Cap-Assisted Colonoscopy Increases Detection of Advanced Adenomas and Polyps

BACKGROUND

Cap-assisted colonoscopy (CAC) has been reported to increase the adenoma detection rate (ADR) in Asian population. However, CAC trials in non-Asian population have had conflicting results. Studies in North America have shown an improvement in ADRs with the use of CAC, but it mainly included white and African American patients. Given the lack of prospective studies of CAC in Hispanics, we conducted this randomized controlled trial.

MATERIALS AND METHODS

This is a randomized controlled trial comparing CAC with standard colonoscopy (SC) in patients undergoing screening or surveillance colonoscopy. Our primary outcome was the ADR. Secondary outcomes were polyp detection rate, mean polyp and ADR, advanced ADR (AADR) and detection rates based on polyp morphology and location.

RESULTS

A total of 440 patients were included in the study (88.5% Hispanic). Cecal and terminal ileum intubation rates were similar in both groups (CAC: 97% and 86% versus SC: 99% and 81%, respectively). CAC did not improve ADR in comparison with SC (0.65 versus 0.52; P = 0.079); however, CAC had a higher AADR in comparison with SC (9.9% versus 4.6%; P = 0.049). CAC detected significantly more pedunculated polyps as compared with flat and sessile polyps (P = 0.011). Complication rates were similar in the CAC and SC groups (0.9% versus 0%).

CONCLUSIONS

In a predominantly Hispanic population, no difference was seen in the mean ADR with the use of CAC. However, CAC, when compared with SC, resulted in an increased AADR and mean polyp detection rate.

Racial disparities in health care access among pediatric patients with craniosynostosis

OBJECTIVE Disparities in surgical access and timing to care result from a combination of complex patient, social, and institutional factors. Due to the perception of delayed presentation for overall health care services and treatment in African American patients on the part of the senior author, this study was designed to identify and quantify these differences in access and care between African American and Caucasian children with craniosynostosis. In addition, hypotheses regarding reasons for this difference are discussed. METHODS A retrospective study was conducted of 132 children between the ages of 0 and 17 years old who previously underwent operations for craniosynostosis at a tertiary pediatric care facility between 2010 and 2013. Patient and family characteristics, age at surgical consultation and time to surgery, and distance to primary care providers and the tertiary center were recorded and analyzed. RESULTS Of the 132 patients in this cohort, 88% were Caucasian and 12% were African American. The median patient age was 5 months (interquartile range [IQR] 2-8 months). African Americans had a significantly greater age at consult compared with Caucasians (median 341 days [IQR 192-584 days] vs median 137 days [IQR 62-235 days], respectively; p = 0.0012). However, after being evaluated in consultation, there was no significant difference in time to surgery between African American and Caucasian patients (median 56 days [IQR 36-98 days] vs median 64 days [IQR 43-87 days], respectively). Using regression analysis, race and type of synostoses were found to be significantly associated with a longer wait time for surgical consultation (p = 0.01 and p = 0.04, respectively, using cutoff points of ≤ 180 days vs > 180 days). Distance traveled to primary care physicians and to the tertiary care facility did not significantly differ between groups. Other factors such as parental education, insurance type, household income, and referring physician type also showed no significant difference between racial groups. CONCLUSIONS This study identified a correlation between race and age at consultation, but no association with time to surgery, distance, or family characteristics such as household income, parental education, insurance type, and referring physician type. This finding implies that delays in early health-seeking behaviors and subsequent referral to surgical specialists from primary care providers are the main reason for this delay among African American craniofacial patients. Future studies should focus on further detail in regards to these barriers, and educational efforts should be designed for the community and the health care personnel caring for them.

Characterization of the Hispanic or latino population in health research: a systematic review

The size and diversity of the Hispanic population in the United States has dramatically increased, with vast implications for health research. We conducted a systematic review of the characterization of the Hispanic population in health research and described its implications. Relevant studies were identified by searches of PubMed, Embase Scopus, and Science/Social Sciences Citation Index from 2000 to 2011. 131 articles met criteria. 56% of the articles reported only "Hispanic" or "Latino" as the characteristic of the Hispanic research population while no other characteristics were reported. 29% of the articles reported language, 27% detailed country of origin and 2% provided the breakdown of race. There is great inconsistency in reported characteristics of Hispanics in health research. The lack of detailed characterization of this population ultimately creates roadblocks in translating evidence into practice when providing care to the large and increasingly diverse Hispanic population in the US.

Characteristics of colorectal cancer survival in an urban county hospital

PURPOSE

Disparities in colorectal cancer (CRC) survival have been associated with race/ethnicity, screening, and insurance status, but less is known about how geographic and socioeconomic heterogeneity may modulate these factors. We examined CRC outcomes in an urban underserved population with sociodemographic factors distinctly different than those previously studied.

METHODS

In this 11-year retrospective study, the demographics and clinical features of 331 CRC patients from a Northern California urban county hospital were reviewed. Cox proportional hazards modeling was used to evaluate differences in 5-year mortality.

RESULTS

The study cohort consisted of 38 % Whites, 37 % Asians, 22 % Hispanics, and 4 % Blacks. Most of the patients either had government-sponsored insurance (62.5 %) or were uninsured (21.8 %). Compared to national SEER data, stage IV disease was more prevalent in our study cohort (37 vs 20 %) and the overall 5-year survival rate was worse (52.9 vs 64.3 %). CRC screening was associated with improved survival (hazard ratio (HR) 0.24, P=0.002), while insurance status was not. In the multivariate analysis, advanced age (HR 2.48, confidence interval (CI) 1.39-4.42, P=0.002) and late stage (stage IV: HR 32.46, CI 9.92-106.25, P<0.001) predicted worse outcomes. Contrary to some population-based studies, Hispanics in our cohort had significantly better overall mortality compared to Whites (HR 0.46, CI 0.29-0.74, P=0.001).

CONCLUSIONS

Disparities in CRC outcomes for urban underserved populations persist. However, there is geographic and socioeconomic heterogeneity in factors that have been previously shown to contribute to mortality. Screening and therapeutic strategies formulated from larger population-based studies may not be generalizable to these unique subpopulations.

Colonoscopy for colorectal cancer screening above age 75: outcomes in symptomatic african american and Hispanic adults

BACKGROUND

US Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adults above 75 years of age. Considerations to support screening in an individual patient are not clearly described. There is limited data to support recommendations in African American (AA) and Hispanics population.

METHODS

We reviewed records of 568 inpatient colonoscopies carried out at our Mt. Sinai Hospital Medical Center, Chicago during 2006-2008 for symptomatic adults ≥75 years of age. Subjects with previous normal screening colonoscopies and presence of one or more "generally indicated" indications as per American Society for Gastrointestinal Endoscopy guidelines were included in the study.

RESULTS

A total of 155 adults (mean age, 81.8 years; 29% males and 71% females; 83.8% AAs and 16.1% Hispanics) met the inclusion criteria. Seventy-nine percent had one previous colonoscopy, whereas 21% of the patients had two or more previous colonoscopies. Common indications for a repeat colonoscopy were anemia 69.7%, hematochezia 39.4%, and fecal occult blood 19.4%. Colonoscopy was completed to the cecum in 65.2% of the subjects. Advanced adenomas/cancers were found in 15/155 (9.7%) colonoscopies. CRC detection rate was 14/155 (9%), of which 9/14 (75%) were staged III/IV. Two (1.3%) patients had complications which resolved conservatively.

CONCLUSION

Symptomatic AAs and Hispanics ≥75 have a high incidence of CRC despite a previous normal colonoscopy. Presence of male sex, new onset anemia and hematochezia, and longer colonoscopy intervals are associated with CRC detection on colonoscopy. The detection of advanced cancer and high comorbidity/low life expectancy limit the benefit of CRC detection.

Demographic disparities among children with frequent ear infections in the United States

OBJECTIVES/HYPOTHESIS

To evaluate current racial/ethnic and socioeconomic disparities in the prevalence of frequent ear infections (FEI) among children in the United States.

STUDY DESIGN

Cross-sectional study.

METHODS

The National Health Interview Survey (years 1997 to 2006) was utilized to evaluate children who were reported by their parent/guardian to have "3 or more ear infections during the past 12 months." Demographic variables evaluated included age, sex, race/ethnicity, income level, and insurance status. Multivariate analyses determined the influence of demographic variables on the prevalence of FEI in children.

RESULTS

Among an annualized population of 72.6 million children (average age, 8.55 +/- 0.19 years), 4.65 +/- 0.07 million children (6.6 +/- 0.1%) reported FEI. FEI was more commonly reported in white (7.0 +/- 0.1%) and Hispanic (6.2 +/- 0.2%) than in black (5.0 +/- 0.2%) and other race/ethnic groups (4.5 +/- 0.3%, P < .001). A larger portion of children in households below the poverty level reported FEI (8.0 +/- 0.3%, P < .001). Of children with no health insurance 5.4 +/- 0.3% had FEI. On multivariate analysis, black, Hispanic and other race/ethnic group had decreased odds ratio for FEI relative to white children (odds ratios: 0.63, 0.76, and 0.60, respectively, all P < .001). Income below poverty level also predicted FEI (odds ratio, 1.322, P < .001), whereas lack of insurance coverage did not (P = .181).

CONCLUSIONS

Despite increasing awareness, there are still notable racial/ethnic and socioeconomic disparities among children with FEI. Further efforts to eliminate these disparities and improve the care of children with FEI are needed.