Social vs. practical problems in attaining a colonoscopy: Different patient profiles?

Background: Colonoscopy is an effective procedure for identifying precancerous polyps and cancerous lesions, but it is unlike other cancer screening tools in that it requires sedation and thus assistance from at least one other individual. The intent of this paper was to identify logistical problems in completing the colonoscopy and to examine their relationships with sociodemographic characteristics. Methods: All eligible patients (n = 2500) from two academic-affiliated colonoscopy centers (one free standing, one hospital-based) were invited to participate in an onsite, pre-colonoscopy survey; patients agreeing to participate (n = 1841, RR = 73.6%) received a $5.00 gift card. Multiple correspondence analysis (MCA) was used to identify the underlying dimensional structure of the problems. Bivariate statistics were performed to compare demographic variables and health literacy levels among patients reporting problems. Multivariate logistic regression with a backwards conditional solution was used to determine the demographic variables independently associated with problems. Results: Multiple correspondence analyses indicated two dimensions of problems (social and practical). Using logistic regression, social problems (e.g., finding someone to accompany the patient) were associated with not living in the same home as the driver, not working due to disability, and younger age. Practical problems (e.g., making an appointment) were associated with “other” minority race, poorer health, lower health literacy, and younger age. Conclusion: Patients experience different problems completing the colonoscopy based on socio-demographics. Particularly at risk are patients who find it difficult to navigate the system, are of younger age, or who may have smaller social networks

Evaluating preferences for colorectal cancer screening in individuals under age 50 using the Analytic Hierarchy Process

In 2021, the United States Preventive Services Task Force updated their recommendation, stating that individuals ages 45-49 should initiate screening for colorectal cancer. Since several screening strategies are recommended, making a shared decision involves including an individual’s preferences. Few studies have included individuals under age 50. In this study, we use a multicriteria decision analysis technique called the Analytic Hierarchy Process to explore preferences for screening strategies and evaluate whether preferences vary by age. Participants evaluated a hierarchy with 3 decision alternatives (colonoscopy, fecal immunochemical test, and computed tomography colonography), 3 criteria (test effectiveness, the screening plan, and features of the test) and 7 sub-criteria. We used the linear fit method to calculate consistency ratios and the eigenvector method for group preferences. We conducted sensitivity analysis to assess whether results are robust to change and tested differences in preferences by participant variables using chi-square and analysis of variance. Of the 579 individuals surveyed, 556 (96%) provided complete responses to the AHP portion of the survey. Of these, 247 participants gave responses consistent enough (CR < 0.18) to be included in the final analysis. Participants that were either white or have lower health literacy were more likely to be excluded due to inconsistency. Colonoscopy was the preferred strategy in those < 50 and fecal immunochemical test was preferred by those over age 50 (p = 0.002). These results were consistent when we restricted analysis to individuals ages 45-55 (p = 0.011). Participants rated test effectiveness as the most important criteria for making their decision (weight = 0.555). Sensitivity analysis showed our results were robust to shifts in criteria and sub-criteria weights. We reveal potential differences in preferences for screening strategies by age that could influence the adoption of screening programs to include individuals under age 50. Researchers and practitioners should consider at-home interventions using the Analytic Hierarchy Process to assist with the formulation of preferences that are key to shared decision-making. The costs associated with different preferences for screening strategies should be explored further if limited resources must be allocated to screen individuals ages 45-49.https://doi.org/10.1186/s12913-021-06705-

A novel marine bioinvasion vector: Ichthyochory, live passage through fish

Many species of Indo-Pacific holobenthic foraminifera have been introduced and successfully established sustainable populations in the Mediterranean Sea over the past few decades. However, known natural and anthropogenic vectors do not explain how these species were introduced long distances from their origin. We present evidence for a novel marine bioinvasion vector explaining this long-distance transport and introduction using both contemporary field and historical analyses. In 2015–2016, we found living specimens of 29 foraminiferal species in the fecal pellets of two Red Sea herbivorous rabbitfish—Siganus rivulatus and Siganus luridus in the Mediterranean. In our historical analysis, we found 34 foraminiferal species in preserved Red Sea rabbitfish specimens, dating between 1967 and 1975. In addition, we found congruent propagation patterns of the non-indigenous rabbitfish and foraminifera, lagging 4–11 yrs between discoveries, respectively. Predation of marine benthos by non-indigenous fish, followed by incomplete digestion and defecation of viable individuals, comprise the main introduction vector of these organisms into novel environments

Universal Screening for Familial Colorectal Cancer Syndromes at Seattle Cancer Care Alliance: Qualitative Study of Providers involved in Implementation and Patients Experience with First Wave of Testing

Thesis (Master's)--University of Washington, 2016-06Introduction: In 2013 the Seattle Cancer Care Alliance (SCCA) implemented universal screening procedures for people who present with colorectal cancer in order to help identify high risk families for which Lynch Syndrome testing would be effective. This qualitative thesis reports on patients experience with the first round of universal screening procedures at the SCCA including their thoughts about colorectal cancer. Provider interviews about the implementation process are used as key informant interviews to explore barriers and facilitators to implementation. Methods: Qualitative interview procedures were utilized for both patient and provider interviews. Patient interviews were coded using Nvivo software to extract themes and analyze data. Results: Providers indicate that implementation of universal screening procedures for Lynch Syndrome are successful. Despite this, the majority of patients did not remember the purpose of the testing or its implications for the health of themselves or their families. Patients also report openness about sharing health information among their families citing varying degrees of support and communication. Conclusion: Public health interventions can target patients and families to ensure uptake of knowledge and sharing of health information among family members for familial diseases like colorectal cancer

COLORECTAL CANCER SCREENING IN INDIVIDUALS UNDER AGE 50: USING A SHARED-DECISION-MAKING FRAMEWORK TO EXPLORE KNOWLEDGE, PREFERENCES, AND DESIRED ROLE

The rates for colon and rectal cancer (CRC) are increasing at an alarming rate in individuals under the age of 50. Because of this, The American Cancer Society gave a qualified recommendation for average risk adults to initiate colorectal cancer screening at age 45. This recommendation challenges the long-standing guidelines to begin screening at age 50. If adopted, this would add approximately 19 million Americans to the eligible screening pool. This shift in thinking is controversial and researchers and guideline recommending organizations have responded with caution. While a large body of literature on CRC screening exists, very few studies have focused on individuals under the age of 50 due to the previous, relative consensus on guidelines. Because the uncertainty and relative equality of screening strategies and outcomes, patients under 50 and clinicians making decisions about screening should consider a shared decision-making framework. In this dissertation, I explored differences in several constructs of the shared decision-making framework by age (<50 & ≥50) using a sample of 579 participants drawn from MTurk, a global crowdsourcing workforce that is often utilized for research studies. In paper 1, I evaluated knowledge of CRC risk factors and symptoms and found that age moderated the relationships between several independent variables including perceived likelihood of getting cancer and numeracy with total knowledge scores. In paper 2, I explored preferences for colorectal cancer screening strategies using a multicriteria decision analysis technique called the Analytic Hierarchy Process and found that participants <50 preferred colonoscopy more often than those ≥50. In paper 3 I used multinomial logistic regression and found that participants <50 preferred the shared and passive role compared to the active role for deciding whether to get screened and deciding which strategy to use more often than participants ≥50. These findings will act as a foundation for future work if it becomes necessary to incorporate younger people into colorectal cancer screening programs

The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics.

Women with inflammatory bowel disease (IBD) have similar rates of fertility to the general population, but have an increased rate of adverse pregnancy outcomes compared with the general population, which may be worsened by disease activity. Infertility is increased in those undergoing ileal pouch-anal anastomosis. Anti-tumor necrosis factor therapy in pregnancy is considered to be low risk and compatible with use during conception in men and women and during pregnancy in at least the first two trimesters. Infliximab (IFX) and certolizumab pegol are also compatible with breastfeeding, but safety data for adalimumab (ADA) are awaited. The safety of natalizumab during pregnancy is unknown. For children with Crohn's disease (CD), IFX is effective at inducing and maintaining remission. Episodic therapy is not as effective as scheduled infusions. Disease duration in children does not appear to affect the efficacy of IFX. IFX promotes growth in prepubertal and early pubertal Crohn's patients. It is also effective for the treatment of extraintestinal manifestations. ADA is effective for children with active CD and for maintaining remission, even if they have lost response to IFX, although there are fewer data. Vaccination of infants exposed to biological therapy in utero should be given at standard schedules during the first 6 months of life, except for live-virus vaccines such as rotavirus. Inactivated vaccines may be safely administered to children with IBD, even when immunocompromised

Views of Cohort Study Participants about Returning Research Results in the Context of Precision Medicine.

BackgroundThe practice of biorepository-based genetics research raises questions related to what ethical obligations researchers have to their participants. It is important to explore and include the thoughts of current biorepository participants as we move forward with this type of research.MethodsThirty participants (17 cancer patients, 7 cancer-free controls, and 6 relatives) were drawn from the Northwest Cancer Genetics Registry and participated in qualitative interviews lasting between 45 and 90 min. Topics explored in this study include which types of genetic test results participants of large biorepositories expect and would like to receive from research analyzing their samples, as well as thoughts on best practice for conducting this type of research.ResultsCancer cases, controls, and first-degree relatives have differing views on what results they would like to receive from biorepository-based research. Participants across all groups attempted to balance the costs and benefits of returning individual research results.DiscussionIn the wake of precision medicine, it is important to describe the range of ways participants in large biorepositories both think and talk about the utilization of their specimens for genetics research

Ulcerative colitis: Paediatric ulcerative colitis--can we predict proctocolectomy?

Given the early onset of ulcerative colitis in children, it is desirable to identify young patients with this disease who are at risk of adverse outcomes. Identification of these patients would enable the introduction of disease-modifying therapies early in the disease course and thus prevent the need for surgical therapy

The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD With the European Crohn's and Colitis Organization: Pregnancy and Pediatrics

Women with inflammatory bowel disease (IBD) have similar rates of fertility to the general population, but have an increased rate of adverse pregnancy outcomes compared with the general population, which may be worsened by disease activity. Infertility is increased in those undergoing ileal pouch-anal anastomosis. Anti-tumor necrosis factor therapy in pregnancy is considered to be low risk and compatible with use during conception in men and women and during pregnancy in at least the first two trimesters. Infliximab (IFX) and certolizumab pegol are also compatible with breastfeeding, but safety data for adalimumab (ADA) are awaited. The safety of natalizumab during pregnancy is unknown. For children with Crohn's disease (CD), IFX is effective at inducing and maintaining remission. Episodic therapy is not as effective as scheduled infusions. Disease duration in children does not appear to affect the efficacy of IFX. IFX promotes growth in prepubertal and early pubertal Crohn's patients. It is also effective for the treatment of extraintestinal manifestations. ADA is effective for children with active CD and for maintaining remission, even if they have lost response to IFX, although there are fewer data. Vaccination of infants exposed to biological therapy in utero should be given at standard schedules during the first 6 months of life, except for live-virus vaccines such as rotavirus. Inactivated vaccines may be safely administered to children with IBD, even when immunocompromised