Low Prevalence of Screen-Detected Colorectal Cancer in an Average-Risk Population: The New Normal.

Prior studies have reported the prevalence of colorectal cancer (CRC) in average-risk screening population ages 50-75 to be 0.7%-1.0%.1,2 However, no estimates from studies enrolling individuals undergoing screening colonoscopy have been reported. The experience of ongoing studies enrolling average-risk individuals is that the prevalence rates are substantially lower. A 2020 study from a community-based cohort undergoing CRC screening with fecal immunochemical testing followed by diagnostic colonoscopy reported a CRC prevalence rate of 1.46 per 1000, or 0.15%.3 The aim of our study is to report the screen-detected prevalence of CRC and advanced neoplasia in average-risk asymptomatic individuals from selected academic and community medical centers in the United States, Canada, and Germany and describe associated risk factors.

Changing patterns of referral into a family history clinic and detection of ovarian cancer: a retrospective 10-year review.

This study examines whether a change in the criteria for genetic testing for ovarian cancer risk changed the nature of referrals into our Familial Cancer service. This is a retrospective review of 273 women who underwent risk reducing surgery (RRS). The primary outcome was to establish whether there was an increase in women having RRS with a confirmed genetic mutation. Secondary outcomes included the incidence of occult cancer and of subsequent primary peritoneal cancer. The results showed an increase in women being offered RRS based on genetic diagnosis; 91% versus 32% before the criteria change. Four occult malignancies (1.5%) and two peritoneal cancers (0.7%) were noted.We have demonstrated a change in the nature of referrals to the familial cancer service from perceived risk to genetic diagnosis. We can now counsel women more accurately. With a defined risk we are enabling them to make an informed decision regarding risk reduction.

Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization.

Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.1: 'foreign body in the esophagus.' Charts were reviewed to confirm EFBI and extract pertinent data related to the ED visit, including time of presentation, length of ED stay, medications administered, type of procedure performed, characteristics of procedures, and time to therapeutic procedure. Hospital charges for EFBI encounters and consult fees were determined from the Physicians' Fee Reference 2010, and were compiled to estimate costs. Of the 548 cases of EFBI identified, 351 subjects (64%) presented to the ED. A total of 118 (34%) patients received a medication to treat EFBI, which was only effective in 8% of those patients. Two hundred ninety (83%) subjects underwent a procedure including esophagogastroduodenoscopy (EGD) (n=206) or ear, nose, and throat surgery (ENT)-performed laryngoscopy/esophagoscopy (n=138). Admission to the hospital occurred in 162 (46%) of cases. There was no relationship between ED arrival time and time-to-procedure or total time in ED. There was also no significant relationship between delivery of ED medications and likelihood of undergoing a procedure, or between ED arrival time and delivery of medications. The charges associated with a typical EFBI episode ranged from $2284-$6218. In conclusion, the majority of patients with EFBI at our institution presented to the ED. Medical management was largely ineffective. A therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that gastroenterology and ENT specialists recognize the urgency of treating EFBI regardless of time of day.

Gastric inhibitory polypeptide (GIP) in maturity-onset diabetes mellitus.

Serum GIP, insulin, and glucose concentrations were determined during a standard oral glucose tolerance test in 80 individuals, 45 of whom were normal and 35 of whom had adult-onset diabetes mellitus according to USPHS criteria. As a group, the diabetics had fasting hyperglycemia (219 +/- 17 mg./dl.) and, in response to glucose, displayed a peak serum glucose of 373 +/- 23 mg./dl. and sustained hyperglycemia (315 +/- 24 mg./dl.) at 180 minutes. There were no statistically significant differences in absolute serum insulin levels between the two groups. However, insulin secretion was delayed, IRI increments were smaller, and the IRI concentrations were inappropriately low for the simultaneous serum glucose concentrations in the diabetics at every time interval tested. Mean fasting serum GIP was 335 +/- 30 pg./ml. in the diabetics as against 262 +/- 15 pg./ml. in normal individuals (p less than 0.025). After the ingestion of glucose, diabetics had significantly higher (p less than 0.001) mean serum GIP levels between five and 120 minutes. By 180 minutes, serum GIP levels remained above fasting in both groups, but the diabetics had higher than normal serum concentrations (p less than 0.05). Peak serum GIP concentrations, which occurred at 30 minutes in both groups, were 1,376 +/- 106 and 806 +/- 75 pg./ml. in the diabetics and normals, respectively (p less than 0.001). Total integrated serum GIP was also greater in diabetics than normals (140,852 +/- 14,208 vs. 64,602 +/- 8,719 pg.-min./ml.-1, p less than 0.001). The higher serum GIP concentrations observed following glucose ingestion in diabetics could not be attributed to obesity or age. We conclude that both fasting and glucose-stimulated GIP concentrations are higher than normal in obese adult-onset diabetics. The significance of this observation is uncertain. However, since our current understanding suggests the GIP may be an important enteric signal for the release of insulin in man, and because GIP has been shown to stimulate the release of immunoreactive glucagon, GIP may play a role in the pathogenesis of diabetes mellitus.

Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study.

OBJECTIVE: Obesity is an important risk factor for type 2 diabetes. Weight loss in patients with type 2 diabetes is associated with improved glycemic control and reduced cardiovascular disease risk factors, but weight loss is notably difficult to achieve and sustain with caloric restriction and exercise. The purpose of this study was to assess the impact of treatment with orlistat, a pancreatic lipase inhibitor, on weight loss, glycemic control, and serum lipid levels in obese patients with type 2 diabetes on sulfonylurea medications. RESEARCH DESIGN AND METHODS: In a multicenter 57-week randomized double-blind placebo-controlled study, 120 mg orlistat or placebo was administered orally three times a day with a mildly hypocaloric diet to 391 obese men and women with type 2 diabetes who were aged > 18 years, had a BMI of 28-40 kg/m2, and were clinically stable on oral sulfonylureas. Changes in body weight, glycemic control, lipid levels, and drug tolerability were measured. RESULTS: After 1 year of treatment, the orlistat group lost 6.2 +/- 0.45% (mean +/- SEM) of initial body weight vs. 4.3 +/- 0.49% in the placebo group (P < 0.001). Twice as many patients receiving orlistat (49 vs. 23%) lost > or = 5% of initial body weight (P < 0.001). Orlistat treatment plus diet compared with placebo plus diet was associated with significant improvement in glycemic control, as reflected in decreases in HbA1c (P < 0.001) and fasting plasma glucose (P < 0.001) and in dosage reductions of oral sulfonylurea medication (P < 0.01). Orlistat therapy also resulted in significantly greater improvements than placebo in several lipid parameters, namely, greater reductions in total cholesterol, (P < 0.001), LDL cholesterol (P < 0.001), triglycerides (P < 0.05), apolipoprotein B (P < 0.001), and the LDL-to-HDL cholesterol ratio (P < 0.001). Mild to moderate and transient gastrointestinal events were reported with orlistat therapy, although their association with study withdrawal was low. Fat-soluble vitamin levels generally remained within the reference range, and vitamin supplementation was required in only a few patients. CONCLUSIONS: Orlistat is an effective treatment modality in obese patients with type 2 diabetes with respect to clinically meaningful weight loss and maintenance of weight loss, improved glycemic control, and improved lipid profile.

The insulinotropic effect of endogenous gastric inhibitory polypeptide in normal subjects.

Intravenously administered porcine GIP is insulinotropic in man. This study was designed to investigate the effects of simultaneous fat ingestion, a potent stimulus for GIP release, and intravenous glucose infusion upon endogenous serum GIP and insulin concentrations in normal subjects. Seven normal volunteers were studied on three separate occasions following: a) the ingestion of 67 grams of emulsified corn oil, b) constant intravenous infusion of glucose, and c) simultaneous administration of corn oil and glucose as in parts (a) and (b) of the study. Serum glucose, insulin (IRI), and GIP concentrations were measured at intervals between 15 and 180 minutes following each stimulus. With corn oil, mean serum GIP concentrations increased from a fasting level of 290 +/- 40 (SE) pg/ml to 1936 +/- 402 pg/ml at 60 minutes without a significant change in serum IRI or glucose concentrations. The infusion of intravenous glucose alone was associated with no rise in serum GIP levels despite a substantial increase in serum IRI and glucose concentrations. With the combined stimuli, mean serum GIP increased less (P is less than .05) between 30 and 90 minutes, and total integrated incremental GIP was significantly less (P is less than .025) than that after corn oil ingestion alone. Following the combined stimuli, incremental insulin levels were higher (P is less than .05) between 15 and 90 minutes, total integrated incremental insulin was greater (P is less than .025), and glucose homeostasis was significantly enhanced (P is less than .05) at 120 and 180 minutes compared with the effects on insulin of glucose infusion alone. We conclude that the potentiation of glucose-stimulated insulin secretion induced by the ingestion of fat is associated with serum GIP levels that are within the insulinotropic range. The augmented secretion of insulin may be mediated partially or completely by endogenous GIP. The lower serum GIP concentrations observed following the combined stimuli suggest a feedback inhibition of GIP release which is perhaps mediated by insulin.

Gastric inhibitory polypeptide (GIP) stimulated by fat ingestion in man.

Ten normal volunteers ingested emulsified corn oil and the immunoreactive GIP, insulin (IRI) and nonesterified fatty acid (NEFA) responses were measured. Serum GIP levels increased after the ingestion of corn oil in all subjects, rising from a mean fasting level of 272 pg/ml to 856 +/- 272 pg/ml (P less than 0.05) by 30 minutes. The peak mean serum GIP concentration of 1,345 +/- 291 pg/ml occurred at 60 minutes; and mean serum GIP levels at 180 minutes remained significantly elevated over fasting values. Serum IRI, glucose and NEFA concentrations did not change during the 180 minutes of study. No changes in serum GIP concentrations occurred when, for control purposes, six volunteers ingested water on another day. We conclude: 1) Fat is a potent stimulus for the release of GIP in normal individuals. 2) Endogenously released GIP is not insulinotropic under the conditions of this study.

Gastric inhibitory polypeptide (GIP) and insulin release in duodenal ulcer patients.

To investigate the role of gastric inhibitory polypeptide (GIP) in the hypersecretion of glucose-stimulated insulin release in duodenal ulcer disease, serum glucose, insulin, and immunoreactive GIP (IR-GIP) were measured in 18 healthy subjects and 10 duodenal ulcer patients after glucose ingestion. Although the serum glucose and insulin were significantly greater (P less than 0.05) at 15 and 60 min in the ulcer group, the total integrated glucose areas were similar (20,552 +/- 837 vs. 19,154 +/- 745 mg-min/ml). In contrast, the total integrated insulin area was significantly greater (P less than 0.05) in the ulcer patients (12,873 +/- 2,082 vs. 8,216 +/- 1,072 micro U-min/ml). Mean IR-GIP levels were significantly greater (P less than 0.05) in the ulcer group at 15-120 min of the study, as was the total integrated area (244,755 +/- 34,934 vs. 126,595 +/- 17,468 pg-min/ml). The exaggerated insulin release to oral glucose may be due to the synergistic action of higher blood glucose and greater IR-GIP release in this disease.

Gastric inhibitory polypeptide hypersecretion in diabetes mellitus: effect of sulfonylurea treatment.

We studied gastric inhibitory peptide (GIP) in response to a mixed meal in both adult-onset diabetics and normal controls. The adult-onset diabetic group was also studied for immunoreactive GIP (IR-GIP), insulin, and glucose with a test meal before and after tolazamide therapy. Mean basal and meal-stimulated IR-GIP concentrations were greater (P less than 0.05) in the adult-onset diabetic group than in normal controls. With treatment, mean fasting glucose significantly decreased (P less than 0.05) from 206 +/- 14 to 162 +/- 11 mg/dl, and postprandial glucose concentrations were reduced (P less than 0.05) between 5-180 min. In contrast, after 1 month of treatment with tolazamide, IR-GIP concentrations were not significantly altered. Further, basal and postmeal serum insulin levels were significantly higher (P less than 0.05) after tolazamide therapy. We conclude that the enteroinsular axis in terms of IR-GIP is overactive in adult-onset diabetics; tolazamide therapy does not appear to effect its meal-stimulated response.

Although DR3-DQB1*0201 may be associated with multiple component diseases of the autoimmune polyglandular syndromes, the human leukocyte antigen DR4-DQB1*0302 haplotype is implicated only in beta-cell autoimmunity.

Human leukocyte antigen (HLA)-DRB1 and -DQB1 alleles were analyzed using a PCR-based sequence-specific priming technique in 16 patients with autoimmune polyglandular syndrome type I (APS-I), 31 patients with APS-II, and 110 patients with component diseases of APS-II, including 9 patients with isolated Addison's disease, 43 patients with Hashimoto's thyroiditis, 22 patients with Graves' disease, and 36 patients with vitiligo. No significant associations was observed between HLA and APS-I patients in our data set, nor was sharing of HLA haplotypes by sibling pairs affected by APS I significantly different from the random expectation. Thus, HLA-DRB1 and -DQB1 genes are probably not involved in APS-I. To delineate the associations between HLA-DRB1, DQB1, and APS-II, we analyzed APS-II patients with or without beta-cell autoimmunity [i.e. insulin-dependent diabetes (IDD) and/or islet cell or glutamic acid decarboxylase autoantibodies]. Our results suggest that the association between DR4-DQB1*0302 and APS-II was entirely due to the presence of pancreatic beta-cell autoimmunity, since this haplotype was otherwise not significantly associated with APS-II or with any other of its component diseases. In contrast, the DR3-DQB1*0201 haplotype was associated not only with IDD, but also with APS-II in the absence of pancreatic beta-cell autoimmunity, as were several its component diseases, including isolated Addison's disease, Graves' disease, and Hashimoto's thyroiditis. Interestingly, the frequency of DQB1*0602, a dominantly protective allele against IDD, was not significantly decreased in the APS-II patients with IDD or beta-cell autoimmunity, albeit the patient numbers were small. This phenomenon may suggest that the development of autoimmunity to nonpancreatic endocrine glands may predispose autoimmunity to the pancreatic beta-cells and involve genes other than those of the MHC.

Authentication of medicinal plants using molecular biology techniques to compliment conventional methods.

Medicinal plants have become extremely popular in the United States as botanical supplements, herbal medicines and sources of lead compounds for pharmaceutical development. It is estimated that in 1997 Americans used or consumed 5.1 billion US dollars worth of herbal medicines. For the protection of consumers, authentication of medicinal plants is a critical issue. Ideally, authentication should occur from the harvesting of the plant material to the final product. Unfortunately there is no single or superior method to assure 100 percent authentication during the entire process, but the goal can be achieved through the application of a variety of different methodologies. The whole process starts with good voucher specimens that act as reference material and to prove chain of custody. Macroscopic and microscopic examinations can be used as rapid and inexpensive identification techniques. Chemical analysis is by far the best method for the detection of contaminants and can be an excellent method for plant identification. Each of these methodologies has limitations and more analytical methods are needed to assist in the authentication process. Molecular biology offers an assortment of techniques that can be very useful for authentication of medicinal plants. This review covers various aspects of authentication methods, with special emphasis on molecular biology techniques.

Dose-response effects of dietary marine oil on carbohydrate and lipid metabolism in normal subjects and patients with hypertriglyceridemia.

Recent studies indicate that marine (omega-3) fatty acids decrease hypertriglyceridemia but worsen hyperglycemia in diabetes. We studied dose-response relationships between omega-3 intake and indices of carbohydrate and lipid metabolism in 21 hypertriglyceridemic patients with (n = 6) or without (n = 15) diabetes, and 6 normal volunteers. All subjects consumed isocaloric diets of 65% carbohydrate, 20% fat, and 15% protein. The basal diet contained 15% of total calories as vegetable oil (omega-6), and the test diets included 15%, 7.5%, or 3.75% calories as fish oil (MaxEPA). After three months of the basal diet, patients were randomized to receive two 3-month omega-3 diets in the following sequences: 15%/7.5%, 7.5%/15%, 7.5%/3.75%, or 3.75%/7.5%. Both 15% and 7.5% diets, regardless of sequence, significantly decreased serum triglycerides but increased low-density lipoprotein (LDL)-cholesterol levels as much as 98% and LDL/high-density lipoprotein (HDL)-cholesterol ratio as much as 1.6-fold. Daily insulin requirements of three diabetic patients increased progressively while they received an omega-3-enriched diet for up to 2 years. In healthy controls, favourable changes induced by an omega-3 fatty acid diet in serum lipids and lipoproteins were associated with a tendency toward an inhibition of C-peptide secretion following a meal challenge. We conclude that substitution of commercially available omega-3 for omega-6 fatty acids improves hypertriglyceridemia but may worsen other lipoproteins indices and may increase insulin requirements in diabetic hypertriglyceridemic subjects.

Insulin-induced attenuation of glucose-stimulated gastric inhibitory polypeptide secretion.

Administration of exogenous insulin before and after intraduodenal glucose results in blunting of the GIP response to glucose. Physiologic levels of serum insulin were attained. Therefore, the present study suggests the existence of negative feedback regulation of GIP release by endogenous insulin (pancreatico-GIP axis).

Validation of a self-reported shelf inventory to measure food purchase behavior.

A mailed, self-reported shelf inventory was validated for use as a tool in assessing the impact of a community nutrition intervention that included a point-of-purchase component. The self-reported inventory was evaluated for overall accuracy as well as for the effects of gender, age, and shopping responsibility on accuracy. In addition, the food-shelf inventory was compared with a specific food frequency questionnaire. Specificity and sensitivity were calculated for self-reported inventories using an interviewer-completed, same-day inventory as the gold standard. Overall sensitivity was 86% and 87%, and overall specificity was 92% and 90% in two validation studies. Results show that the mailed, self-reported shelf inventory is a valid measure of the presence or absence of particular foods in households. As such, it may be a useful tool for assessing the impact of point-of-purchase nutrition interventions.

Nutrition knowledge, attitudes, and practices of older and younger elderly in rural areas.

Using a mailed survey, we gathered data to examine selected aspects of nutrition attitudes, knowledge, and practices of two groups of randomly selected older individuals living in rural areas. In one group respondents were 75 through 85 years old, and in the other group respondents were 60 through 70 years old. A senior nutrition survey and a shelf inventory were used to obtain information from the 698 respondents. The 60- through 70-year-old group expressed significantly more (P less than .001) positive attitudes for efficacy, intention, and outcome expectation than the older group. In addition, the younger group had a higher level (P less than .01) of knowledge about fat and salt. They also tended to make more healthful food selections in 7 of 11 categories of the shelf inventory. Our study suggests that 75- through 85-year-old individuals have different nutrition attitudes, knowledge, and practices. Nutrition education should focus on positive messages that are age appropriate, practical, and achievable. Specific topics should include information about beneficial outcomes of healthful eating behaviors.

Assessing beliefs of older rural Americans about nutrition education: use of the focus group approach.

We used the focus group interview technique as a preliminary research step in developing a nutrition education intervention for rural seniors who, because of less than optimal eating habits and changing demographics, are an important target audience. Sixty-eight well, active, rural North Dakota seniors, 60 years or older, from communities of 2,500 or fewer people, participated in five focus groups conducted in late summer 1988. As a qualitative research approach, focus group interviews offer a means of obtaining in-depth information on a specific topic from representatives of a target audience in a discussion group atmosphere. Focus groups require careful preparation and structuring and should include a capable moderator, a prepared discussion guide, carefully recruited participants, and a comfortable setting. The process generated ideas that we are using to develop a health promotion nutrition intervention that will be a mailed-home approach, including use of incentives, social role models, cholesterol screening, and learning activities. The intervention relies on the interest and ability of seniors to make positive health changes. We conclude that the focus group approach is useful in developing nutrition education interventions.

The family team approach to fitness: a proposal.

Disseminating health information to parents from school-based programs is beneficial in at least four ways: children need the support of their parents if they are to implement the behavior changes they learn in school, parents can benefit from the information themselves, adults may be especially willing to learn about promoting health when they have young children in the home, and efforts to promote healthful behavior changes among children may be more effective if interventions are aimed at attitudes and habits of the family rather than those of individual persons. In this paper are summaries of published research on influencing parents in youth-directed health education interventions, including recent data collected in the Minnesota Heart Health Program. Following the review of the literature is a plan for an in-home nutrition and physical activity intervention that could maximize the impact on the eating and exercise patterns of the parents and their children. Very little research has been reported on how important parents are as participants in the health promotion efforts directed to their children. Funding this proposal would help researchers to learn more about maximizing the impact of primary prevention interventions by studying a process for improving eating and exercise patterns of the family unit--the children and their parents--that could serve as a model health promotion program.

Parent nutrition education: a conceptual model.

Getting nutrition information to parents is beneficial for several reasons. Children need support from their parents to implement behavior changes learned in primary prevention interventions. In addition, positive eating behavior changes last longer if interventions are aimed at family attitudes and habits rather than individuals. Finally, parents also can benefit from the information. This article summarizes selected research about the impact of youth-directed nutrition education interventions on parents. A conceptual model is proposed to guide development and evaluation of future interventions with a parent component.

Ambulatory diagnoses-cluster statistics of patient visits at a clinic in the Amazon Region of Ecuador.

INTRODUCTION: Mondana Clinic is a small rural clinic located in the Napo river region of the Amazon basin in Ecuador. Since its opening in 1997 the clinic has grown to be the primary health care facility for approximately 3000 individuals. METHODS: A retrospective study was performed tabulating the ambulatory diagnosis, age, sex, and domicile of patients over a 9 month period in 1999. RESULTS: During the study period there were 765 patient visits that resulted in at least one diagnosis. Of the patient visits, 175 (22.8%) resulted in multiple diagnoses. Women accounted for 58% of the patient visits, which is similar to the 60% of ambulatory patient visits made in the USA by women. The age distribution showed 66% of patients were under 25 years of age. When comparing diagnoses of males with females, several differences were noted. As expected, urinary tract infections were approximately four-fold more common in females than in males. Gastritis and headaches were also more common reasons for patient visits in the female population than in the male. Conversely, lacerations, abrasions, and contusions ranked higher in the male than in the female population for patient visits. CONCLUSION: This study is the first to provide public health information for this region that will prove useful to the health professionals and funding agencies working in the region. Furthermore, it provides a baseline for comparison with other regions in Ecuador and South America in general, as well as comparisons with data-rich countries such as the USA.