Longitudinal Adherence With Fecal Occult Blood Test Screening in Community Practice

PURPOSE Although screening with fecal occult blood testing (FOBT) reduces colorectal cancer (CRC) mortality, its effectiveness may diminish if patients do not adhere with repeated screenings. Among patients who had previously engaged in FOBT screening, we assessed subsequent adherence with FOBT screening.METHODS We assessed longitudinal adherence with biennial FOBT screening (every other year) within a cohort of patients enrolled in an integrated Washington State health plan. Among 11,110 patients who participated in FOBT screening during a 2-year baseline period (2000–2001), we ascertained CRC screening use during a subsequent 2-year observation period (2002–2003). We used multinomial logistic regression to identify patient characteristics associated with higher incidence of repeat CRC screening (with or without FOBT) relative to patients who received no CRC screening.RESULTS Despite prior participation in FOBT screening, less than one-half of patients (44.4%; 95% CI, 42.9%–45.8%) completed FOBT screening during the 2-year observation period. Although 8.8% of patients (95% CI, 8.0%–9.7%) received other CRC tests without FOBT during the observation period, nearly one-half, 46.8% (95% CI, 45.3%–48.4%), received no CRC screening. After adjustment for other patient characteristics, receipt of a preventive health examination was strongly associated with FOBT adherence relative to no CRC screening (adjusted relative rate ratio = 11.16; 95% CI, 9.61–12.96).CONCLUSIONS Longitudinal adherence with FOBT screening was low in this insured population, potentially compromising its effectiveness in population CRC mortality reduction. Interventions to promote adherence may be necessary to achieve high effectiveness in population-based FOBT screening programs.     

Human papillomavirus infection and lymphoma incidence using cervical conization as a surrogate marker: a Danish nationwide cohort study

Persistent human papillomavirus (HPV) infection may promote carcinogenesis by hyperactivation of the immune system. We, therefore, explored the associations between HPV infection and risk of Hodgkin and non‐Hodgkin lymphoma in a nationwide cohort study using conization as a surrogate marker. We identified all Danish women who underwent conization between 1978 and 2011. We computed standardized incidence ratios and 95% confidence intervals for Hodgkin and non‐Hodgkin lymphoma based on national cancer incidence rates. Among 87 435 women who underwent conization, we noted an increased incidence of Hodgkin (standardized incidence ratio 1.48, 95% confidence interval 1.05–2.02) but only a slight increase for non‐Hodgkin lymphoma (standardized incidence ratio 1.10, 95% confidence interval 0.97–1.25). As measured by conization, HPV infection is associated with an increased risk of lymphoma. This association may be attributable to a chronic immune activation induced by persistent HPV infection and/or failure of the immune system both to clear HPV infection and to control lymphoma development. Copyright © 2015 John Wiley & Sons, Ltd.     

Changes in urinary excretion of water and sodium transporters during amiloride and bendroflumethiazide treatment

AIM:To quantify changes in urinary excretion of aquaporin2 water channels(u-AQP2),the sodiumpotassium-chloride co-transporter(u-NKCC2) and the epithelial sodium channels(u-ENa C) during treatment with bendroflumethiazide(BFTZ),amiloride and placebo.METHODS:In a randomized,double-blinded,placebocontrolled,3-way crossover study we examined 23 healthy subjects on a standardized diet and fluid intake.The subjects were treated with amiloride 5 mg,BFTZ 1.25 mg or placebo twice a day for 4.5 d before each examination day.On the examination day,glomerular filtration rate was measured by the constant infusion clearance technique with 51Cr-EDTA as reference substance.To estimate the changes in water transport via AQP2 and sodium transport via NKCC2 and ENa C,u-NKCC2,the gamma fraction of ENa C(u-ENa Cγ),andu-AQP2 were measured at baseline and after infusion with 3% hypertonic saline.U-NKCC2,u-ENa Cγ,u-AQP2 and plasma concentrations of vasopressin(p-AVP),renin(PRC),angiotensin Ⅱ(p-ANG Ⅱ) and aldosterone(p-Aldo) were measured,by radioimmunoassay.Central blood pressure was estimated by applanation tonometry and body fluid volumes were estimated by bio-impedance spectroscopy.General linear model with repeated measures or related samples Friedman's two-way analysis was used to compare differences.Post hoc Bonferroni correction was used for multiple comparisons of post infusion periods to baseline within each treatment group.RESULTS:At baseline there were no differences in u-NKCC2,u-ENa Cγ and u-AQP2.PRC,p-Ang Ⅱ and p-Aldo were increased during active treatments(P 0.001).After hypertonic saline,u-NKCC2 increased during amiloride(6% ± 34%;P = 0.081) and increased significantly during placebo(17% ± 24%;P = 0.010).U-AQP2 increased significantly during amiloride(31% ± 22%;P 0.001) and placebo(34% ± 27%;P 0.001),while u-NKCC2 and u-AQP2 did not change significantly during BFTZ(-7% ± 28%;P = 0.257 and 5% ± 16%;P = 0.261).U-ENa Cγ increased in all three groups(P 0.050).PRC,AngⅡ and p-Aldo decreased to the same extent,while AVP increased,but to a smaller degree during BFTZ(P = 0.048).c DBP decreased significantly during BFTZ(P 0.001),but not during amiloride or placebo.There were no significant differences in body fluid volumes.CONCLUSION:After hypertonic saline,u-NKCC2 and u-AQP2 increased during amiloride,but not during BFTZ.Lower p-AVP during BFTZ potentially caused less stimulation of NKCC2 and AQP2 and subsequent lower reabsorption of water and sodium.     

Who should staff neonatal transport teams?

Neonatal transport is variously staffed by diverse combinations of nurses, doctors and paramedical staff. There is no evidence that neonatal transport undertaken with staff from any particular professional background results in improved outcomes for infants; instead, it appears that beneficial outcomes result from using staff who are specifically trained in transport practice, regardless of their professional background. Core transport competencies that are transferrable should be a routine part of the training of transport team members.