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Transition clinic attendance is associated with improved beliefs and attitudes toward medicine in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2017年第29期23卷 5405-5411页

作者： Nancy Fu kevan jacobson Andrew Round Kathi Evans Hong Qian Brian Bressler Division of Gastroenterology Department of Medicine University of British Columbia Division of Gastroenterology Hepatology and Nutrition Department of Pediatrics University of British Columbia Faculty of Medicine University of British Columbia Centre of Health Evaluation and Outcome Sciences

To evaluated the differences in knowledge, adherence, attitudes, and beliefs about medicine in adolescents with inflammatory bowel disease (IBD) attending transition clinics. METHODSWe prospectively enrolled patients from July 2012 to June 2013. All adolescents who attended a tertiary-centre-based dedicated IBD transition clinic were invited to participate. Adolescent controls were recruited from university-affiliated gastroenterology offices. Participants completed questionnaires about their disease and reported adherence to prescribed therapy. Beliefs in Medicine Questionnaire was used to evaluate patients’ attitudes and beliefs. Beliefs of medication overuse, harm, necessity and concerns were rated on a Likert scale. Based on necessity and concern ratings, attitudes were then characterized as accepting, ambivalent, skeptical and indifferent. RESULTSOne hundred and twelve adolescents were included and 59 attended transition clinics. Self-reported adherence rates were poor, with only 67.4% and 56.8% of patients on any IBD medication were adherent in the transition and control groups, respectively. Adolescents in the transition cohort held significantly stronger beliefs that medications were necessary (P = 0.0035). Approximately 20% of adolescents in both cohorts had accepting attitudes toward their prescribed medicine. However, compared to the control group, adolescents in the transition cohort were less skeptical of (6.8% vs 20.8%) and more ambivalent (61% vs 34%) (OR = 0.15; 95%CI: 0.03-0.75; P = 0.02) to treatment. CONCLUSIONAttendance at dedicated transition clinics was associated with differences in attitudes in adolescents with IBD.

关键词： Inflammatory bowel disease Adolescents Transition Beliefs Knowledge Attitudes

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Spatial cluster mapping and environmental modeling in pediatric inflammatory bowel disease

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World Journal of Gastroenterology 2023年第23期29卷 3688-3702页

作者： Mielle Michaux Justin M Chan Luke Bergmann Luis F Chaves Brian Klinkenberg kevan jacobson Department of Pediatrics Division of GastroenterologyHepatology and NutritionFaculty of MedicineBritish Columbia Children’s HospitalUniversity of British ColumbiaVancouver V6H 3V4British ColumbiaCanada British Columbia Children’s Hospital Research Institute British Columbia Children’s HospitalVancouver V5Z 4H4British ColumbiaCanada Department of Geography University of British ColumbiaVancouver V6T 1Z2British ColumbiaCanada Department of Environmental and Occupational Health School of Public HealthIndiana UniversityBloomingtonIN 47405United States Department of Cellular and Physiological Sciences University of British ColumbiaVancouver V6T 1Z3British ColumbiaCanada

BACKGROUND Geographical(geospatial)clusters have been observed in inflammatory bowel disease(IBD)incidence and linked to environmental determinants of disease,but pediatric spatial patterns in North America are *** hypothesized that we would identify geospatial clusters in the pediatric IBD(PIBD)population of British Columbia(BC),Canada and associate incidence with ethnicity and environmental *** To identify PIBD clusters and model how spatial patterns are associated with population ethnicity and environmental *** One thousand one hundred eighty-three patients were included from a BC Children’s Hospital clinical registry who met the criteria of diagnosis with IBD≤age 16.9 from 2001–2016 with a valid postal code on file.A spatial cluster detection routine was used to identify areas with similar *** ecological analysis employed Poisson rate models of IBD,Crohn’s disease(CD),and ulcerative colitis(UC)cases as functions of areal population ethnicity,rurality,average family size and income,average population exposure to green space,air pollution,and vitamin-D weighted ultraviolet light from the Canadian Environmental Health Research Consortium,and pesticide *** Hot spots(high incidence)were identified in Metro Vancouver(IBD,CD,UC),southern Okanagan regions(IBD,CD),and Vancouver Island(CD).Cold spots(low incidence)were identified in Southeastern BC(IBD,CD,UC),Northern BC(IBD,CD),and on BC’s coast(UC).No high incidence hot spots were detected in the densest urban *** results were represented as incidence rate ratios(IRR)with 95%*** risk factors for PIBD included fine particulate matter(PM2.5)pollution(IRR=1.294,CI=1.113-1.507,P<0.001)and agricultural application of petroleum oil to orchards and grapes(IRR=1.135,CI=1.007-1.270,P=0.033).South Asian population(IRR=1.020,CI=1.011-1.028,P<0.001)was a risk factor and Indigenous population(IRR=0.956,CI=0.941-0.971,P<0.001),family size(IRR=0.467,CI=0.268-0.81

关键词： Inflammatory bowel diseases Crohn disease Ulcerative colitis Pesticides Air pollution South Asian people

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Consecutive fecal calprotectin measurements for predicting relapse in pediatric Crohn's disease patients

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World Journal of Gastroenterology 2019年第10期25卷 1266-1277页

作者： Alice Jane Foster Matthew Smyth Alam Lakhani Benjamin Jung Rollin F Brant kevan jacobson Division of Gastroenterology Hepatology and NutritionBritish Columbia Children’s Hospital Pediatrics B.C.Children’s Hospital Research Institute Pediatrics British Columbia children’s HospitalUniversity of British Columbia Department of Statistics University of British Columbia Department of Cellular and Physiological Sciences Faculty of Medicine

BACKGROUND Asymptomatic children with Crohn's disease(CD) require ongoing monitoring to ensure early recognition of a disease *** In a cohort of pediatric CD patients, we aimed to assess the utility of serial fecal calprotectin measurements to detect intestinal inflammatory activity and predict disease *** In this prospective longitudinal cohort study, children with CD on infliximab therapy in clinical remission were included. Fecal calprotectin levels were assessed at baseline and at subsequent 2-5 visits. Clinical and biochemical disease activity were assessed using the Pediatric Crohn's Disease Activity Index, Creactive protein and erythrocyte sedimentation rate at baseline and at visits over the following 18 *** 53 children were included and eighteen patients(34%) had a clinical disease relapse during the study. Baseline fecal calprotectin levels were higher in patients that developed symptomatic relapse [median(interquartile range), relapse 723μg/g(283-1758) vs 244 μg/g(61-627), P = 0.02]. Fecal calprotectin levels > 250μg/g demonstrated good predictive accuracy of a clinical flare within 3 mo(area under the receiver operator curve was 0.86, 95% confidence limits 0.781 to 0.937).CONCLUSION Routine fecal calprotectin testing in children with CD in clinical remission is useful to predict relapse. Levels > 250 μg/g are a good predictor of relapse in the following 3 mo. This information is important to guide monitoring standards used in this population.

关键词： Fecal calprotectin Disease relapse Biomarker Crohn’s disease Children

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