Do Shared Exposures Link the Lungs and Gut? Association Between Asthma and Inflammatory Bowel Disease

Immune-mediated, inflammatory conditions of the gut (eg, inflammatory bowel disease [IBD]) and the lungs (eg, asthma) may be driven by common factors including the interplay between genetic risk factors and environmental exposures that impact the microbiome. The increasing incidence of these immune-mediated conditions in recent years has been attributed frequently to the hygiene hypothesis, which postulates that IBD, asthma, and related immune-mediated conditions are results of improved sanitation including clean water, decreased family size, and improved living conditions. These improvements in hygiene lead to decreased microbial and antigenic exposures (ie, Helicobacter pylori and helminths) early in life, and thus a loss of an early opportunity to prime the immune system

Increasing incidence of pediatric inflammatory bowel disease in France: Implications for etiology, diagnosis, prognosis, and treatment

The significant increase in pediatric-onset inflammatory bowel disease in recent decades appears to be a global phenomenon, with studies from multiple geographic areas noting an increase in Crohn's disease (CD) and ulcerative colitis (UC). In this large, population-based cohort from northern France, the rapid increase in pediatric CD and UC from 1988-2011 may be due to multiple potential etiologies including environmental factors and advancements in diagnostic capabilities. We should consider the clinical implications of this rise in incidence, including potential risk stratification approaches that may offer the ability to modify the disease course of patients with earlier diagnosis

Thrombotic and Infectious Risks of Parenteral Nutrition in Hospitalized Pediatric Inflammatory Bowel Disease

Background Malnutrition is common in inflammatory bowel disease (IBD), requiring timely and sufficient nutritional supplementation. In patients hospitalized for active disease, symptoms and/or altered intestinal function hinder enteral nutrition feasibility. In this scenario, parenteral nutrition (PN) is used. We aimed (1) to assess the frequency of PN use between 1997 and 2012 among hospitalized pediatric patients with IBD, (2) to determine the risk of in-hospital thrombus and infection associated with PN, and (3) to identify predictors of thrombus and infection in pediatric IBD hospitalizations utilizing PN. Methods We performed a cross-sectional analysis of pediatric patients hospitalized between 1997 and 2012. We used the Kids' Inpatient Database (KID) to identify pediatric patients (ó18 years of age) with Crohn's disease (CD) or ulcerative colitis (UC), PN exposure, and primary outcomes including thrombus and infection. We used multivariable regression to identify risk factors for outcomes of interest. Results Parenteral nutrition was utilized in 3732 (12%) of 30,914 IBD hospitalizations. Three percent of PN patients experienced a thrombotic complication, and 5.5% experienced an infectious complication. Multivariate analysis showed PN as an independent risk factor for thrombus (odds ratio [OR], 4.3; 95% confidence interval [CI], 3.2-5.6) and infection (OR, 3.8; 95% CI, 3.1-4.6). Surgery was an independent risk factor for thrombus (OR, 2.0; 95% CI, 1.4-2.7) and infection (OR, 2.5; 95% CI, 2.0-3.1) in hospitalizations exposed to PN. Conclusions Hospitalized pediatric IBD patients, particularly surgical, receiving PN are at increased risk for thrombosis and infection. Clinicians must balance these risks with the benefits of PN

A Bayesian Approach to Calibrating Period-Luminosity Relations of RR Lyrae Stars in the Mid-Infrared

A Bayesian approach to calibrating period-luminosity (PL) relations has substantial benefits over generic least-squares fits. In particular, the Bayesian approach takes into account the full prior distribution of the model parameters, such as the a priori distances, and refits these parameters as part of the process of settling on the most highly-constrained final fit. Additionally, the Bayesian approach can naturally ingest data from multiple wavebands and simultaneously fit the parameters of PL relations for each waveband in a procedure that constrains the parameter posterior distributions so as to minimize the scatter of the final fits appropriately in all wavebands. Here we describe the generalized approach to Bayesian model fitting and then specialize to a detailed description of applying Bayesian linear model fitting to the mid-infrared PL relations of RR Lyrae variable stars. For this example application we quantify the improvement afforded by using a Bayesian model fit. We also compare distances previously predicted in our example application to recently published parallax distances measured with the Hubble Space Telescope and find their agreement to be a vindication of our methodology. Our intent with this article is to spread awareness of the benefits and applicability of this Bayesian approach and encourage future PL relation investigations to consider employing this powerful analysis method.Comment: 6 pages, 1 figure. Accepted for publication in Astrophysics & Space Science. Following a presentation at the conference The Fundamental Cosmic Distance Scale: State of the Art and the Gaia Perspective, Naples, May 201

Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

BACKGROUND: Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease of different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database, we aimed to evaluate differences in the management of pediatric patients with inflammatory bowel disease by race, focusing on length of stay (LOS).METHODS: We performed a cross-sectional analysis using 2000 to 2012 data from the Kids' Inpatient Database, a nationally representative database. We identified pediatric patients (ó18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and LOS, controlling for age, payer status need for surgery, and year of admission.RESULTS: We identified 27,295 hospitalizations for children with inflammatory bowel disease (62% CD and 38% UC), Compared with white patients with CD, black (adjusted odds ratio 1.37; 95% confidence interval, 1.22-1.53; P < 0.001) and Hispanic patients (adjusted odds ratio: 1.37; 95% confidence interval: 1.19-1.59; P < 0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared with white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (adjusted odds ratio: 1.20; 95% confidence interval, 1.02-1.42, P = 0.015).CONCLUSIONS: After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B656)

High patient activation is associated with remission in patients with inflammatory bowel disease

Background: High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one's care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn's disease or ulcerative colitis. Methods: We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity. Results: Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29-0.36) and depression (aOR, 0.33; 95% CI, 0.29- 0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20-2.45). Conclusions: In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes

Black and White Patients with Inflammatory Bowel Disease Show Similar Biologic Use Patterns with Medicaid Insurance

Background: Prior studies have identified racial disparities in the treatment and outcomes of inflammatory bowel disease (IBD). These disparities could be secondary to differences in biology, care delivery, or access to appropriate therapy. The primary aim of this study was to compare medication use among Medicaid-insured black and white patients with IBD, given uniform access to gastroenterologists and therapies. Methods: We analyzed Medicaid Analytic eXtract data from 4 states (California, Georgia, North Carolina, and Texas) between 2006 and 2011. We compared the use of IBD-specific therapies, including analyses of postoperative therapy among patients with Crohn disease (CD). We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders. Results: We identified 14,735 patients with IBD (4672 black [32%], 8277 with CD [58%]). In multivariable analysis, there was no significant difference in the odds of anti-tumor necrosis factor use by race for CD (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 0.99-1.28] or ulcerative colitis (aOR = 1.12; 95% CI, 0.96-1.32). Black patients with CD were more likely than white patients to receive combination therapy (aOR = 1.50; 95% CI, 1.15-1.96), and black patients were more likely than white patients to receive immunomodulator monotherapy after surgery for CD (31% vs 18%; P = 0.004). Conclusions: In patients with Medicaid insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Disparities in IBD treatment discussed in prior literature seem to be driven by socioeconomic or other issues affecting access to care

Benchmark low-mass objects in Moving Groups

This is an Open Access article distributed under the terms of the Creative Commons Attribution License 2.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.In order to compile a sample of ultracool dwarfs that will serve as benchmarks for testing theoretical formation and evolutionary models, we selected low-mass cool (>M7) objects that are potentially members of five known young Moving Groups in the solar neighbourhood. We have studied the kinematics of the sample, finding that 49 targets belong to the young disk area, from which 36 are kinematic member of one of the five moving groups under study. Some of the identified low-mass members have been spectroscopically characterised (T-eff, log g) and confirmed as young members through a detailed study of age indicators

A Novel Patient-Reported Outcome-Based Evaluation (PROBE) of Quality of Life in Patients with Inflammatory Bowel Disease

OBJECTIVES:There is increased interest in measuring patient-reported outcomes (PROs) such as quality of life (QoL) among patients with inflammatory bowel disease (IBD). We aimed to create and validate a new measure of QoL to assess the psychosocial burden of IBD using publicly available assessment tools.METHODS:Using the Crohn's & Colitis Foundation's IBD Partners cohort, we performed several cross-sectional and longitudinal analyses to create a new PRO-based evaluation (PROBE) of QoL among patients with Crohn's disease (CD) and ulcerative colitis (UC). We used factor analysis and Pearson correlation test to identify candidate questions for inclusion, Wilcoxon rank-sum test to examine responsiveness of the PROBE to changes in disease activity, and test-retest reliability assessments in patients with stable disease activity. We also compared the PROBE to the Short Inflammatory Bowel Disease Questionnaire to assess construct validity.RESULTS:A total of 4,854 patients (64% CD, 36% UC) completed surveys with 6 items included in the final PROBE. Compared with baseline there was a significant decrease in PROBE scores at follow-up among patients who experienced a flare for UC (25.0 vs 22.2, P = 0.001) and CD (23.1 vs 21.0, P < 0.001). Among patients with stable disease activity, Cronbach alpha was 0.87 in CD and 0.82 in UC. The PROBE correlated well with the Short Inflammatory Bowel Disease Questionnaire in CD (r = 0.88) and UC (r = 0.86).DISCUSSION:We created a novel measure to assess QoL in patients with IBD using publicly available survey items. This new PROBE can be used to facilitate clinical care, clinical and epidemiological research, and quality improvement

Patients With Pouchitis Demonstrate a Significant Cost Burden in the First Two Years After Ileal Pouch-Anal Anastomosis

Pouchitis, the most common long-term complication after colectomy with IPAA for UC, can lead to increased health-care costs and diminished quality of life. In this study, we aimed to compare the total costs among patients diagnosed with pouchitis in the first 2 years after an IPAA to those among patients who were not diagnosed with pouchitis, using a large administrative claims database. Additionally, we aimed to investigate the specific drivers of cost among patients with an IPAA during the two-year study period, including inpatient hospitalizations, Emergency Department (ED) visits, and pharmacy-related costs