Colonoscopy quality assessment.

AIM: Colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. MATERIAL AND METHOD: This is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. RESULTS: Indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). CONCLUSIONS: Quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.

Heritability of body mass index: a comparison between the Netherlands and Spain.

A high body mass index (BMI) is commonly used as an index of overweight and obesity. There is persistent evidence of high heritability for variation in BMI, but the effects of common environment appear inconsistent across different European countries. Our objective was to compare genetic and environmental effects on BMI in a sample of twins from two different European countries with distinct population and cultural backgrounds. We analysed data of adult female twins from the Netherlands Twin Register (222 monozygotic [MZ] and 103 dizygotic [DZ] pairs) and the Murcia Twin Register (Spain; 202 MZ and 235 DZ pairs). BMI was based on self-reported weight and height. Dutch women were taller and heavier, but Spanish women had a significantly higher mean BMI. The age related weight increase was significantly stronger in the Spanish sample. Genetic analyses showed that genetic factors are the main contributors to variation in height, weight, and BMI, within both countries. For height and weight, estimates of genetic variances did not differ, but for height, the estimate for the environmental variance was significantly larger in Spanish women. For BMI, both the genetic and the environmental variance components were larger in Spanish than in Dutch women.

Obesidad, actividad física y dolor lumbar: un análisis genéticamente informativo / Obesity, physical activity and low back pain: a genetically informative analysis

Objetivo: Analizar la relación entre obesidad, actividad física y dolor lumbar a través de un estudio transversal de gemelos caso-control. Material y método: La muestra general la componen 1.613 individuos gemelos, de entre 47 y 73 años, y participantes en el Registro de Gemelos de Murcia. Los datos fueron obtenidos mediante entrevista telefónica y se recogió información sobre dolor de espalda, datos antropométricos y actividad física. La cigosidad fue evaluada mediante cuestionario. El análisis caso-control se realizó sobre 199 parejas completas y discordantes para dolor lumbar. Resultados: La prevalencia del dolor lumbar en la muestra total fue del 33,1% (mujeres: 36,4%; varones: 29,1%). El Índice de Masa Corporal (IMC) fue de 27.2 (DE: 4,3). En la muestra general, ser mujer, IMC elevado, frecuencia baja de actividad física moderada e intensa y sedentarismo se asociaron con mayor riesgo de padecer dolor lumbar. Sin embargo, todas las asociaciones perdieron significación estadística en el análisis caso-control. Conclusión: Es necesario considerar las características individuales o grupales al valorar el papel del IMC o la actividad física en la prevención del dolor lumbar. Esto incluye la necesidad de tener en cuenta el papel de los factores genéticos en futuras investigaciones sobre esta relación (AU)

Objective: Our main objective was to analyse the relationship between obesity, physical activity and low back pain using a cross-sectional co-twin design. Material and method: The total sample comprised 1,613 subjects, aged 47 to 73, from the Murcia Twin Registry. Data were obtained through telephone interview, and information about back pain, anthropometric data and physical activity was collected. One-hundred and ninety-nine pairs complete and discordant for low back pain were available for the case-control analysis. Results: Prevalence of low back pain was 33.1% (females: 36.4%; males: 29.1%). Mean Body Mass Index (BMI) was 27.2 (SD: 4.3). For the general sample, being female, a high BMI, low frequency of moderate or intense physical activity and sedentarism were associated to a higher risk of low back pain. However, all associations lost statistical significance in the case-control analyses. Conclusion: Individual and group characteristics must be considered when evaluating the role of BMI or physical activity on prevention of low back pain. This includes the need to take into account the role of genetic factors in future research about this relationship (AU)

Valoración de la calidad en la práctica de la colonoscopia / Colonoscopy quality assessment

Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se presenta la aplicación de algunos de estos indicadores. Los indicadores propuestos en este estudio son: nivel de limpieza, intubación cecal, indicador de pólipos y tiempo de retirada. Pacientes y método: estudio prospectivo de 12 meses de las colonoscopias realizadas en un programa de cribado de cáncer colorrectal en el área de salud VI de la Región de Murcia. En este estudio se incluyen todos los pacientes con resultado positivo al test de sangre oculta en heces (SOH) desde febrero de 2006 a febrero de 2007 (n: 609). Se extrae una muestra de 30 pacientes para evaluar la fiabilidad de los indicadores y realizar un análisis preliminar de los resultados. Resultados: los resultados preliminares obtenidos de cumplimiento para cada indicador fueron los siguientes: indicador de nivel de limpieza (87%). Índice de kappa 0,74 (IC del 95%: 0,48-0,99); intubación cecal (90%) 0,74 (IC del 95%: 0,49-0,99); indicador de pólipos (96%), índice de kappa de 0,78 (IC del 95%: 0,53-0,99); tiempo de retirada: 13,36 min (IC del 95%: 10,48-16,11). Índice kappa de 0,78 (IC del 95%: 0,49-0,99). Conclusiones: la definición y aplicación de indicadores de calidad en la práctica de la colonoscopia es posible. Se precisan más estudios para definir el papel de estos indicadores en la práctica asistencial(AU)

Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice(AU)