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Dheri AK, Kuenzig ME, Mack DR, Murthy SK, Kaplan GG, Donelle J, Smith G, Benchimol EI. Shifting Health Care Use from Hospitalisations and Surgeries to Outpatient Visits in Children with Inflammatory Bowel Disease: A Population-based Cohort Study from Ontario, Canada. J Crohns Colitis 2021; 15:1991-2000. [PMID: 34019625 PMCID: PMC8684492 DOI: 10.1093/ecco-jcc/jjab095] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Modern, specialised care for children with inflammatory bowel disease [IBD] may have resulted in changes in health services use. We report trends over time in health services utilisation and surgery for children with IBD and children without IBD. METHODS Children aged <18 years, diagnosed with IBD between 1994 and 2013 [n = 5518] and followed until 2015 in Ontario, Canada, were identified from health administrative data and matched to children without IBD on age, sex, rural/urban household, and income [n = 26,677]. We report the annual percentage change [APC] with 95% confidence intervals [CI] in the rate of outpatient visits, emergency department [ED] visits, and hospitalisations, using negative binomial regression for events within 5 years from the diagnosis/index date. We used Cox proportional hazards regression models to report APC in hazards of intestinal resection [Crohn's disease; CD] and colectomy [ulcerative colitis; UC]. RESULTS IBD-specific hospitalisation rates decreased by 2.5% [95% CI 1.8-3.2%] annually, and all-cause hospitalisation rates in children without IBD decreased by 4.3% [95% CI 3.5-5.1%] annually. Intestinal resection risk in CD decreased by 6.0% [95% CI 4.6-7.3%] annually and colectomy risk in UC decreased by 3.0% [95% CI 0.7-5.2%] annually. In contrast, IBD-specific outpatient visit rates increased after 2005 by 4.0% [95% CI 3.1-4.9%] annually. Similar trends in outpatient visits were not observed in children without IBD. CONCLUSIONS Hospitalisations and surgeries decreased over time while outpatient visits increased after 2005. Decreasing hospitalisations were mirrored in children without IBD, likely resulting from a combination of changes in disease management and health system factors.
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Affiliation(s)
- Aman K Dheri
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON,Canada,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, ON,Canada
| | - David R Mack
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,CHEO Research Institute, Ottawa, ON,Canada,Department of Pediatrics, University of Ottawa, Ottawa, ON,Canada
| | - Sanjay K Murthy
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada,ICES, Toronto, ON,Canada,Department of Medicine, University of Ottawa, Ottawa, ON,Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB,Canada
| | | | | | - Eric I Benchimol
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON,Canada,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, ON,Canada,CHEO Research Institute, Ottawa, ON,Canada,Department of Pediatrics, University of Ottawa, Ottawa, ON,Canada,ICES, Toronto, ON,Canada,Department of Paediatrics and Institute of Health Policy, Management andEvaluation,Corresponding author: Eric Benchimol, Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. Tel.: [416]813–1500; fax: [416]813–4972;
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Niriella MA, Liyanage IK, Kodisinghe SK, De Silva AP, Jayatissa AVGAM, Navarathne NMM, Peiris RK, Kalubovila UP, Kumarasena SR, Jayasekara RW, de Silva HJ. Changing phenotype, early clinical course and clinical predictors of inflammatory bowel disease in Sri Lanka: a retrospective, tertiary care-based, multi-centre study. BMC Gastroenterol 2021; 21:71. [PMID: 33593289 PMCID: PMC7885349 DOI: 10.1186/s12876-021-01644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is increasing in the Asia-Pacific region, with changes in disease phenotype and course. We aimed to assess the changing phenotypes of IBD over ten years, describe the early clinical course (ECC) and identify the clinical predictors (CP) of poor outcomes among a large, multi-centre, cohort of Sri Lankan IBD patients. Methods We included patients [diagnosed between June/2003–December/2009-Group-1(G1), January/2010–June/2016-Group-2(G2)] with ulcerative colitis (UC) and Crohn disease (CD) from five national-referral centres. Changing phenotype from G1 to G2, ECC (disease duration < 3-years) and CP of poor outcomes (disease duration ≥ 1-year) was assessed. Poor outcomes were complicated-disease (CompD-stricturing/penetrating-CD, extensive-UC/pancolitis, perforation/bleeding/colectomy/malignancy) and treatment-refractory disease (TRD-frequently-relapsing, steroid-dependent/refractory and biologic use). Results 375 (UC-227, CD-148) patients were recruited. Both G1/G2 had more UC than CD (77% vs 23%, 54.5 vs 45.5 respectively, p < 0.01). Increase of CD from G1-to-G2 was significant (23–45.4%, p < 0.001). In both groups, left-sided colitis (E2) and ileo-colonic (L3)/non-stricturing, non-penetrating disease behaviour (B1) CD predominated. Extensive-colitis (E3) (36.4% vs 22.7, p < 0.05) and stricturing-CD (B2) (26.1% vs 4.0%, p < 0.01) was commoner in G1. ECC was assessed in 173-patients (UC-94, CD-79). Aggressive disease behaviour and TRD were low among both UC and CD. Immunomodulator use was significantly higher among CD than UC (61.5% vs 29.0% respectively, p < 0.01). Anti-TNF use was low among both groups (UC-3.2%, CD-7.7%). Disease complications among UC [bleeding (2.1%), malignancy-(1.1%), surgery-(2.1%)] and CD [stricture-(3.9%), perforation-(1.3%), malignancy-(1.3%), surgery-(8.9%)] were generally low. CPs were assessed in 271-patients (UC-163, CD-108). Having a family history of IBD (for UC), extraintestinal manifestation (EIM), severe disease at presentation, being in younger age categories and severe disease at presentation, (for both UC and CD) predicted poor outcomes. Conclusion There was an increase in CD over time without change in disease phenotype for both UC and CD. A relatively benign ECC was observed. Family history (UC), EIMs (UC/CD), severe disease at presentation (UC/CD), younger age (CD/UC) CPs of poor outcomes.
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Affiliation(s)
- M A Niriella
- Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - I K Liyanage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.,University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - S K Kodisinghe
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - A P De Silva
- Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A V G A M Jayatissa
- Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - N M M Navarathne
- Gastroenterology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - R K Peiris
- Gastroenterology Unit, Colombo South Teaching Hospital, Kalubovila, Sri Lanka
| | - U P Kalubovila
- Gastroenterology Unit, Teaching Hospital, Kandy, Sri Lanka
| | - S R Kumarasena
- Gastroenterology Unit, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - R W Jayasekara
- Human Genetics Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - H J de Silva
- Department of Clinical Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Venkatakrishnan A, Holzknecht ZE, Holzknecht R, Bowles DE, Kotzé SH, Modliszewski JL, Parker W. Evolution of bacteria in the human gut in response to changing environments: An invisible player in the game of health. Comput Struct Biotechnol J 2021; 19:752-758. [PMID: 33552447 PMCID: PMC7829112 DOI: 10.1016/j.csbj.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/23/2023] Open
Abstract
Several factors in Western society, including widespread use of antibiotics, chronic inflammation, and loss of complex eukaryotic symbionts such as helminths, have a dramatic impact on the ecosystem of the gut, affecting the microbiota hosted there. In addition, reductions in dietary fiber are profoundly impactful on the microbiota, causing extensive destruction of the niche space that supports the normally diverse microbial community in the gut. Abundant evidence now supports the view that, following dramatic alterations in the gut ecosystem, microorganisms undergo rapid change via Darwinian evolution. Such evolutionary change creates functionally distinct bacteria that may potentially have properties of pathogens but yet are difficult to distinguish from their benign predecessors.
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Affiliation(s)
| | - Zoie E Holzknecht
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rob Holzknecht
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dawn E Bowles
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Sanet H Kotzé
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town 8000, South Africa
| | - Jennifer L Modliszewski
- Genomic Analysis and Bioinformatics Shared Resource, Duke Center for Genomic and Computational Biology, Duke University School of Medicine, Durham, NC, USA
| | - William Parker
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Adams DJ, Nylund CM. Hospitalization for Varicella and Zoster in Children with Inflammatory Bowel Disease. J Pediatr 2016; 171:140-5. [PMID: 26826886 DOI: 10.1016/j.jpeds.2015.12.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/01/2015] [Accepted: 12/23/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the association between inflammatory bowel disease (IBD) and varicella- and herpes zoster-related pediatric hospitalizations. STUDY DESIGN We performed a cross-sectional inpatient study using the triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for years 1997-2012 to evaluate the association between a secondary diagnosis of IBD and a primary diagnosis of varicella or herpes zoster for hospitalized children ages 5-20 years. Billing codes were used to identify varicella, herpes zoster, ulcerative colitis, Crohn's disease, and other immunocompromising conditions. A logistic regression model was fitted to quantify the odds of varicella or zoster between these categories. RESULTS There were 8 828 712 weighted admissions meeting the study criteria, 4434 with varicella and 4488 with herpes zoster. There was an association of IBD and immunocompromising conditions with hospitalization for varicella and herpes zoster. This association was stronger among children with Crohn's disease (varicella OR, 12.75; 95% CI, 8.30-19.59; zoster OR, 7.91; 95% CI, 5.60-11.18) compared with children with ulcerative colitis (varicella OR 4.25; 95% CI 1.98-9.12, zoster OR 3.90; 95% CI 1.98-7.67). CONCLUSIONS IBD in children is associated with hospitalizations for varicella and herpes zoster. These results highlight the importance of efforts to vaccinate patients with IBD without varicella immunity, ideally before the initiation of immunosuppressive therapy. Furthermore, research is needed on the safety and efficacy of the varicella vaccine in children with IBD on immunomodulators or biologic therapy.
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Affiliation(s)
- Daniel J Adams
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Annese V, Duricova D, Gower-Rousseau C, Jess T, Langholz E. Impact of New Treatments on Hospitalisation, Surgery, Infection, and Mortality in IBD: a Focus Paper by the Epidemiology Committee of ECCO. J Crohns Colitis 2016; 10:216-25. [PMID: 26520163 DOI: 10.1093/ecco-jcc/jjv190] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/08/2015] [Indexed: 02/08/2023]
Abstract
The medical management of inflammatory bowel disease has changed considerably over time with wider use of immunosuppressant therapy and the introduction of biological therapy. To what extent this change of medical paradigms has influenced and modified the disease course is incompletely known. To address this issue, an extensive review of the literature has been carried out on time trends of hospitalization, surgery, infections, cancer, and mortality rates in inflammatory bowel disease [IBD] patients. Preference was given to population-based studies but, when data from these sources were limited, large cohort studies and randomised controlled trials were also considered. In general, data on hospitalisation rates are strikingly heterogeneous and conflicting. In contrast, the consistent drop in surgery/colectomy rates suggests that the growing use of immunosuppressants and biological agents has had a positive impact on the course of IBD. Most clinical trial data indicate that the risk of serious infections is not increased in patients treated with anti-tumour necrosis factor alpha [TNFα] agents, but a different picture emerges from cohort studies. The use of thiopurines increases the risk for non-melanoma skin cancers and to a lesser extent for lymphoma and cervical cancer [absolute risk: low], whereas no clear increase in the cancer risk has been reported for anti-TNF agents. Finally, the majority of studies reported in the literature do not reveal any increase in mortality with immunosuppressant therapy or biologicals/anti-TNF agents.
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Affiliation(s)
- Vito Annese
- Emergency Department, Gastroenterology Unit, AOU Careggi, Florence, Italy
| | - Dana Duricova
- Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE a.s. and Charles University in Prague, Prague, Czech Republic
| | - Corinne Gower-Rousseau
- Epidemiology Unit, Lille University and Hospital, Université Lille Nord de France, Lille, France
| | - Tine Jess
- Department of Epidemiology Research, Statens Serum Institut, National Center for Health Data and Disease Control, Copenhagen, Denmark
| | - Ebbe Langholz
- Department of Medicine, Gentofte Hospital, Hellerup, Denmark
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Meregaglia M, Banks H, Fattore G. Hospital Burden and Gastrointestinal Surgery in Inflammatory Bowel Disease Patients in Italy: A Retrospective Observational Study. J Crohns Colitis 2015; 9:853-62. [PMID: 26069194 DOI: 10.1093/ecco-jcc/jjv104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUNDS AND AIMS Despite recent advances in medical therapies for inflammatory bowel disease [IBD], little is known about their impact on inpatient management. Our objectives were to explore hospitalisation and surgery trends for all IBD patients in Italy at three time points over 7 years. METHODS National hospital discharge records were retrospectively reviewed for all admissions with a Crohn's disease [CD, 555*] or ulcerative colitis [UC, 556*] diagnosis in 2005, 2008, and 2011. Quantitative variables [mean, standard deviation] and categorical variables [frequencies] were described; comparison among admission-years was made by analysis of variance and chi-square tests. A multivariate logistic regression analysis was performed to identify predictors of surgery risk regarding demographics, inpatient management, and clinical features; p-values ≤ 0.05 were considered statistically significant. RESULTS Overall, 109657 hospitalisations occurred over the 3 years, with a decreasing trend observed in UC admissions. Mean age was higher in UC [50.1±19.7] than in CD [43.2±21.9]. The number of paediatric admissions rose from 3637 to 4372 between 2005 and 2011. An increasing proportion of CD [from 12.4% to 14.6%] and UC [from 5.8% to 8.0%] admissions reported a digestive system-related, surgical diagnosis-related group in the same period; overall, gastrointestinal surgical admissions increased from 3299 to 3964. In regression analysis, male gender, age, admission year, northern university hospital, disease localisation, and cancer as independent factors significantly affected the likelihood of surgery. CONCLUSIONS Despite a reduction in total IBD hospitalisations, surgical and paediatric admissions rose over time. Further study is needed to clarify benefits associated with new drugs in terms of inpatient management.
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Affiliation(s)
- Michela Meregaglia
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Helen Banks
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Giovanni Fattore
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Pant C, Deshpande A, Fraga-Lovejoy C, O'Connor J, Gilroy R, Olyaee M. Emergency Department Visits Related to Inflammatory Bowel Disease: Results From Nationwide Emergency Department Sample. J Pediatr Gastroenterol Nutr 2015; 61:282-4. [PMID: 25859825 DOI: 10.1097/MPG.0000000000000815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We analyzed a national US database to study the presentation of children with inflammatory bowel disease (IBD) to the emergency department (ED). Our results indicate that from 2006 to 2010, there was a significant increase in the number of ED visits related to children with IBD accompanied by a contemporaneous decline in the rate of hospitalization that followed these ED visits. Earlier published results have highlighted an increased overall rate of hospitalizations in the United States related to children with IBD. In this context, our results support the evidence for an increased prevalence of pediatric IBD in the United States in recent years.
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Vejzovic V, Bramhagen AC, Idvall E, Wennick A. Parents' experiences when their child is undergoing an elective colonoscopy. J SPEC PEDIATR NURS 2015; 20:123-30. [PMID: 25845734 DOI: 10.1111/jspn.12109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose was to illuminate parents' experiences when their children are undergoing an elective colonoscopy performed using polyethylene glycol-based regimes for bowel preparation. DESIGN AND METHODS Individual interviews with 12 parents were performed and analysed using content analysis. RESULTS The parents' experiences were structured into one theme: "Charged with conflicting emotions" with three categories: "Being forced to force," "Losing one's sense of being a parent" and "Standing without guidance." PRACTICE IMPLICATIONS Understanding parents' experiences can help healthcare staff guide parents in helping their children undergo a colonoscopy.
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Affiliation(s)
- Vedrana Vejzovic
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Sandberg KC, Davis MM, Gebremariam A, Adler J. Disproportionate rise in Clostridium difficile-associated hospitalizations among US youth with inflammatory bowel disease, 1997-2011. J Pediatr Gastroenterol Nutr 2015; 60:486-92. [PMID: 25419679 DOI: 10.1097/MPG.0000000000000636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our aim was to characterize the temporal changes in burden that Clostridium difficile infection (CDI) added to the hospital care of children and young adults with inflammatory bowel disease (IBD) in the United States. METHODS Retrospective analysis of annual, nationally representative samples of children and young adults with IBD. RESULTS There was a 5-fold increase in IBD hospitalizations with CDI from 1997 to 2011 (P for trend <0.01). During the same period, IBD hospitalizations without CDI increased 2-fold (P for trend <0.01). Mean length of stay for IBD hospitalizations with CDI was consistently longer than that for hospitalizations without CDI and did not significantly change over time (P for trend = 0.47). CDI-related total hospital days in the United States rose from 1702 to 10,194 days per million individuals per year from 1997 to 2011 (P for trend <0.01). Children and young adults hospitalized with CDI had a significantly lower odds of colectomy (0.31) compared with those without CDI. Total charges for CDI-related hospitalizations among children and young adults in the United States rose from $8.7 million in 1997 to $68.2 million in 2011. CONCLUSIONS A widening gap in burden has opened between IBD hospitalizations with and without CDI during the last decade and a half. CDI-related hospitalizations are associated with disproportionately longer lengths of stay, more hospital days, and more charges than hospitalizations without CDI over time. Further work within health systems, hospitals, and practices can help us better understand this enlarging gap to improve clinical care for this vulnerable population.
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Abstract
Shenzhen in China has undergone rapid economic development over the years. The purpose of this study was to investigate disease development trends among women and children inpatients in Shenzhen. A maternal and child health care hospital in Futian District was chosen for this retrospective study. The data were collected from 55 246 inpatients' information from 2003 to 2012 and were classified into gynecological and pediatric diseases. Descriptive analysis was conducted with Microsoft Excel 2007. The results showed that the number of inpatients had increased year by year, and the constituents of disease had been substantially changed in the study period. More interventions and large-scale studies are needed to improve maternal and child health care in Shenzhen.
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Affiliation(s)
- Nili Ren
- Affiliated People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Jianduan Zhang
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lilong Huo
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Kai Chen
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Chuang Sun
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Fangyi Wu
- Affiliated People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Li Li
- Affiliated People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Jingdong Ma
- Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Pant C, Olyaee M, Sferra TJ, Gilroy R, Almadhoun O, Deshpande A. Emergency department visits for gastrointestinal bleeding in children: results from the Nationwide Emergency Department Sample 2006-2011. Curr Med Res Opin 2015; 31:347-51. [PMID: 25466210 DOI: 10.1185/03007995.2014.986569] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the epidemiology and trends in pediatric gastrointestinal (GI) bleeding associated emergency department (ED) visits in the US. METHODS Estimates of GI bleeding associated ED visits were calculated in children from birth to 19 years of age using the Nationwide Emergency Department Sample (NEDS). RESULTS From 2006 to 2011, there were an estimated total of 437,283 ED visits associated with diagnosis of GI bleeding. Specifically, there were 88,675 cases of upper GI bleeding, 132,102 cases of lower GI bleeding and 217,008 cases of unspecified GI bleeding. GI bleeding associated ED visits increased from 82.2/100,000 children in 2006 to 93.9/100,000 children in 2011 (14.3% increase; P < 0.01). The rate of increase was chiefly noted for lower GI bleeding (31.3%) followed by unspecified GI bleeding (10.4%) with a relatively minor increase in upper GI bleeding (1.1%). The greatest number of visits occurred in children 15-19 years of age (39.2%). A majority of patients underwent routine discharge (80.8%). Risk factors independently associated with an increased rate of hospital admission included ≥3 comorbid conditions (adjusted odds ratio [aOR] 112.2; 95% CI 103.4-121.7), presentation to a teaching hospital (aOR 3.2; 95% CI 3.1-3.2), the presence of upper GI bleeding (aOR 3.1; 95% 3.0-3.2), health coverage with private insurance (aOR 1.6; 95% CI 1.6-1.7) and children <5 years of age (aOR 1.3; 95% CI 1.2-1.3). CONCLUSION Our results indicate that there has been an increasing incidence of GI bleeding associated ED visits in children from 2006 to 2011 with cases of lower GI bleeding accounting for the largest increase. Only a small number of children merited admission to the hospital, suggesting that a majority of visits involved non-life-threatening bleeds. These data represent important complementary information to the overall study of pediatric GI bleeding in the US.
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Affiliation(s)
- Chaitanya Pant
- Division of Gastroenterology, Hepatology and Motility, Department of Internal Medicine, University of Kansas Medical Center , Kansas City, KS , USA
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Sandberg KC, Davis MM, Gebremariam A, Adler J. Increasing hospitalizations in inflammatory bowel disease among children in the United States, 1988-2011. Inflamm Bowel Dis 2014; 20:1754-60. [PMID: 25185689 DOI: 10.1097/MIB.0000000000000195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our objective was to characterize national trends in inflammatory bowel disease (IBD)-related hospitalizations for children. We hypothesized that over time, improvements in care would be associated with a decrease in hospitalization rates, similar to what has been observed in Canadian children with IBD. METHODS Retrospective, serial, cross-sectional analysis of annual, nationally representative samples of children with IBD. RESULTS Overall, discharges for all children irrespective of diagnosis decreased from 1988 to 2011 (P for trend <0.001). In contrast, discharges for children with IBD rose over the same time period from 6.1 (95% confidence interval [CI], 4.0-8.2) to 8.2 (95% CI, 5.5-10.9) per 100,000 individuals per year (P for trend <0.001). More of this rise occurred in hospitalizations that did not have IBD-related endoscopy or surgery performed (P for trend <0.001). Although mean length of stay decreased over the study period (P for trend <0.001), total hospital days increased over the latter half of the study with a significant increase over the entire study period (P for trend <0.001). CONCLUSIONS Contrary to clinically informed hypotheses, nationally representative rates of hospitalization for pediatric patients with IBD have increased since the mid-1990s. This directly contrasts with stable rates over the preceding years. Most of the expansion in hospital care seems to be related to hospitalizations that do not include procedures. Several lines of future research may greatly facilitate a better understanding of the epidemiologic, therapeutic, and health care resource issues at play.
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Vejzovic V, Wennick A, Idvall E, Bramhagen AC. A private affair: children's experiences prior to colonoscopy. J Clin Nurs 2014; 24:1038-47. [DOI: 10.1111/jocn.12661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Vedrana Vejzovic
- Department of Care Science; Faculty of Health and Society; Malmö University; Malmö Sweden
| | - Anne Wennick
- Department of Care Science; Faculty of Health and Society; Malmö University; Malmö Sweden
| | - Ewa Idvall
- Department of Care Science; Faculty of Health and Society; Malmö University; Malmö Sweden
- Department of Intensive Care and Perioperative Medicine; Skåne University Hospital; Malmö Sweden
| | - Ann-Cathrine Bramhagen
- Department of Care Science; Faculty of Health and Society; Malmö University; Malmö Sweden
- Skåne University Hospital; Malmö Sweden
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Park KT, Sin A, Wu M, Bass D, Bhattacharya J. Utilization trends of anti-TNF agents and health outcomes in adults and children with inflammatory bowel diseases: a single-center experience. Inflamm Bowel Dis 2014; 20:1242-9. [PMID: 24846718 DOI: 10.1097/MIB.0000000000000061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Utilization trends and health effects of infliximab and adalimumab in inflammatory bowel disease (IBD) are incompletely understood. We aimed to describe utilization trends of these 2 anti-tumor necrosis factor (TNF) agents, determine the correlation between utilization with rates of hospitalization and surgery and describe differences in use between adults and children. METHODS Longitudinal data were analyzed for drug utilization, hospitalization, and abdominal surgery. Descriptive statistics were used to show trends, and utilization quotients were compared for standardization. Multivariate logistic regression analysis assessed the association between drug use and rates of hospitalization and surgery. RESULTS Four hundred thirty-eight pediatric and 2514 adult patients with IBD generated a total of 51,882 inpatient and outpatient encounters, representing 1185 Crohn's disease, 1531 ulcerative colitis, and 236 indeterminate colitis patients. From 2007 through 2012, utilization quotients declined for hospitalization but remained unchanged for surgery; adalimumab saw a 3-fold increase, despite continued dominance of infliximab. Median band and mean fitted plots showed downward hospitalization trends from 2006 to 2012. Utilization of infliximab peaked in 2008, Q4 with gradual decline to 2012, Q2; and adalimumab showed moderate increased utilization since 2007, Q1. Use of infliximab (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.70-0.83) and adalimumab (OR, 0.79; 95% CI, 0.72-0.87) was associated with decreased hospitalization risk but not associated with reduced abdominal surgery risk. Children had increased hospitalization (OR, 2.68; 95% CI, 2.49-2.88) but decreased risk for abdominal surgery (OR, 0.57; 95% CI, 0.46-0.70). CONCLUSIONS Current infliximab use remains substantially greater than adalimumab use, despite recent increased use of adalimumab. Although trends for hospitalization for IBD are decreasing, it is not reflected in abdominal surgery rates in a tertiary IBD referral center.
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Abstract
Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care.
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Affiliation(s)
- Renée Marchioni Beery
- Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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