnosis. Median (interquartile range) age at diagnosis was 37 (32–43) years. Most women were European (92.3%) and lived in urban areas (73.6%). Overall prevalence of endometriosis consistently increased during the 2009–2018 period, and it was 1.24% in 2018. Trends were the highest for women with less socioeconomic deprivation and for the 35–44 years age group. Median incidence rates were 94.9 (92.6–102.9) per 100,000 women-years, being the highest in women aged 35–44 years throughout the whole study period. Overall, incidence increased between 2015 and 2017, and plateaued or decreased in 2018. Incidence rates in women from the most deprived and rural areas were lower, although incidence time trends by socioeconomic status were unclear. Conclusion: Healthcare services and public health strategies need to be strengthened to ensure timely endometriosis diagnosis and treatment. Special attention should be given to the most affected populations and the social inequities of health.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Berta Raventós
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordina Munrós-Feliu
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de la Salut, Barcelona, Spain,Sexual and Reproductive Health Care Research Group (GRASSIR), University Institute in Primary Care Research Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Sexual and Reproductive Health Care Research Group (GRASSIR), University Institute in Primary Care Research Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain,Servei d’Atenció a la Salut Sexual i Reproductiva (ASSIR), Direcció Assistencial d’Atenció Primària, Institut Català de la Salut, Barcelona, Spain,Universitat de Barcelona, Barcelona, Spain
| | | | - Francisco Carmona
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Pujolar-Díaz
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Flo Arcas
- Associació d’Afectades d’Endometriosi de Catalunya (EndoCat), Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain,Departament d’Infermeria, Universitat de Girona, Girona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain,Talita Duarte-Salles, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain.
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Gkiouleka A, Huijts T. Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender. Soc Sci Med 2020; 267:113218. [PMID: 32732096 DOI: 10.1016/j.socscimed.2020.113218] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.
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Affiliation(s)
- Anna Gkiouleka
- Department of Sociology, University of York, Wentworth College, Heslington, YO10 5DD, York, UK.
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4
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Mahumud RA, Keramat SA, Ormsby GM, Sultana M, Rawal LB, Alam K, Gow J, Renzaho AMN. Wealth-related inequalities of women's knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis. Int J Equity Health 2020; 19:42. [PMID: 32216799 PMCID: PMC7098106 DOI: 10.1186/s12939-020-01159-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women's knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. METHODS A total of 1,802,413 sample observations from 18 RCC's latest national-level Demographic and Health Surveys (2008 to 2017-18) were analysed to assess wealth-related inequalities in terms of women's knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women's knowledge and utilisation of CCS services. RESULTS Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d'Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women's knowledge of CCS services were male-headed households (- 2.24%; 95% CI: - 3.10%, - 1.59%; P < 0.01), currently experiencing amenorrhea (- 1.37%; 95% CI: - 2.37%, - 1.05%; P < 0.05), having no problems accessing medical assistance (- 10.00%; 95% CI: - 12.65%, - 4.89%; P < 0.05), being insured (- 6.94%; 95% CI: - 9.58%, - 4.29%; P < 0.01) and having an urban place of residence (- 9.76%; 95% CI: - 12.59%, - 5.69%; P < 0.01). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (- 8.23%;95% CI: - 12.46%, - 5.80%; P < 0.01), being unemployed (- 14.16%; 95% CI: - 19.23%, - 8.47%; P < 0.01) and living in urban communities (- 9.76%; 95% CI: - 15.62%, - 5.80%; P < 0.01). CONCLUSIONS Women's knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.
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Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences, Western Sydney University, Penrith-2751, New South Wales, Australia. .,Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia. .,Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Dhaka, 1212, Bangladesh. .,Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia. .,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.
| | - Syed Afroz Keramat
- Economics Discipline, Social Science School, Khulna University, Khulna, 9208, Bangladesh
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh.,Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Lal B Rawal
- School of Health Medical and Allied Sciences, CQUniversity Sydney, Sydney, New South Wales, Australia
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, 4350, Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Andre M N Renzaho
- School of Social Sciences, Western Sydney University, Penrith-2751, New South Wales, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, New South Wales, Australia
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Grimley CE, Kato PM, Grunfeld EA. Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence. Br J Health Psychol 2019; 25:107-128. [PMID: 31876992 DOI: 10.1111/bjhp.12397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.
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Affiliation(s)
| | - Pamela M Kato
- P. M. Kato Consulting, Mountain View, California, USA
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck College, University of London, UK
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6
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Merino-Ventosa M, Urbanos-Garrido RM. Changes in income-related inequalities in cervical cancer screening during the Spanish economic crisis: a decomposition analysis. Int J Equity Health 2018; 17:184. [PMID: 30545425 PMCID: PMC6293596 DOI: 10.1186/s12939-018-0894-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/20/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cervical cancer is one of the most prevalent cancers, but it may be prevented by early detection. Social inequalities in the use of cytology testing have been identified in the literature. However, the degree of income-related inequality has not been quantified and determinants of inequality changes during the economic crisis remain unknown. METHODS Using the Spanish National Health Surveys (2006-07 / 2011-12), we analyzed how income-related inequalities in the use of cervical cancer screening for women aged 25-64 changed across the economic crisis. We used corrected concentration indices (CCI) which were further decomposed in order to compute the contribution of the explanatory variables. An Oaxaca-type approach was employed to investigate the origin of changes over time. RESULTS Our final sample consisted of 10,743 observations in 2006-07 and 6587 in 2011-12. Despite the higher prevalence of screening over time (from 73.9 to 77.9%), pro-rich inequality significantly increased (from CCI = 0.1726 to CCI = 0.1880, p < 0.001). Income was the main determinant of inequality in cervical screening, although its contribution decreased over time, as well as the contribution of the type of health insurance, mainly due to changes in elasticity. Other factors, such as nationality or the educational level, seem to have played an important role in the increase of pro-rich inequality of cytology testing. CONCLUSIONS Reducing cervical screening inequalities would require actions focused on most vulnerable groups such as migrants, low income and low educated population. The implementation of population-based screening programs would also help to cope with income-related inequalities in cytology testing.
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Affiliation(s)
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, School of Economics, Complutense University of Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Madrid, Spain
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Crampe-Casnabet C, Franck JE, Ringa V, Coeuret-Pellicer M, Chauvin P, Menvielle G. Role of obesity in differences in cervical cancer screening rates by migration history. The CONSTANCES survey. Cancer Epidemiol 2018; 58:98-103. [PMID: 30530110 DOI: 10.1016/j.canep.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/02/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immigrant women often have lower cervical cancer screening (CCS) rates, tend to have a higher body mass index (BMI) and may be more vulnerable to BMI-related stigmatization. Our aim was to assess the role of BMI in differences in CCS rates by migration history. METHODS Analyses were based on the 2012-2015 inclusion data (n = 27,226) for the population-based CONSTANCES cohort, including detailed, self-reported information on demographics and socioeconomic characteristics, migration history, health behaviours, health, and health care use. Measured BMI (underweight (<18.5), normal-weight (18.5-25), overweight (25-30), obese (>30)) was collected. Poisson regression models with robust variance were conducted to assess the contribution of BMI to differences in CCS rates by migration history, and analyses stratified by BMI were done. Multiple imputations were performed. RESULTS The CCS rates ranged from 87% among French-born women with two French parents to 86% among French-born women with at least one parent of foreign origin, 82% among naturalized immigrants and 74% among non-naturalized immigrants. After adjusting for covariates, non-naturalized immigrants showed an 11% (95% CI: 8%-14%) lower CCS rate than French-born women with two French parents. Adjusting for BMI did not change the estimates. When stratifying by BMI category, non-naturalized immigrants showed an 11% (7%-14%) lower CCS rate then French-born with two French parents when normal weight, a 9% (2%-16%) lower CCS rate when overweight, and an 18% (5%-30%) lower CCS rate when obese. CONCLUSION Migration history and BMI jointly impact CCS rates. They were lower among all non-naturalized immigrants, particularly those who were obese.
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Affiliation(s)
- Cyrielle Crampe-Casnabet
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Jeanna-Eve Franck
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Virginie Ringa
- CESP, INSERM U1018, Univ Paris-Saclay, Univ Paris-Sud, UVSQ, Villejuif, France.
| | - Mireille Coeuret-Pellicer
- Inserm, Population-based Epidemiologic Cohorts Unit, UMS 011, Villejuif, France; University of Versailles St-Quentin, UMRS 1018, Villejuif, France.
| | - Pierre Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
| | - Gwenn Menvielle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Department of social epidemiology, F75012 Paris, France.
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March S, Villalonga B, Sanchez-Contador C, Vidal C, Mascaro A, Bennasar MDL, Esteva M. Barriers to and discourses about breast cancer prevention among immigrant women in Spain: a qualitative study. BMJ Open 2018; 8:e021425. [PMID: 30455384 PMCID: PMC6252688 DOI: 10.1136/bmjopen-2017-021425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To identify knowledge, barriers and discourses about breast cancer screening in Spain among female immigrants from low-income countries and native Spanish women from a low socioeconomic class. DESIGN Qualitative interview study with thematic analysis interpreted using cultural mediators. SETTING Mallorca, Spain. PARTICIPANTS Thirty-six in-depth interviews, using cultural mediators, of immigrant women living in Mallorca who were 50-69 years old and were from Maghreb, Sub-Saharan Africa, Eastern Europe, Latin America, China or were native to Spain and from a low socioeconomic class. RESULTS We analysed the interviews to assess breast cancer perceptions and beliefs, discourses about breast cancer prevention and barriers to accessing breast cancer prevention programmes. Although the women reported an association of breast cancer with death, they acknowledged the effectiveness of early detection. They also exhibited reluctance to talk about cancer. Discourses about cancer prevention tended to be proactive or fatalistic, depending on the woman's country of origin. For all women, fear of results and lack of time were barriers that limited participation in breast cancer prevention programmes. Language barriers, frequent changes of residence and fear due to status as an irregular (undocumented) immigrant were barriers specific to immigrant women. CONCLUSIONS The culture of origin affects whether an immigrant has a fatalistic or proactive approach toward breast cancer screening. Immigrants from low-income countries and Spanish natives from a low socioeconomic class experience barriers in access to breast cancer screening. Frequently changing homes is also a barrier for immigrant women.
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Affiliation(s)
- Sebastià March
- Research Unit, Primary Care Department, Balearic Islands Health Service, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Barbara Villalonga
- Arquitecto Bennassar Health Center, Majorca Primary Care Department, Balearic Islands Health Service, Palma, Spain
| | | | - Clara Vidal
- Research Unit, Primary Care Department, Balearic Islands Health Service, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Aina Mascaro
- Majorca Primary Care Department, Balearic Islands Health Service, Palma, Spain
| | - Maria de Lluc Bennasar
- Research Unit, Primary Care Department, Balearic Islands Health Service, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
| | - Magdalena Esteva
- Research Unit, Primary Care Department, Balearic Islands Health Service, Balearic Islands Health Research Institute (IdISBa), Palma, Spain
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Idehen EE, Koponen P, Härkänen T, Kangasniemi M, Pietilä AM, Korhonen T. Disparities in cervical screening participation: a comparison of Russian, Somali and Kurdish immigrants with the general Finnish population. Int J Equity Health 2018; 17:56. [PMID: 29728104 PMCID: PMC5935973 DOI: 10.1186/s12939-018-0768-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervical cancer is currently ranked as the fourth commonly diagnosed cancer in women globally. A higher incidence has been reported in low- and-middle-income countries, and the disease poses significant public health challenges. Evidence suggests that this disease is preventable by means of regular screening using the Papanicolaou (Pap) test. However, limited knowledge exists about disparities in cervical screening participation among immigrants compared with non-immigrants, in countries with universal cervical screening programmes. We aimed to examine disparities in cervical screening participation among women of Russian, Somali, and Kurdish, origin in Finland, comparing them with the general Finnish population (Finns). We controlled for differences in several socio-demographic and health-related variables as potential confounders. Methods We employed data from the Finnish Migrant Health and Well-being Study 2010–2012 and the National Health 2011 Survey. Data collection involved face-to-face interviews. Data on screening participation in the previous five years from women aged 29–60 were available from 537 immigrants (257 Russians, 113 Somalis, 167 Kurds) and from 436 Finns. For statistical analyses, we used multiple logistic regression. Results Age-adjusted screening participation rates were as follows: Russians 79% (95% CI 72.9–84.4), Somalis 41% (95% CI 31.4–50.1), and Kurds 64% (95% CI 57.2–70.8), compared with 94% (95% CI 91.4–95.9) among Finns. After additionally adjusting for socio-demographic and health-related confounders, all the immigrant groups showed a significantly lower likelihood of screening participation when compared with Finns. The Odds Ratios were as follows: Russians 0.32 (95% CI 0.18–0.58), Somalis 0.10 (95% CI 0.04–0.23), and Kurds 0.17 (95% CI 0.09–0.35). However, when additionally accounting for country of origin-confounder interactions, such differences were attenuated. Conclusions Our results indicate disparities in screening participation among these immigrants and a lower likelihood of screening participation compared with the general Finnish population. To improve equity in cervical cancer screening participation, appropriate culturally tailored intervention programmes for each immigrant group might be beneficial.
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Affiliation(s)
- Esther E Idehen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.
| | - Päivikki Koponen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tellervo Korhonen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Yliopistoranta 1, P. O. Box 1627, 70211, Kuopio, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Carmona-Torres JM, Cobo-Cuenca AI, Martín-Espinosa NM, Piriz-Campos RM, Laredo-Aguilera JA, Rodríguez-Borrego MA. [Prevalence in the performance of mammographies in Spain: Analysis by Communities 2006-2014 and influencing factors]. Aten Primaria 2018; 50:228-237. [PMID: 28732722 PMCID: PMC6836949 DOI: 10.1016/j.aprim.2017.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the frequency of the performance of mammography with preventive purpose of the screening of breast cancer in Spanish women, the evolution between the years 2006-2014, the sociodemographic profile of the women who undergo the mammography and to analyze the factors that influence in their adhesion. DESIGN Transversal study. SITES Spain. PARTICIPANTS A total of 53.628 women over 15 years old that are surveyed in the National Health Survey in Spain 2006 and 2011/12 and the European Health Survey in Spain 2009 and 2014. MEASUREMENTS The following variables were used: mammography, frequency of mammography performance and the reason for the realization, as well as sociodemographic variables. Social class was obtained from the last occupation of the main family supporter. A logistic regression analysis was performed with sociodemographic variables. RESULTS The prevalence of mammography has been increasing from 2006 to 2014, and also for the reason that the participants had received a letter, they were telephoned or offered in their Health Center to undergo this test. There are significant differences in the performance of mammography in the different autonomous communities. CONCLUSIONS Performing mammography has increased significantly from 2006 to 2014, although there are still differences between autonomous communities, with Ceuta and Melilla being the least percentage of performed mammography. The factors that are related to greater performed mammography are: higher educational level, higher social class, married civil status, Spanish nationality and age.
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Affiliation(s)
- Juan Manuel Carmona-Torres
- Universidad de Castilla-La Mancha (UCLM), E.U. Enfermería y Fisioterapia de Toledo, Toledo, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| | - Ana Isabel Cobo-Cuenca
- Universidad de Castilla-La Mancha (UCLM), E.U. Enfermería y Fisioterapia de Toledo, Toledo, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España.
| | | | - Rosa María Piriz-Campos
- Universidad de Castilla-La Mancha (UCLM), E.U. Enfermería y Fisioterapia de Toledo, Toledo, España
| | | | - María Aurora Rodríguez-Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Universidad de Córdoba, Córdoba, España; Hospital Universitario Reina Sofía, Córdoba, España
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11
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Graetz V, Rechel B, Groot W, Norredam M, Pavlova M. Utilization of health care services by migrants in Europe-a systematic literature review. Br Med Bull 2017; 121:5-18. [PMID: 28108435 DOI: 10.1093/bmb/ldw057] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/25/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. SOURCES OF DATA A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. AREAS OF AGREEMENT Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. AREAS OF CONTROVERSY Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. GROWING POINTS Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. AREAS TIMELY FOR DEVELOPING RESEARCH A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants.
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Affiliation(s)
- V Graetz
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - B Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
| | - W Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
| | - M Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - M Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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12
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Visioli CB, Crocetti E, Zappa M, Iossa A, Andersson KL, Bulgaresi P, Alfieri A, Amunni G. Participation and risk of high grade cytological lesions among immigrants and Italian-born women in an organized cervical cancer screening program in Central Italy. J Immigr Minor Health 2016; 17:670-8. [PMID: 24917238 DOI: 10.1007/s10903-014-0050-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Few studies analyzed the risk for high-grade squamous intraepithelial lesions or worse (HSIL+) among immigrants and natives attending organized cervical cancer (CC) screening programs (SP). We evaluated participation and diagnosis of HSIL+ by country of birth with logistic models. Overall 540,779 invitation letters were delivered to target women of Florence SP in three screening rounds (years 2000-2002, 2003-2005, 2006-2008). The probability of attending screening was lower for immigrants than natives, but the difference decreased from 35% (1st round) to 20% (2nd-3rd round) for women born in high migration pressure (HMP) countries. The risk of HSIL+ was double than natives for HMP-born women from countries with high prevalence of human papillomavirus, even adjusting for age and previous history of Pap test. This is an important public health problem due to an increasing proportion over time of immigrant women with a lower attendance and greater risk for CC.
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Affiliation(s)
- Carmen Beatriz Visioli
- Clinical and Descriptive Epidemiology Unit, ISPO - Istituto per lo Studio e la Prevenzione Oncologica, Via delle Oblate 2, 50144, Florence, Italy,
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13
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González-Rábago Y, La Parra D, Martín U, Malmusi D. Participación y representatividad de la población inmigrante en la Encuesta Nacional de Salud de España 2011-2012. GACETA SANITARIA 2014; 28:281-6. [DOI: 10.1016/j.gaceta.2014.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022]
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14
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Prévention des cancers du col de l’utérus et du sein chez les femmes en situation de grande précarité : étude épidémiologique. Bull Cancer 2014; 101:663-8. [DOI: 10.1684/bdc.2014.1919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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To what extent is women's economic situation associated with cancer screening uptake when nationwide screening exists? A study of breast and cervical cancer screening in France in 2010. Cancer Causes Control 2014; 25:977-83. [PMID: 24842393 DOI: 10.1007/s10552-014-0397-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 05/08/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE In France, larger social inequalities are reported for cervical cancer screening, based on individual practice, than for breast cancer screening for which organized screening exists. Our aim was to investigate the association between women's economic situation and breast and cervical cancer screening. METHODS We used data from a large French national health survey conducted in 2010. The economic situation was assessed using the number of adverse economic conditions respondents were facing, based on three variables (low income, lacking food, and perceived financial difficulties). Logistic regressions were adjusted for socioeconomic and sociodemographic characteristics, healthcare use and insurance, and health behaviors. RESULTS Mammography was less frequent among women experiencing two or more adverse economic conditions, whereas Pap smear was less frequent among women experiencing at least one adverse economic condition. For both screenings, higher rates were observed among women who lived in the Paris region. Sociodemographic indicators and health behaviors were associated with Pap smear, whereas healthcare use and insurance characteristics were associated with mammography. CONCLUSIONS The women's economic situation is an important determinant of breast and cervical cancer screening in France in 2010. Alleviating economic barriers to female cancers screening should be a priority in future programs implementation.
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Rodríguez-Salés V, Roura E, Ibañez R, Peris M, Bosch FX, de Sanjosé S. Coverage of Cervical Cancer Screening in Catalonia for the Period 2008-2011 among Immigrants and Spanish-Born Women. Front Oncol 2013; 3:297. [PMID: 24392348 PMCID: PMC3868944 DOI: 10.3389/fonc.2013.00297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/25/2013] [Indexed: 01/09/2023] Open
Abstract
Background: Female immigration in Catalonia, Spain, increased dramatically in the last 10 years. The Public Health system in the Region, provides a free of charge opportunistic cervical cancer screening. Aim: This study examines cervical cancer screening coverage and prevalence of cytology abnormalities in Catalonia by immigration status. Methods: The study analyzes the cytologies registered among women aged 25–65 that have been attended at the Primary Health Centers (PHC) for any reason (n = 1,242,230) during 2008–2011. Coverage was estimated from Governmental data base Information System Primary Care (SISAP) that includes 77% of PHC. The database is anonymous, and includes information on age, country of birth, diagnostic center, and cytology results. Results: During the period 2008–2011, 642,643 smears were performed in a total of 506,189 women over 14 years, of whom 18.3% were immigrants. Cytology coverage was higher among immigrant women compared to Spanish born (51.2 and 39% respectively). Immigrant women also had a higher prevalence of abnormal Paps compared to the Spanish population, 4.5 and 2.9% respectively (p < 0.001). Conclusion: Immigrant women in Catalonia had a high access to the Public Health Services and to cervical cancer screening facilities. The higher prevalence of abnormal cytologies in immigrant women compared to native women indicates the relevance to prioritize cervical cancer screening activities on a regular base in new comers.
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Affiliation(s)
- Vanesa Rodríguez-Salés
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Esther Roura
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain ; CIBER en Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
| | - Raquel Ibañez
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Mercè Peris
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain
| | - Sílvia de Sanjosé
- Unit of Infections and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL , Barcelona , Spain ; CIBER en Epidemiología y Salud Pública (CIBERESP) , Barcelona , Spain
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17
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Pons-Vigués M, Puigpinós-Riera R, Rodríguez D, Fernández de Sanmamed MJ, Pasarín MI, Pérez G, Borrell C, Casamitjana M, Benet J. Country of origin and prevention of breast cancer: Beliefs, knowledge and barriers. Health Place 2012; 18:1270-81. [DOI: 10.1016/j.healthplace.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 08/27/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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18
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Sanz-Barbero B, Sopacua M, Otero-García L, Borda-Olivas A, Zunzunegui MV. Inequalities in the use of mammography in Spain: effect of caring for disabled family. Int J Public Health 2012; 57:953-7. [PMID: 22890613 DOI: 10.1007/s00038-012-0395-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 07/02/2012] [Accepted: 07/11/2012] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the association between caring for disabled household members and the use of mammography in Spain during the 2 years before the interview. METHODS Weighted cross-sectional data from the 2006 National Health Survey in Spain. Using logistic regression models we analyzed the association between the dependent variable and caring for disabled family members. RESULTS After adjusting for predisposing, enabling and need determinants of the use of mammography screening, having primary caregiving responsibilities for disabled family members-dependent persons, was associated with a lower probability of having received a mammogram (OR 0.56; 95 % CI 0.32-0.98). CONCLUSIONS Although women in Spain have incorporated mammography into their preventive healthcare regimen, inequalities in its use persist in some groups of women such those with primary caregiving responsibilities for disabled family members.
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Affiliation(s)
- Belén Sanz-Barbero
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
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19
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Pons-Vigués M, Puigpinós-Riera R, Serral G, Pasarín MI, Rodríguez D, Pérez G, Benet J, Casamitjana M, Borrell C. Knowledge, attitude and perceptions of breast cancer screening among native and immigrant women in Barcelona, Spain. Psychooncology 2011; 21:618-29. [DOI: 10.1002/pon.1940] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 01/12/2011] [Accepted: 01/24/2011] [Indexed: 11/10/2022]
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