The Use of Standardized Questions in Identifying Patients with Dyssynergic Defecation.

BACKGROUND: Dyssynergic defecation (DD) is present in approximately 30% of patients with idiopathic chronic constipation (CC). Diagnostic criteria for DD require objective testing such as anorectal manometry (ARM); yet, ARM remains a limited resource in Canada. The aim of this study is to determine the predictability of DD in patients with CC using a standardized self-reported symptom questionnaire. METHOD: In this study, 166 consecutive English-speaking patients with CC who were referred for ARM completed a symptom questionnaire. DD was diagnosed if pelvic floor dyssynergy was demonstrated by ARM and balloon expulsion time was more than one minute. Likelihood ratios (LRs) were calculated for individual symptoms and prespecified symptom combinations. Likelihood ratios greater than five or less than 0.2 were considered significant. A recursive partitioning tree was used to find the symptoms best able to predict DD. RESULTS: No single constipation symptom was sufficient to predict a diagnosis of DD. Patients who reported sometimes feeling an urge to defecate and a prolonged straining duration of greater than five minutes were more likely to have DD (LR = 7.74). In patients who reported straining often or always and had a short straining duration of less than two minutes, the diagnosis of DD was less likely (LR = 0.04). The recursive partitioning tree analysis similarly identified a sense of urge with a prolonged straining duration as predictor for DD, as well as an incomplete evacuation as another potential predictor. CONCLUSION: Questions regarding need to strain, duration of straining, urge to defecate, and incomplete evacuation are useful to predict the presence of DD in patients with CC. These questions will enable clinicians to make a clinical diagnosis of DD to guide treatment.

Lack of follow-up colonoscopy after positive FOBT in an organized colorectal cancer screening program is associated with modifiable health care practices.

BACKGROUND: ColonCancerCheck (CCC), Ontario's organized colorectal cancer (CRC) screening program, uses guaiac fecal occult blood testing (gFOBT). To reduce CRC-related mortality, persons with a positive gFOBT must have colonoscopy. We identified factors associated with failure to have colonoscopy within 6months of a positive gFOBT. METHODS: Population-based, retrospective cohort analysis of CCC participants with positive gFOBT (April 2008 to December 2009) using health administrative data. Patient, physician and health care utilization factors associated with a lack of follow-up colonoscopy were identified using descriptive and multivariate analyses. RESULTS: There were 21,839 participants with a positive gFOBT; 14,091 (64%) had colonoscopy within 6months. The strongest factors associated with failure to follow-up were recent colonoscopy (in 2years prior vs. >10years or never, OR: 4.31, 95% C.I.: 3.82, 4.86), as well as repeat gFOBT (OR: 6.08, 95% C.I.: 5.46, 6.78) and hospital admission (OR: 4.35, 95% C.I.: 3.57, 5.26) in the follow-up period. CONCLUSION: In the first 18months of the CCC Program, 1/3 of those with a positive gFOBT did not have colonoscopy within 6months. Identification of potentially modifiable factors associated with failure to follow up lay the groundwork for interventions to address this critical quality gap.

Anthropometric reference values for community-dwelling older adults from northeastern Brazil / Valores antropométricos de referência para idosos residentes em comunidade do nordeste Brasileiro

The aging process is continuous and irreversible and is characterized by physiological and structural alterations and changes in body composition. The aim of this study was to report anthropometric reference values for community-dwelling older adults from northeastern Brazilaccording to gender and age group. This cross-sectional study used data from an epidemiological population-based study involving 316 older adults. The following measures and anthropometric indicators were evaluated: weight, height, body mass index (BMI), triceps skinfold (TSF), waist circumference, arm circumference, calf circumference, and arm muscle circumference (AMC). All data are reported as means, standard deviations, and percentiles. Comparisons between age groups were performed using one-way ANOVA. The study included 173 women (54.7%) and 143 men (45.3%). Body weight and BMI were higher in younger women (60-64 years) compared to older ones (80 years or older). Arm circumference, TSF and AMC were lower in women aged ≥ 75 years compared to women aged 60-64 years. For men, arm circumference and AMC were lower in the oldest age group (≥ 80 years) compared to the youngest group (60 to 74 years). These differences were significant. The present study indicates that changes in body measures occur differently between genders with advancing age. The reduction in muscle mass and body fat is more prominent in women than in men and anthropometric changes are more noticeable in the older age group.

O processo de envelhecimento é contínuo e irreversível, no qual podem ser observadas alterações fisiológicas, estruturais e na composição corporal. O objetivo deste estudo foi apresentar valores antropométricos de referência para idosos residentes em comunidade do Nordeste do Brasil, de acordo com sexo e grupo etário. Trata-se de estudo descritivo, baseado em dados originados de uma pesquisa epidemiológica, de base populacional, envolvendo 316 idosos. Foram avaliadas as seguintes medidas e indicadores antropométricos: massa corporal, estatura, índice de massa corporal (IMC), dobra cutânea tricipital (DCT), perímetros da cintura, do braço e da panturrilha e a circunferência muscular do braço (CMB). Os dados foram apresentados como médias, desvios padrões e percentis. Comparações entre grupos etários foram realizadas por Anova one-way. Participaram do estudo 173 mulheres (54,7%) e 143 homens (45,3%). Os valores de massa corporal e IMC foram maiores nas mulheres de 60-64 anos, comparadas às mulheres com 80 anos e mais. Os valores do PB, DCT e da CMB foram menores nas mulheres de 75 anos e mais, comparadas às mulheres do grupo etário de 60-64 anos. Para os homens, os valores de PB e CMB foram menores nos indivíduos do grupo etário velhos (≥ 80 anos), comparado aos homens de 60 a 74 anos Essas diferenças foram significativas. Os resultados indicam a ocorrência de alterações nas dimensões corporais, distintas entre os sexos, com o avanço da idade. A redução da massa muscular e da gordura corporal é mais acentuada nas mulheres e as alterações antropométricas são mais perceptíveis no grupo etário mais velho.

The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: a nationwide, population-based study.

PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P < 0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P < 0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased in-hospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.