-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND & AIMS: Cross-sectional studies have identified high levels of fatigue in patients with active or quiescent inflammatory bowel disease (IBD), but there has been little attention to the long-term effects of fatigue in these patients. We performed a longitudinal study of fatigue in patients with IBD to determine its course and contributing factors. METHODS: Data were obtained from participants in the Manitoba IBD Cohort Study (n=312; 51% with Crohn's disease), a longitudinal population-based study. Symptomatic disease activity was measured every 6 months for 2 y to characterize long-term disease patterns as active, fluctuating, or inactive, based on the validated Manitoba IBD Index. We collected data on fatigue (Multidimensional Fatigue Inventory), psychological function, and laboratory biomarkers at the point of study entry and 1 and 2 y later. RESULTS: Of the study participants, 26% had consistently inactive, 29% had fluctuating, and 45% had consistently active disease over the 2-year time period. Mean levels of fatigue were strongly associated with disease activity; participants with consistently inactive disease had the lowest level of fatigue at each time point. Multivariate analyses indicated fatigue levels increased over time regardless of disease pattern (P <.001). Adjusting for disease activity, disease type and age, sex (female; P <.001), and psychological variables of distress (P <.001), reduced psychological well-being (P =.002), and poor sleep quality (P <.001) were independently associated with increases in fatigue over time. CONCLUSION: Fatigue can increase over time in patients with IBD, even when their disease is in remission. Psychological factors are useful targets for intervention to reduce fatigue.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2013; · 5.64 Impact Factor
-
Lesley A Graff,
Norah Vincent,
John R Walker,
Ian Clara,
Rachel Carr,
Jason Ediger,
Norine Miller,
Linda Rogala,
Patricia Rawsthorne, Lisa Lix,
Charles N Bernstein
[show abstract]
[hide abstract]
ABSTRACT: There has been little investigation of fatigue, a common symptom in inflammatory bowel disease (IBD). The aim of this study was to evaluate fatigue more comprehensively, considering relationships with psychological and biological factors simultaneously in a population-based IBD community sample.
Manitoba IBD Cohort Study participants (n = 318; 51% Crohn's disease [CD]) were assessed by survey, interview, and blood sample. Fatigue, sleep quality, daytime drowsiness, stress, psychological distress, and quality of life were measured with validated scales. Hemoglobin (Hg) and C-reactive protein (CRP) levels were also obtained. Differences were tested across disease activity and disease subtype.
Elevated CRP was found for 23% of the sample and 12% were anemic; 46% had active disease. Overall, 72% of those with active and 30% with inactive disease reached clinical thresholds for fatigue (Multidimensional Fatigue Inventory; P < 0.001); 77% and 49% of those with active or inactive disease, respectively, experienced poor sleep (P < 0.001). There were few differences between those with CD and ulcerative colitis (UC) on the factors assessed, except for higher CRP levels in CD (mean 8.8 versus 5.3, P < 0.02). Multiple logistic regression analyses found that elevated fatigue was associated with active disease (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.2-7.8), poor sleep quality (OR 4.0, 95% CI 1.9-8.6), and perceived stress (OR 4.2, 95% CI 2.2-8.1), but not with hours of sleep, Hg, or CRP.
Fatigue and poor sleep are not only highly prevalent in active disease, but both are still significant concerns for many with inactive disease. Psychological factors are associated with fatigue in IBD in addition to disease and sleep considerations.
Inflammatory Bowel Diseases 09/2011; 17(9):1882-9. · 4.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine if higher bone mineral density (BMD) is a risk factor for breast cancer in women age 50 years and older. 37,860 women ≥ 50-year old with no previous breast cancer diagnosis had baseline BMD assessment between January 1999 and December 2007. Cox proportional hazards models were created for time to a new breast cancer as a function of lumbar spine or femoral neck BMD quartile (1st = lowest as reference) with adjustment for relevant covariates. A secondary analysis was performed to look for an association with estrogen receptor-positive (ER-positive) breast cancers. 794 invasive and in situ breast cancers (484 ER-positive) occurred with a median follow up of 5.4 years. Increased breast cancer risk was seen for the 3rd and 4th quartiles of lumbar spine BMD with hazard ratios (HRs) of 1.26 (95% CI, 1.01-1.58) and 1.45 (95% CI, 1.16-1.81), respectively and for the 3rd quartile of femoral neck BMD with a HR of 1.33 (95% CI, 1.07-1.64). A test for linear trend showed that lumbar spine BMD (P < 0.001) and femoral neck BMD (P = 0.04) were associated with increased risk. Higher lumbar spine BMD was also associated with increased risk of ER-positive breast cancer with HR of 1.45 (95% CI, 1.08-1.94), and 1.68 (95% CI, 1.24-2.27) for women in the 2nd and 4th quartiles, respectively. A test for linear trend showed lumbar spine BMD was associated with increasing risk of ER-positive breast cancer (P = 0.003). Increased ER-positive breast cancer risk was seen for the 3rd quartile of femoral neck BMD with a HR of 1.43 (95% CI, 1.08-1.89). Higher lumbar spine and femoral neck BMD are associated with higher risk of breast cancer in women ≥50-year old. Lumbar spine and femoral neck BMD are associated with increased risk of ER-positive breast cancer.
Breast Cancer Research and Treatment 04/2011; 126(3):679-86. · 4.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Previous studies showed that core cooling rates are similar when only the head or only the body is cooled. Structural equation modeling was used on data from two cold water studies involving body-only, or whole body (including head) cooling. Exposure of both the body and head increased core cooling, while only body cooling elicited shivering. Body fat attenuates shivering and core cooling. It is postulated that this protection occurs mainly during body cooling where fat acts as insulation against cold. This explains why head cooling increases surface heat loss with only 11% while increasing core cooling by 39%.
Computers in biology and medicine 02/2011; 41(3):154-8. · 1.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: This study compares a community inflammatory bowel disease (IBD) sample of individuals with a matched non-IBD community sample of individuals on psychological functioning and health perceptions.
The American Journal of Gastroenterology 09/2009; 104(12):2959-2969. · 7.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study compares a community inflammatory bowel disease (IBD) sample of individuals with a matched non-IBD community sample of individuals on psychological functioning and health perceptions.
Participants in the population-based Manitoba IBD Cohort Study (n=388) were directly compared with sex-, age-, and region-matched controls from a national random-sample health survey on the aspects of psychological health, coping, and perceived general health.
Overall, the IBD sample had lower psychological well-being and mastery, as well as higher distress than did the non-IBD controls (P<or=0.02). Those with IBD used avoidant coping significantly more often, and active coping modestly more often than did the non-IBD sample; both had similar levels of "self-soothing" behaviors. Patients with Crohn's disease and ulcerative colitis had similarly poor levels of functioning along these dimensions compared with the non-IBD sample, as did those with active disease (P<0.01). However, those with inactive disease were similar to the non-IBD sample, and had modestly higher mastery levels. Whereas nearly half of the non-IBD group reported chronic health conditions, those with IBD were threefold more likely to report poorer health (odds ratio 3.07, 95% confidence interval: 2.10-4.47). Psychological factors explained a greater amount of variance in perceived health for the IBD than for the non-IBD sample.
Those with IBD have significantly poorer psychological health than do those without IBD and view their general health status more negatively, although adaptive stress-coping strategies were similar. However, when disease is quiescent there is little detriment to functioning. Active disease should be a flag to consider psychological needs in the care of an IBD patient.
The American Journal of Gastroenterology 09/2009; 104(12):2959-69. · 7.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although tamoxifen has been shown to increase bone mineral density in clinical trials, it is less clear whether this significantly affects fracture rates. Even fewer data are available on skeletal outcomes when tamoxifen is used outside of the context of a clinical trial. A population-based case-control study was undertaken to determine whether tamoxifen use is associated with osteoporotic fractures in routine clinical practice.
Population-based administrative data for the Province of Manitoba, Canada, were examined for tamoxifen use and nontraumatic fracture codes in women 50 years of age or older. Women with osteoporotic fractures (vertebral, wrist or hip; n = 11,096) from 1996 to 2004 were each compared with three controls without fracture, matched for age, ethnicity, and comorbidity (n = 33,209). Tamoxifen use was classified as never, past use, or current use.
Lower osteoporotic fracture rates were associated with current tamoxifen use (univariate odds ratio [OR] = 0.68; 95% CI, 0.55 to 0.84). After controlling for demographic and medical diagnoses known to affect fracture risk, current use was associated with a significantly reduced overall osteoporotic fracture risk (adjusted OR = 0.68; 95% CI, 0.55 to 0.88) and of hip fractures (adjusted OR = 0.47; 95% CI, 0.28 to 0.77). Neither recent nor remote past tamoxifen use was associated with reduced osteoporotic fracture risk. Breast cancer was not independently associated with osteoporotic fractures (adjusted OR = 0.95; 95% CI, 0.81 to 1.12).
In a population-based case-control study, current tamoxifen use was associated with a substantial reduction in osteoporotic fractures.
Journal of Clinical Oncology 11/2008; 26(32):5227-32. · 18.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and antipsychotics have each been associated with an increased risk of fracture in older individuals. The aim of this study was to better define the magnitude of fracture risk with psychotropic medications and to determine whether a dose-effect relationship exists.
Population-based administrative databases were used to examine psychotropic medication exposure and fractures in persons aged 50 years and older in Manitoba between 1996 and 2004. Persons with osteoporotic fractures (vertebral, wrist, or hip [n = 15,792]) were compared with controls (3 controls for each case matched for age, sex, ethnicity, and comorbidity [n = 47,289]). Medications examined included antidepressants (SSRIs vs other monoamines), antipsychotics, lithium, and benzodiazepines.
Selective serotonin reuptake inhibitors were associated with the highest adjusted odds of osteoporotic fractures (odds ratio [OR] = 1.45; 95% confidence interval [CI], 1.32-1.59). Other monoamine antidepressants (OR = 1.15; 95% CI, 1.07-1.24) and benzodiazepines (OR = 1.10; 95% CI, 1.04-1.16) were also associated with greater fracture risk, although the relationship was weaker. Lithium was associated with lower fracture risk (OR = 0.63; 95% CI, 0.43-0.93), whereas the relationship with antipsychotics was not significant in the models that adjusted for diagnoses. A dose-effect relationship was seen with SSRIs and benzodiazepines.
This study provides novel insight into the relationship between fractures and psychotropic medications in the elderly. Selective serotonin reuptake inhibitors seem to have a greater risk than other psychotropic classes, and higher doses may further increase that risk. Lithium seems to be protective against fractures.
Journal of clinical psychopharmacology 09/2008; 28(4):384-91. · 5.09 Impact Factor
-
John R Walker,
Jason P Ediger,
Lesley A Graff,
Jay M Greenfeld,
Ian Clara, Lisa Lix,
Patricia Rawsthorne,
Norine Miller,
Linda Rogala,
Cory M McPhail,
Charles N Bernstein
[show abstract]
[hide abstract]
ABSTRACT: Given the impact of anxiety and mood disorders on health, it is important to consider these disorders in persons with inflammatory bowel disease (IBD). We assessed the prevalence of anxiety and mood disorders in a population-based IBD cohort.
A structured diagnostic interview was administered to participants in the cohort (N = 351), and rates were compared to age-, gender-, and region-matched controls drawn from a national survey (N = 779).
A comparison of lifetime prevalence suggests higher rates of panic, generalized anxiety, and obsessive-compulsive disorders and major depression and lower rates of social anxiety and bipolar disorders in the IBD sample than in national samples in the United States and New Zealand. Direct comparisons with matched controls (with data available for three anxiety disorders) found lifetime prevalence (IBD vs controls) as follows: social anxiety disorder lower in IBD (6%vs 11%, OR 0.52, 95% CI 0.32-0.85), panic disorder not significantly different (8.0%vs 4.7%, OR 1.59, 95% CI 0.96-2.63), agoraphobia without panic not significantly different (1.1%vs 0.6%, OR 1.44, 95% CI 0.37-5.55), and major depression higher (27.2%vs 12.3%, OR 2.20, 95% CI 1.64-2.95). Comparing IBD respondents with and without lifetime anxiety or mood disorder, those with a disorder reported lower quality of life and earlier onset of IBD symptoms and there was a trend toward earlier IBD diagnosis.
Clinicians should be aware of the increased prevalence of depression and possibly other anxiety disorders in persons with IBD as these disorders may influence response to treatment and quality of life.
The American Journal of Gastroenterology 09/2008; 103(8):1989-97. · 7.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Manitoba IBD Cohort Study is a longitudinal, population-based study of multiple determinants of health outcomes in persons with inflammatory bowel disease (IBD) diagnosed within 7 years at enrollment. In this cross-sectional substudy we compared IBD participants' levels of social support, self-perceived stress, disability, and access to healthcare with those of a matched community sample.
IBD participants (n = 388) were interviewed using the Canadian Community Health Surveys (CCHS) 1.1 and 1.2 to assess psychosocial variables. The national CCHS data were accessed to extract a community comparison group, matched on age, sex, and geographic residence.
Compared to the community sample, IBD participants received more tangible, affective, or emotional support in the past year and were more likely to have experienced a positive social interaction. Those with IBD were as likely to be employed as those in the community sample, although they reported greater rates of reduced activity and days missed. Work was not identified as a significant source of stress, but physical health was more likely to be identified as a main stressor by those with active IBD compared to the non-IBD sample. Individuals with IBD were twice as likely to report unmet healthcare needs than the community sample; however, there was agreement across both groups regarding common barriers, including long waits and availability.
While the disease may contribute to greater interference with work quality and daily activities, IBD patients have similar levels of stress and appear to have enhanced social supports relative to those in the community without IBD.
Inflammatory Bowel Diseases 05/2008; 14(4):526-35. · 4.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cigarette smoking is accepted as an important factor that increases the risk for the initiation and progress of chronic periodontitis. However, the effect of cigarette smoking on the recurrence of disease in patients undergoing regular maintenance therapy is less understood. Therefore, we set out to assess disease progression longitudinally in smoking and non-smoking subjects with chronic periodontitis undergoing periodontal maintenance therapy every 3 to 4 months.
A total of 108 subjects undergoing regular maintenance therapy for chronic periodontitis were followed over a 3-year period. Self-reports of smoking status were confirmed by analysis of exhaled carbon monoxide concentrations. Clinical parameters (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [CAL], probing depth [PD], and tooth loss) were recorded at yearly reevaluation visits. The study was carried out in a university hospital setting.
Longitudinal measurements were obtained from 81 (75%) subjects. There were no differences in inflammatory indices at baseline or over time (PI and BOP; both P >0.05) between smokers (N = 16; age: 54 +/- 6 years) and non-smokers (N = 65; age: 59 +/- 14 years). Likewise, there was no difference between the smoking groups with respect to disease progression (measured as changes in prevalence [number] and proportion [percentage] of progressing sites and as mean CAL, PD, and tooth loss; all P >0.05).
In this small population, regular maintenance treatment in a cross-section of highly motivated subjects with chronic periodontitis seemed to be equally successful in preventing progressive periodontal tissue destruction in current smokers and current non-smokers.
Journal of Periodontology 04/2008; 79(3):461-8. · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed.
Social Science [?] Medicine 02/2008; 66(1):117-29. · 2.70 Impact Factor
-
Jason P Ediger,
John R Walker,
Lesley Graff, Lisa Lix,
Ian Clara,
Patricia Rawsthorne,
Linda Rogala,
Norine Miller,
Cory McPhail,
Kathleen Deering,
Charles N Bernstein
[show abstract]
[hide abstract]
ABSTRACT: This study reports cross-sectional medication adherence data from year 1 of the Manitoba Inflammatory Bowel Disease (IBD) Cohort Study, a longitudinal, population-based study of multiple determinants of health outcomes in IBD in those diagnosed within 7 yr.
A total of 326 participants completed a validated multi-item self-report measure of adherence, which assesses a range of adherence behaviors. Demographic, clinical, and psycho-social characteristics were also assessed by survey. Adherence was initially considered as a continuous variable and then categorized as high or low adherence for logistic regression analysis to determine predictors of adherence behavior.
Using the cutoff score of 20/25 on the Medication Adherence Report Scale, high adherence was reported by 73% of men and 63% of women. For men, predictors of low adherence included diagnosis (UC: OR 4.42, 95% CI 1.66-11.75) and employment status (employed: OR 11.27, 95% CI 2.05-62.08). For women, predictors of low adherence included younger age (under 30 versus over 50 OR 3.64, 95% CI 1.41-9.43; under 30 vs. 40-49 yr: OR 2.62, 95% CI 1.07-6.42). High scores on the Obstacles to Medication Use Scale strongly related to low adherence for both men (OR 4.05, 95% CI 1.40-11.70) and women (OR 3.89, 95% CI 1.90-7.99). 5-ASA use (oral or rectal) was not related to adherence. For women, immunosuppressant use versus no use was associated with high adherence (OR 4.49, 95% CI 1.58-12.76). Low trait agreeableness was associated with low adherence (OR 2.03, 95% CI 1.12-3.66).
Approximately one-third of IBD patients were low adherers. Predictors of adherence differed markedly between genders, although obstacles such as medication cost were relevant for both men and women.
The American Journal of Gastroenterology 08/2007; 102(7):1417-26. · 7.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intra-urban residential mobility of a cohort with schizophrenia was compared to a matched cohort with no mental illness using population-based administrative data. The percentage of individuals with one or more changes in postal code in the three-year mobility study period was examined, along with measures of the movement between different intra-urban areas. The schizophrenia cohort was more likely to move than the matched cohort; however, this depends on their age, income level, and area of residence at baseline. Age, gender, marital status, income quintile, and use of physicians and hospitalizations were associated with mobility. Individuals in the schizophrenia cohort were significantly more likely to move from the suburb to the inner city, and significantly less likely to move from the inner city to the suburb than those with no mental illness. Implications of the findings and directions for future research are discussed, with particular attention paid to the utility of administrative data for further mental health research.
Health & Place 07/2007; 13(2):310-23. · 2.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Issues around end-of-life health care have attracted increasing attention in the last decade. One question that has arisen is whether very elderly individuals receive overly aggressive treatment at the end of life. The purpose of this study was to address this issue by examining whether health care use at the end life varies by age.
The study included all adults 65 years old or older who died in Manitoba, Canada in 2000 (N = 7678). Measures were derived from administrative data files and included location of death, hospitalizations, intensive care unit (ICU) admission, long-term care (LTC) use, physician visits, and prescription drug use in the last 30 days versus 180 days before death, respectively.
Individuals 85 years old or older had increased odds of being in a LTC institution and also dying there than did individuals 65-74 years old. They had, correspondingly, lower odds of being hospitalized and being admitted to an ICU. Although some statistically significant age differences emerged for physician visits, the effects were small. Prescription drug use did not vary by age.
These findings indicate that very elderly individuals tended to receive care within LTC settings, with care that might be considered aggressive declining with increasing age. However, health care use among all age groups was substantial. A critical issue that needs to be examined in future research is how to ensure quality end-of-life care in a variety of clinical contexts and care settings for individuals of all ages.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/2007; 62(4):400-7. · 4.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A principal objective of the Canadian Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was to reduce the variation in the way that breast cancer was being treated. To evaluate whether this goal has been reached, we examined variations among surgeons for 4 measures of surgical care and tested for differences in province-wide rates and in variations among surgeons before and after the guidelines were released.
We studied a population-based cohort of 7022 women living in Manitoba in whom breast cancer was diagnosed from 1995 to 2003 inclusive. Demographic, tumour and treatment information was obtained from the Manitoba Cancer Registry. We examined 4 measures of care: breast-conserving surgery, axillary assessment in invasive disease, axillary node dissection in noninvasive disease and the adequacy of axillary node dissection. Generalized linear models were used to test for significant variations in care among surgeons and to test for differences in province-wide rates and variations in these rates among surgeons before and after introduction of the guidelines.
We found clinically significant variations in the province-wide rates of all 4 measures examined. These variations were statistically significant for all measures except axillary node dissection in noninvasive disease. No significant differences in either the province-wide rates or in variations in these rates among surgeons before and after introduction of the guidelines were found for any of the measures.
Our results suggest that the Canadian breast cancer guidelines are not meeting their stated objective. New strategies for guideline dissemination and implementation may be required.
Canadian Medical Association Journal 04/2007; 176(6):771-6. · 8.22 Impact Factor
-
Lesley A Graff,
John R Walker, Lisa Lix,
Ian Clara,
Patricia Rawsthorne,
Linda Rogala,
Norine Miller,
Laura Jakul,
Cory McPhail,
Jason Ediger,
Charles N Bernstein
[show abstract]
[hide abstract]
ABSTRACT: We aimed to assess the relationship of disease type and disease activity with psychological functioning and quality of life (QOL) in a population-based cohort of patients with recently diagnosed inflammatory bowel disease (IBD).
A total of 388 individuals diagnosed within 7 years were recruited from a population-based registry of IBD patients for the Manitoba IBD Cohort Study. Participants completed a clinical interview and standardized self-report measures of positive and negative psychological functioning, and QOL. Disease activity was determined by symptom self-report over the prior 6 months; Harvey-Bradshaw or Powell-Tuck disease activity indices also were used. Disease type was determined through chart verification.
Seventy-four percent of Crohn's disease and 66% of ulcerative colitis participants had active disease during the previous 6 months. Multivariate regression showed that those with active disease had higher levels of distress, health anxiety, and perceived stress, lower social support, well-being and mastery, and poorer disease-specific QOL, relative to those with inactive disease. Disease type was not contributory to psychological functioning or QOL. Pain anxiety (fear of pain) and pain-specific catastrophizing were not associated with disease activity, after controlling for other psychological variables. Participants with either active or inactive disease had suboptimal general QOL.
Ulcerative colitis and Crohn's disease participants were not differentiated in their psychological profiles. Given the strong association between disease-specific QOL, psychological functioning, and disease activity, it is important to be aware of related difficulties in patients with active IBD. There is a continued impact on QOL by the disease, even when it is inactive.
Clinical Gastroenterology and Hepatology 01/2007; 4(12):1491-1501. · 5.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This commentary discusses the approach taken by the Manitoba Centre for Health Policy to systematize its working knowledge. Web-based knowledge tools facilitate maintenance of the information-rich environments present in almost every province. The malleability of administrative data means that variables can be defined in many different ways. Keeping track of what has been done becomes critical to facilitate reuse. New social data sets pose particular challenges and opportunities. Some more general issues of design are highlighted by a perusal of websites associated with other research efforts (the Panel Study of Income Dynamics, the National Bureau of Economic Research and the Institute for Clinical and Evaluative Sciences).
Healthcare policy = Politiques de sante 06/2006; 1(4):50-5.
-
[show abstract]
[hide abstract]
ABSTRACT: The Manitoba Inflammatory Bowel Disease (IBD) Cohort Study is a population-based prospective cohort study of recently diagnosed IBD (n=396). At enrollment, 162 (41%) indicated gastrointestinal symptom>or=3 years before diagnosis. We aimed to determine whether coexistence of irritable bowel syndrome (IBS) had a role in symptoms before IBD diagnosis.
Patients were interviewed about symptoms and investigations before IBD diagnosis. Patients were assessed retrospectively for preexisting IBS.
Of 112 patients interviewed, 58% had Crohn's disease, 37% UC, 3% proctitis, and 2% indeterminant colitis. Symptoms at IBD diagnosis were considered the same (7%), worse (43%), different (20%), or both worse and different (30%) than at initial onset. Mean time between initial symptoms and diagnosis was 11 years (range, 3-48 years). Increasing age at IBD diagnosis correlated with a longer period after initial symptoms and diagnosis of IBD (r=.32, P<.0001). Gender and specific IBD diagnosis had no effect on this time period. Patients were identified as no previous IBS (51%), likely IBS (25%), and possible IBS (24%). Those with likely and possible IBS had a trend toward longer symptom duration before IBD diagnosis than those without IBS (P=.07). Of the total IBD cohort (n=396), considering only those with symptoms for >or=3 years before diagnosis, 14% were considered to have likely or possible IBS.
These data suggest that older patients and those with likely and possible preexisting IBS are more likely to experience longer symptom duration before diagnosis of IBD. The prevalence rate of IBS was similar to estimated base rates in the general population.
Clinical Gastroenterology and Hepatology 05/2006; 4(5):614-20. · 5.63 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In publicly funded health care systems, the utilization of health care services should be equitable, irrespective of socioeconomic status (SES). Although the association between SES and health care utilization has been examined in Canada relative to surgical, cardiac and preventive health care services, no published studies have specifically explored the association between SES and diagnostic imaging.
We examined over 300,000 diagnostic imaging claims made in the Winnipeg Regional Health Authority between Apr. 1, 2001, and Mar. 31, 2002. Using patient postal codes, we assigned SES on the basis of average household incomes in Canada's 1996 census. Using multiple regression, we examined the association between income quintile, patient age group (< or =16, 17-64, > or = 65 years), patient morbidity level according to the Johns Hopkins University Adjusted Clinical Group method (high, moderate, low), and imaging modality (general radiology, vascular, computed tomography, magnetic resonance, and general and obstetric ultrasound).
Relative rates (RR) of diagnostic imaging utilization (highest v. lowest income quintile) were significantly increased in pediatric and adult patient groups at all morbidity levels receiving general radiology (highest RR 2.47, 95% confidence interval [CI] 2.07-2.93); pediatric and adult patient groups at high and low morbidity levels and elderly patient groups at low morbidity levels receiving general ultrasound (highest RR 2.26, 95% CI 1.20-4.26); pediatric and adult patient groups at all morbidity levels and elderly patients at high and moderate morbidity levels receiving magnetic resonance imaging (highest RR 2.51, 95% CI 1.78- 3.52); and adult patient groups at all morbidity levels receiving computed tomography (highest RR 1.46, 95% CI 1.35- 1.59). A lower RR of diagnostic imaging utilization in the highest income quintile was found only among patients receiving obstetric ultrasound (RR 0.80, 95% CI 0.73-0.87). No significant associations were found among elderly patients receiving general radiology or computed tomography or adult patients receiving vascular imaging.
We found a pattern of increased diagnostic imaging utilization in patient groups with a higher SES. Further research is needed to better understand the nature of this finding and how it contributes to health outcomes.
Canadian Medical Association Journal 12/2005; 173(10):1173-7. · 8.22 Impact Factor
