Timing and Risk Factors for a Positive Fecal Immunochemical Test in Subsequent Screening for Colorectal Neoplasms.

BACKGROUND: Following a negative test, the performance of fecal immunochemical testing in the subsequent screening round is rarely reported. It is crucial to allocate resources to participants who are more likely to test positive subsequently following an initial negative result. OBJECTIVE: To identify risk factors associated with a positive result in subsequent screening. METHODS: Dataset was composed of consecutive participants who voluntarily underwent fecal tests and colonoscopy in a routine medical examination at the National Taiwan University Hospital between January 2007 and December 2011. Risk factor assessment of positive fecal test in subsequent screening was performed by using the Cox proportional hazards models. RESULTS: Our cohort consisted of 3783 participants during a 5-year period. In three rounds of subsequent testing, 3783, 1537, and 624 participants underwent fecal tests, respectively; 5.7%, 5.1%, and 3.9% tested positive, respectively, and the positive predictive values were 40.2%, 20.3%, and 20.8%, respectively. Age ≥60 years (adjusted hazard ratio: 1.53, 95% CI: 1.21-1.93) and male gender (1.32, 95% CI: 1.02-1.69) were risk factors; however, an interaction between age and gender was noted. Men had higher risk than women when they were <60 years of age (p = 0.002), while this difference was no longer observed when ≥60 years of age (p = 0.74). The optimal interval of screening timing for participant with baseline negative fecal test was 2 years. CONCLUSIONS: Following a negative test, older age and male gender are risk factors for a positive result in the subsequent rounds while the gender difference diminishes with age. Biennial screening is sufficient following a negative fecal test.

Trajectories of the multidimensional dying experience for terminally ill cancer patients.

CONTEXT: Studies exploring the trajectories of physical-psychological-social-spiritual dying experiences frequently treat changes in these experiences as consistent across different domains and over time. OBJECTIVE: This prospective, longitudinal investigation was designed to characterize trajectories of the multidimensional dying experience for cancer patients in their last year of life. METHODS: Trajectories of physical-psychological-social-spiritual/existential dimensions and overall quality of life (QOL) were identified among 313 cancer patients using mixed-effects models to test for linear, quadratic, or cubic changes. Changes in each variable were evaluated for clinical significance using minimal important difference. RESULTS: When patients transitioned to their end of life, symptom distress, functional dependence, anxiety, and depressive symptoms slightly increased, followed by a stable status for approximately four to six months, and accelerated dramatically to the first clinically significant changes at three to four months before death. Perceived social support and post-traumatic growth declined gradually to clinically significant changes at one and four months before death, respectively. Perceived sense of burden to others increased steadily in the last year of life, with no clinically significant changes identified. Overall QOL deteriorated gradually in the last year but did not reach a clinically significant change until 2.5 months before death. CONCLUSION: All dimensions deteriorated in the last year of life but with distinctive physical-psychological-social-spiritual/existential and overall QOL trajectories. Recognizing trajectory patterns and tipping points of accelerating deterioration in each dimension can help clinicians anticipate times of increased distress, initiate timely, effective interventions to relieve patient suffering, and facilitate high-quality end-of-life care tailored to patients' needs and preferences.

A closer examination of the interaction among risk factors for low back pain.

PURPOSE: To evaluate the interactions of risk factors and identify their most powerful discrimination pathway for the occurrence of low back pain (LBP). DESIGN: A cross-sectional study. SETTING: Taiwan. SUBJECTS: Taiwanese population of 30 to 64 years old. MEASURES: A self-reported question, "Have you experienced LBP within the last 3 months?" was used to evaluate LBP. The study variables included demographics (age, gender, occupation, education level, marital status, and household income), biometric health measures (bone mineral density and body mass index), dietary habits (weekly milk, coffee, tea, and soybean consumption), and other lifestyle factors (smoking habits, alcohol consumption, betel nut chewing, body weight control, exercise regularity, and stress management). ANALYSIS: Logistic regression and classification tree analyses. RESULTS: A total of 969 Taiwanese participants were analyzed. Primary logistic regression analysis identified three critical risk factors (gender, bone mineral density, and exercise regularity) for the occurrence of LBP. By classification tree analysis, demographic factors, dietary habits, and lifestyle factors had modifying effects on LBP. CONCLUSIONS: Various factors contribute to the risk of LBP. Interactions between risk factors should be considered when developing future strategies for the prevention and management of LBP.