Screening High Risk Individuals for Hepatitis B: Physician Knowledge,Attitudes, and Beliefs

Background  

Although the overall incidence of hepatitis B virus (HBV) has declined since the introduction of universal vaccine guidelines, the incidence remains elevated in high risk groups. Recent guidelines from the Centers for Disease Control (CDC) have underscored the importance of vaccination against HBV in high risk individuals. However, the incidence of HBV in this group remains elevated, suggesting underuse of vaccinations by healthcare providers.     

A Prospective Study of Young Men at High Risk for Alcoholism: Neuropsychological Assessment

As part of the first phase of a prospective longitudinal study on alcoholism, a battery of neuropsychological tests covering general intelligence, memory, attention, field-dependence, categorizing ability, and organizing and planning, was administered to 204 18-19-year-old males. Of these, 134 subjects are the sons of alcoholic fathers and are thereby themselves at high risk for becoming alcoholic. The remaining 70 subjects comprise a control group matched for several social and familial variables. The high risk group was found to have a relatively poorer vocabulary and to perform worse on tests of categorizing ability and organization and planning. All of these findings concur with other results from this study. The anticipated future alcoholics from among the high risk subjects may prove to be those who differed most on these tests.     

A Prospective Study of the Prevalence of Colonic Neoplasms in Asymptomatic Patients with an Age-Related Risk

This study was designed to determine the prevalence of colorectal neoplasia in healthy, asymptomatic adults with an age-related risk for colorectal neoplasia. Ninety patients were studied with air contrast barium enema and colonoscopy. The study population included 61 males and 21 females, with an age range of 51-82 yr (65 +/- 2 yr). Adenomatous polyps were found in 27% of males and 14% of females or 24% of patients overall. Sixty-six percent of these neoplasms were above the rectosigmoid junction and the mean size of the polyps was 6.5 +/- 1.2 mm. In two patients, carcinoma was discovered. A linear association between age and the prevalence of colonic neoplasia was not demonstrated. This study demonstrates a relatively high prevalence of colonic neoplasia in patients with an age-related risk.     

Screening HIV Patients at Risk for NAFLD Using MRI-PDFF and Transient Elastography: A European Multicenter Prospective Study

1. Download : Download high-res image (412KB)
2. Download : Download full-size image

     

Executive Cognitive Functioning Predicts Reactive Aggression in Boys at High Risk for Substance Abuse: A Prospective Study

This study assessed the ability of executive cognitive functioning (ECF) to predict reactive aggression in boys at high and low risk for substance abuse using a 2-year prospective design. ECF is defined as the self-regulation of goal-directed behavior. Reactive aggression involves impulsive hostile reactions committed with little forethought. ECF was measured using five neuropsychological tests in 198 10- to 12-year-old boys with (SA+) and without (SA-) a paternal history of substance abuse/dependence. Reactive aggression was measured, 2 years later, using a composite index of items derived from two self-report measures. It was hypothesized that ECF would predict reactive aggression, and that this relation would be stronger for the SA+ compared with the SA- boys. SA+ subjects demonstrated lower ECF scores and higher reactive aggression scores, compared with SA- controls. ECF predicted reactive aggression in the SA+ group (β= 0.37, p = 0.001), but not in the SA- group (β= 0.09, p = NS). This suggests that compromised ECF may be a risk factor for reactive aggression in SA+ youth. The hypothesis that the relation between ECF and reactive aggression is a manifestation of a mild dysfunction of the prefrontal cortex is discussed.     

Serial Defibrillation Threshold Measures in Man: A Prospective Controlled Study

Serial DFT Measures in Man. Introduction; The defibrillation threshold (DFT) may change throughout the first year following implantation of a cardioverter defibrillator, but it remains uncertain if changes are a consequence of changes in clinical condition or are related to fundamental alterations at the electrode-tissue interface. The purpose of this study was to evaluate the extent and time course of DFT changes over the first year following implantable cardioverter defibrillator (ICD) surgery when extraneous clinical and device variables potentially affecting the DFT were excluded. Methods and Results.: We prospectively enrolled 61 patients undergoing epicardial or non-thoracotomy/transvenous ICD therapy into a series of follow-up studies where the DFT was measured at implant and at 1, 6,12, and 52 weeks following implantation in a uniform manner. Stored energy DFT was measured and recorded for all patients. Patient exclusion criteria were: (1) inability to complete all five measures of the DFT; (2) institution of Class I or Class III antiarrhythmic drugs at any time during the study; (3) lead system changes (relocation or new leads) or programming changes in pulse width or current pathway; or (4) development of a significant change in their clinical status, such as decompensated congestive heart failure or acute ischemia. Only 20 of the 61 patients satisfied the criteria required to complete the study. Two of the excluded patients developed high DFTs, which required reprogramming of the current pathway. Eight patients had an epicardial lead system, and 12 had a nonthoracotomy lead system. The rise in DFT over the first 12 weeks was significant for the eight epicardial lead system patients (P = 0.05) and for the 12 nonthoracotomy lead system patients (P = 0.004). The peak rise in DFT occurred at 1 week for the patients with an epicardial lead system (3.4 ± 1.8 J to 7.9 ± 3.8 J) and at 12 weeks for the patients with a transvenous lead system (10.3 ± 5.3 J to 16.1 ± 7.4 J). Conclusions: This study confirms a transient significant rise in the DFT in the first 12 weeks following ICD surgery that partially returns to the implant value over the remainder of the year. Because specific clinical and technical variables were excluded from this study, the observations made in this patient population suggest that the rise in DFT may be a consequence of changes at the electrode-tissue interface.     

Screening Colonoscopy for Colorectal Cancer in Asymptomatic People: A Meta-Analysis

Objective The preferred method for screening asymptomatic people for colorectal cancer (CRC) is colonoscopy, according to the new American guidelines. The aim of our study was to perform a meta-analysis of the prospective cohorts using total colonoscopy for screening this population for CRC. We looked for the diagnostic yield of the procedure as well as for its safety in a screening setting. Methods We included papers with more than 500 participants and only those reporting diagnostic yield of adenoma (and/or advanced adenoma) and CRC. Nested analysis were performed for secondary endpoints of complications and CRC stages when this information was available. All analyses were performed with StatDirect Statistical software, version 2.6.1 (). Results Our search yielded ten studies of screening colonoscopy conducted in asymptomatic people that met our inclusion criteria, with a total of 68,324 participants. Colonoscopy was complete and reached the cecum in 97% of the procedures. Colorectal cancer was found in 0.78% of the participants (95% confidence interval 0.13–2.97%). Stage I or II were found in 77% of the patients with CRC. Advanced adenoma was found in 5% of the cases (95% confidence interval 4–6%). Complications were rare and described in five cohorts. Perforation developed in 0.01% of the cases (95% confidence interval 0.006–0.02%) and bleeding in 0.05% (95% confidence interval 0.02–0.09%). Conclusions Our findings support the notion that colonoscopy is feasible and a suitable method for screening for CRC in asymptomatic people.     

Asymptomatic Peptic Disease in Patients undergoing Major Elective Operations: A Prospective Endoscopic Study

Postoperative bleeding is usually attributed to stress ulcers; however, occult preoperative lesions could also be responsible. To determine their frequency and nature, we prospectively examined 72 patients endoscopically prior to major elective operations. Entry criteria included a planned stay in the Surgical Intensive Care Unit, greater than 2 days, and a negative history, physical examination, and stool guaiac. Gastric and duodenal mucosae were scored separately, using a 0- to 7-point scale. Scores were graded negative (0), hyperemia (1), gastroduodenitis (2-5), mucosal erosions (6), and ulcers (7). Erosions or ulcers were found in 14% of patients and gastroduodenitis is an additional 10%. We found that none of the 27 risk factors or any combination of factors tested correlated with ulcers, erosions, or gastroduodenitis. Thus, patients with asymptomatic gastroduodenal erosions or ulcerations could not be identified preoperatively, except by endoscopy. Until the significance of these lesions as cause of postoperative bleeding is determined, we recommend routine postoperative gastric pH titration with antacids for patients undergoing major elective operations.