Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes.

BACKGROUND: The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow-up for abnormal FITs and the use of high-quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs). METHODS: FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of ≥150 consecutive patients with abnormal FITs in 2015-2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate. RESULTS: Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87-0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41-0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness. CONCLUSIONS: In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.

Vitamin D Status Is Associated with Metabolic Syndrome in a Clinic-Based Sample of Hispanic Adults.

BACKGROUND: Vitamin D status has been associated with metabolic syndrome (MetSyn) and its components in different populations, but few studies have assessed this among Hispanics. The objective of this analysis was to assess such association in a clinic-based sample of Hispanic adults. METHODS: Medical records were reviewed retrospectively for the years 2005-2013. MetSyn was assessed using the revised NCEP-ATP III criteria. Vitamin D status was evaluated from reported serum 25(OH)D levels. A multivariable logistic regression model was used to assess the association between MetSyn risk and vitamin D status, controlling for important confounders. RESULTS: From 1379 medical records evaluated, 712 met the inclusion criteria. Most were females (62.6%), with a mean age of 53.8 ± 14.1 years, mean body mass index (BMI) of 30.1 ± 6.4 kg/m(2), and mean serum 25(OH)D levels of 24.4 ± 8.3 ng/mL. MetSyn was identified in 40.5% of the participants. Serum 25(OH)D levels in those with MetSyn (22.7 ± 8.0 ng/mL) were significantly lower compared to those without MetSyn (25.5 ± 8.4 ng/mL; P < 0.001). Serum 25(OH)D levels were inversely correlated to triglycerides, waist circumference, and fasting blood glucose (P < 0.05). In the multivariable logistic regression model, decreased serum 25(OH)D levels were associated with higher odds of MetSyn, even after adjusting for age, gender, BMI, and seasonality. CONCLUSION: In this clinic-based sample, the odds of MetSyn increased as serum 25(OH)D levels decreased. These results have important public health implications for developing recommendations directed to increase vitamin D status in this sample.