The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known ...about the association between this rate and patients' risks of a subsequent colorectal cancer (interval cancer) and death.
Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions.
We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval CI, 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98).
The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.).
Background: Exposure to organophosphate (OP) pesticides, well-known neurotoxicants, has been associated with neurobehavioral deficits in children. Objectives: We investigated whether OP exposure, as ...measured by urinary dialkyl phosphate (DAP) metabolites in pregnant women and their children, was associated with attention-related outcomes among Mexican-American children living in an agricultural region of California. Methods: Children were assessed at ages 3.5 years (n = 331) and 5 years (n = 323). Mothers completed the Child Behavior Checklist (CBCL). We administered the NEPSY-II visual attention sub-test to children at 3.5 years and Conners' Kiddie Continuous Performance Test (K-CPT) at 5 years. The K-CPT yielded a standardized attention deficit/hyperactivity disorder (ADHD) Confidence Index score. Psychometricians scored behavior of the 5-year-olds during testing using the Hillside Behavior Rating Scale. Results: Prenatal DAPs (nanomoles per liter) were nonsignificantly associated with maternal report of attention problems and ADHD at age 3.5 years but were significantly related at age 5 years CBCL attention problems: β = 0.7 points; 95% confidence interval (CI), 0.2-1.2; ADHD: β = 1.3; 95% CI, 0.4-2.1. Prenatal DAPs were associated with scores on the K-CPT ADHD Confidence Index > 70th percentile odds ratio (OR) = 5.1; 95% CI, 1.7-15.7 and with a composite ADHD indicator of the various measures (OR = 3.5; 95% CI, 1.1-10.7). Some outcomes exhibited evidence of effect modification by sex, with associations found only among boys. There was also limited evidence of associations between child DAPs and attention. Conclusions: In utero DAPs and, to a lesser extent, postnatal DAPs were associated adversely with attention as assessed by maternal report, psychometrician observation, and direct assessment. These associations were somewhat stronger at 5 years than at 3.5 years and were stronger in boys.
We propose an integrative model for the development of anti-racism in white adolescents that unpacks and combines critical consciousness, color consciousness, anti-racism, and Critical Race Theory ...frameworks. Black and Brown youth in the U.S. face increasing rates of peer-directed racism, which contribute to long-term negative physical, psychological, academic, and behavioral outcomes. Despite increased focus on how critical consciousness and anti-racism develop uniquely in adolescence, there are no existing theories that provide an integrated, comprehensive model of anti-racist development in white adolescents. Our model unpacks and reorganizes the core features of four prominent theories into cognitive, psychological, and behavioral components of anti-racism development in white adolescents based on existing research to support a next-generation of hypotheses for future research. In doing so, we aim to provide a contemporary theoretical foundation for research that will elucidate anti-racism development among white youth, and help to dismantle structural racism against Black and Brown people in the U.S.
Over the past several decades, an increasing number of refugee children and families have involuntarily migrated to countries around the world to seek safety and refuge. As the refugee population ...increases, it is becoming more important to understand factors that promote and foster resilience among refugee youth. The present review examines the past 20 years of resilience research with refugee children to identify individual, family, school, community, and societal factors fostering resilience. This review highlights various factors that promote resilience among refugee children, including social support (from friends and community), a sense of belonging, valuing education, having a positive outlook, family connectedness, and connections to home culture. Recommendations for interventions and programs to promote resilience as well as future directions for resilience research are discussed.
Au cours des dernières décennies, un nombre accru d'enfants réfugiés et leurs familles ont involontairement migré vers d'autres pays à travers le monde afin d'y trouver refuge et sécurité. Face à cette population de réfugiés croissante, il devient de plus en plus important de comprendre les facteurs qui promouvoient et favorisent la résilience chez les jeunes réfugiés. La présente étude examine les recherches effectuées au cours des 20 dernières années sur la résilience chez les jeunes réfugiés afin d'identifier les facteurs individuels, familiaux, scolaires, communautaires et sociaux susceptibles de favoriser la résilience. Cette étude met en lumière différents facteurs qui favorisent la résilience chez les jeunes réfugiés, y compris le soutien social (par ex. les amis, la communauté), le sentiment d'appartenance, la valorisation de l'éducation, l'optimisme, les liens familiaux et les liens avec la culture du pays d'origine. Des recommandations en matière d'interventions et de programmes pour promouvoir la résilience ainsi que des pistes de recherches futures y sont discutées.
The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results require follow-up colonoscopy. However, follow-up intervals vary, which may result in ...neoplastic progression.
To evaluate time to colonoscopy after a positive FIT result and its association with risk of colorectal cancer and advanced-stage disease at diagnosis.
Retrospective cohort study (January 1, 2010-December 31, 2014) within Kaiser Permanente Northern and Southern California. Participants were 70 124 patients aged 50 through 70 years eligible for colorectal cancer screening with a positive FIT result who had a follow-up colonoscopy.
Time (days) to colonoscopy after a positive FIT result.
Risk of any colorectal cancer and advanced-stage disease (defined as stage III and IV cancer). Odds ratios (ORs) and 95% CIs were adjusted for patient demographics and baseline risk factors.
Of the 70 124 patients with positive FIT results (median age, 61 years IQR, 55-67 years; men, 52.7%), there were 2191 cases of any colorectal cancer and 601 cases of advanced-stage disease diagnosed. Compared with colonoscopy follow-up within 8 to 30 days (n = 27 176), there were no significant differences between follow-up at 2 months (n = 24 644), 3 months (n = 8666), 4 to 6 months (n = 5251), or 7 to 9 months (n = 1335) for risk of any colorectal cancer (cases per 1000 patients: 8-30 days, 30; 2 months, 28; 3 months, 31; 4-6 months, 31; and 7-9 months, 43) or advanced-stage disease (cases per 1000 patients: 8-30 days, 8; 2 months, 7; 3 months, 7; 4-6 months, 9; and 7-9 months, 13). Risks were significantly higher for examinations at 10 to 12 months (n = 748) for any colorectal cancer (OR, 1.48 95% CI, 1.05-2.08; 49 cases per 1000 patients) and advanced-stage disease (OR, 1.97 95% CI, 1.14-3.42; 19 cases per 1000 patients) and more than 12 months (n = 747) for any colorectal cancer (OR, 2.25 95% CI, 1.89-2.68; 76 cases per 1000 patients) and advanced-stage disease (OR, 3.22 95% CI, 2.44-4.25; 31 cases per 1000 patients).
Among patients with a positive fecal immunochemical test result, compared with follow-up colonoscopy at 8 to 30 days, follow-up after 10 months was associated with a higher risk of colorectal cancer and more advanced-stage disease at the time of diagnosis. Further research is needed to assess whether this relationship is causal.
Background: Exposure to polybrominated diphenyl ether (PBDE) flame retardants is widespread, with 97% of Americans having detectable levels. Although PBDEs have been associated with reproductive and ...hormonal effects in animals, no human studies have examined their association with fertility. Objectives: This study was designed to determine whether maternal concentrations of PBDEs in serum collected during pregnancy are associated with time to pregnancy and menstrual cycle characteristics. Methods: Pregnant women (n = 223) living in a low-income, predominantly Mexican-immigrant community in California were interviewed to determine how many months they took to become pregnant. Blood samples were collected and analyzed for PBDEs. PBDE concentrations were lipid adjusted and log₁₀ transformed. Analyses were limited to PBDE congeners detected in > 75% of the population (BDEs 47, 99, 100, 153). Cox proportional hazards models modified for discrete time were used to obtain fecundability odds ratios (fORs) for the association of PBDEs and time to pregnancy. Results: We detected all four congeners in > 97% of women. Increasing levels of BDEs 47, 99, 100, 153 and the sum of these four congeners were all associated with longer time to pregnancy. We observed significantly reduced fORs for BDE-100 adjusted fOR = 0.6; 95% confidence interval (CI), 0.4–0.9, BDE-153 (adjusted fOR = 0.5; 95% CI, 0.3–0.8), and the sum of the four congeners (adjusted fOR = 0.7; 95% CI, 0.5–1.0). PBDEs were not associated with menstrual cycle characteristics. Conclusions: We found significant decreases in fecundability associated with PBDE exposure in women. Future studies are needed to replicate and confirm this finding.
The immigrant paradox in childhood and adolescence is a population‐level phenomenon wherein U.S.‐born youth (or more highly acculturated immigrants) have less optimal developmental outcomes than ...newcomer immigrant youth. These patterns, which hold true after accounting for the generally lower income and parent education levels among first‐generation immigrant families, have existed for decades in the United States. In this article, we address this topic in child development research, offering insights into studies to explain why the paradox occurs from the standpoint of both risk and resilience. We also present ideas for research and implications for developing policies and methods for effective practice with immigrant families.
Objective:
In nationally funded research in the U.S., ethnicity and race are measured with checkbox questions, the limited categories of which may yield significant missing data and low salience to ...available categories, particularly among adults of color. How adolescent-generated data compare to these limited categories, and how adolescents, not just those of color, describe their culture are understudied. In our sample, we asked the following: (a) how do adolescents' ethnicity/race and culture identifications compare?, (b) how do adolescents' open-ended ethnicity/race and checkbox ethnicity/race labels compare?, and (c) how do adolescents' ethnicity/race labels compare to available categories for identification on the National Institutes of Health's (NIH's) demographic form?
Method:
Data from 76 adolescents (64.5% female, M
age = 15.78 years) were qualitatively and quantitatively analyzed.
Results:
White adolescents were as likely as adolescents of color to identify with cultural labels, and most adolescents described culture differently than race/ethnicity. White adolescents' open-ended and checkbox labels overlapped more (38.8%) than adolescents of colors' (22.5%). Only 17% of adolescents' open-ended race/ethnicity identification labels and 54% of their checkbox identifications were available on the NIH's demographic form.
Conclusions:
As measurement of demographic data is reduced to few options that favor privileged identities, innovative methods to measure individuals' identities are warranted. Using tools that do not reflect individuals' identity labels may increase error and reflects structural problems of research inequity. Our findings provide initial evidence of this methodological issue in a sample of adolescents. Building inclusive demographic tools from individuals' self-descriptors that remain feasible and practical for use can diminish inequity associated with describing "diverse" populations.
Public Significance Statement
This study provided support for measuring culture and expanding ethnicity/race reporting categories using individuals' own labels in a sample of ethnic/racially diverse adolescents. As limited-category ethnicity/race measurement forms favor privileged identities, we provide support for adapting them to be more inclusive and valid in representing an increasingly diversifying population.
Reliable community-based colorectal adenoma prevalence estimates are needed to inform colonoscopy quality standards and to estimate patient colorectal cancer risks; however, minimal data exist from ...populations with large numbers of diverse patients and examiners.
We evaluated the prevalence of adenomas detected by sex, age, race/ethnicity, and colon location among 20,792 Kaiser Permanente Northern California members ≥50 years of age who received a screening colonoscopy examination (102 gastroenterologists, 2006-2008).
Prevalence of detected adenomas increased more rapidly with age in the proximal colon (adjusted odds ratio OR, 2.39; 95% confidence interval CI, 2.05-2.80; 70-74 vs 50-54 years) than in the distal colon (OR, 1.89; 95% CI, 1.63-2.19). Prevalence was higher among men vs women at all ages (OR, 1.77; 95% CI, 1.66-1.89), increasing in men from 25% to 39% at ≥70 years and in women from 15% at 50-54 years to 26% (P < .001). Proximal adenoma prevalence was higher among blacks than whites (OR, 1.26; 95% CI, 1.04-1.54), although total prevalence was similar, including persons <60 years old (OR, 1.17; 95% CI, 0.91-1.50).
Prevalence of detected adenomas increases substantially with age and is much higher in men; proximal adenomas are more common among blacks than whites, although the total prevalence and the prevalence for ages <60 years were similar by race. These demographic differences are such that current adenoma detection guidelines may not be valid, without adjustment, for comparing providers serving different populations. The variation in prevalence and location may also have implications for the effectiveness of screening methods in different demographic groups.
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