Carbon dioxide insufflation can significantly reduce toilet use after colonoscopy: a double-blind randomized controlled trial.

BACKGROUND AND STUDY AIMS: Carbon dioxide (CO2) insufflation during colonoscopy can significantly decrease abdominal pain and bloating after the procedure, but its impact on the frequency and duration of toilet use remains unknown. The aim of this study was to assess the impact of CO2 insufflation on toilet use after screening colonoscopy. METHODS: From 138 average-risk individuals who underwent screening colonoscopy during March to August 2013, 120 were enrolled and randomized to receive either CO2 or air insufflation at colonoscopy. Both the colonoscopist and participant were blinded to the type of gas used. Abdominal pain and distension were assessed using a visual analog scoring system. The frequency and duration of toilet visits during a 2-hour postcolonoscopy period were recorded using a radiofrequency identification system. RESULTS: Baseline characteristics were similar in both groups in terms of age, sex, and procedure time. In the 2 hours after colonoscopy, 50 participants (83 %) in the air group and 18 participants (30 %) in the CO2 group (P < 0.001) used the toilet at least once. The mean (± SD) duration of each toilet visit was 5.93 ±â€Š4.65 minutes in the air group and 1.53 ±â€Š2.84 minutes in the CO2 group (P < 0.001). The abdominal discomfort score was lower in the CO2 group than in the air group both at the end of the colonoscopy (P < 0.001) and 2 hours later (P < 0.001). CONCLUSION: Insufflation with CO2 can significantly reduce abdominal discomfort and toilet use after colonoscopy. Use of this technique may help reduce patient burden and allow more efficient use of space in the endoscopy unit.

Increased cancer mortality in Taiwanese inter-island migrants.

Higher mortality due to various forms of cancer was observed in emigrants, who had moved from the isolated and impoverished Taiwanese island of Matsu to the more affluent main island. A total of 13,691 ethnic Matsunese aged 30 years and above were enrolled in a study comparing cumulative and standardised mortality rates between emigrants to the main island of Taiwan and those who stayed behind. Poisson regression modelling was used to analyse the effects of migration. For all causes of mortality, the adjusted relative risk was 1.24 with a confidence interval (CI) at the 95% level of 1.08-1.42 for emigrants compared to Matsunese non-emigrants. Deaths from cancer and diabetes in emigrants showed similar results, i.e. an adjusted relative risk of 1.25 (95% CI, 1.00-1.57) and 1.93 (95% CI, 1.20-3.11), respectively. Higher cumulative incidence rates for all cancers and the three leading cancer forms (hepatocellular carcinoma, gastric cancer and lung cancer) in emigrants were also observed. However, no significant difference in the survival time of most of the cancer forms was noted between the two groups. The finding that moving to a more affluent area paradoxically leads to incidence of cancer and higher mortality might be explained by adoption of various forms of unhealthy behaviour, psycho-social factors and the general risks related to life in urbanized environments.

Cost-effectiveness analysis for Pap smear screening and human papillomavirus DNA testing and vaccination.

INTRODUCTION: As the effectiveness of cytology-based screening programme for cervical cancer in mortality reduction has reached a plateau, various preventive strategies have been considered, including intensive Pap smear screening and the supplemental use of human papillomavirus (HPV) DNA test or HPV vaccination. Cost and effectiveness of these various preventive strategies are therefore of great concern for health policy makers. OBJECTIVE: We intended to assess whether the combination of HPV DNA testing or HPV vaccination with Pap smear screening programme or the sole annual Pap smear screening is more effective and cost-effective in prevention of cervical cancer than the existing triennial Pap smear screening programme. METHODS: A Markov decision model was constructed to compare total costs and effectiveness between different preventive strategies (including annual Pap smear, HPV DNA testing or HPV vaccination together with Pap smear screening programme) as opposed to the triennial Pap smear screening alone (the comparator). Probabilistic cost-effectiveness (C-E) analysis was adopted to plot a series of simulated incremental C-E ratios scattered over C-E plane and also to yield the acceptability curve for different comparisons of strategies. The threshold of vaccine cost and the influence of attendance rate were also investigated. RESULTS: Compared with triennial Pap smear screening programme, most of preventive strategies cost more but gain additional life years (quadrant I of C-E plane) except HPV DNA testing with Pap smear every 5 years dominated by triennial Pap smear screening programme. The most cost-effective strategy was annual Pap smear (incremental C-E ratio = $31 698), followed by HPV DNA testing with Pap smear every 3 years ($36 627), and vaccination programme with triennial Pap smear screening ($44 688) with the corresponding cost-effective probabilities by the acceptability curve being 65.52%, 52.08% and 35.84% given the threshold of $40 000 of willingness to pay. Vaccination combined with triennial Pap smear would be as cost-effective as annual Pap smear provided the cost of vaccination was lowered to $250 per full course of injection. CONCLUSIONS: Among various preventive strategies annual Pap smear screening programme is still the most cost-effective and additional HPV DNA testing is a cost-effective choice under a reasonable threshold of willingness to pay. Vaccination programme in combination with triennial screening would be cost-effective if vaccine cost can be greatly reduced in a large economic scale.