Search

Zhang and Savalei proposed an alternative scale format to the Likert format, called the Expanded format. In this format, response options are presented in complete sentences, which can reduce acquiescence bias and method effects. The goal of the current study was to compare the psychometric properties of the Rosenberg Self-Esteem Scale (RSES) in the Expanded format and in two other alternative formats, relative to several versions of the traditional Likert format. We conducted two studies to compare the psychometric properties of the RSES across the different formats. We found that compared with the Likert format, the alternative formats tend to have a unidimensional factor structure, less response inconsistency, and comparable validity. In addition, we found that the Expanded format resulted in the best factor structure among the three alternative formats. Researchers should consider the Expanded format, especially when creating short psychological scales such as the RSES. [ABSTRACT FROM AUTHOR]

Background: We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. Methods: Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003–2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott's adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. Results: Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p <.01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. Conclusion: The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents. [ABSTRACT FROM AUTHOR]

Introduction. Information on the psychosocial distress and needs of sarcoma patients at diagnosis is sparse. The Canadian Problem Checklist (CPC) and Psychosocial Screen for Cancer-Revised (PSSCAN-R) are validated tools to identify cancer patients' distress and are administered to all new patients referred to BC Cancer prior to their consultation. We used the CPC and PSSCAN-R to understand sarcoma patients' needs at the initial oncology consultation in British Columbia, Canada. Materials and Methods. All sarcoma patients who completed the CPC and PSSCAN-R within 6 months of diagnosis between 2011 and 2016 were included. The retrospective chart review identified baseline demographics: age, performance status, disease location, resectability, and histology. Analysis was conducted using descriptive statistics, chi-squared test, Fisher's exact test, and Kaplan–Meier method. Results. 413 sarcoma patients were identified. The majority of patients were over the age of 40 (83.3%) with ECOG performance status 0-1 (82.6%) and lower extremity tumors (55.4%). The most common diagnoses were liposarcoma 21.3%, undifferentiated pleomorphic sarcoma 12.1%, and myxofibrosarcoma 11.1%. At the initial consultation, 42.6% of patients were deemed resectable, 8.5% unresectable/metastatic, and 48.9% required further staging investigations. The top three patient-reported distress symptoms were feeling tense and unable to relax (50%), feeling nervous and shaky (48%), and experiencing repetitive and scary thoughts (42%). 38% of patients had subclinical/clinical anxiety symptoms, and 21% of patients had subclinical/clinical depression symptoms. 5% of patients expressed suicidal ideation. The top three concerns/needs were understanding of illness/treatment (45.5%), fear/worries (45.3%), and worry about family (23%). No differences in overall survival were identified for patients displaying symptoms of depression or anxiety versus no symptoms. Discussion. Up to 45% of sarcoma patients experience some form of psychological distress at disease presentation. Patients desire information about their diagnosis and treatment. Tailored interventions to individual psychological comorbidity and improved patient education resources would be beneficial. [ABSTRACT FROM AUTHOR]

The article discusses a study that obtained sound levels and acoustic characteristic data in classroom serving children who are deaf and hard of hearing in grades K-2 in Canada and the U.S. Study highlights include signal-to-noise ratio recommended by the American Speech-Language-Hearing Association, sources of classroom noise, and the concept of the inverse square law.

Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12-1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients. [ABSTRACT FROM AUTHOR]

Many psychological scales written in the Likert format include reverse worded (RW) items in order to control acquiescence bias. However, studies have shown that RW items often contaminate the factor structure of the scale by creating one or more method factors. The present study examines an alternative scale format, called the Expanded format, which replaces each response option in the Likert scale with a full sentence. We hypothesized that this format would result in a cleaner factor structure as compared with the Likert format. We tested this hypothesis on three popular psychological scales: the Rosenberg Self-Esteem scale, the Conscientiousness subscale of the Big Five Inventory, and the Beck Depression Inventory II. Scales in both formats showed comparable reliabilities. However, scales in the Expanded format had better (i.e., lower and more theoretically defensible) dimensionalities than scales in the Likert format, as assessed by both exploratory factor analyses and confirmatory factor analyses. We encourage further study and wider use of the Expanded format, particularly when a scale’s dimensionality is of theoretical interest. [ABSTRACT FROM AUTHOR]

Background: Children diagnosed with cancer often require extensive care for medical, psychosocial and educational problems during and after therapy. Part of this care is provided by family physicians and non-cancer specialists, but their involvement in the first years after diagnosis has barely been studied. Studying non-oncology physician visits may provide insight into the roles of different health care providers. Methods: We included 757 children diagnosed with cancer under age 15 between 1991 and 2001 from a Canadian provincial registry, and matched each to 10 controls of the same birth year and sex. We determined the number of family physician and non-cancer specialist visits in the 5 years after diagnosis (for patients) or inclusion (for controls) using data from the provincial health insurance plan. Results: In the first year after diagnosis, almost all patients visited both a family physician and non-cancer specialist. Although after 5 years percentages decreased to 85 and 76 %, respectively, these were still significantly higher than in controls. In the first year after diagnosis, both family physicians and non-cancer specialists were often consulted for neoplasms (62 and 90 %, respectively) and to discuss results of lab tests. In addition, family physicians were often consulted for general symptoms and non-cancer specialists for nervous system problems and complications of medical care. Conclusions: Family physicians and non-cancer specialists are highly involved in the care for children with cancer in the first years after diagnosis, including for health problems related to cancer or its treatment. This necessitates good communication among all physicians. [ABSTRACT FROM AUTHOR]

Purpose A nurse navigator (NN) pilot project for patients with lung cancer was implemented in British Columbia, a publicly funded health-care system. The purpose was to improve referral practices, timelines, and availability of molecular testing for patients with advanced non-small-cell lung cancer (NSCLC). Methods Patients with stage IIIB/IV NSCLC referred to the BC Cancer Agency, Vancouver, in 2011 and 2014, pre- and post-implementation of an NN, were included. Referral patterns, systemic therapy, radiotherapy (XRT) timelines, and molecular testing practices were compared. Results The study included 408 patients: 212 in 2011 and 196 in 2014. Medical oncology (MO) end points comparing 2011 data with 2014 findings revealed that referral rates remained stable, and the proportion of patients who received systemic therapy increased from 57% to 69% (P = .05). Time from referral to MO consult was 18 days in 2011 versus 15.5 days in 2014 (P = .11); referral to systemic treatment was reduced from 48 to 38 days (P = .016). Comparison of molecular testing showed time between referral and the epidermal growth factor (EGFR) result was reduced from 34 days in 2011 to 20 days in 2014 (P < .001); rates of testing increased from 62% to 91%, respectively (P < .001); and EGFR mutation-positive rates were 19% versus 26%, respectively (P = .26). The radiation oncology (RO) end point results were as follows: 87% of patients were referred for RO consults in 2011 versus 80% in 2014 (P = .05), and the same proportion of patients received XRT (91% v87%, respectively). Time from referral to RO consult decreased from 10 days in 2011 to 8 days in 2014 (P = .005); and referral toXRT in 2011 and 2014 was 18 days versus 11.5 days, respectively (P < .001). Conclusion Implementation of an NN was associated with reduced wait times and increased molecular testing, improving appropriate delivery of first-line targeted therapy. NN involvement facilitates correct allocation of physician and clinical resources. [ABSTRACT FROM AUTHOR]

Reasoned action approaches have primarily been applied to understand exercise behaviour for the past three decades, yet emerging findings in unconscious and Dual Process research show that behavior may also be predicted by automatic processes such as habit. The purpose of this study was to: (1) investigate the behavioral requirements for exercise habit formation, (2) how Dual Process approach predicts behaviour, and (3) what predicts habit by testing a model (Lally and Gardner in Health Psychol Rev 7:S137-S158, ). Participants (n = 111) were new gym members who completed surveys across 12 weeks. It was found that exercising for at least four bouts per week for 6 weeks was the minimum requirement to establish an exercise habit. Dual Process analysis using Linear Mixed Models (LMM) revealed habit and intention to be parallel predictors of exercise behavior in the trajectory analysis. Finally, the habit antecedent model in LLM showed that consistency (β = .21), low behavioral complexity (β = .19), environment (β = .17) and affective judgments (β = .13) all significantly ( p < .05) predicted changes in habit formation over time. Trainers should keep exercises fun and simple for new clients and focus on consistency which could lead to habit formation in nearly 6 weeks. [ABSTRACT FROM AUTHOR]

Background. We examined (1) patient characteristics and disease-modifying drug (DMD) exposure in late-onset (LOMS, ≥50 years at symptom onset) versus adult-onset (AOMS, 18–<50 years) MS and (2) the association between interferon-beta (IFNβ) and disability progression in older relapsing-onset MS adults (≥50 years). Methods. This retrospective study (1980–2004, British Columbia, Canada) included 358 LOMS and 5627 AOMS patients. IFNβ-treated relapsing-onset MS patients aged ≥50 (regardless of onset age, 90) were compared with 171 contemporary and 106 historical controls. Times to EDSS 6 from onset and from IFNβ eligibility were examined using survival analyses. Results. LOMS patients (6%) were more likely to be male, with motor onset and a primary-progressive course, and exhibit faster progression and were less likely to take DMDs. Nonetheless, 57% were relapsing-onset, of which 31% were prescribed DMDs, most commonly IFNβ. Among older relapsing-onset MS adults, no significant association between IFNβ exposure and disability progression was found when either the contemporary (hazard ratio [HR]: 0.46; 95% CI: 0.18–1.22) or historical controls (HR: 0.54; 95% CI: 0.20–1.42) were considered. Conclusion. LOMS differed clinically from AOMS. One-third of older relapsing-onset MS patients were prescribed a DMD. IFNβ exposure was not significantly associated with reduced disability in older MS patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine whether general practitioner visits for alcohol-attributed diseases increased in a decade when several regulatory changes were made to the distribution and price of alcohol in British Columbia Canada. Methods: General practitioner consultations for alcohol-attributed diseases were examined using data from British Columbia’s Medical Services Plan database. Negative binomial regression was used to measure the significance of yearly variations using incidence rate ratios by disease type per year. Results: From 2001 to 2011, 690,401 visits were made to general practitioners by 198,623 persons with alcoholattributed diseases. Most visits (86.2%) were for alcohol dependency syndrome (N = 595,371). General practitioner visits for alcohol-attributed diseases increased significantly (p < .001) by 53.3% from 14,882 cases in 2001 to 22,823 cases in 2011. While the number of cases increased from 2001-2011, the frequency of visits to general practitioners significantly decreased from 3.9 in 2001 to 2.7 visits per case in 2011 (F = 428.1, p < .001). Conclusion: From 2001 to 2011 there were significant increases in the number of persons presenting to general practitioners with alcohol-attributed diseases in British Columbia. The results of this study demonstrate the need to provide enhanced support to general practitioners in the treatment of patients with substance use disorders given the increasing number of primary health care patients with alcohol-attributed diseases. [ABSTRACT FROM AUTHOR]

Introduction: We sought to assess awareness of, exposure to and interest in general practitioner (GP) surgery and enhanced surgical skills (ESS) among family practice residents in British Columbia, Alberta and Saskatchewan. Methods: We distributed a survey to all family practice residents at 4 universities in BC, Alberta and Saskatchewan. The survey assessed demographic information, awareness of and exposure to GP surgery or ESS during training, and interest in pursuing formal ESS training. Results: We received 174 responses (27.2% response rate). Numerous respondents were unaware of GP surgery (9.9% ± 4.5%) and ESS (17.9% ± 5.7%). Awareness was higher among respondents from rural hometowns (GP surgery and ESS awareness 100% and 94.1%, respectively), and with prior exposure to GP surgery (GP surgery and ESS awareness 96.9% and 95.4%, respectively). A minority (38.2%) had been exposed to GP surgery, with exposure higher in respondents from rural training sites and in their second postgraduate year (72.5% and 47.4%, respectively). A quarter (25.1%) of respondents were considering ESS training. Factors encouraging training included increased procedures, challenging medicine and impact on patient outcomes. The importance of ESS training opportunities and service was rated highly. Conclusion: Many respondents were unaware of ESS as a career option. Exposure to GP surgery during training was associated with increased awareness. Furthermore, exposure fostered interest in this important field. These results may be helpful in the development of formal ESS training programs and in curricula for family practice residency programs. [ABSTRACT FROM AUTHOR]

Background: Cardiac troponin elevation portends a worse prognosis in diverse patient populations. The significance of troponin elevation in patients discharged from emergency departments (EDs) without inpatient admission is not well known. Methods: Patients without a diagnosis of acute coronary syndrome discharged from two EDs between April 1, 2006, and December 31, 2007, with an abnormal cardiac troponin (troponin positive [TP]) were compared to a troponin-negative (TN) cohort matched for age, sex, and primary discharge diagnosis. Outcomes were obtained by linking with a regional ED and a provincial vital statistics database and adjusted for the following: estimated glomerular filtration rate, do-not- resuscitate status, history of coronary artery disease, Canadian Triage and Acuity Scale, and left ventricular hypertrophy on electrocardiography. The primary outcome was a composite of death or admission to hospital within 1 year. Results: Our total cohort (n = 344) consisted of 172 TP and 172 TN patients. In the univariate analysis, TP patients had a higher rate of the primary outcome (OR 3.2, 95% CI 2.1-5.0, p < 0.001) and both of its components (p < 0.001). After adjusting for covariates, positive troponin remained an independent predictor of the primary outcome (OR 2.1, 95% CI 1.3-3.4, p = 0.005) and inpatient admission (OR 2.0, 95% CI 1.2-3.4, p = 0.006). There was no significant difference in death (OR 1.3, 95% CI 0.6-2.9, p = 0.5) after adjustment. Conclusions: A positive troponin assay during ED stay in discharged patients is an independent marker for risk of subsequent admission. Our findings suggest that the prognostic power of an abnormal troponin extends to patients discharged from the ED. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the impact of a multifaceted knowledge translation strategy for a new vaccination pain management guideline on public health immunizers' attitudes, beliefs and use of pain-relieving strategies during childhood vaccination. METHOD: Using a randomized controlled pre-post study design, public health nurses (PHNs) at intervention sites received a multifaceted knowledge translation intervention about new pain management guidelines incorporated in the British Columbia Immunization Program Manual, including education, supplies and online support. Attitudes and beliefs of PHNs toward immunization pain and pain management, and use of pain-relieving strategies were compared for the intervention sites between the pre- and postimplementation phases. RESULTS: A total of 516 children were immunized by 31 PHNs pre-and postimplementation in the intervention sites. Postimplementation, satisfaction and confidence with ability to manage pain and willingness to use newly recommended strategies were significantly more positive (P<0.05) in the intervention sites, and overall use of at least one newly recommended strategy increased from 49.8% preintervention to 77.6% postimplementation (P<0.001). CONCLUSION: The knowledge translation intervention improved PHN immunizers' attitudes, beliefs and practices regarding paediatric vaccination pain management. Reducing pain may result in a better immunization experience for children, caregivers and immunizers. [ABSTRACT FROM AUTHOR]

Background: The goal of the study was to assess perceived level of satisfaction with end-of-life care, focusing on the last 48 hours of life. Methods: A previously validated instrument was used in a telephone survey with bereaved family members (n=90) of patients who died within an organization in British Columbia. Results: Bereaved family members had many unmet needs for information about the patient's changing condition, the process of dying, how symptoms would be managed and what to do at the time of death. In addition, many bereaved relatives felt that the patient or resident had an unmet need for emotional support and that their own emotional needs were not addressed adequately. The last place of care had the most significant effect on all of these variables, with acute care and residential care having the most unmet needs. Hospice had the fewest unmet needs, followed by the palliative and the intensive care units. Conclusions: We discuss these findings in relation to overall satisfaction with care, focus on individual, ethnocultural and diversity issues, information and decision-making, symptom management and attending to the family. We conclude by offering possible practices address the end-of-life needs of patients and family members. [ABSTRACT FROM AUTHOR]

We report secondary findings froma randomized controlled trial on the effects of exercise on memory in older adults with probable MCI.We randomized 86 women aged 70-80 years with subjectivememory complaints into one of three groups: resistance training, aerobic training, or balance and tone (control). All participants exercised twice per week for six months. We measured verbal memory and learning using the Rey Auditory Verbal Learning Test (RAVLT) and spatial memory using a computerized test, before and after trial completion. We found that the aerobic training group remembered significantly more items in the loss after interference condition of the RAVLT compared with the control group after six months of training. In addition, both experimental groups showed improved spatial memory performance in the most difficult condition where they were required to memorize the spatial location of three items, compared with the control group. Lastly, we found a significant correlation between spatial memory performance and overall physical capacity after intervention in the aerobic training group. Taken together, our results provide support for the prevailing notion that exercise can positively impact cognitive functioning and may represent an effective strategy to improve memory in those who have begun to experience cognitive decline. [ABSTRACT FROM AUTHOR]

Background: The school food environment is important to target as less healthful food and beverages are widely available at schools. This study examined whether the availability of specific food/beverage items was associated with a number of school environmental factors. Methods: Principals from elementary (n = 369) and middle/high schools (n = 118) in British Columbia (BC), Canada completed a survey measuring characteristics of the school environment. Our measurement framework integrated constructs from the Theories of Organizational Change and elements from Stillman's Tobacco Policy Framework adapted for obesity prevention. Our measurement framework included assessment of policy institutionalization of nutritional guidelines at the district and school levels, climate, nutritional capacity and resources (nutritional resources and participation in nutritional programs), nutritional practices, and school community support for enacting stricter nutritional guidelines. We used hierarchical mixed-effects logistic regression analyses to examine associations with the availability of fruit, vegetables, pizza/hamburgers/hot dogs, chocolate candy, sugar-sweetened beverages, and french fried potatoes. Results: In elementary schools, fruit and vegetable availability was more likely among schools that have more nutritional resources (OR = 6.74 and 5.23, respectively). In addition, fruit availability in elementary schools was highest in schools that participated in the BC School Fruit and Vegetable Nutritional Program and the BC Milk program (OR = 4.54 and OR = 3.05, respectively). In middle/high schools, having more nutritional resources was associated with vegetable availability only (OR = 5.78). Finally, middle/high schools that have healthier nutritional practices (i.e., which align with upcoming provincial/state guidelines) were less likely to have the following food/ beverage items available at school: chocolate candy (OR = .80) and sugar-sweetened beverages (OR = .76). Conclusions: School nutritional capacity, resources, and practices were associated with the availability of specific food/beverage items in BC public schools. Policies targeting the school environment are increasingly being considered as one of the strategies used to address childhood obesity, as a result it is important to further understand the factors associated with the availability of specific food/beverage items at school. [ABSTRACT FROM AUTHOR]

In metropolitan areas, road traffic is a major contributor to ambient air pollution and the dominant source of community noise. The authors investigated the independent and joint influences of community noise and traffic-related air pollution on risk of coronary heart disease (CHD) mortality in a population-based cohort study with a 5-year exposure period (January 1994–December 1998) and a 4-year follow-up period (January 1999–December 2002). Individuals who were 45–85 years of age and resided in metropolitan Vancouver, Canada, during the exposure period and did not have known CHD at baseline were included (n = 445,868). Individual exposures to community noise and traffic-related air pollutants, including black carbon, particulate matter less than or equal to 2.5 μm in aerodynamic diameter, nitrogen dioxide, and nitric oxide, were estimated at each person’s residence using a noise prediction model and land-use regression models, respectively. CHD deaths were identified from the provincial death registration database. After adjustment for potential confounders, including traffic-related air pollutants or noise, elevations in noise and black carbon equal to the interquartile ranges were associated with 6% (95% confidence interval: 1, 11) and 4% (95% confidence interval: 1, 8) increases, respectively, in CHD mortality. Subjects in the highest noise decile had a 22% (95% confidence interval: 4, 43) increase in CHD mortality compared with persons in the lowest decile. These findings suggest that there are independent effects of traffic-related noise and air pollution on CHD mortality. [ABSTRACT FROM PUBLISHER]

Higher levels of VAT at the same body size and lower levels of physical activity (PA) have been reported in persons of Chinese and South Asian origin compared to European origin. The purpose of this study was to test the hypothesis that higher levels of VAT in persons of Chinese and South Asian origin versus European origin are associated with lower levels of PA. Chinese, European, and South Asian participants were assessed for sociodemographics, obesity-related measures, anthropometrics, and PA. Bivariate correlations, analysis of covariance, and regression models were used to explore ethnic differences in PA and the role of PA in explaining obesity-related measures. We observed ethnic differences in both body fat distribution and PA. Chinese and South Asians had higher amounts of VAT at a given BMI but lower amounts of moderate PA, vigorous PA, and moderate-to-vigorous PA (MVPA). Furthermore, we found ethnic-specific differences in the associations between body fat distribution and PA with only Europeans showing a consistent negative relationship between body fat distribution and PA. When ethnic differences in PA were taken into account, there were no longer any differences in VAT between the Chinese and European groups, while VAT remained higher in South Asians than Europeans. [ABSTRACT FROM AUTHOR]

Ipsilateral breast tumor recurrence (IBTR) is an increasingly common clinical challenge. IBTRs include True Recurrences (TR; persistent disease) and New Primaries (NP; de novo tumors), but discrimination between these is difficult. We assessed tumor infiltrating leukocytes (TIL) as biomarkers for distinguishing these types of IBTR using primary tumors and matched IBTRs from 24 breast cancer patients, half of which were identified as putative TRs and half as NPs using a previously reported clinical algorithm. Intratumoral lymphocyte populations (CD3, CD8, CD4, CD25, FOXP3, TIA1, CD20) and macrophages (CD68) were quantified by immunohistochemistry in each tumor. Compared to matched primaries, TRs showed significant trends towards increased CD++ and CD8+ TIL, while these populations were often diminished in NPs. Comparison of IBTRs showed that TRs had significantly higher levels of CD3+ (P = 0.0136), CD8+ (P = 0.0092), and CD25+ (P = 0.0159) TIL than NPs. We conclude that TIL may be a novel diagnostic biomarker to distinguish NP from TR IBTRs. [ABSTRACT FROM AUTHOR]