Background: Metabolic syndrome has been linked to an increased risk of colorectal cancer (CRC) incidence and mortality, but whether adopting a healthy lifestyle could attenuate the risk of CRC conferred by metabolic syndrome remains unclear. The aim of the study is to investigate the individual and joint effects of modifiable healthy lifestyle and metabolic health status on CRC incidence and mortality in the UK population. Methods: This prospective study included 328,236 individuals from the UK Biobank. An overall metabolic health status was assessed at baseline and categorized based on the presence or absence of metabolic syndrome. We estimated the association of the healthy lifestyle score (derived from 4 modifiable behaviors: smoking, alcohol consumption, diet, physical activity and categorized into "favorable," "intermediate", and "unfavorable") with CRC incidence and mortality, stratified by metabolic health status. Results: During a median follow-up of 12.5 years, 3,852 CRC incidences and 1,076 deaths from CRC were newly identified. The risk of incident CRC and its mortality increased with the number of abnormal metabolic factors and decreased with healthy lifestyle score (P trend = 0.000). MetS was associated with greater CRC incidence (HR = 1.24, 95% CI: 1.16 - 1.33) and mortality (HR = 1.24, 95% CI: 1.08 - 1.41) when compared with those without MetS. An unfavorable lifestyle was associated with an increased risk (HR = 1.25, 95% CI: 1.15 - 1.36) and mortality (HR = 1.36, 95% CI: 1.16 - 1.59) of CRC across all metabolic health status. Participants adopting an unfavorable lifestyle with MetS had a higher risk (HR = 1.56, 95% CI: 1.38 - 1.76) and mortality (HR = 1.75, 95% CI: 1.40 - 2.20) than those adopting a favorable healthy lifestyle without MetS. Conclusion: This study indicated that adherence to a healthy lifestyle could substantially reduce the burden of CRC regardless of the metabolic status. Behavioral lifestyle changes should be encouraged for CRC prevention even in participants with MetS.

BACKGROUND: A compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery. OBJECTIVE: This scoping review aimed to map global evidence on the status of CRC health service delivery practice. METHODS: An exhaustive literature review and Delphi technique were used to answer the 2 research questions: ""What is the current status of CRC health care practices among health workers?"" and ""Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?"" The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis. RESULTS: A total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices. CONCLUSIONS: This scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal.