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Alcohol policy interventions, including those that increase alcohol taxes, raise the drinking and purchase age, reduce days or hours of sale, and impose strong marketing bans, reduce alcohol consumption.

The goal of this study was to explore diagnostic colonoscopy completion in adults with abnormal screening fecal immunochemical test (FIT) results. This was a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (Stop CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in federally qualified community health clinics. Diagnostic colonoscopy completion and reasons for non-completion were ascertained through a manual review of electronic health records, and completion was compared across a wide range of individual patient health and sociodemographic characteristics. Among 2,018 adults with an abnormal FIT result, 1066 (52.8%) completed a follow-up colonoscopy within 12 months. Completion was generally similar across a wide range of participant subpopulations; however, completion was higher for participants who were younger, Hispanic, Spanish-speaking, and had zero or one of the Charlson medical comorbidities, compared to their counterparts. Neighborhood-level predictors were not associated with diagnostic colonoscopy completion. Thus, completion of a diagnostic colonoscopy was relatively low in a large sample of community health clinic adults who had an abnormal screening FIT result. While completion was generally similar across a wide range of characteristics, younger, healthier, Hispanic participants tended to have a higher likelihood of completion.

Background Colorectal cancer (CRC) screening rates remain suboptimal, particularly in low-income and underserved populations. Mailed fecal immunochemical testing (FIT) may overcome common barriers to screening; however, the effect of mailed FIT kits may differ across important subpopulations. The goal of the current study was to examine sociodemographic and health-related factors that moderate the effect of an intervention of automated direct mail of FIT kits at health clinics serving low-income populations. Methods This study is a secondary analysis of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) study, a cluster-randomized pragmatic trial to increase uptake of CRC screening in patients seen at federally qualified health centers. The intervention involved tools embedded in the electronic medical records to enable participating clinics to mail FIT kits and related materials to eligible participants. We examined the rate of FIT completion by potential moderating characteristics using electronic health record data supplemented by the American Community Survey and the Centers for Medicare & Medicaid Services Geographic Variation datasets, linked via geocoding to patients’ addresses. All patients aged 50–75 seen in participating health clinics who were eligible for CRC screening were included. Results Although not always statistically significant, we saw a consistent pattern of increased FIT return rates among intervention participants compared to control participants across all subgroups studied, with incidence rate ratios (IRRs) generally ranging from 1.25 to 1.50. FIT completion in the intervention group ranged from 15 and 20% across subpopulations, typically three to six percentage points higher than the control group participants. The only moderator with a statistically significant interaction was race: persons of Asian descent showed a twofold response to the intervention (adjusted incidence rate ratio [aIRR] = 2.06, 95% confidence interval 1.41 to 3.00). Conclusions Response to a mailed FIT intervention was generally consistent across a wide range of individual and neighborhood-level patient characteristics, including typically underserved patients and those in low-resource communities. Trial registration ClinicalTrials.gov, NCT01742065 . Registered on 5 December 2012.

Objective: The objective of this study was to evaluate work-related asthma among health maintenance organization (HMO) members. Recent reports suggest that the incidence of work-related asthma may be much higher than Sentinel Event Notification Systems for Occupational Risks (SENSOR) data estimate. Methods: Using the HMO's electronic medical record, we identified 1747 persons with evidence of new or recurrent asthma. Interviews with 352 of them elicited information about workplace exposures, symptoms, and home environment. Industrial hygienists rated the potential asthmagenicity of the respondents' work environments. Results: Based on the industrial hygienist ratings and self-reported work-relatedness of asthma symptoms, we classifie 33% of those interviewed as having potentially work-related asthma, suggesting an overall work-related asthma incidence/recurrence rate o 28 cases per 10,000. Conclusions: The contribution of occupation to th occurrence of adult onset asthma may be much higher than typically suggested in the literature.

To determine whether persons with asymptomatic bilateral hilar lymphadenopathy (ABHL) and normal results of a physical examination should be observed with a presumptive diagnosis of stage 1 sarcoidosis (S1S) (ABHLps), its most frequent cause, or undergo mediastinoscopy to avoid overlooking an alternative diagnosis (AD) requiring treatment. We surveyed the English-language medical literature to estimate the proportion of persons with tuberculosis (TB), Hodgkin's disease (HD), and non-Hodgkin's lymphoma (NHL) who present with ABHL and calculated the number of mediastinoscopies required to identify each AD by computing the following ratio: incidence S1S/incidence of each AD presenting as ABHL (I(S1S)/I[ABHL-AD]). Risks of mediastinoscopy and benefits of earlier ascertainment of AD were derived from the published literature. Cost estimates were based on institutional charges. We conducted a regional survey of practicing pulmonologists to ascertain their diagnostic preferences. We estimate that if 33,000 persons with ABHL underwent mediastinoscopy, 32,982 (99.95%) would be found to have S1S or, very rarely, a disorder not requiring intervention; 407 would require hospitalization for complications at a cost in excess of $1 million; and 204 would experience major morbidity; 8 persons with TB, 9 with HD, and 1 with NHL would be identified at a cost of $100 to $200 million. The benefit for persons diagnosed as having AD would be minimal and likely offset by the procedural mortality. Seventy percent of pulmonologists responding to the survey favored observation over transbronchial lung biopsy or mediastinoscopy in patients with ABHL. A policy of continued observation of patients presenting with ABHL is preferable to diagnostic mediastinoscopy from both the risk/benefit and cost/benefit standpoint.

The isolation of genes from a given genomic region can be a rate-limiting step in the discovery of disease genes. We describe an approach to the isolation of cDNAs that have sequences in common with large genomic clones such as bacterial artificial chromosomes. We applied this method to loci both amplified and deleted in cancer, illustrating its usage in the identification of both oncogenes and tumor suppressor genes, respectively. The method, called rapid isolation of cDNAs by hybridization (RICH), depends on solution hybridization, enzymatic modification, and amplification/selection of sequences present in both cDNA populations and the genomic clones. The method should facilitate the development of transcription maps for large genomic clones, possibly even yeast artificial chromosomes.

The development of a reliable asthma registry is an important first step for conducting population-based asthma disease management. This study developed a computerized algorithm for defining prevalent asthma, identified operational difficulties, and summarized data on asthma prevalence in the study population. As part of a study of the incidence of occupational asthma, we used the electronic databases of a large health maintenance organization to develop a computerized algorithm for defining prevalent asthma and validated it against chart review. The predictive values of eight health care utilization profiles were validated by chart review to establish the algorithm. The 1-year treated prevalence of asthma was 4.1% among members aged 15–55; the pharmacy database identified 61% of cases, and the outpatient care database 66%. Extending the outpatient care window from 1 year to 2 years increased estimated prevalence to 5.3%, with 81% now found in the outpatient care database. This analysis illustrates the benefit of using multiple databases for more accurate enumeration of cases and the impact of extending the search in time. These results are useful for researchers who can use such databases in selecting algorithms to define and identify asthma for their own purposes.

To determine whether persons with asymptomatic bilateral hilar lymphadenopathy (ABHL) and normal results of a physical examination should be observed with a presumptive diagnosis of stage 1 sarcoidosis (S1S) (ABHLps), its most frequent cause, or undergo mediastinoscopy to avoid overlooking an alternative diagnosis (AD) requiring treatment. We surveyed the English-language medical literature to estimate the proportion of persons with tuberculosis (TB), Hodgkin's disease (HD), and non-Hodgkin's lymphoma (NHL) who present with ABHL and calculated the number of mediastinoscopies required to identify each AD by computing the following ratio: incidence S1S/incidence of each AD presenting as ABHL (IS1S/IABHL-AD). Bisks of mediastinoscopy and benefits of earlier ascertainment of AD were derived from the published literature. Cost estimates were based on institutional charges. We conducted a regional survey of practicing pulmonologists to ascertain their diagnostic preferences. We estimate that if 33,000 persons with ABHL underwent mediastinoscopy, 32,982 (99.95%) would be found to have S1S or, very rarely, a disorder not requiring intervention; 407 would require hospitalization for complications at a cost in excess of $1 million; and 204 would experience major morbidity; 8 persons with TB, 9 with HD, and 1 with NHL would be identified at a cost of $100 to $200 million. The benefit for persons diagnosed as having AD would be minimal and likely offset by the procedural mortality. Seventy percent of pulmonologists responding to the survey favored observation over transbronchial lung biopsy or mediastinoscopy in patients with ABHL. A policy of continued observation of patients presenting with ABHL is preferable to diagnostic mediastinoscopy from both the risk/benefit and cost/benefit standpoint.