Not to be Overlooked: The Need for Increased Dialogue Between Patient and Provider Surrounding Medical Foods in IBD

Background Medical foods are treatments with growing evidence for use in a variety of gastrointestinal diseases. They are safe and have proven efficacy in helping to manage inflammatory bowel disease (IBD). They can be used as monotherapy or in addition to traditional therapies. While medical foods offer new, evidence-based options to treat IBD, physician awareness of them remains uncertain. We examined the frequency with which gastroenterologists discussed their use for IBD management and explored associations with gender or race. Methods A retrospective review of all IBD patients seen at an urban university gastroenterology practice in a 6-month period was performed. There were no exclusion factors. Patient age, gender, ethnicity, and disease type were obtained. Records were evaluated for discussions about medical foods as IBD therapy. The associations between discussion of medical foods and gender or race were analyzed with a Chi-square test. Results 268 records were reviewed. Of those, 118 were men and 150 were women, with a mean age of 43. 80 were Black, 143 White, 6 Latino, 10 Asian, and 29 other. 158 had a diagnosis of Crohn’s and 109 had ulcerative colitis (UC), while 1 had indeterminate colitis. 8 (3%) in the cohort had a documented discussion about using medical foods to treat IBD. 6 discussed VSL#3 (2 Crohn’s, 4 UC), while 2 discussed Ensure (2 Crohn’s). There was no association between discussion of medical foods and gender (P=0.3) or race (P=0.9). Conclusion Medical foods are emerging in IBD management, with new evidence supporting their use in a diversity of clinical settings. While previously unclear, our study demonstrates that few IBD patients have documented discussions about medical foods. Though some discussions about medical foods may be undocumented, that only 3% of patients had documented discussions suggests clinicians are missing an opportunity to utilize this therapeutic option. Given the growing evidence for therapeutic use of medical foods in IBD, physicians should increase the visibility of their use

Home remodeling and risk of childhood leukemia

PurposeWe investigated the relationship between the risk of childhood leukemia and home remodeling, a surrogate for indoor chemical exposures.MethodsWe collected information on remodeling activities carried out between birth and diagnosis in homes of 609 acute lymphoblastic leukemia (ALL) cases, 89 acute myeloid leukemia (AML) cases, and 893 matched controls participating in the California Childhood Leukemia Study (1995-2008). We used multivariable logistic regression to estimate the risk of ALL and AML associated with six remodeling activities: construction, painting, recarpeting, reflooring, roofing, and weatherproofing. Models were adjusted for age, sex, Hispanic ethnicity, race, household annual income, and residential mobility.ResultsConstruction in the home between birth and diagnosis was associated with a significant increase in ALL risk (odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.14-2.02) and a nonsignificant increase in AML risk (OR: 1.75, 95% CI: 0.98-3.15). No other remodeling activities were associated with ALL or AML risk in the main analysis. When stratifying by Hispanic ethnicity, a positive relationship between ALL risk and painting was evident in Hispanic children (OR: 1.47, 95% CI: 1.04-2.07).ConclusionsSpecific home remodeling activities appeared to be associated with increased risk of childhood ALL

Home remodeling and risk of childhood leukemia

PURPOSE: We investigated the relationship between the risk of childhood leukemia and home remodeling, a surrogate for indoor chemical exposures. METHODS: We collected information on remodeling activities carried out between birth and diagnosis in homes of 609 acute lymphoblastic leukemia (ALL) cases, 89 acute myeloid leukemia (AML) cases, and 893 matched controls participating in the California Childhood Leukemia Study (1995 – 2008). We used multivariable logistic regression to estimate the risk of ALL and AML associated with six remodeling activities: construction, painting, recarpeting, reflooring, roofing, and weather proofing. Models were adjusted for age, sex, Hispanic ethnicity, race, household annual income, and residential mobility. RESULTS: Construction in the home between birth and diagnosis was associated with a significant increase in ALL risk (OR: 1.52, 95% CI: 1.14, 2.02) and a non-significant increase in AML risk (OR: 1.75, 95% CI: 0.98, 3.15). No other remodeling activities were associated with ALL or AML risk in the main analysis. When stratifying by Hispanic ethnicity, a positive relationship between ALL risk and painting was evident in Hispanic children (OR: 1.47, 95% CI: 1.04, 2.07). CONCLUSIONS: Specific home remodeling activities appeared to be associated with increased risk of childhood ALL