Epidemiological and pathophysiological studies on diverticular disease in the colon

Background: Diverticular disease of the colon is common and is associated with a high and increasing societal burden with great economical and human costs. Prevalence increases with age and with an overall aging population, investigating risk factors are important. The pathogenesis is complex and poorly understood. Low-grade inflammation and gut dysbiosis have been suggested to play a role but population studies are lacking. While genetic and lifestyle factors have been associated with increased risk for complicated diverticular disease in adults, environmental risk factors are underexplored. The aim of this thesis was to investigate the prevalence of diverticulosis, its association with gastrointestinal symptoms and colonic inflammation in a general population, and to identify early lifestyle and environmental risk factors for developing future symptomatic diverticular disease, in a young population. Methods and Main results: In paper I, we performed a population-based colonoscopy study of randomly selected adults born in Sweden (18–70 years old) assessing the association between abdominal symptoms, mental health, colonoscopy findings and diverticulosis (n=742). We found the prevalence of diverticulosis to be age-dependent and diverticulosis was associated with diarrhea across all age groups. In those older than 60 years of age, diverticulosis was further associated with abdominal pain and diarrhea-predominant IBS. In paper II, a nested case control study from paper I was performed (n=127 cases with diverticulosis and n=127 controls). The findings were that in a general community sample, neither asymptomatic nor symptomatic diverticulosis, were associated with serological or colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified. Papers III and IV were population-based cohort studies of Swedish male conscripts ages 18-20, investigating the association between lifestyle and environmental exposure variables, and symptomatic diverticular disease requiring hospitalization from 1969-2009 (n=49,321). In papers III and IV, we found that exposure to parental divorce, being overweight or obese, a smoker, a risk user of alcohol and/or having low cardiovascular fitness in late adolescence is associated with an increased risk of hospitalized diverticular disease later in life. Conclusions: Diverticulosis is common, age-dependent and associated with diarrhea and age-specific symptoms but not inflammation. Early adulthood lifestyle and environmental factors such as obesity, smoking, risky alcohol use, physical inactivity and early adverse events such as parental divorce increase the risk for developing severe diverticular disease. Future studies investigating alternate pathophysiologic mechanisms for diverticulosis are needed and prospective age-specific studies evaluating early life events and the role of modified lifestyle risk factors and course of diverticular disease are recommended

Health-related quality of life and chronic wound characteristics among patients with chronic wounds treated in primary care: A cross-sectional study in Singapore.

Chronic wounds commonly decrease patients' quality of life. Understanding how chronic wounds impact a patient's health-related quality of life (HRQoL) is important for healthcare service delivery and treatment management. This study explored HRQoL among patients suffering from chronic wounds and investigated associations with patients' socio-demographics and wound characteristics. Two hundred and thirty-three patients across six primary care clinics were assessed and responded to a survey that collected information on socio-demographic, wound characteristics, and HRQoL using the EQ-5D-5L instrument. Data were analysed by descriptive statistics and generalised linear models. The mean age of patients was 61.2 (SD: 14.6) years; 68.2% were males; and 61.8% were of Chinese origin. Arterial ulcers had the greatest negative impact on HRQoL related to mobility, self-care, pain/discomfort and anxiety/depression, and the lowest VAS mean score 62.31 (SD: 28.3; range: 0-100) indicating the worst health. HRQoL related to mobility was significantly associated with age (β = 0.008, P < .001), non-Chinese ethnicity (β = 0.25, P = .001), mixed ulcers (β = -0.41, P = .022), atypical hard-to-heal wounds (β = -0.38, P = .021), wounds with low (β = 0.24, P = .044) to moderate (β = 0.29, P = .018) exudate level, and a wound duration ≥6 months (β = 0.19, P = .033). The findings can be used to improve healthcare delivery for patients with chronic wound to optimise their HRQoL

The humanistic and economic burden of chronic wounds: a protocol for a systematic review

Background: Chronic non-healing wounds present a substantial economic burden to healthcare system; significant reductions in quality of life for those affected, and precede often serious events such as limp amputations or even premature deaths. This burden is also likely to increase with a larger proportion of elderly and increasing prevalence of life-style diseases such as obesity and diabetes. Reviews of the evidence on the burden of illness associated with chronic wounds have not been comprehensive in scope and have not provided an assessment of the distribution of the health care costs across categories of resource use. Methods/design: This study is a systematic review of multiple databases for studies on adult patients with chronic wounds and with the primary objective to assess the impact on health-related quality of life by category of ulcers, and associated direct and indirect costs. Eligible studies will primary be empirical studies evaluating, describing or comparing measurement of quality of life and economic impact. Two reviewers will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form. Differences in applied methodologies and uncertainties will clearly be accounted for. Conservative valuations of costs and impact on health-related quality of life will be prioritised. Variations that may depend on age distribution, the categorisation of ulcer, healthcare system etc. will be described clearly. Discussion: The proposed systematic review will yield a comprehensive assessment of the humanistic and economic burden of chronic wounds in an adult population. A better understanding of the humanistic and economic burden of chronic wounds is essential for policy and planning purposes, to monitor trends in disease burden and not at least in order to estimate the real-world cost-effectiveness of new treatments and therapies. Systematic review registration: PROSPERO CRD4201603749

The cost of childhood atopic dermatitis in a multi-ethnic Asian population: a cost-of-illness study.

BACKGROUND: Childhood atopic dermatitis can often have a negative impact on quality of life for affected children and their caregivers. The condition contributes to increased healthcare costs and can pose heavy economic burdens on healthcare systems and societies. OBJECTIVES: The objective of this study is to provide a comprehensive estimate of the economic burden of childhood atopic dermatitis in a Singaporean sample and to investigate associated factors. METHODS: This cross-sectional cost-of-illness study applied a societal perspective. Data was collected between December 2016 and December 2017 in Singapore. Caregivers to children below 16 years of age with physician-confirmed diagnosis of atopic dermatitis were recruited and socio-demographics, clinical characteristics, health service utilisation data and time spent on caregiving were collected from all eligible participants. RESULTS: The average annual cost per child with atopic dermatitis was estimated at US$7,943 (mild US$6,651, moderate US$7,935 and severe US$14,335) in 2017 prices. The major cost was for informal caregiving (46% of the total cost) followed by out-of-pocket expenses (37%). Healthcare utilisation contributed to 17% of the total cost of which 43% was for medications. CONCLUSIONS: Childhood atopic dermatitis imposes substantial costs with a large proportion arising from informal caregiving and out-of-pocket expenses. The cost for atopic dermatitis is also strongly related to disease severity. This information is important for policymakers and other health planners when considering how to better support affected families. This article is protected by copyright. All rights reserved

Factors Influencing Family Burden of Paediatric Patients with Atopic Dermatitis: A Cross-sectional Study

Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin condition that affects about 10–20% of children and 2-15% of adults in developed countries (1). In Singapore, the prevalence among children and adolescents is 20.8% (2). Itchiness, the most common complaint, results in behavioural and social impairments among paediatric AD patients, which in turn impacts on the wellbeing of caregivers, particularly family members (3, 4). A sick child can markedly affect normal family life and the mental and social wellbeing of other family members (5). Their family members, namely parents, may experience feelings of helplessness and stress as they struggle to treat their child’s symptoms, and this can lead to feelings of guilt as they feel they are failing in their duty to care for their offspring (6). In return, family quality of life can greatly influence patient-related outcomes. Previous studies have demonstrated that paediatric atopic eczema can significantly affect family life; however, they provide limited quantitative data on the factors influencing family life and functions (6). Therefore, we conducted this study in an effort to gain in-depth insights into the family burden caused by paediatric AD, and to explore the social and clinical factors potentially impacting family life and function

Annual Research Review: Child and adolescent mental health interventions: a review of progress in economic studies across different disorders

Background: Resources for supporting children and adolescents with psychiatric disorders continue to be scarce. Economics research can identify current patterns of expenditure, and help inform allocation of treatment and support resources between competing needs or uses. Scope and methods: The aim was to identify the costs of supporting children and adolescents, the economic impacts of childhood psychiatric disorders in adulthood and any new evidence on the cost-effectiveness of interventions. An electronic search of databases (including PubMed, Medline and Psychinfo) identified peer-reviewed journal articles published between 2005 and 2012. Findings: Sixty-seven papers provided data on support and treatment costs now or in the future, or cost-effectiveness analyses of services. Half the articles came from the United States. Most articles focussed on autism spectrum disorder (ASD; 23 articles), attention deficit hyperactivity disorder (ADHD; n = 15), conduct disorder (CD; n = 7), and anxiety or depression (n = 8). Conclusion: Only 14 studies used a cost perspective wider than health care; most included education costs (n = 11), but only five included costs to the justice system. The number of studies estimating costs to the family has increased, particularly for children with autism spectrum disorder (ASD). In the United Kingdom, support costs for children and adolescents with conduct disorder (CD) appear to be lower than for those with attention deficit hyperactivity disorder (ADHD), although for the United States, the opposite may be true. Support costs for children and adolescents with ASD may be higher than both CD and ADHD. However, there were many differences between the samples and the methods employed making comparisons between studies difficult. Outcomes in adulthood include negative impacts on (mental) health, quality of life, public sector services, employment status and income. The evidence base is improving for child and adolescent psychiatric disorders, although only one full cost-effectiveness analysis was identified since the previous review published in 2012. However, we still do not know enough about the economic implications of support and treatment for specific disorders

Cotton-hydrogel composite for improved wound healing: antimicrobial activity and anti-inflammatory evaluation - part 2

Infection is one of the major risk factors for the development of chronic wounds.Antimicrobial wound dressing has been pointed out as a viable option for the preven-tion and treatment of wound infections. Thus, we developed a composite materialbased on cotton textile substrates functionalized with cyclodextrin‐hydroxypropylmethyl cellulose‐based hydrogel. The composites' ability to encapsulate and releasegallic acid (antimicrobial phenolic acid) was evaluated, as well as their mechanicalproperties and antimicrobial and anti‐inflammatory capacity. All composites were ableto retain gallic acid in their structure, with similar loading profile. The presence of gal-lic acid on composites was confirmed by FTIR and TGA. Composites storage moduliwas reduced by the presence of gallic acid. The results suggest a straight relationbetween the swelling ability and gallic acid drug delivery profile. The drug deliverymechanism, of the developed composites, was mainly controlled by Fickian diffusion,based on the experimental data fitting to the Peppas‐Sahlin model. Gallic acid antimi-crobial and anti‐inflammatory properties were transferred to the composite materials.According to the results, the developed composites can be applied on the preventionor treatment of chronic woundsThis article is a result of the project TSSiPRO—NORTE‐01‐0145‐ FEDER‐000015—supported by the regional operational program NORTE 2020, under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund. The authors, also, acknowledge the Portuguese Foundation for Science and Technology (FCT) funding from the project UID/CTM/00264/2013 and UID/AGR/00690/2013 and FEDER funds through the COMPETE 2020–Programa Operacional Competitividade e Internacionalização (POCI) with the reference project POCI‐01‐0145‐FEDER‐007136.info:eu-repo/semantics/publishedVersio

Specific and cross-reactive immune response to oral Salmonella Typhi Ty21a and parenteral Vi capsular polysaccharide typhoid vaccines administered concomitantly

Peer reviewe

Societal Burden of Clinically Anxious Youth Referred for Treatment: A Cost-of-illness Study

A prevalence-based cost-of-illness study using a societal perspective was conducted to investigate the cost-of-illness in clinically anxious youth aged 8–18 in The Netherlands. Discriminant validity of the cost diary used was obtained by comparing costs of families with an anxious child (n = 118) to costs of families from the general population (n = 41). To examine the convergent validity, bottom-up acquired costs derived from cost diaries were compared to top-down acquired costs obtained from national registrations. Bottom-up acquired costs measured by means of cost diaries amounted to €2,748 per family of a clinically referred anxious child per annum. Societal costs of families with clinically anxious children were almost 21 times as high compared to families from the general population. With respect to convergent validity, total health care costs using the bottom-up approach from clinically anxious children were quite comparable to those of top-down data of anxious children, although costs within the subcategories differed considerably. Clinical anxiety disorders in childhood cost the Dutch society more than 20 million euros a year. Based on results of discriminate and convergent validity, the cost diary seems a valid method in establishing cost-of-illness in childhood anxiety disorders