Diagnostic Delay Is Associated with Complicated Disease and Growth Impairment in Paediatric Crohn\u27s Disease

Background: Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay. Methods: We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis \u3e75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression. Results: Overall (64% Crohn\u27s disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was \u3e9.2 months; in CD, \u3e10.8 months and in UC/IBD-U, \u3e6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay. Conclusions: Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD

The effect of three different warm-up intensities on kayak ergometer performance

BISHOP, D., D. BONETTI, and B. DAWSON. The effect of three different warm-up intensities on kayak ergometer performance. Med. Sci. Sports Exerc., Vol. 33, No. 6, 2001, pp. 1026–1032. Purpose: The purpose of this study was to investigate the influence of warm-up (WU) intensity on supramaximal kayak ergometer performance. Methods: In the initial testing session, eight institute of sport kayak squad members performed a graded exercise test for determination of [latin capital V with dot above]O2max and lactate (La) parameters. In a random, counterbalanced order, subjects subsequently performed WU for 15-min at either their aerobic threshold (W1), their anaerobic threshold (W3), or mid-way between their aerobic threshold and anaerobic threshold (W2). A 5-min passive rest period and then a 2-min, all-out kayak ergometer test followed the WU. Results: For the three different WU conditions, no significant differences were observed for average power, peak [latin capital V with dot above]O2, total [latin capital V with dot above]O2, total [latin capital V with dot above]CO2, or accumulated oxygen deficit (AOD) during the 2-min test. However, when compared with W3, differences in average power approached significance after both W1 (P = 0.09) and W2 (P = 0.10). Furthermore, when compared with W3, average power during the first half of the 2-min test was significantly greater after W2 (P W2>W3;P < 0.05) and blood [La] (W1<W2<W3;P < 0.05). Despite the significantly different metabolic acidemia after each WU condition, there were no significant differences in the [latin capital V with dot above]O2 responses to the 2-min test. However, the greater metabolic acidemia after W3 was associated with impaired 2-min kayak ergometer performance. Conclusions: It was concluded, that although a degree of metabolic acidemia may be necessary to speed O2 kinetics, if the WU is too intense, the associated metabolic acidemia may impair supramaximal performance by reducing the anaerobic energy contribution and/or interfering with muscle contractile processes

Diagnostic Delay Is Associated With Complicated Disease and Growth Impairment in Paediatric Crohn's Disease

Background: Paediatric data on the association between diagnostic delay and inflammatory bowel disease [IBD] complications are lacking. We aimed to determine the effect of diagnostic delay on stricturing/fistulising complications, surgery, and growth impairment in a large paediatric cohort, and to identify predictors of diagnostic delay. Methods: We conducted a national, prospective, multicentre IBD inception cohort study including 1399 children. Diagnostic delay was defined as time from symptom onset to diagnosis >75th percentile. Multivariable proportional hazards [PH] regression was used to examine the association between diagnostic delay and stricturing/fistulising complications and surgery, and multivariable linear regression to examine the association between diagnostic delay and growth. Predictors of diagnostic delay were identified using Cox PH regression. Results: Overall (64% Crohn's disease [CD]; 36% ulcerative colitis/IBD unclassified [UC/IBD-U]; 57% male]), median time to diagnosis was 4.2 (interquartile range [IQR] 2.0-9.2) months. For the overall cohort, diagnostic delay was >9.2 months; in CD, >10.8 months and in UC/IBD-U, >6.6 months. In CD, diagnostic delay was associated with a 2.5-fold higher rate of strictures/internal fistulae (hazard ratio [HR] 2.53, 95% confidence interval [CI] 1.41-4.56). Every additional month of diagnostic delay was associated with a decrease in height-for-age z-score of 0.013 standard deviations [95% CI 0.005-0.021]. Associations persisted after adjusting for disease location and therapy. No independent association was observed between diagnostic delay and surgery in CD or UC/IBD-U. Diagnostic delay was more common in CD, particularly small bowel CD. Abdominal pain, including isolated abdominal pain in CD, was associated with diagnostic delay. Conclusions: Diagnostic delay represents a risk factor for stricturing/internal fistulising complications and growth impairment in paediatric CD