Colorectal polyps in young adults: a retrospective review of colonoscopy data from Toowoomba and the Darling Downs.

BACKGROUND: Polyps are the predominant precursors of colorectal cancer. In the past three decades, the incidence and mortality rates of colorectal cancer have been increasing in adults younger than 50 years. AIMS: The aim of this clinical audit was to evaluate the prevalence, characteristics and clinical associations of polyps in adults aged 18-49 years presenting to an established private gastroenterology clinic in the Toowoomba Darling Downs region. METHODS: The audit included data from 353 patient records held by the Toowoomba Gastroenterology Clinic. Data extracted from patient medical records through the Medical Director program software contained structured endoscopy/colonoscopy and histology reports of excised lesions of patients presenting to the clinic. The extract involved identifying all patients aged 18-49 years in the database from January 2019 to March 2022. Patients were screened based on audit inclusion and exclusion criteria. Patients were risk stratified for recommended surveillance intervals as per Australian Clinical Guidelines. RESULTS: Of the sample population, 33.4% were identified with polyps and 22.4% were identified with neoplastic polyps (NPs). A total of 6.7% of 18- to 29-year-old patients were identified with intermediate risk for colorectal cancer (CRC) screening, and 19.8% and 19.3% of 30- to 39-year-old and 40- to 49-year-old patients identified with intermediate or high risk for CRC screening respectively. Increased age, greater size of polyps and surveillance of previous polyps were associated with increased NP prevalence. CONCLUSIONS: Data from this audit supported the temporal trend of increasing prevalence of polyps in adults younger than 50 years. Patient cohorts aged 30-39 and 40-49 years may benefit from earlier first colonoscopies. Findings could be the impetus for future research in young adults presenting for colonoscopy.

Finding what works-Patients' long-term experiences of weight maintenance post bariatric surgery: A systematic review and thematic synthesis of qualitative studies.

Individuals with obesity can attain significant weight loss in a relatively short timeframe following bariatric surgery; however, new healthy behaviors must be sustained in perpetuity to maintain weight loss. This study investigates patients' views on the facilitators and barriers to long-term weight loss maintenance following bariatric surgery. Systematic searches of Medline, PsycINFO, and CINAHL databases identified 403 studies with 15 fitting the study inclusion criteria. Included studies were independently appraised using Critical Appraisal Skills Program (CASP). Data extraction and thematic synthesis generated three themes: changing food relationships, navigating inter- and intrapersonal influences, and caring health professionals. These appeared across six organizing sub-themes: building new food relationships, creating healthy habits, relationships with others, internalized stressors, finding and defining success, and ongoing patient education. Patients experienced a variety of barriers and facilitators to weight loss maintenance, with some facilitators diminishing over time. The findings demonstrate the importance of considering patients' perspectives and individual contexts to assist them to negotiate and overcome challenges to long-term weight loss maintenance post-bariatric surgery.

Video capsule endoscopy in patients with iron deficiency anaemia: experience at a regional Australian service.

OBJECTIVE: The objective of this study was to identify the diagnostic performance of video capsule endoscopy (VCE) among patients presenting with iron deficiency anaemia (IDA) and negative bidirectional endoscopy to a gasteroendoscopy practice in regional Australia. The secondary objectives were to identify the distribution of findings and factors predictive of positive findings in a regional setting. RESULTS: In total 123 procedures were included in the study. Mean age of the patients was 67.9 years. Females made up 60.2% (n = 74) of the study population. Mean haemoglobin and ferritin levels were 93.3 g/L and 11.9 ug/L, respectively. Positive findings were present in 67 procedures (54.5%) with the most frequent finding being small bowel angiodysplasia (53.7%, n = 36/67), followed by ulceration/significant erosion (26.8%, n = 18/67), fresh blood (20.8%, n = 14/67) and tumour/polyp (16.4%, n = 11/67). Haemoglobin level was the only variable associated with positive findings (p = 0.005) in the study population. Of the procedures reporting positive findings outside the small bowel, the majority (80%) were within reach of conventional upper endoscopy and may have implications for future practice, particularly when allocating health resources in a rural setting.

A cross-sectional study of skin cancer secondary prevention in rural general practice.

BACKGROUND AND OBJECTIVES: As a result of the lack of evidence of reduction in mortality, secondary prevention of melanoma and keratinocyte skin cancers (KSCs) with active screening is not recommended except for individuals at high risk. Limited access to medical professionals for diagnosis and specialised treatment of skin cancers are related to poorer health outcomes for Australians living in rural areas. The aim of this study was to evaluate the secondary prevention of skin cancer in general practice. METHOD: A clinical audit of 317 melanomas and 5463 KSCs was conducted, examining the nature of consultation and stage of cancer at diagnosis. RESULTS: It was more common for an uncomplicated melanoma ≤1 mm in size to be identified by a general practitioner (GP) during a planned whole-body skin examination than to be the presenting complaint found by the patient (χ2 = 4.2, P <0.05). Half (49%) of KSCs found were the presenting complaint, with 21% an incidental diagnosis during another presentation and 30% found during whole-body skin examinations. Half of all squamous cell carcinomas found were at the intra-epidermal stage. DISCUSSION: Secondary prevention of skin cancer by GPs is a value proposition for rural populations.

Epidemiology of melanoma in rural southern Queensland.

OBJECTIVE: The objective of this study is to define the epidemiology of melanoma in rural communities in southern Queensland. DESIGN: The design used was a 6-year clinical record audit of melanoma cases identified by billing records and electronic clinical records, confirmed and typed with histology. SETTING AND PARTICIPANTS: This study was based on seven agricultural communities on the Darling Downs with patients presenting to local primary care clinics. MAIN OUTCOME MEASURES: Outcomes measured were confirmed type, depth and anatomic distribution of melanoma identified at these practices during the study period. RESULTS: The results from 317 cases of melanoma found anatomic distribution was significantly different (χ2  = 9.6, P < 0.05) to that reported previously from the Queensland Cancer Registry. A high proportion (87%) of melanoma diagnosed by these general practitioners were 1 mm or less when treated. CONCLUSIONS: Conclusions drawn from these findings are that melanoma risk is not so much lesser in rural, inland communities compared with coastal and metropolitan regions, but different. Differences may relate to comprehensive data capture available in rural community studies and to different sun exposure and protection behaviours. The higher proportion of melanoma identified at early stages suggests rural primary care is an effective method of secondary prevention.

Chronic Disease and Health Risk Behaviors Among Rural Agricultural Workforce in Queensland.

INTRODUCTION: Little is known of the lifestyle behaviors and prevalence of chronic disease in the Australian agricultural workforce. This study aimed to assess behavioral risk factors and the prevalence of chronic disease among attendees of agricultural events in rural Queensland. METHODS: Data on lifestyle risk factors and prevalence of diabetes and cardiovascular diseases were collected from participants in four separate cross-sectional studies in rural southern Queensland. Anthropometric measures, blood pressure, serum cholesterol, and glucose levels of consenting participants were assessed by trained medical students under the supervision of rural clinicians. Data were analyzed using SPSS 22 statistical software package and t-tests and chi-square tests were used to compare differences between groups. RESULTS: A total of 702 attendees participated; the majority were agricultural workers (n = 393). Greater psychological distress was reported among participants from these rural communities (42%) than in the Australian population (31%); however, levels of psychological distress was similar between agricultural workers and others in the sample. Fewer people in these agricultural communities reported smoking (10%), and they reported being more active (86%) than the average Australian, but a greater proportion reported high-risk alcohol consumption (53%) and were found to be hypertensive (31%). These findings were accentuated among agricultural workers. CONCLUSION: This method of investigation both raises awareness in the community and identifies health risks for further management in a group that has otherwise been poorly defined. Resident agricultural workers have different health risks and behaviors, though psychological distress appears to be borne across these communities.

Prevalence and predictors of default with tuberculosis treatment in Sri Lanka.

The objectives of this study were to determine the default rate and predictors for default in patients undergoing antituberculosis treatment. All consenting patients with a confirmed diagnosis of tuberculosis admitted to a unit of the Chest Hospital, Welisara, Sri Lanka from April 2001 to April 2002 were recruited into the study. Personal and follow-up data were recorded on a pre-tested questionnaire and data sheet, respectively. A defaulter was defined as a patient who interrupted treatment for more than two consecutive months before the end of the course of treatment. Of the 892 patients recruited, 770 were new cases and 122 were relapses. The default rates were 10.3% (95% CI: 8.3-12.6) and 30.3% (95% CI: 22.7-38.1) among new cases and retreatment cases, respectively, during the intensive phase of treatment and 10.9% (95% CI:8.7-13.3) and 16.5% (95% CI:9.7-25.5), respectively, during the continuation phase. Ninety percent of new cases and 94% of retreatment cases were sputum positive for acid-fast bacilli at diagnosis. Two hundred five patients (22.9%) defaulted on treatment (95% CI: 20.3-25.8). Using logistic regression analysis, regular smokers (OR = 1.9), smear positive patients who were previous defaulters (OR = 2.4) and patients having involvement of less than 3 zones of the lung on chest x-ray (OR = 0.5) were more likely to default compared to patients who did not smoke regularly, smear positive patients who had relapsed after taking the full course of treatment and patients with less lung involvement. Skilled and unskilled laborers were the most likely occupation to default (OR = 2.03) followed by sales personnel (OR = 2.00), compared to the unemployed or home-bound. A high default rate of 23% was observed among the study participants. Smoking status, occupation, history of treatment compliance of the patient, and extent of lung involvement were predictors for defaulting.