Michael K. Chapko

Predictors of colorectal cancer screening participation in the United States

OBJECTIVE:Our aim was to identify predictors of colorectal cancer screening in the United States and subgroups with particularly low rates of screening.METHODS:The responses to a telephone-administered questionnaire of a nationally representative sample of 61,068 persons aged ≥50 yr were analyzed. Current screening was defined as either sigmoidoscopy/colonoscopy in the preceding 5 years or fecal occult blood testing (FOBT) in the preceding year, or both.RESULTS:Overall, current colorectal cancer screening was reported by 43.4% (sigmoidoscopy/colonoscopy by 22.8%, FOBT by 9.9%, and both by 10.7%). The lowest rates of screening were reported by the following subgroups: those aged 50–54 yr (31.2%), Hispanics (31.2%), Asian/Pacific Islanders (34.8%), those with education less than the ninth grade (34.4%), no health care coverage (20.4%), or coverage by Medicaid (29.2%), those who had no routine doctors visit in the last year (20.3%), and every-day smokers (32.1%). The most important modifiable predictors of current colorectal cancer screening were health care coverage (OR = 1.7, 95% CI = 1.5–1.9) and a routine doctors visit in the last year (OR = 3.5, 95% CI = 3.2–3.8). FOBT was more common in women than in men (OR = 1.8, 95% CI = 1.6–2.0); sigmoidoscopy/colonoscopy was more common in Hispanics (OR = 1.4, 95% CI = 1.1–1.7) and Asian/Pacific Islanders (OR = 2.4, 95%= CI 1.5–3.9) relative to whites, in persons without routine doctors visits in the preceding year (OR = 3.3, 95% CI = 2.8–4), and in persons with poor self-reported health (OR = 1.3, 95% CI = 1.2–1.5).CONCLUSION:Interventions should be developed to improve screening for the subgroups who reported the lowest screening rates. Such interventions may incorporate individual screening strategy preferences.

Long-term evaluation of root resorption occurring during orthodontic treatment

The present study was undertaken to evaluate the long-term status of teeth that had undergone root resorption during active orthodontic treatment. A total of 100 patients who exhibited root resorption during appliance therapy were recalled at a mean period of 14.1 years (SD 0.4) after treatment. At those examinations full-mouth sets of periapical radiographs were taken and tooth mobility evaluated. Pretreatment, posttreatment, and long-term periapical radiographs were examined and compared for changes in root length and contour with time. At each stage scores were given on a scale from 0 to 4, depending on the degree of resorption. The maxillary incisors were affected more frequently and to a greater degree than the rest of the teeth during active treatment. The long-term evaluation showed no apparent changes after appliance removal except remodeling of rough and sharp edges. Hypermobility was observed in only two instances.

HIV infection and vaginal douching in central Africa.

Objective:To determine whether vaginal douching is associated with HIV infection. Methods:A total of 397 female patients who attended the referral clinic for sexually transmitted diseases in Bangui, Central African Republic, from August 1994 to February 1995, were interviewed regarding sexual behavior, sexual history, and vaginal douching during the previous 3 years. Pelvic examinations were conducted and vaginal and cervical fluids evaluated for genital infections. Blood was drawn for HIV and syphilis serologic testing. Results:The seroprevalence of HIV infection in the study population was 34%. Twenty-one per cent of the 115 HIV-seropositive women had a consistent practice of douching with commercial antiseptics versus 35% of the 223 HIV-seronegative women [odds ratio (OR), 0.6; 95% confidence interval (CI), 0.4–0.9; after adjusting for lifetime number of sexual partners, marital status, and condom use]. In contrast, a higher percentage of HIV-seropositive than HIV-seronegative women had a consistent practice of douching with a non-commercial preparation (14.8 versus 6.7%; adjusted OR, 1.7; 95% CI, 1.0–3.0). Conclusion:Our results suggest that vaginal douching with non-commercial preparations is associated with an increased prevalence of HIV, whereas douching with commercial antiseptic preparations was associated with a lower prevalence of HIV. The findings from this cross-sectional survey require confirmation in prospective studies.

Stability and relapse of mandibular anterior alignment: A cephalometric appraisal of first-premolar-extraction cases treated by traditional edgewise orthodontics☆

Assessment at least 10 years postretention of fifty-four cases previously treated in the permanent-dentition stage with first-premolar extractions, traditional edgewise mechanotherapy, and retention revealed considerable variation among patients. The long-term response to mandibular anterior alignment was unpredictable; no cephalometric parameters, such as maxillary and mandibular incisor proclination, horizontal and vertical growth amounts, mandibular plane angle, etc., were useful in establishing a prognosis. Few associations of value were found between cephalometric parameters and dental-cast measurements, such as overbite, arch length, intercanine width, and overjet. Only a slight tendency was found for incisor inclination to return toward the pretreatment value during the postretention period. It was possible to predict, on the basis of an analysis of pre- and posttreatment cephalometric records, those cases which had greater than 4 mm deepening of overbite postretention as well as those cases which had decreases of 3 mm or more in arch-length postretention. The practical use of these predictions were of limited clinical value, however.

A long-term study of the relationship of third molars to changes in the mandibular dental arch

The purpose of this study is to determine the relationship of third molars to changes in the mandibular dental arch. The sample for this study consisted of four groups and subgroups. The groups consisted of premolar extraction treated, nonextraction treated with initial generalized spacing, nonextraction treated, and serial extraction untreated subjects. The subgroups were divided into persons who had mandibular third molars that were either impacted, erupted into function, congenitally absent, or extracted at least 10 years before postretention records. The mean postretention time interval was 13 years, with a range of 10 to 28 years. The mean postretention age was 28 years 6 months, with a range of 18 years 6 months to 39 years 4 months. Two-way analysis of variance with repeated measures was used to compare the changes over time (before treatment, at end of active treatment, and after retention) of groups and third molar subgroups. With time, mandibular incisor irregularity increased while arch length and intercanine width decreased. The eruption patterns of mandibular incisors and first molars were similarly dispersed in all groups studied. The findings between the subgroups in which mandibular third molars were impacted, erupted into function, congenitally absent, or extracted 10 years before postretention records revealed no significant differences between any of the subgroups for the parameters studied. No significant differences in mandibular growth were found between the third molar subgroups; this suggests that persons with third molars erupted into satisfactory function do not have a significantly different mandibular growth pattern than those whose third molars are impacted or congenitally missing. In the majority of cases some degree of mandibular incisor crowding took place after retention, but this change was not significantly different between third molar subgroups. This finding suggests that the recommendation for mandibular third molar removal with the objective of alleviating or preventing mandibular incisor irregularity may not be justified.

Prevalence and predictors of sexual dysfunction in long-term survivors of marrow transplantation.

PURPOSE To describe the prevalence of sexual difficulties in men and women after marrow transplantation (MT), and to define medical, demographic, sexual, and psychologic predictors of sexual dysfunction 3 years after MT. PATIENTS AND METHODS Four hundred seven adult MT patients were assessed pretransplantation. Survivors repeated measures of psychologic and sexual functioning at 1 and 3 years posttransplantation. RESULTS Data were analyzed from 102 event-free 3-year survivors who defined themselves as sexually active. Men and women did not differ in sexual satisfaction pretransplantation. At 1 and 3 years posttransplantation, women reported significantly more sexual dysfunction than men. Eighty percent of women and 29% of men reported at least one sexual problem by 3 years after MT. No pretransplantation variables were significant predictors of 3-year sexual satisfaction for women. For men, pretransplantation variables of older age, poorer psychologic function, not being married, and lower sexual satisfaction predicted sexual dissatisfaction at 3 years (R2=.28; P < .001). Women who were more dissatisfied 3 years after MT did not receive hormone replacement therapy (HRT) at 1 -year posttransplantation and were less satisfied at 1 year, but not pretransplantation (R2=.35; P < .001). CONCLUSION Sexual problems are significant in the lives of MT survivors, particularly for women. Although HRT before 1 year posttransplantation improves sexual function, it does not ensure sexual quality of life. Intervention for women is needed to apply hormonal, mechanical, and behavioral methods to prevent sexual difficulties as early after transplantation as possible.

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient Clinics

OBJECTIVE To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. DATA SOURCES/STUDY SETTING VA administrative and Medicare claims data from 2001 to 2004. STUDY DESIGN Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. PRINCIPAL FINDINGS A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3-4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). CONCLUSIONS Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.

Physician Participation in Research Surveys A Randomized Study of Inducements to Return Mailed Research Questionnaires

The authors randomly selected 400 physicians from a population of 1,545 practicing physicians providing follow-up care to patients who received bone marrow or blood stem cell transplants at the Fred Hutchinson Cancer Research Center to determine interest in receiving Internet-based transplant information. In a two-factor completely randomized factorial design, the 400 physicians were assigned to receive mailed surveys with either no compensation or a

Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

5 check and either no follow-up call or a follow-up call 3 weeks after mailing. Overall, 51.5% of the physicians returned the mailed surveys. Comparison of logit models showed that inclusion of a

Coronary artery stent outcomes in a Medicare population: Less emergency bypass surgery and lower mortality rates in patients with stents

5 check in the mailer significantly (p = .016) increased the probability of returning the surveys (57.5% vs. 45.5%). In contrast, the telephone follow-up had no overall effect. The authors concluded a modest financial reward can significantly improve physician response rates to research surveys but a telephone follow-up may be inefficient and even ineffective.