The potential limitations of colonoscopy for prevention of incidence and mortality from colorectal cancer that develops in the proximal colon raise very important questions, particularly on the ...incremental benefit of colonoscopy over flexible sigmoidoscopy for colorectal cancer screening. Here, Baxter and Rabeneck explore the effectiveness of colonoscopy for reducing the burden of colorectal cancer in the population.
Summary
Background : Two surgical procedures with curative intent are available to patients with rectal cancer: lower anterior resection and abdominoperineal resection; however, lower anterior ...resection may improve quality of life and functional status.
Aim : To examine temporal changes in after lower anterior resection and abdominoperineal resection between 1989 and 2000. Potential factors associated with the use of lower anterior resection were evaluated.
Methods : Using national administrative data, we identified patients who received lower anterior resection or abdominoperineal resection. Logistic regression models examined the association between use of lower anterior resection and time period of surgical resection.
Results : A total of 5201 rectal cancer patients underwent resection. The use of lower anterior resection increased from 40.0% (1989–91) to 50.1% (1998–2000) paralleled by a corresponding decline in abdominoperineal resection (60.1 to 49.9%; P < 0.001). Patients who received surgery during 1992–94, 1995–97 and 1998–2000 were 6, 7 and 28% more likely to receive lower anterior resection, when compared with 1989–1991 after adjusting for demographic characteristics, co‐morbidity and hospital surgical volume. Older age, lower co‐morbidity score and lower hospital surgical volume were predictive of lower anterior resection.
Conclusions : An increase in the use of lower anterior resection for rectal cancer was observed over time. This observed increase in use is not confined to high‐volume hospitals.
The incidence and mortality rates for colorectal cancer (CRC) in Canada are among the highest in the world. For individuals >/=50 yr, CRC screening is effective in reducing both CRC incidence and ...mortality. The goal of this research was to conduct a Canadian population-based study of the use of tests and procedures to evaluate the large bowel to estimate the extent of CRC screening.
We identified an inception cohort of all residents of Ontario aged 50-59 on January 1, 1995, without a previous history of CRC or large-bowel evaluation by five tests or procedures: fecal occult blood test (FOBT), barium enema, rigid sigmoidoscopy, flexible sigmoidoscopy, and colonoscopy. We followed these individuals to December 31, 2000, identified all tests received, and determined the proportion that received one or more tests or procedures of each type. Data were obtained from three sources: the Ontario Health Insurance Plan (OHIP) database, the Canadian Institute for Health Information-Discharge Abstract Database (CIHI-DAD), and the Registered Persons Database (RPDB).
We identified 982,443 individuals in our inception cohort without prior CRC or large bowel evaluation. The proportion that had at least one test or procedure was less than 10% for each type. The largest proportion (9.3%) had one or more FOBTs. Classified according to the initial test received, 14.5% had a non-endoscopic test (FOBT, barium enema) and 6% had an endoscopic test (rigid sigmoidoscopy, flexible sigmoidoscopy, colonoscopy). The majority (79.5%) had no test or procedure to evaluate the large bowel.
An extraordinarily low proportion (<20.5%) of screen-eligible 50-59-yr-old men and women in Ontario were screened for CRC during a 6-yr follow-up. Given the high burden of CRC in Canada a major opportunity exists to improve the health of Canadians by increasing our screening efforts.
AIDS enteropathy: what's in a name? Rabeneck, L
Journal of clinical gastroenterology,
1994-September, Letnik:
19, Številka:
2
Journal Article
Recenzirano
The term acquired immunodeficiency syndrome (AIDS) enteropathy was first used in 1984 to refer to changes in intestinal structure and function in human immunodeficiency virus (HIV)-infected patients. ...Since then, confusion has arisen regarding the meaning of the term. To identify the sources of this confusion we performed a methodologic critique of published clinical research on the topic. We carried out a literature search to identify clinical studies that included at least 20 subjects. Among the six cross-sectional studies we identified, no consensus exists regarding the term itself, to whom it applies, the elements on which it is based, and the criteria for its definition. Further, methodologic problems pertaining to the selection of cases and controls limited the conclusions that could be drawn from these studies. Alterations of mucosal structure and function occur in some HIV-infected patients. However, the nature of these alterations and their relationships to symptoms (diarrhea), immune function, and enteric pathogens remain unclear. Further research is needed to develop a taxonomy for AIDS enteropathy. In carrying out this research, attention to methodologic issues will be important.
We conducted a prospective cohort study to describe the association between alcohol use, HIV disease progression, and drug toxicity and to determine health care provider awareness of excessive ...alcohol use by recruiting 881 HIV-infected veterans (median age, 49 years; 99% male; 54% African American) from 3 VA HIV clinics. Twenty percent of patients were hazardous drinkers by the Alcohol Use Disorders Identification Test, 33% were binge drinkers, 32% had a chart ICD-9 alcohol diagnosis, and 12.5% and 66.7%, respectively, were described by their health care providers as currently and ever drinking “too much.” Hazardous/binge drinkers more often had detectable viral loads (P < 0.001). Patients with alcohol diagnoses more often had elevated alanine transaminase or aspartate transaminase levels (P ≤ 0.02), anemia (P < 0.001), and elevated mean corpuscular volume (P < 0.001). Health care providers missed hazardous drinking in patients with undetectable viral loads (P = 0.01), patients without hepatitis C (P = 0.09), and patients with normal aspartate transaminase levels (P = 0.07) and missed alcohol diagnoses in patients without hepatitis and those with CD4 cell counts of >200/mL. We conclude that in HIV-positive veterans, hazardous drinking and alcohol diagnoses were common and associated with HIV disease progression and/or hepatic comorbidity and anemia. Health care providers more often missed alcohol problems in patients with less severe HIV infection and those without evidence of liver disease. Health care providers should routinely screen and counsel patients regarding alcohol problems as part of standard of care to minimize disease progression and bone marrow and hepatic toxicity.
The potential association between gastroesophageal reflux disease (GERD) and extraesophageal manifestations remains unknown in children without neurological defects. We conducted a large case-control ...study to examine the association between GERD and several upper and lower respiratory disorders in these children.
We identified all patients between 2 and 18 years of age with GERD who were seen at Texas Children's Hospital between 1996 and 2000. Patients seen during the same time period without GERD were randomly selected as controls (4:1 ratio). Patients with mental retardation, cerebral palsy, or congenital esophageal anomalies were excluded. We compared the presence of several predefined upper and lower respiratory disorders in cases and controls.
We identified 1980 patients with GERD and 7920 controls without GERD. Cases and controls were without neurological deficits or congenital esophageal anomalies. Cases were older than controls (9.2 years ± 4.6 vs. 8.6 ± 4.9, P < 0.0001), and were more likely to be female (51.2% vs. 47.2%, P = 0.0028) and white (60.2% vs. 41.2%, P < 0.0001). Compared with controls in univariate analyses, cases with GERD had more sinusitis (4.2% vs. 1.4%, P < 0.0001), laryngitis (0.7% vs. 0.2%), asthma (13.2% vs. 6.8%, P < 0.0001), pneumonia (6.3% vs. 2.3%, P < 0.0001), and bronchiectasis (1.0% vs. 0.1%, P < 0.0001). However, otitis media was less common in cases than controls (2.1% vs. 4.6%, P < 0.0001). After adjusting for differences in age, gender, and ethnicity in the regression analyses, GERD remained a significant risk factor for sinusitis (adjusted odds ratio OR, 2.3; 95% confidence intervals CI, 1.7–3.2; P < 0.0001), laryngitis (OR, 2.6; CI, 1.2–5.6; P = 0.0228), asthma (OR, 1.9; CI, 1.6–2.3; P < 0.0001), pneumonia (OR, 2.3; CI, 1.8–2.9; P < 0.0001), and bronchiectasis (OR, 2.3; CI, 1.1–4.6; P = 0.0193).
GERD in children without neurological defects is associated with a several-fold increase in the risk of sinusitis, laryngitis, asthma, pneumonia, and bronchiectasis. Further studies are needed to examine whether a cause-effect relationship exists between GERD and these disorders in children.
Dyspepsia is a common problem that is important from the perspectives of both patient health and economics. While there has been variability in the definitions used to describe dyspepsia, there have ...also been few standardized outcomes tools designed to measure dyspepsia-related health, especially in relation to changes in dyspepsia over time. An evaluative tool was developed, the Severity of Dyspepsia Assessment (SODA), which takes into account the multidimensional nature of dyspepsia using three scales (Pain, Non-pain Symptoms, and Satisfaction with Dyspepsia-related Health) and demonstrates good psychometric properties with respect to validity, reliability and sensitivity to change in the measurement of dyspepsia-related health. Although originally developed for the assessment of uninvestigated dyspepsia, the validation of SODA for use in clinical trials suggested its ability to compare treatment effects of non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX)-2-specific inhibitors. In comparative trials of celecoxib or valdecoxib with non-specific NSAIDs, COX-2-specific inhibitors were demonstrated to have superior dyspepsia tolerability than non-specific NSAIDs. These data demonstrate that SODA is an effective instrument for measuring dyspepsia-related health with a broad range of applications.
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