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Evaluation of the Effectiveness and Cost-Effectiveness of Personalized Surveillance After Colorectal Adenomatous Polypectomy. 评估结直肠腺瘤性息肉切除术后个性化监测的有效性和成本效益。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxx002
Ethna McFerran, James F O'Mahony, Richard Fallis, Duncan McVicar, Ann G Zauber, Frank Kee

Lifetime risk of developing colorectal cancer is 5%, and 5-year survival at early stage is 92%. Individuals with precancerous lesions removed at primary screening are typically recommended surveillance colonoscopy. Because greater benefits are anticipated for those with higher risk of colorectal cancer, scope for risk-specific surveillance recommendations exists. This review assesses published cost-effectiveness estimates of postpolypectomy surveillance to consider the potential for personalized recommendations by risk group. Meta-analyses of incidence of advanced neoplasia postpolypectomy for low-risk cases were comparable to those without adenoma, with both rates under the lifetime risk of 5%. This group may not benefit from intensive surveillance, which risks unnecessary harm and inefficient use of often scarce colonoscopy capacity. Therefore, greater personalization through deintensified strategies for low-risk individuals could be beneficial. The potential for noninvasive testing, such as fecal immunochemical tests, combined with primary prevention or chemoprevention may reserve colonoscopy for targeted use in personalized risk-stratified surveillance. This review appraised evidence supporting a program of personalized surveillance in patients with colorectal adenoma according to risk group and compared the effectiveness of surveillance colonoscopy with alternative prevention strategies. It assessed trade-offs among costs, benefits, and adverse effects that must be considered in a decision to adopt or reject personalized surveillance.

终生罹患大肠癌的风险为 5%,早期患者的 5 年生存率为 92%。对于在初筛中切除了癌前病变的人,通常建议进行结肠镜监测检查。由于预计患结直肠癌风险较高的人群可获得更大的益处,因此存在针对特定风险提出监测建议的空间。本综述评估了已发表的息肉切除术后监测的成本效益估算,以考虑按风险组别提出个性化建议的可能性。对低风险病例切除息肉术后晚期肿瘤发生率的 Meta 分析结果与无腺瘤的病例相当,两者的发生率均低于 5% 的终生风险。这部分患者可能无法从强化监测中获益,因为强化监测可能会造成不必要的伤害,并使稀缺的结肠镜检查能力得不到有效利用。因此,通过针对低风险人群的非强化策略来提高个性化程度可能是有益的。无创检测(如粪便免疫化学检测)与一级预防或化学预防相结合的潜力可为结肠镜检查在个性化风险分级监控中的有针对性使用预留空间。本综述评估了支持根据风险组别对结直肠腺瘤患者进行个性化监测计划的证据,并比较了结肠镜监测与其他预防策略的有效性。它评估了在决定采用或拒绝个性化监测时必须考虑的成本、效益和不良反应之间的权衡。
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引用次数: 0
RE: "WHAT DO WE KNOW ABOUT THE ASSOCIATION BETWEEN FIREARM LEGISLATION AND FIREARM-RELATED INJURIES?" 回答:“我们对枪支立法和枪支相关伤害之间的关系了解多少?”
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxx011
In the article “Disasters: Introduction and State of the Art” by Noji (1), multiple instances of improper or missing attribution were brought to the Editor’s attention. Upon investigation, the following irregularities, which have been acknowledged by the author, were identified. On page 5, the second full paragraph in the second column, which begins “Major advances have been made during the past decade...” was taken from the article by Salama et al. (2, p. 1801; reference 20 in the original article). Although that article is cited as a reference, it was not made clear that the entire paragraph was a quote. In addition, on pages 5 and 6, several paragraphs were taken verbatim without proper attribution from the article by Noji and Toole (3).
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引用次数: 4
The Health System and Policy Implications of Changing Epidemiology for Oral Cavity and Oropharyngeal Cancers in the United States From 1995 to 2016. 1995年至2016年美国口腔和口咽癌流行病学变化的卫生系统和政策影响
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxw001
Charles W LeHew, Darien J Weatherspoon, Caryn E Peterson, Abigail Goben, Karolina Reitmajer, Herve Sroussi, Linda M Kaste

Oral cavity and oropharyngeal cancers are typically grouped under the general term, "oral cancer." Yet, the incidence of oropharyngeal cancers is increasing in the United States, while the incidence of oral cavity cancers has declined. These 2 distinct but conflated groups of oral cancers are attributed to different risk factors. Incidence and survival trends were examined across US population groups and by anatomical subsite. Disparities in incidence and survival by sex, race/ethnicity, and subsite were identified. Risk factors are complex, interactive, and not fully identified. Cancer control research illustrates health disparities in access to care and patient outcomes. Database and supplemental searches yielded 433 articles published between 1995 and 2016 characterizing aspects of oral cancer epidemiology relating to incidence, survival, risk, disparities, and cancer control. Oral cavity cancer survival in black men remains the most intractable burden. Although understanding of oral cancer etiology is improving, application to policy is limited. Cancer control efforts are diverse, sporadic, limited in scope, and generally lacking in success, and they need stratification by oral cavity cancers/oropharyngeal cancers. Further intervention and epidemiologic research, improved workforce capacity, and integrated care delivery are identified as important directions for public health policy. Sustained, multilevel campaigns modeled on tobacco control success are suggested.

口腔癌和口咽癌通常归为“口腔癌”的总称。然而,口咽癌的发病率在美国正在增加,而口腔癌的发病率却在下降。这两种不同但合并的口腔癌是由不同的风险因素引起的。发病率和生存趋势在美国人群和解剖亚位点进行了检查。确定了不同性别、种族/民族和亚部位的发病率和生存率差异。风险因素是复杂的、相互作用的,而且不能完全确定。癌症控制研究表明,在获得护理和患者预后方面存在健康差异。数据库和补充检索产生了1995年至2016年间发表的433篇文章,这些文章描述了口腔癌流行病学与发病率、生存率、风险、差异和癌症控制有关的各个方面。口腔癌在黑人男性中的生存仍然是最棘手的负担。虽然对口腔癌病因的了解正在提高,但在政策上的应用仍然有限。癌症控制工作是多种多样的、零星的、范围有限的,而且通常缺乏成功,需要根据口腔癌/口咽癌进行分层。进一步的干预和流行病学研究、提高劳动力能力和提供综合护理被确定为公共卫生政策的重要方向。建议以烟草控制的成功为蓝本开展持续的多层次运动。
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引用次数: 36
Implementing Evidence-Based Palliative Care Programs and Policy for Cancer Patients: Epidemiologic and Policy Implications of the 2016 American Society of Clinical Oncology Clinical Practice Guideline Update. 为癌症患者实施循证姑息治疗计划和政策:2016年美国临床肿瘤学会临床实践指南更新的流行病学和政策影响》。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxw002
Sarina R Isenberg, Rebecca A Aslakson, Thomas J Smith

The American Society of Clinical Oncology (ASCO) recently convened an Ad Hoc Palliative Care Expert Panel to update a 2012 provisional clinical opinion by conducting a systematic review of clinical trials in palliative care in oncology. The key takeaways from the updated ASCO clinical practice guidelines (CPGs) are that more people should be referred to interdisciplinary palliative care teams and that more palliative care specialists and palliative care-trained oncologists are needed to meet this demand. The following summary statement is based on multiple randomized clinical trials: "Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment. Referral of patients to interdisciplinary palliative care teams is optimal, and services may complement existing programs" (J Clin Oncol. 2017;35(1):96). This paper addresses potential epidemiologic and policy interpretations and implications of the ASCO CPGs. Our review of the CPGs demonstrates that to have clinicians implement these guidelines, there is a need for support from stakeholders across the health-care continuum, health system and institutional change, and changes in health-care financing. Because of rising costs and the need to improve value, the need for coordinated care, and change in end-of-life care patterns, many of these changes are already underway.

美国临床肿瘤学会(ASCO)最近召集了一个姑息关怀特设专家组,通过对肿瘤姑息关怀临床试验进行系统回顾,更新了2012年的临时临床意见。更新后的 ASCO 临床实践指南 (CPG) 的主要观点是,应将更多患者转诊至跨学科姑息关怀团队,同时需要更多姑息关怀专家和接受过姑息关怀培训的肿瘤学家来满足这一需求。以下总结声明是基于多项随机临床试验得出的:"晚期癌症住院病人和门诊病人在接受积极治疗的同时,应在病程早期接受专门的姑息关怀服务。将患者转诊至跨学科姑息关怀团队是最佳选择,姑息关怀服务可作为现有项目的补充"(J Clin Oncol.2017;35(1):96).本文探讨了 ASCO CPGs 潜在的流行病学和政策解释及影响。我们对 CPGs 的回顾表明,要让临床医生执行这些指南,需要整个医疗保健连续体的利益相关者的支持、医疗系统和机构的变革以及医疗保健融资的变化。由于成本上升、提高价值的需要、协调护理的需要以及临终关怀模式的改变,许多变革已经在进行中。
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引用次数: 0
Vitamin D and Cancer Risk and Mortality: State of the Science, Gaps, and Challenges. 维生素D与癌症风险和死亡率:科学现状、差距和挑战。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxx005
Alison M Mondul, Stephanie J Weinstein, Tracy M Layne, Demetrius Albanes

There has been substantial enthusiasm recently regarding the potential role of vitamin D in the primary and secondary prevention of cancer. Laboratory studies demonstrate a range of anticarcinogenic effects for vitamin D compounds, but human studies have yielded little consistent evidence supporting a protective association. Higher circulating levels of vitamin D (i.e., 25-hydroxyvitamin D or 25(OH)D) appear to be associated with reduced risk of colorectal and bladder malignancies, but higher risk of prostate and possibly pancreatic cancers, with no clear association for most other organ sites examined. Despite there being no official institutional recommendations regarding the use of vitamin D supplements for cancer prevention, screenings for vitamin D deficiency and vitamin D supplement use have increased substantially over the past decade. These widespread practices demonstrate that population sociobehavioral changes are often adopted before scientifically well-informed policies and recommendations are available. This review critically examines the currently available epidemiologic literature regarding the associations between circulating 25(OH)D, vitamin D supplementation, and vitamin D-related genetic variation and cancer risk and mortality, with a particular emphasis on prospective studies. We identify several important gaps in our scientific knowledge that should be addressed in order to provide sufficient reproducible data to inform evidence-based recommendations related to optimal 25(OH)D concentrations (and any role for vitamin D supplementation) for the primary and secondary prevention of cancer. With few exceptions, such recommendations cannot be made at this time.

最近,人们对维生素D在一级和二级预防癌症中的潜在作用非常感兴趣。实验室研究证明维生素D化合物具有一系列的抗癌作用,但人体研究几乎没有得出一致的证据来支持维生素D与抗癌之间的联系。较高的循环维生素D水平(即25-羟基维生素D或25(OH)D)似乎与降低结肠直肠癌和膀胱恶性肿瘤的风险有关,但前列腺癌和可能的胰腺癌的风险较高,与大多数其他器官部位的研究没有明确的联系。尽管没有关于使用维生素D补充剂预防癌症的官方机构建议,但在过去十年中,维生素D缺乏症的筛查和维生素D补充剂的使用大幅增加。这些广泛的做法表明,人口社会行为的改变往往在科学上有充分信息的政策和建议出台之前就被采纳了。这篇综述严格审查了目前可用的流行病学文献关于循环25(OH)D、维生素D补充和维生素D相关遗传变异与癌症风险和死亡率之间的关系,特别强调了前瞻性研究。我们确定了我们科学知识中的几个重要空白,这些空白应该得到解决,以便提供足够的可重复数据,为基于证据的建议提供有关最佳25(OH)D浓度(以及维生素D补充的任何作用),以一级和二级预防癌症。除少数例外情况外,目前无法提出此类建议。
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引用次数: 144
RE: "DISASTERS: INTRODUCTION AND STATE OF THE ART". 回复:“灾难:介绍和最新技术”。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2017-01-01 DOI: 10.1093/epirev/mxx010
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引用次数: 0
Alcohol Use and Firearm Violence. 饮酒与枪支暴力。
IF 5.2 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-01-01 Epub Date: 2016-01-24 DOI: 10.1093/epirev/mxv010
Charles C Branas, SeungHoon Han, Douglas J Wiebe

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

虽然滥用枪支是发生枪支暴力的必要条件,但除了枪支本身之外,还有其他一些促成因素也可以通过改变来预防枪支暴力。酒精就是其中一个关键的可改变因素。为了探讨这个问题,我们进行了一项为期 40 年(1975-2014 年)的系统文献回顾和荟萃分析。其中一大类研究表明,超过三分之一的枪支暴力死者在死前曾急性饮酒,超过四分之一的死者在死前曾大量饮酒。另一组大型研究表明,酗酒与使用枪支作为自杀手段密切相关。两项对照研究表明,饮酒(尤其是大量饮酒)后造成的枪支伤害在自我造成的枪支伤害受害者中具有显著的统计学意义。一小部分研究调查了酒精与枪支法律以及酒精销售点与枪支暴力之间的交叉关系。其中一项对照研究发现,销售外卖酒类的店外销售点与枪支袭击有显著关联。还需要进行更多的人群风险因素和干预措施的对照研究,包括随机试验,目前只发现了一项随机试验。值得进一步研究的政策包括:重新划分店外酒类销售点,规定血液中的酒精含量,加重对醉酒后携带或使用枪支的处罚,以及将醉酒驾车前科作为取消个人购买或持有枪支资格的更精确标准。
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引用次数: 0
Editorial Board. 编辑委员会。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-01-01 DOI: 10.1093/epirev/mxv015
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引用次数: 0
Subscription Page. 订阅页面。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-01-01 DOI: 10.1093/epirev/mxv016
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引用次数: 0
Are We Missing Something Pertinent? A Bias Analysis of Unmeasured Confounding in the Firearm-Suicide Literature. 我们是否错过了一些相关的东西?枪械自杀文献中未测量混杂的偏倚分析。
IF 5.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2016-01-01 DOI: 10.1093/epirev/mxv011
M. Miller, S. Swanson, D. Azrael
Despite the magnitude and consistency of risk estimates in the peer-reviewed literature linking firearm availability and suicide, inferring causality has been questioned on the theoretical basis that existing studies may have failed to account for the possibility that members of households with firearms differ from members of households without firearms in important ways related to suicide risk. The current bias analysis directly addresses this concern by describing the salient characteristics that such an unmeasured confounder would need to possess in order to yield the associations between firearm availability and suicide observed in the literature when, in fact, the causal effect is null. Four US studies, published between 1992 and 2003, met our eligibility criteria. We find that any such unmeasured confounder would need to possess an untenable combination of characteristics, such as being not only 1) as potent a suicide risk factor as the psychiatric disorders most tightly linked to suicide (e.g., major depressive and substance use disorders) but also 2) an order of magnitude more imbalanced across households with versus without firearms than is any known risk factor. No such confounder has been found or even suggested. The current study strongly suggests that unmeasured confounding alone is unlikely to explain the association between firearms and suicide.
尽管在同行评议的文献中,将枪支的可获得性与自杀联系起来的风险估计的幅度和一致性,推断因果关系在理论基础上受到质疑,因为现有的研究可能未能解释有枪支的家庭成员与没有枪支的家庭成员在与自杀风险相关的重要方面存在差异的可能性。当前的偏倚分析直接解决了这一问题,它描述了这样一个无法测量的混杂因素需要具备的显著特征,才能得出文献中观察到的枪支可获得性与自杀之间的关联,而事实上,因果关系是无效的。1992年至2003年间发表的4项美国研究符合我们的入选标准。我们发现,任何此类无法测量的混杂因素都需要具备一个站不住脚的特征组合,例如,不仅是1)与与自杀最密切相关的精神疾病(例如,重度抑郁症和物质使用障碍)一样强大的自杀风险因素,而且2)与任何已知的风险因素相比,有枪支与没有枪支的家庭之间的数量级更不平衡。没有发现甚至没有提出这样的混杂因素。目前的研究强烈表明,未测量的混杂因素不太可能单独解释枪支和自杀之间的联系。
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引用次数: 49
期刊
Epidemiologic Reviews
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