Epidemiology of overall and early-onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort

Serrated polyps (SPs) are precursors to one-third of colorectal cancers (CRCs), with histological subtypes: hyperplastic polyps (HPs), sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs). The incidence of early-onset CRC before the age of 50 is increasing, with limited understanding of SPs in younger cohorts. Using a large colonoscopy-based cohort, we characterized epidemiologic profiles of SP subtypes, compared to conventional adenomas, with secondary analysis on early-onset polyps. Ninety-four thousand four hundred and twenty-seven patients underwent screening colonoscopies between 2010 and 2018. Demographic, endoscopic and histopathologic characteristics of each polyp subtype were described. High-risk polyps included SSLs ≥10 mm/with dysplasia and conventional adenomas ≥10 mm/with tubulovillous/villous histology/high-grade dysplasia. We examined polyp prevalence with age and compared early- (age < 50) and late-onset polyps (age ≥ 50). Eighteen thousand one hundred and twenty-five patients had SPs (4357 SSLs, 15 415 HPs, 120 TSAs) and 26 699 had conventional adenomas. High-risk SSLs were enriched in the ascending colon (44.1% vs 2.6-35.8% for other locations; P < .003). Early- and late-onset SPs had similar subsite distribution. Early-onset conventional adenomas were more enriched in the distal colon/rectum (51.8% vs 43.4%, P < .001). Multiple conventional adenomas were more represented in late-onset groups (40.8% vs 33.8%, P < .001), with no difference in SSLs. The prevalence of conventional adenomas/high-risk conventional adenomas increased continuously with age, whereas the prevalence of SSLs/high-risk SSLs was stable from age 40 years onwards. A higher proportion of women were diagnosed with early-onset than late-onset SSLs (62.9% vs 57.6%, P = .03). Conventional adenomas, SSLs, early- and late-onset polyps have distinct epidemiology. The findings have implications for improved colonoscopy screening and surveillance and understanding the etiologic heterogeneity of CRC.     

Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP)

IntroductionLung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT).MethodsClinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analysed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs.ResultsA total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumours along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%.ConclusionLargest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.     

Obstructive Sleep Apnea and Type 2 Diabetes: A Screening Approach

Obstructive sleep apnea (OSA) is a sleep disorder common among patients with type 2 diabetes (T2D). The aim of this quality improvement project was to increase identification and referral for sleep study for individuals with T2D at moderate to high risk for OSA. Pre- and post-intervention patient samples were analyzed to compare the number of referrals for sleep study. Results demonstrated that none of the patients pre-intervention were referred for sleep study compared with 77% of patients post-intervention. This project demonstrated implementing an evidence-based tool to screen patients with T2D for OSA leads to higher rates of detection and referral.     

“We see each other from a distance”: Neighbourhood social relationships during the COVID-19 pandemic matter for older adults’ social connectedness

IntroductionWe extend previous research to illustrate how individual, interpersonal and neighbourhood factors in a high-density urban setting in Vancouver, Canada, shape social connectedness experiences of community-dwelling older adults during the first wave of the COVID-19 pandemic.MethodsWe conducted 31 semi-structured interviews and collected objective measures of loneliness and social connectedness (surveys).ResultsThree dimensions of the neighbourhood environment influenced social connectedness: (i) interactions with neighbours, (ii) involvement with neighbourhood-based organizations, and (ii) outdoor pedestrian spaces. Seventy-one percent of participants felt a strong sense of belonging to their local community, while 39% were classified as high or extremely lonely.SummaryMany participants leveraged pre-existing social ties to maintain connections during the pandemic. However, volunteer outreach was vital for more isolated older adults. Although many participants felt lonely and isolated at times, the relative ease and accessibility with which they could connect with others in their neighbourhood environment, may have helped mitigate persistent loneliness.ConclusionStrategies that foster social connectedness over the longer term, need to prioritize the needs of older adults who face multiple barriers to equitable social participation.     

Oral cancer prediction by noninvasive genetic screening

Oral squamous cell carcinomas (OSCCs) develop in genetically altered epithelium in the mucosal lining, also coined as fields, which are mostly not visible but occasionally present as white oral leukoplakia (OL) lesions. We developed a noninvasive genetic assay using next-generation sequencing (NGS) on brushed cells to detect the presence of genetically altered fields, including those that are not macroscopically visible. The assay demonstrated high accuracy in OL patients when brush samples were compared with biopsies as gold standard. In a cohort of Fanconi anemia patients, detection of mutations in prospectively collected oral brushes predicted oral cancer also when visible abnormalities were absent. We further provide insight in the molecular landscape of OL with frequent changes of TP53, FAT1 and NOTCH1. NGS analysis of noninvasively collected samples offers a highly accurate method to detect genetically altered fields in the oral cavity, and predicts development of OSCC in high-risk individuals. Noninvasive genetic screening can be employed to screen high-risk populations for cancer and precancer, map the extension of OL lesions beyond what is visible, map the oral cavity for precancerous changes even when visible abnormalities are absent, test accuracy of promising imaging modalities, monitor interventions and determine genetic progression as well as the natural history of the disease in the human patient.     

Challenges for precision public health communication in the era of genomic medicine

Although still in the early stages of development, the advent of fast, high-output, and cost-effective next-generation DNA sequencing technology is moving precision medicine into public health. Before this shift toward next-generation sequencing in public health settings, individual patients met geneticists after showing symptoms and through limited family screening. In the new era of precision public health, everyone is a possible participant in genetic sequencing, simply by being born (newborn screening), by donating blood (biobanking), or through population screening. These initiatives are increasingly offered to individuals throughout their life and more individuals are encountering opportunities to use DNA sequencing. This article raises awareness of these growing areas and calls for different models of public engagement and communication about genomics, including screening asymptomatic populations, obtaining consent for unspecified and unforeseen future uses of genomic data, and managing variants of uncertain significance. Given that such communication challenges loom large, established norms of practice in genomic medicine and research should be reconsidered.     

High-Order Positivity-Preserving Well-Balanced Discontinuous Galerkin Methods for Euler Equations with Gravitation on Unstructured Meshes

In this paper, we propose a high-order accurate discontinuous Galerkin (DG) method for the compressible Euler equations under gravitational fields on unstructured meshes. The scheme preserves a general hydrostatic equilibrium state and provably guarantees the positivity of density and pressure at the same time. Comparing with the work on the well-balanced scheme for Euler equations with gravitation on rectangular meshes, the extension to triangular meshes is conceptually plausible but highly nontrivial. We first introduce a special way to recover the equilibrium state and then design a group of novel variables at the interface of two adjacent cells, which plays an important role in the well-balanced and positivity-preserving properties. One main challenge is that the well-balanced schemes may not have the weak positivity property. In order to achieve the well-balanced and positivity-preserving properties simultaneously while maintaining high-order accuracy, we carefully design DG spatial discretization with well-balanced numerical fluxes and suitable source term approximation. For the ideal gas, we prove that the resulting well-balanced scheme, coupled with strong stability preserving time discretizations, satisfies a weak positivity property. A simple existing limiter can be applied to enforce the positivity-preserving property, without losing high-order accuracy and conservation. Extensive one- and two-dimensional numerical examples demonstrate the desired properties of the proposed scheme, as well as its high resolution and robustness.     

Considerations for systematic reviews of quantitative surveys: Learnings from a systematic review of the Patients’ Attitudes Towards Deprescribing questionnaire

This commentary looks at the process of conducting a systematic review of surveys and validated questionnaires. Surveys and other questionnaire style tools are often used in the field of social and administrative pharmacy, to capture beliefs, attitudes and experiences of patients and healthcare professionals (including pharmacists). Currently, there is little guidance available on how to conduct a systematic review of these types of studies. Considerations related to the process of a systematic review are highlighted, including identification of articles, data extraction, assessing quality of articles and synthesis and analysis of data.     

Mobile daily diaries to characterize stressors and acute health symptoms in an environmental justice neighborhood

Low-income communities and communities of color face multiple, cumulative environmental and social burdens. Methods development in environmental justice research has largely focused on spatial and quantitative approaches. Less attention has been paid to developing methodologies that help collect information on everyday stressors and quality of life experiences for residents in overburdened communities. Mixed methods approaches can be one way to structure study designs that help consider how residents experience environmental and socioeconomic impacts in a localized community context. In neighborhoods burdened by cumulative stressors, traditional cross-sectional epidemiological research designs can also be challenging, as well as limited or narrow in their application. However, repeat sampling of measures within a vulnerable population can approach a quasi-experimental design and help consider variations within residents in a single neighborhood as well as better parse relationships between exposures and outcomes. Through a community-academic partnership with university partners, local community partners, and a local promotores de salud (community health workers) network, we pilot tested a novel mobile daily diary approach in both English and Spanish in an urban, predominantly immigrant community in South Los Angeles as a potential method to collect information on daily stress, environmental quality, and health status/symptoms. We collected resident responses via a once per day 7-day SMS/text messaging survey. We sought to gather granular data on daily resident experiences of air pollution and environmental hazards. Residents reported acute health symptoms and stressors, with repeat measures demonstrating how residents might rank, categorize, or cope with stressors. We find that residents in environmental justice communities record variation in their daily diary responses and document changes in environmental quality, stressors, and odors. Refining this type of method could enable a more rigorous examination of co-occurrences of environmental quality and acute health symptoms. This approach supports the inclusion of residents in the research process and helps more systematically integrate open-ended environmental health relevant data in environmental justice efforts. Used with measured data such as air monitoring or health measures, mixed methods generated data can help support efforts that aim to alleviate sources of daily stress, alongside efforts to reduce overall pollution burdens. Mobile daily diaries can be one way to capture variable responses to environmental quality, acute health symptoms, and stressors.     

A systematic review of the methodological quality of economic evaluations in genetic screening and testing for monogenic disorders

PurposeUnderstanding the value of genetic screening and testing for monogenic disorders requires high-quality, methodologically robust economic evaluations. This systematic review sought to assess the methodological quality among such studies and examined opportunities for improvement.MethodsWe searched PubMed, Cochrane, Embase, and Web of Science for economic evaluations of genetic screening/testing (2013-2019). Methodological rigor and adherence to best practices were systematically assessed using the British Medical Journal checklist.ResultsAcross the 47 identified studies, there were substantial variations in modeling approaches, reporting detail, and sophistication. Models ranged from simple decision trees to individual-level microsimulations that compared between 2 and >20 alternative interventions. Many studies failed to report sufficient detail to enable replication or did not justify modeling assumptions, especially for costing methods and utility values. Meta-analyses, systematic reviews, or calibration were rarely used to derive parameter estimates. Nearly all studies conducted some sensitivity analysis, and more sophisticated studies implemented probabilistic sensitivity/uncertainty analysis, threshold analysis, and value of information analysis.ConclusionWe describe a heterogeneous body of work and present recommendations and exemplar studies across the methodological domains of (1) perspective, scope, and parameter selection; (2) use of uncertainty/sensitivity analyses; and (3) reporting transparency for improvement in the economic evaluation of genetic screening/testing.