Video Education on Hereditary Breast and Ovarian Cancer (HBOC) for Physicians: an Interventional Study.

The National Comprehensive Cancer Network (NCCN) guidelines are the gold standard in hereditary cancer risk assessment, screening, and treatment. A minority of physicians follow NCCN guidelines for BRCA1 or BRCA2 mutations. This study assesses the impact of an interventional educational program on HBOC in terms of knowledge. Physicians were sent an invite to join either an intervention survey (web-training offered prior to the knowledge survey) or control survey (web-training offered after the knowledge survey). Sixty-nine physicians in the intervention arm and 67 physicians in the control arm completed the survey. The interventional group regularly answered items correctly at a higher frequency than the control group. For example, 64.71% (n = 44) of physicians in the intervention group knew that multi-gene testing does not have to include only highly penetrant genes compared to 32.84% (n = 22) of the control group (p < 0.01). Similar results were seen with other specific survey items. The current study is important in that it shows web-based education to be a feasible and effective modality for training on hereditary breast cancer. This type of education may be incorporated into CME programs and can be used as a foundation for further studies as well.

Physician Risk Assessment Knowledge Regarding BRCA Genetics Testing.

The study aim was to evaluate the association between genetics referrals, training in medical school, residency, or continuing medical education and physician knowledge of hereditary breast and ovarian cancer (HBOC). A survey of 55 questions was administered to 140 physicians evaluating knowledge and practice patterns regarding HBOC. Physicians with genetics training during residency were more likely to recognize that most instances of ovarian cancer are not hereditary (odds ratio (OR) = 3.16; 95 % confidence interval (CI) 1.32, 7.58). Physicians with continuing medical education (CME) training on genetics were more likely to identify that screening can be improved for those with a hereditary mutation (OR = 4.28; 95 % CI 1.32, 13.90). Primary care physicians who frequently referred for genetics were more likely to recognize that maternal history is not more important than paternal history (OR = 2.51; 95 % CI 1.11, 5.66), that screening can be improved for those with hereditary risk (OR = 4.06; 95 % CI 1.08, 15.22), and that females with a hereditary breast cancer risk would have different recommendations for screening than someone without this risk (OR = 4.91; 95 % CI 1.04, 23.25). Our data suggest that training and frequency of genetics referrals may be associated with knowledge of general risk assessment for HBOC.

A pooled multisite analysis of the effects of female reproductive hormones on glioma risk.

PURPOSE: The association between female reproductive factors and glioma risk is unclear, but most published studies have been limited by small sample size. We conducted a pooled multisite study of pre- and postmenopausal women, investigating the effect of female reproductive factors, including hormonal medications. METHODS: Unconditional logistic regression was used to calculate odds ratios (ORs) and 95 % confidence intervals (95 % CIs) assessing the effects of female reproductive factors and female hormonal medications in glioma cases and unrelated controls. RESULTS: Menarche over the age of 15 as compared to under 12 was associated with a statistically significant risk for glioma (OR 2.00, 95 % CI 1.47-2.71). Use of oral contraceptive pills (OCP) was inversely associated with risk of glioma (OR 0.61, 95 % CI 0.50-0.74), and there was an inverse trend with longer duration of OCP use (p for trend <0.0001). Use of hormone replacement therapy (HRT) was also inversely associated with risk of glioma (OR 0.55, 95 % CI 0.44-0.68), and there was an inverse trend with longer duration of use (p for trend <0.0001). Compared to those reporting neither OCP use nor HRT use, those who reported using both were less likely to have a diagnosis of glioma (OR 0.34, 95 % CI 0.24-0.48). CONCLUSIONS: Female reproductive hormones may decrease the risk for glioma. The association appears to be strongest with greater length of use and use of both HRT and OCP.

Effect of modifiable risk factors in Parkinson's disease: A case-control study looking at common dietary factors, toxicants, and anti-inflammatory medications.

OBJECTIVE: To investigate how common modifiable exposures, including dietary factors, select toxicants, and anti-inflammatory medications, may affect Parkinson's disease. METHODS: Using surveys, a case-control study was conducted at a medical center, comparing Parkinson's disease patients (N = 149) and healthy controls (N = 105). Subjects reported exposure to red meats, vegetables, alcohol, tobacco, anti-inflammatory medications, and pesticides. The relationship between exposures and Parkinson's disease diagnosis was analyzed by logistic regression to generate odds ratio and 95% confidence interval. RESULTS: Consuming red meat "sometimes" or "always" was positively associated with Parkinson's disease as compared to eating red meats "rarely" or "never"; (odds ratio = 2.15, 95% confidence interval = 1.06, 4.39; p = 0.03) and (odds ratio = 4.47, 95% confidence interval = 1.67, 11.94; p = 0.003), respectively. Exposure to pesticides showed a positive association with Parkinson's disease (odds ratio = 2.84, 95% confidence interval = 1.34, 6.00; p = 0.007). "Always" use of aspirin was inversely associated with Parkinson's disease (odds ratio = 0.32, 95% confidence interval = 0.14, 0.70; p = 0.004). "Ever" having used anti-histamines was inversely associated with Parkinson's disease (odds ratio = 0.37, 95% confidence interval = 0.17, 0.81; p = 0.01). DISCUSSION: Our study suggests that there are modifiable external factors that are associated with Parkinson's disease. The present study can thus assist clinicians, policy makers, and people living with Parkinson's disease in improving the experience and management of Parkinson's disease.

The role of mask mandates, stay at home orders and school closure in curbing the COVID-19 pandemic prior to vaccination.

BACKGROUND: COVID-19 has quickly spread throughout the world, necessitating assessment of effective containment methods. The purpose of this study was to examine the impact of government mandated school closures, stay at home orders and mask requirements METHODS: Cumulative incidence rates were calculated at 14-day intervals until the day of the first vaccine administration in the country. Rate ratios were calculated using negative binomial regression while investigating the effects of adjusting for several sociodemographic and medical factors RESULTS: Faster implementation of mask mandates was consistently shown to be protective. States with mask mandates made at three to six months had a 1.61 times higher rate than those who implemented within one month (adjusted rate ratio = 1.61, 95% confidence interval: 1.23-2.10, P = .001). States with mask mandates made after 6 months or with no mandate had a 2.16 times higher rate than those who implemented within 1 month (adjusted rate ratio = 2.16, 95% confidence interval: 1.64-2.88, P < .0001). In contrast, both stay at home orders and school closures had no significant influence on disease trajectory. DISCUSSION: The benefits of mask mandates are apparent, especially when mandates were issued within a month. The impact of school closing and stay at home orders were less clear. CONCLUSIONS: Our results suggest that of the different physical distancing measures implemented by the government, mask mandates are the most important.

Medical Student Perspectives on Their Role as Emerging Physicians During the COVID-19 Pandemic.

The COVID-19 pandemic caused a large strain on the US medical system, with shortage of medical personnel being a key issue. The role of medical school students during a pandemic is not well established. Understanding the perspectives of medical students with regard to their role is essential in determining how to facilitate the use of their skills in combating the pandemic. To evaluate medical student perspectives on the COVID-19 pandemic, an anonymous online survey was distributed to medical students, primarily in the Northeastern United States. In the sample of 232 students, there were significant differences between students in different class years when assessing moral obligations to assist with the COVID-19 pandemic (p = 0.002). A higher percentage of first and second year medical students (pre-clinical training, around 48%) felt that healthcare students are morally obligated to assist as compared to third and fourth year students (clinical training, 30.43% of third years and 23.19% of fourth years). In all class years, the majority said they would regret their decision if they had chosen not to study medicine (62.32% to 79.31%) and most students did not feel their motivation to become a physician had been decreased (84.78% to 87.50%). Though the study was limited because the majority of subjects were from New York, the results provide insight into medical students' attitudes about the COVID-19 pandemic and can be used in the planning of how best to utilize medical students in this and in future situations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01374-z.

Effects of depression and exercise on health-related quality of life in patients with Parkinson's disease.

OBJECTIVES: There is limited literature describing the effect exercise may have on depression and an individual's health-related quality of life (HRQoL) in Parkinson's Disease (PD). We aim to quantify this effect. METHODS: A cross-sectional questionnaire was administered to 60 PD subjects. The Parkinson's Disease Questionnaire-39 (PDQ-39) summary index and the Geriatric Depression Scale-30 were used to quantify HRQoL and depression, respectively. Data were obtained on exercise habits. ANOVA and multivariate linear regression analysis were used to calculate mean differences in HRQoL. RESULTS: Depression was consistently related to HRQoL (p < 0.05). Of those who exercised as an adult before PD diagnosis, 49.02% (n = 25) reported depression as compared to 88.89% (n = 8) of those who did not report adult exercise (p = 0.03). Those who exercised frequently as an adult prior to PD diagnosis had a better PDQ-39 Cognitive Index (p = 0.03). Those who were not depressed and were currently exercising had a significantly higher HRQoL than those who were depressed and did not exercise (p < 0.01). DISCUSSION: Exercising and depression may interact to affect HRQoL. Thus, coordination of mental health evaluation and exercise regimens in persons with PD may improve HRQoL.

Association between glioma and history of allergies, asthma, and eczema: a case-control study with three groups of controls.

Because glioma etiology is largely unknown, the inverse association of glioma risk with atopic conditions is promising and deserves close scrutiny. We examined the association between a history of allergies, asthma, and eczema, and glioma risk using sibling, friend, and clinic-based controls. This analysis included 388 incident glioma cases and 80 sibling, 191 friend, and 177 clinic-based controls. Each subject's medical history was assessed via a Web-based or telephone survey. Odds ratios (OR) and their 95% confidence intervals (CI) for the associations with allergies, asthma, eczema, and the overall number of these conditions were calculated from conditional (for sibling and friend controls) and unconditional (for clinic-based controls) logistic models. Allergies were consistently inversely associated with the glioma: ORs were 0.53 (95% CI, 0.15-1.84), 0.54 (95% CI, 0.28-1.07), and 0.34 (95% CI, 0.23-0.50) with sibling, friend, and clinic-based controls, respectively. Asthma showed an inverse association only in the comparison with sibling controls (OR, 0.43; 95% CI, 0.19-1.00). Eczema showed an inverse association only in the comparison with friend controls (OR, 0.42; 95% CI, 0.15-1.18). The overall number of these conditions (ordinal score 0, 1, 2, 3) was inversely associated with glioma: The risk decreased 31% to 45% with each addition of an atopic condition. These estimates were the most stable when different control groups were considered. Comparing the prevalence of these conditions in the three control groups with published data, we note that clinic-based controls generally better approximate the prevalence data for population-based groups. These controls seem to present a reasonable choice for clinic-centered case-control studies.

Assessing breast cancer risk and providing treatment recommendations: immediate impact of an educational session.

The widespread availability of information regarding advancements in breast cancer care has heightened public awareness about risk and prevention, but there is limited knowledge as to the translation of these evolving advancements into physician practice patterns. The purpose of this study was to: (a) determine current practice patterns/treatment recommendations for evaluating patients at high-risk for breast cancer and (b) measure the immediate effect of an educational session on new knowledge acquired for high-risk patients. Five thousand and one health care provider surveys were sent to physicians in the greater Chicago area. The survey inquired about practice patterns and offered an opportunity to attend an educational session utilizing our "Spectrum of Care Options" framework. To evaluate session effectiveness, pre and post-tests were administered to participants. Of 767 survey respondents, 78 attended an educational session, 64 completed a pre and post-test, and 65 completed program evaluations. Pretest scores averaged 67.1% correct (range = 29-100%, SD = 15.8%) while post-test scores averaged 80.3% correct (range = 59-100%, SD = 11.0%), p < 0.0001. Participants rated the following on a 1-5 (poor to excellent) Likert scale (average scores): presentations 4.74, instructional materials 4.58, usefulness to practice 4.60, new knowledge gained 4.71, and likelihood of changing practice 4.49. Primary care physicians and surgeons are interested in identifying and treating high-risk patients, but may lack sufficient state-of-the art knowledge to do so. An educational session providing information on this subject, based on Spectrum of Care Options, significantly improved their knowledge and may influence their future practices.

Quality of hypertension care: An improvement initiative in two outpatient health care centers.

RATIONALE, AIMS, AND OBJECTIVES: Hypertension control is an important public health goal; however, significant barriers remain in primary care practice. Our objective was to identify areas for improvement in hypertension care and implement changes in management to improve outcomes. We also aimed to evaluate whether quality improvement influences physician attitudes towards and adherence to current hypertension guidelines. METHOD: We conducted a non-experimental pre- vs post- design quality improvement study for ambulatory patients with a history of hypertension. Specific measures of hypertension care were assessed at baseline and 3 months post-implementation of the quality improvement initiative. De-identified data were collected from 100 charts, randomly selected from the practice's electronic medical records, and compared with a national sample of peer data. The Intervention was based on the American Academy of Family Physicians METRIC Performance Improvement module. This consisted of creating a computerized registry, system improvements to the electronic medical records, and peer education workshops on best practices. A 7-item survey was completed by primary care physicians pre- and post-intervention. RESULTS: Improvement was demonstrated in several primary outcome measures: increased number of patients counselled on sodium intake (P = 0.005), physical activity (P = 0.001), alcohol consumption (P = 0.03), and weight reduction (P < 0.0001). Practice self-assessment findings did not show a statistically significant change following the intervention. CONCLUSIONS: This quality improvement increased provider compliance with hypertension guidelines. However, more effort is required to modify physician practices for full compliance with the 2017 updated hypertension guidelines.

Oral rapid HIV testing in the dental setting: Experiences from three dental hygiene clinics.

Background: Oral rapid HIV testing (ORHT) is implemented in the dental setting to make individuals aware of their possibly undiagnosed HIV infection. The testing process and characteristics of clients willing to receive ORHT has yet, however, to be systematically collected. Case description: Three dental hygiene clinics located in academic institutions implemented ORHT from March 2016 to April 2017. Results: 231 persons received ORHT; all had non-reactive results. Most had seen a primary care provider in the past year (n = 130), had had a previous ORHT (n = 111), and described themselves as extremely likely or likely to accept a chairside screening in the future (n = 169). The main reason cited for accepting ORHT was that it was free (n = 138). Conclusion: In order to ensure everyone living with HIV is aware of their infection, HIV testing should be expanded into non-traditional settings. The dental setting may help achieve this important public health milestone.

Contexte: Le test de dépistage rapide du VIH par voie orale (TDRVO) a été mis en place dans le milieu dentaire pour que les gens soient sensibilisés à la possibilité d'une infection au VIH non diagnostiquée. Toutefois, les données du processus de dépistage et les caractéristiques des clients disposés à recevoir le TDRVO restent à être recueillies systématiquement. Description du cas: Le TDRVO a été mis en place dans 3 cliniques d'hygiène dentaire situées dans des établissements scolaires, de mars 2016 à avril 2017. Résultats: 231 personnes ont reçu un TDRVO; elles ont toutes obtenu des résultats non réactifs. La plupart des personnes avaient consulté un prestataire de soins primaires au cours de la dernière année (n = 130), avaient précédemment obtenu un TDRVO (n = 111) et s'étaient décrites comme étant extrêmement susceptibles ou susceptibles à accepter un dépistage au fauteuil à l'avenir (n = 169). La gratuité du TDRVO demeure la raison principale pour avoir accepté le test (n = 138). Conclusion: Le test de dépistage du VIH devrait être offert dans des milieux non traditionnels pour veiller à ce que les gens vivant avec le VIH soient conscients de leur infection. Le milieu dentaire peut aider à franchir cette étape importante de santé publique.

Medication use and falls: Applying Beers criteria to medication review in Parkinson's disease.

OBJECTIVES: Our goal was to assess the association between potentially inappropriate medication use and risk of falls in the Parkinson's disease population. METHODS: This was a retrospective cohort study conducted at an outpatient Parkinson's Disease Treatment Center. Individuals 65 years of age or older, diagnosed with Parkinson's disease who attended at least three visits in 2015 for physical, occupational therapy, or physician's visits were included in the study. Electronic medical records were utilized to perform chart reviews, and medications were analyzed to identify prescription medications, combination preparations, over-the-counter medications, and dietary supplements. The goal of this study was to test the following hypothesis: elderly individuals with Parkinson's disease who take multiple potentially inappropriate medications are more likely to experience a fall compared to elderly individuals with Parkinson's disease who do not take multiple potentially inappropriate medications. RESULTS: A higher mean number of prescription medications were associated with falls in elderly Parkinson's disease patients (6.53 vs 5.21, p < 0.01). Polypharmacy (taking five or more prescription and nonprescription medications) was not significantly associated with falls. Patients taking potentially inappropriate medications specifically contraindicated for those with a history of falls and fractures were more likely to report falls (p < 0.04). Analysis of the specific therapeutic medication categories demonstrated no significant differences between those who did and did not report falls. CONCLUSION: A future prospective study at Parkinson's disease center should include an electronic medical record-based intervention to reduce the total number of medications, as well as to minimize the use of high-risk medications.

Patients' Willingness to Participate in Rapid HIV Testing: A pilot study in three New York City dental hygiene clinics.

Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics.Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months. The survey questionnaire was based on the decisional conflict scale measuring personal perceptions; with zero indicating extremely high conflict to four indicating no conflict. Patients were assessed for their acceptance of RHT, provider preference for administration of the test and their willingness to pay for RHT.Results: Over half (72.2%) indicated acceptance of HIV testing in a dental hygiene clinic setting; with 85.3% choosing oral RHT, 4.9% fingerstick RHT, and 8.8% venipuncture. Respondents were amenable to testing when offered by dental hygienists (71.7%) and dentists (72.4%). Over 30% indicated their willingness to receive HIV testing in the dental setting when offered at no additional cost. The mean decisional conflict score was 3.42/4.0 indicating no decisional conflict.Conclusions: Patients are willing to undergo oral RHT when offered as a service and provided by dental hygienists in the dental setting. Patients appear to be aware of the benefits and risks associated with RHT. Further research is needed to evaluate the public health benefits and logistical challenges facing the delivery of RHT within in the dental setting.

Acceptance of technology-based tools in a sample of Parkinson's patients.

Objectives Parkinson's disease is the second most common neurodegenerative movement disorder in the United States. Patients' opinions of technology-based tools for education and communication as related to Parkinson's disease are unclear with little documented research addressing the issue. The goal of this research was to investigate patient opinions about technology-based tools with a focus on differences between patients of different age groups. Methods A cross-sectional survey was used to assess views on using multiple different electronic methods for receiving instructions and communicating with healthcare providers in 109 Parkinson's disease patients. Results Approximately 28% (n = 28) of the subjects reported having unmet needs related to Parkinson's disease. Those 65 and over were less likely to believe that using technology to communicate with the healthcare center would result in themselves having a better understanding of their care (odds ratio = 0.36, 95% confidence interval: 0.14, 0.95). Those over 75 had a lower odds of being willing to use electronic methods (odds ratio = 0.33, 95% confidence interval: 0.14, 0.79), a lower odds of believing that technology would result in better self-understanding of medical needs (odds ratio = 0.27, 95% confidence interval: 0.12, 0.63) and a lower odds of believing that technology would result in their healthcare providers better understanding their needs (odds ratio = 0.32, 95% confidence interval: 0.14, 0.73). Discussion The results of this study indicate that older Parkinson's disease patients report a less favorable view regarding the role of technology in communicating with healthcare providers and for understanding their care.

Erosive Esophagitis in the Obese: The Effect of Ethnicity and Gender on Its Association.

Background. Data examining the association between obesity and erosive esophagitis (ErE) have been inconsistent, with very little known about interracial variation. Goals. To examine the association between obesity and ErE among patients of different ethnic/racial backgrounds. Methods. The study sample included 2251 patients who underwent esophagogastroduodenoscopy (EGD). The effects of body mass index (BMI) on ErE were assessed by gender and in different ethnic groups. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis. Results. The prevalence of ErE was 29.4% (661/2251). Overweight and obese subjects were significantly more likely to have ErE than individuals with a normal BMI, with the highest risk seen in the morbidly obese (OR 6.26; 95% CI 3.82-10.28; p < 0.0001). Normal weight Black patients were less likely to have ErE as compared to Caucasians (OR 0.46; 95% CI 0.27-0.79; p = 0.005), while the odds ratio comparing normal weight Hispanics to normal weight Whites was not statistically significant. No effect modification was seen between BMI and race/ethnicity or BMI and gender. Significant trends were seen in each gender and ethnicity. Conclusions. The effect of BMI on ErE does not appear to vary by race/ethnicity or gender.

A pooled multisite analysis of the effects of atopic medical conditions in glioma risk in different ethnic groups.

PURPOSE: The incidences of atopic conditions (allergies, asthma, or eczema) and glioma vary by ethnicity. Atopic conditions are inversely associated with gliomas. We conducted a pooled multisite study investigating the associations of atopic conditions with glioma in different race/ethnicity groups. METHODS: Using glioma cases and healthy controls, unconditional logistic regression was conducted to assess the associations of atopic conditions with glioma separately in white, black, Asian, and Hispanic subpopulations. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Glioblastoma multiforme cases were less likely than controls to report a history of atopic conditions in whites (OR = 0.46, [95% CI, 0.38-0.54]) and Asians (OR = 0.27, [95% CI, 0.10-0.73]). The same trend was seen when looking at glioma cases of all histologies. An inverse association was not seen in blacks for glioblastoma multiforme or all histologies combined. CONCLUSIONS: The inverse association between glioma and atopic conditions may vary by ethnicity due to a difference in the biology of atopic conditions in different ethnicities but may be due to chance because of the limitations of small nonwhite sample sizes.

Use of a novel assay to measure pre- to posttraining palpatory skills of first-year osteopathic medical students.

CONTEXT: Although palpation is a central skill in the practice of osteopathic medicine, few data are available on factors affecting the development of palpatory skills. OBJECTIVE: To use a novel palpatory skills assay to assess the role of training and practice in the development of palpatory skills in an osteopathic medical student population. METHODS: The palpatory skills of first-year osteopathic medical students were assessed using a simple, objective palpation assay that consisted of locating a dime placed under sheets of copy paper at depths of 50, 100, 150, 200, 300, and 400 sheets. Two trials were performed at each depth. The assay was performed at the beginning and at the end of the students' first term. To determine whether practice with the assay impacted participant performance, a third assay was conducted to compare the performance of students who completed the assays at the beginning and at the end of the term with that of students who had never completed the assay. RESULTS: Sixty-three participants completed the assays at the beginning and end of the term. Fifty-seven of those 63 participants and 192 participants who had not previously completed the assay completed the third assay. A wide variability in number of correct responses per participant was observed at both the beginning (range, 0-11 correct) and the end (range, 2-12 correct) of the term. The mean (SD) number of correct responses per participant increased from the beginning (5.49 [2.78]) to the end (7.17 [2.27]) of the term. Analysis using the generalized estimating equation model demonstrated that both paper depth and experience (ie, beginning vs end of the term) were statistically significant determinants of the number of correct responses (P<.001). The Kaplan-Meier method indicated that the median paper depth at which participants first scored no correct responses increased from 200 sheets (95% CI, 171-229) at the beginning of the term to 300 sheets (95% CI, 232-367) at the end of the term (P<.001). In the third assay, no significant differences were noted in the performance of students who had completed the 2 previous assays vs participants who had not completed the previous assays (P=.136). CONCLUSION: Participants' palpatory skills improved from the beginning to the end of the term. The range of participants' palpatory skills at the beginning of the term suggests that other factors in addition to training influenced participants' palpatory skill level. Additional research is needed to identify and investigate factors that influence the development of palpatory skills.

Ethnic disparities in the risk of colorectal adenomas associated with lipid levels: a retrospective multiethnic study.

BACKGROUND: Although data exists showing that uncontrolled lipid levels in white and black patients is associated with colorectal adenomas, there are currently no studies looking only at the Hispanic population. PURPOSE: With the rapid increase in the Hispanic population, we aimed to look at their risk of colorectal adenomas in association with lipid levels. METHODS: We retrospectively analyzed 1473 patients undergoing colonoscopy from 2009 to 2011 at a community hospital. Statistical analysis was performed using Chi-squared for categorical variables and t test for continuous variables with age-, gender-, and race-adjusted odds ratios. Unconditional logistic regression model was used to estimate 95 % confidence intervals (CI). SAS 9.3 software was used to perform all statistical analysis. RESULTS: In our general population, there was an association with elevated triglyceride levels greater than 150 and presence of multiple colorectal adenomas with odds ratio (OR) 1.60 (1.03, 2.48). There was an association with proximal colon adenomas and cholesterol levels between 200 and 239 with OR 1.57 (1.07, 2.30), and low-density lipoprotein (LDL) levels of greater than 130 with OR 1.54 (1.04, 2.30). There was no association between high-density lipoproteins (HDL) levels and colorectal adenomas. The Hispanic population showed no statistical correlation between elevated triglycerides, cholesterol, or LDL with the presence, size, location, or multiplicity of colorectal adenomas. CONCLUSIONS: We found a significant correlation between elevated lipid levels and colorectal adenomas in white and black patients; however, there was no such association in the Hispanic population. This finding can possibly be due to environmental factors such as dietary, colonic flora, or genetic susceptibility, which fosters further investigation and research.

The association of H. pylori and colorectal adenoma: does it exist in the US Hispanic population?

BACKGROUND: Although data on the association between colorectal adenomas and Helicobacter pylori (H. pylori) exists in White and Black patients, there is no data on this association in a US Hispanic population. Our aim was to study the association of adenoma detection and biopsy proven H. pylori infection in a cohort of US Hispanics. METHODS: Data were collected from Nassau University Medical Center, a 530-bed tertiary care teaching hospital in East Meadow, New York. Patients who underwent both an esophagogastroduodenoscopy (EGD) and colonoscopy from July 2009 to March 2011 were pulled from an electronic database. A total of 1,737 patients completed colonoscopies during this time with 95 excluded: 17 inflammatory bowel disease, 12 malignancy, 22 prior history of colorectal adenoma, and 44 incomplete. Among the colonoscopies, 799 patients had EGD's performed prior to colonoscopies that were eligible for our study. RESULTS: H. pylori prevalence was highest in Hispanics 40.9%, followed by Blacks 29.1% (OR 0.59, 95% CI: 0.42-0.84), then Whites 7.9% (OR 0.12, 95% CI: 0.06-0.24). The adenoma detection rate was significantly higher in Whites 23.2% and Blacks 21.8% compared to Hispanics 14.5%, P=0.0002 respectively. Smoking and alcohol were lower in the H. pylori group, 18.6% (n=44) vs. 26.1% (n=147) for smoking (P=0.02) and 14.4% (n=34) vs. 19% (n=107) for alcohol (P=0.12), respectively. There was no evidence in the Hispanics for an association between adenoma detection and H. pylori infection. Furthermore size, location, and multiple polyps did not differ between the two groups. CONCLUSIONS: While data has shown an association between H. pylori and colorectal adenomas, we did not find this in our Hispanic population. With the growing population of Hispanics in the U.S, large scale studies are needed to conclusively characterize the role of H. pylori infection in colorectal adenoma and adenocarcinoma in this group of patients.