High-resolution anoscopy, is there a benefit in proceeding directly to the operating room?

BACKGROUND: The development of high-resolution anoscopy (HRA) has advanced our ability to detect anal dysplasia. Historically, HRA is performed in a clinical setting and subsequent ablation is performed in the clinical setting or operating room. The aim of this study was to determine the most effective venue for the performance of HRA. METHODS: Following institutional review board (IRB) approval, the correlation between anal cytology and HRA performed in the clinic versus in the operating room was evaluated. Data were extracted from our IRB-approved prospective HRA database over the time period of 2013-2017. RESULTS: One hundred twenty-eight HRAs were compared (101 in the clinical setting, 27 in the operating room). There was a statistically significant difference in the correlation between anal cytology and HRA pathology for procedures performed in the clinical setting (55% [56/101]) versus those performed in the operating room (82% [22/27]) (p = 0.014). More biopsies were obtained in the operating room than in the clinic setting (3 vs. 1, p < 0.0001). The majority of patients who had HRA in a clinical setting with subsequent HRA in the operating room stated that they preferred to have their HRAs performed in the operating room due to discomfort from the HRA procedure. CONCLUSIONS: Detection rates for anal dysplasia on HRA, are significantly higher when performed in the operating room. To prevent discomfort in the clinical setting, patients with high-grade dysplasia on anal pap testing may benefit from proceeding directly to the operating room for concurrent HRA and ablation.

Is criminal violence a non-communicable disease? Exploring the epidemiology of violence in Jamaica.

There is a high level of criminal violence that afflicts the Jamaican society. While it is certainly noncommunicable in the context of medicine and public health, the concepts of social contagion and the well-established fact of the intergenerational transfer of effects of trauma raise questions as to whether or not it is non-communicable in a social sense. Historically, scholars have linked Jamaican criminal violence to three main roots: poverty and urban decay, political patronage, garrisonisation and more recently to a fourth, the growth in transnational organized crime (TOC). Traditionally as well, policymakers have brought the three discrete perspectives of criminology, criminal justice and public health to bear on the problem. This paper applies a conceptual framework derived from a combination of epidemiology and the behavioural sciences to argue that a sustainable resolution to this looming and intractable social problem must take the form of a cocktail of policies that encompasses all three approaches at levels ranging from the community to the international.

Is criminal violence a non-communicable disease? Exploring the epidemiology of violence in Jamaica / ¿Es la violencia criminal una enfermedad no comunicable? Explorando la epidemiología de la violencia en Jamaica

There is a high level of criminal violence that afflicts the Jamaican society. While it is certainly non-communicable in the context of medicine and public health, the concepts of social contagion and the well-established fact of the intergenerational transfer of effects of trauma raise questions as to whether or not it is non-communicable in a social sense. Historically, scholars have linked Jamaican criminal violence to three main roots: poverty and urban decay, political patronage, garrisonisation and more recently to a fourth, the growth in transnational organized crime (TOC). Traditionally as well, policy-makers have brought the three discrete perspectives of criminology, criminal justice and public health to bear on the problem. This paper applies a conceptual framework derived from a combination of epidemiology and the behavioural sciences to argue that a sustainable resolution to this looming and intractable social problem must take the form of a cocktail of policies that encompasses all three approaches at levels ranging from the community to the international.

Un nivel alto de violencia criminal tiene lugar en Jamaica y las matanzas resultantes tiene un alto costo para la sociedad. Si bien no es ciertamente comunicable en el contexto de la medicina y la salud pública, los conceptos de contagio social y el hecho bien establecido de la transferencia inter-generacional de los efectos del trauma, suscitan preguntas sobre si tal violencia es o no comunicable en un sentido social. Históricamente, los estudiosos han vinculado la violencia criminal en Jamaica a tres raíces principales: la pobreza y la decadencia urbana, el patronato político, y la "garrisonización" o establecimiento de "barrios cuarteles". Una cuarta raíz se ha añadido recientemente, a saber, el crecimiento del crimen organizado trasnacional (COT). Tradicionalmente también, los diseñadores de políticas y los políticos han apuntado a la relación del problema con tres perspectivas discretas representadas por la criminología, la justicia criminal y la salud pública. Este trabajo aplica un marco conceptual derivado de una combinación de epidemiología y ciencias del comportamiento como base argumentativa de que una resolución sostenible a este inextricable y difícil problema social debe tomar la forma de un cóctel de políticas que abarquen los tres enfoques, desde el nivel comunitario al nivel internacional.