INTRODUCTION: The incidence of early-onset colorectal cancer is increasing. This study explored the feasibility of fecal immunochemical test (FIT) and risk factors for predicting colorectal neoplasm in younger adults. METHODS: This single-center study included 6,457 participants who underwent health examination from 2013 to 2016 including index colonoscopy (3,307 individuals aged 30–49 years as the younger adult group and 3,150 aged ≥50 years as the average-risk group). Primary outcomes were adenoma detection rate (ADR) and advanced ADR (AADR). Findings of younger participants were stratified by the results of FIT and clinical risk factors and were compared with those of the average-risk group. RESULTS: Among participants aged 30–49 years, a positive FIT was associated with significantly higher ADR (28.5% vs 15.5, P < 0.001) and AADR (14.5% vs 3.7%, P < 0.001) than a negative FIT. Moreover, a positive FIT was associated with higher AADR in younger participants than in average-risk counterparts (14.5% vs 9.8%, P = 0.028). Although no single risk factor predicted FIT positivity in younger participants, nonalcoholic fatty liver disease was independently associated with higher ADR (odds ratio = 2.60, 95% confidence interval = 1.27–5.34, P = 0.001), and metabolic syndrome was independently predictive of higher AADR in younger participants than in average-risk participants (odds ratio = 3.46, 95% confidence interval = 1.66–7.21, P = 0.001). DISCUSSION: A positive FIT in people aged 30–49 years implies a higher risk of colorectal neoplasm, particularly among patients with nonalcoholic fatty liver disease and metabolic syndrome.
A low-residue diet (LRD) is recommended as part of bowel preparation before a colonoscopy. However, the optimal duration of the LRD is unclear. A retrospective cross-sectional study was therefore conducted at E-Da Dachang Hospital. We compared bowel preparations using the Aronchick score and other quality metrics during two consecutive periods: May 2019 to December 2019 (3-day LRD) and January 2020 to August 2020 (1-day LRD). A total of 2823 patients were enrolled (1592 in the 3-day LRD group and 1231 in the 1-day LRD group). The most common bowel cleansing agent was sodium picosulfate and magnesium citrate (SPMC, 84.2%), followed by polyethylene glycol (PEG, 10.0%) and sodium phosphate (5.8%). Compared with patients in the 3-day LRD group, patients in the 1-day LRD group had higher SPMC use (88.1% vs 81.3%, P < .001) and supplemental laxative use (25.9% vs 19.3%, P < .001).The proportion of adequate bowel preparation (84.2% vs 85.1%, P = .563), cecal intubation rate, adenoma detection rate, and right-side adenoma detection rate were not significantly different between 1-day LRD and 3-day LRD groups. More advanced adenomas (5.9% vs 3.4%, P = .002) and sessile serrated lesions (8.9% vs 6.3%, P = .014) were observed in the 1-day LRD group. In addition, the types of laxatives (SPMC, sodium phosphate, and PEG) and the use of supplemental laxatives did not affect bowel preparation scores. In conclusion, a 1-day LRD led to bowel preparation similar to that achieved through a 3-day LRD regardless of the type of primary cleansing agent or the use of supplemental laxatives.
Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system.
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