Molecular epidemiology of norovirus in children and the elderly in Atlanta, Georgia, United States.

Noroviruses are an important cause of gastroenteritis, which can be severe at the extremes of ages. Data documenting the endemic burden of norovirus among children and elderly adults are lacking. Stool specimens submitted for clinical testing were collected from elderly (≥ 65 years) adults and children (<18 years) with acute vomiting and/or diarrhea seeking care at several metropolitan Atlanta adult and pediatric hospitals from January 2013-June 2013. Specimens were tested for norovirus with real-time RT-PCR and sequenced if norovirus was detected. Corresponding clinical and demographic data were abstracted from retrospective chart review. Norovirus was detected in 11% (11/104) of elderly specimens and 11% (67/628) of pediatric, with GII.4 Sydney_2012 detected in 64% (7/11) of elderly norovirus-positive and 11% (8/67) of pediatric specimens, P < 0.001. In comparison to hospitalized children, hospitalized elderly with norovirus were more commonly admitted to the intensive care unit (ICU) (36% vs. 7%, P = 0.02). Norovirus in the elderly can be associated with severe illness requiring ICU admissions. The pediatric group demonstrated greater variability in genotype distribution. Ongoing surveillance of norovirus genotypes is crucial for norovirus vaccine development in understanding circulating and emerging genotypes.

Rotavirus and Norovirus in Pediatric Healthcare-Associated Gastroenteritis.

Rotavirus and norovirus are important etiologies of gastroenteritis among hospitalized children. During 2012-2013, we tested 207 residual stool specimens from children with healthcare-associated vomiting and/or diarrhea for rotavirus and norovirus. Twenty (10%) were rotavirus positive, and 3 (3%) were norovirus positive, stressing the importance of these pathogens in hospitalized children.

High self-efficacy predicts adherence to surveillance colonoscopy in inflammatory bowel disease.

BACKGROUND: Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. In this study, we assessed individual self-efficacy (SE) to estimate the probability of adherence to surveillance colonoscopies. METHODS: Three hundred seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and with at least one third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. Medical charts were abstracted for demographic and clinical variables. The questionnaire contained a group of items assessing SE for undergoing colonoscopy. RESULTS: We validated our 20-question SE scale and used 8 of the items that highlighted scheduling, preparation, and postprocedure recovery, to develop 2 shorter SE scales. All 3 scales were reliable with Cronbach's α ranging from 0.845 to 0.905 and correlated with chart-documented adherence to surveillance colonoscopy (P < 0.001). We then developed logistic regression models to predict adherence to surveillance colonoscopy using each scale separately along with other key variables (i.e., disease location, knowledge of correct adherence intervals, and information sources of patients consulted regarding Crohn's disease and ulcerative colitis) and demonstrated model accuracy up to 74%. CONCLUSIONS: SE, as measured by our validated scales, correlates with chart-adherence to surveillance colonoscopy. Our adherence model, which includes SE, predicts adherence with 74% certainty. An 8-item validated clinical questionnaire can be administered to assess whether patients in this population may require further intervention for adherence.

Factors that affect adherence to surveillance colonoscopy in patients with inflammatory bowel disease.

BACKGROUND: Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. This study explores factors that affect adherence to surveillance colonoscopy. METHODS: Three hundred and seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. RESULTS: Two hundred and eight patients were female and 189 had ulcerative colitis. The mean age was 49.9 years and mean disease duration 22.9 years. The total number of surveillance colonoscopies performed was 1529, and the mean number per patient was 4.01. The mean interval between surveillance colonoscopies was 2.71 years; 282 patients had a mean interval of <3 years. Self-reported adherence was consistently higher than chart-documented adherence. Significant categories of reasons for nonadherence were logistics (P = 0.012), health perceptions (P = 0.0001); stress regarding procedure, job, or personal life (P = 0.0002); and procedure problems (P = 0.001). The most frequently cited most important reason was difficulty with the bowel preparation (18 patients; 4.8%). Of the 26 patients with inflammatory bowel disease-related dysplasia, 3 had cancer, 4 high-grade dysplasia, 15 low-grade dysplasia, and 4 indefinite dysplasia. Detection of dysplasia was not related to adherence or to lack of adherence. CONCLUSIONS: In this study, 25.5% of our patients underwent surveillance colonoscopies at >3-year intervals on average. Significant categories of reasons for nonadherence included logistics, health perceptions, stress, and procedure problems.

Doctor message can alter patients' behavior and attitudes regarding inflammatory bowel disease and colon cancer.

BACKGROUND: Patients with extensive ulcerative (UC) or Crohn's (CD) colitis have an increased risk of colon cancer and require colonoscopic surveillance. This study explores patient attitudes and behavior regarding inflammatory bowel disease (IBD), colonoscopies, and colon cancer risk. METHODS: In all, 514 patients with UC or CD colitis for at least 7 years and at least one-third of the colon involved participated in this cross-sectional questionnaire study performed at three tertiary referral IBD clinics. RESULTS: In all, 288 patients were female, 262 had UC, and 252 had CD. The mean age was 48 (range, 20-88) and mean number of years with symptoms was 20 (range, 7-51); 70.8% reported "my doctor" as an extensive information source. The mean perceived lifetime risk of developing colon cancer without having routine colonoscopies was 56% (SD 24.193). We developed and validated a scale of 10 important messages that IBD patients remember doctors discussing with them ("Doctor Told Scale"). Higher scores correlated with better quality of life (P < 0.001) and positive descriptors of colonoscopies and IBD (P < 0.001). Patients with higher scores perceived a higher chance of getting colon cancer without having surveillance colonoscopies (P < 0.001) and were more likely to report that the correct surveillance interval is every 2 years (P < 0.01). CONCLUSIONS: Patients who remember their doctor's messages are more likely to have a positive outlook about colonoscopies and IBD, have a better quality of life, undergo surveillance colonoscopies at the correct interval, and perceive cancer risk more realistically.