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Primary and secondary prevention of colorectal cancer: An evidence- based review

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Family Medicine and Community Health 2017年第1期5卷 78-84页

作者： Sandra J.Gonzalez maria C.mejia de grubb Robert S.Levine department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Colorectal cancer (CRC) is a common cancer that affects one in three men and one in four women worldwide. Late-stage detection is associated with significantly lower 5-year survival rates. Although it is well established that CRC mortality rates have decreased in the past several decades, adoption of routine screening continues to lag behind screening for other common cancers such as cervical and breast cancer. The decrease in overall rates has been attributed, in part, to improved primary and secondary prevention efforts, including smoking prevention and cessation programs, nutritional counseling, and the use of evidence-based screening protocols, as well as access to better treatment. despite the increased screening rates, it is estimated that at least one-third of eligible people do not receive appropriate screening. The objective of this review is to describe the current epidemiology of CRC and to demonstrate effective primary and secondary prevention strategies for the primary care provider.

关键词： Colorectal cancer adenocarcinoma modifiable risk factors primary prevention secondary prevention primary care

Patient-centered medical home and integrated care in the United States: An opportunity to maximize delivery of primary care

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Family Medicine and Community Health 2015年第2期3卷 48-53页

作者： Sandra J.Gonzalez maria C.mejia de grubb Roger J.Zoorob department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

The reciprocal relationship between mental and physical health is well ***,untreated,and poorly managed mental health conditions are associated with numerous physical health complications,poor treatment adherence,and decreased quality of *** growing evidence regarding the importance of effectively addressing these conditions in primary care,the rates of identification remain low and follow-up and management by primary care providers has been *** objective of this review was to demonstrate the role of Patient-Centered Medical Home(PCMH)and mental health integration in addressing comprehensive health care needs in primary care patients,and to describe common barriers and facilitators to the implementation of these types of programs.

关键词： Patient-centered medical home integrated primary care health care service delivery mental health chronic disease management behavioral health integration

Exploring point-of-care transformation in diabetic care:A quality improvement approach

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Family Medicine and Community Health 2015年第2期3卷 20-26页

作者： Malvika Juneja maria C.mejia de grubb Haijun Wang Kiara Spooner Roger J.Zoorob department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA

Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)at a community health center in Houston,***:This was a before-and-after POC intervention among adult patients who received primary care services between 1 July 2014 and 31 december 2014(baseline visit)and who had at least one 3-month follow-up ***:Three hundred eighty-seven patients were included in the *** majority were9%)at baseline,with the highest average levels among Hispanic(10.9%)and black(10.7%)*** was a significant difference in the HbA1c level before(mean=10.65,SD=1.9291)and after(mean=9.25,SD=1.8187)*** absolute reduction in the level of HbA1c was 1.4%(t=12.834,pdecrease from ***:There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c,improving self-management,and reducing long-term costs.

关键词： Diabetes point of care stat HbA1c

Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999-2009

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Family Medicine and Community Health 2017年第1期5卷 3-12页

作者： maria C.mejia de grubb Barbara Kilbourne Katy Kilbourne Michael Langston Lisa Gittner Roger J.Zoorob Robert Levine department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Sociology department Tennessee State UniversityNashvilleTNUSA department of Family and Community Medicine Meharry Medical CollegeNashvilleTNUSA department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTNUSA department of Political Science Texas Tech University College of Arts and SciencesLubbockTXUSA

Background:The American Cancer Society estimates that about 25%of all US cancer deaths will be due to lung cancer-more than from cancers of the colon,breast,and prostate ***:We ascertained county-level age-adjusted and age-specific death rates and 95%confidence intervals from the Centers for Disease Control and Prevention Compressed Mortality *** regression analyses were used to estimate the strength and direction of relationships between county poverty,smoking,fine particulate matter(PM2.5)air pollution,and US Census divisions and race-and sex-specific lung cancer ***:Poverty,smoking,and particulate matter air pollution were positively and signifi-cantly related to lung cancer deaths among white men,but of these,only poverty and smoking were significantly associated with lung cancer deaths among white *** in the South Atlantic,East South Central,and West South Central US Census divisions at the time of death was significantly associated with lung cancer deaths for both white men and white *** with white men,poverty and smoking were associated with lung cancer deaths among black men,but of these,only adult smoking had a statistically significant association among black ***:The results support the need for further research,particularly in high-risk areas,to better differentiate factors specific to race and sex and to understand the impact of local risk factors.

关键词： Lung cancer mortality geographic risk factors environmental hot spot

Temporal trends in colorectal cancer incidence among Asian American populations in the United States, 1994-2013

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Family Medicine and Community Health 2017年第1期5卷 56-64页

作者： Haijun Wang maria C.mejia de grubb Sandra J.Gonzalez Mohamad Sidani Jianping Ma Roger J.Zoorob department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Shenzhen Nanshan Center for Chronic Disease Control ShenzhenGuangdongChina

Objective:To investigate the incidence and trends in colorectal cancer(CRC)among Asian American populations in the United ***:CRC incidence data from 1994 through 2013 were obtained from 13 Surveillance,Epidemiology,and End Results ****Stat and IBM SPSS Statistics were ***:The age-adjusted incidence of CRC among Asian Americans decreased from 45.6 per 100,000 in 1994 to 33.0 per 100,000 in 2013,with the annual percent change being−1.8%(Pdences were higher for men,the elderly(aged 60 years or older),and several geographic *** those younger than 70 years,the rectal site was more affected compared with those aged 70 years or older,in whom the proximal site were more *** patients presented with localized and regional ***,80 years or older,in situ stage,and some geo-graphic areas such as Connecticut and California experienced significant incidence decreases in the 20-year observation ***:Although CRC incidence has declined among Asian American populations in the United States in the past 2 decades,there are persistent differences by age and geographic *** research is needed to guide the design and implementation of tailored strategies to reduce CRC outcome differences across Asian American populations.

关键词： Colorectal cancer proximal colon distal colon rectal cancer incidence trend

Evaluation of obstetrics procedure competency of family medicine residents

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Family Medicine and Community Health 2015年第2期3卷 69-78页

作者： Haijun Wang Eric Warwick maria Cmejia de grubb Nanfu deng Jane Corboy department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA Medical School Baylor College of MedicineHoustonTXUSA department of Family Medicine Oregon Health&Science University3181 SW Sam Jackson Park RdPortlandOR 97239-3098USA

Objective:To establish a procedure evaluation system to monitor residents’improvement in obstetrics(OB)procedures performance and skills during the training ***:A web-based procedure logging and evaluation system was developed using *** technology with a SQL server as a backend ***’logged OB proce-dures were captured by the *** OB procedures logged within 7 days were evaluated by supervising faculty using three observable outcomes(procedure competency,procedure-related medical knowledge level,and patient care).Results:Between 1 July 2005 and 30 June 2008,a total of 8543 procedures were reported,of which 1263 OB procedures were evaluated by supervising *** were significant varia-tions in the number of logged procedures by gender,residency track,and US versus non-US medi-cal *** 84%of the procedures were performed(independently or with assis-tance)by ***’procedure skills,procedure-related medical knowledge,and patient care skills improved over time,with significant variations by gender among the three ***:The benefits of specific evaluation of procedural competence in postgraduate medical education are well *** and reliable tools to assess and monitor resi-dents’procedural skills are warranted.

关键词： Resident procedure family medicine evaluation

Rural congestive heart failure mortality among US elderly, 1999-2013: Identifying counties with promising outcomes and opportunities for implementation research

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Family Medicine and Community Health 2015年第2期3卷 27-38页

作者： maria C.mejia de grubb Robert S.Levine Barbara Kilbourne Baqar A.Husaini Tyler Skelton Lisa Gittner Michael A.Langston George E.Rust department of Family and Community Medicine Baylor College of MedicineHoustonTXUSA department of Sociology Tennessee State UniversityNashvilleTennesseeUSA Center for PreventionResearch Tennessee State University College of AgricultureNashvilleTennesseeUSA department of Political Science Texas Tech UniversityLubbockTXUSA department of Electrical Engineering and Computer Science University of TennesseeKnoxvilleTennesseeUSA department of Family Medicine National Center for Primary CareMorehouse School of MedicineAtlantaGeorgiaUSA

Objective:describe modern trends in congestive heart failure(CHF)among elderly(>65 years of age)in the United States,to identify potentially successful rural *** CHF mortality using multiple-(MCOD)versus underlying-(UCOD)cause of death ***:*** for Disease Control and Prevention mortality files(WONdeR internet site).Results:Using MCOD data,overall mortality rates/100,000 population(and 95%confidence intervals)for CHF among persons>65 years of age(1999-2013)were 482.0(481.2-482.8)for large central and large fringe metropolitan(LCLF)counties,549.6(548.6-550.7)in small and medium metropolitan(SM)counties,and 652.6(650.9-654.0)in micropolitan and non-core,non-metropolitan(MNCNM)*** positive deviance NCNM counties(collectively including 198,581 residents>65 years of age)had an overall CHF rate of 300.9(275.0-326.9)in *** was significantly lower than the LCLF rate for 2013(482.0[481.2-482.8]),and rep-resented a reduction of 47%since *** CHF occurrence as estimated with MCOD was 3.4-fold higher than that obtained with ***:These data illustrate underestimation of CHF by UCOD data and the importance of correct death *** CHF mortality rates are higher than urban rates,but some positive deviance counties demonstrate that this is not *** research is needed to understand the relative contribution of research innovation,medical care,and public health to rural-urban disparities and the relative success of positive deviance counties.

关键词： Congestive heart failure elderly mortality rural