The role of 5-aminosalicylic acid (5-ASA) in Crohn's disease is unclear. The outcome of the first course of 5-ASA monotherapy with emphasis on 5-ASA dependency was retrospectively assessed in consecutive cohort of 537 Crohn's disease patients diagnosed 1953-2007.
Following outcome definitions were used: Immediate outcome (30 days after 5-ASA start) defined as complete/partial response (total regression/improvement of symptoms) and no response (no regression of symptoms with a need of corticosteroids, immunomodulator or surgery). Long-term outcome defined as prolonged response (still in complete/partial response 1 year after induction of response); 5-ASA dependency (relapse on stable/reduced dose of 5-ASA requiring dose escalation to regain response or relapse =1 year after 5-ASA cessation regaining response after 5-ASA re-introduction).
One hundred sixty-five (31%) patients had monotherapy with 5-ASA. In 50% 5-ASA monotherapy was initiated =1 year after diagnosis (range 0-49 years). Complete/partial response was obtained in 75% and no response in 25% of patients. Thirty-six percent had prolonged response, 23% developed 5-ASA dependency and 38% were non-responders in long-term outcome. Female gender had higher probability to develop prolonged response or 5-ASA dependency (OR 2.89, 95%CI: 1.08-7.75, p=0.04). The median duration (range) of 5-ASA monotherapy was 34 months (1-304) in prolonged responders, 63 (6-336) in 5-ASA dependent and 2 (0-10) in non-responders.
A selected phenotype of Crohn's disease patients may profit from 5-ASA. Fifty-nine percent of patients obtained long-term benefit with 23% becoming 5-ASA dependent. Prospective studies are warranted to assess the role of 5-ASA in Crohn's disease.
The study aimed to explore changes in the prevalence of psychological distress and co-occurring psychological symptoms among 19-34 years old Finnish university students between the years 2000 and 2012.
The prevalence of perceived frequent psychological symptoms was compared in four nationwide cross-sectional student health surveys with random samples (N=11,502) in the following years: 2000 (N=3,174), 2004 (N=3,153), 2008 (N=2,750), and 2012 (N=2,425).
In the time phase from 2000 to 2012, the overall psychological distress (12-item General Health Questionnaire, GHQ-12) increased from 22% to 28%, while there was also an increase in the frequently experienced psychological symptoms (depressiveness from 13% to 15%, anxiety from 8% to 13%, concentration problems from 12% to 18%, and psychological tension from 13% to 18% with a peak prevalence observed in 2008). The co-occurrence of different psychological symptoms increased as well. Psychological distress was more common in females and in older students.
The findings suggest an increasing trend of frequent psychological distress among Finnish university students over the years from 2000 to 2012, with the peak prevalence occurring in 2008, which may reflect the growing multifaceted environmental demands.
The objective of the study was to determine completeness of 24-hour urine collection in pregnancy.
This was a retrospective laboratory/chart review of 24-hour urine collections at British Columbia Women's Hospital. Completeness was assessed by 24-hour urinary creatinine excretion (UcreatV): expected according to maternal weight for single collections and between-measurement difference for serial collections.
For 198 randomly selected pregnant women with a hypertensive disorder (63% preeclampsia), 24-hour urine collections were frequently inaccurate (13-54%) on the basis of UcreatV of 97-220 micromol/kg per day (11.0-25.0 mg/kg per day) or 133-177 micromol/kg per day (15.1-20.1 mg/kg per day) of prepregnancy weight (respectively). Lean body weight resulted in more inaccurate collections (24-68%). The current weight was frequently unavailable (28%) and thus not used. For 161 women (81% proteinuric) with serial 24-hour urine levels, a median [interquartile range] of 11 [5-31] days apart, between-measurement difference in UcreatV was 14.4% [6.0-24.9]; 40 women (24.8%) had values 25% or greater, exceeding analytic and biologic variation.
Twenty-four hour urine collection is frequently inaccurate and not a precise measure of proteinuria or creatinine clearance.
25-hydroxyvitamin D (25[OH]D) deficiency is associated with compromised bone mineralisation, fatigue, suppressed immune function and unsatisfactory skeletal muscle recovery. We investigated the risk of 25(OH)D insufficiency or deficiency in endurance athletes compared to sedentary non-athletes living at 64° north.
University student-athletes (TS) and sedentary students (SS) volunteered to participate in this study. TS engaged in regular exercise while SS exercised no more than 20 minutes/week. Metabolic Equivalent of Task (MET) scores for participants were determined. Vitamin D intake was assessed using the National Cancer Institute's 24-hour food recall (ASA24). Fasting plasma 25(OH)D levels were quantified via enzyme-linked immunosorbent assay.
TS reported higher activity levels than SS as assessed with MET-minutes/week and ranking of physical activity levels (p
Cites: Chem Biol. 2014 Mar 20;21(3):319-29 PMID 24529992
Broadened recruitment to higher education is on the agenda in many countries, and it is also widely recognized that the number of dyslexic students entering higher education is increasing. In Sweden, as in many other European countries, higher education institutions are required to accommodate students with dyslexia. The present study focuses on the study outcome for 50 students with diagnosed dyslexia, mainly in teacher education and nurses' training, at three universities in Northern Sweden. The students trusted their own ability to find information on the Internet but mistrusted their own abilities in reading course books and articles in English and in taking notes. The mean rate of study was 23.5 European Credit Transfer and Accumulation System credits per semester, which is slightly below the national baseline of 26.7. The results show that more than half of the students are examined at a normal rate of study but that about one fifth have a very low rate of study. Messages Most students with dyslexia can compensate for their reading problems. Taking notes during lessons and reading in foreign language may be especially difficult for students with dyslexia. Diagnoses should distinguish between reading comprehension and word decoding. More than half of the students with dyslexia can achieve at a normal rate of study. One-fifth of the students with dyslexia may need a longer period of study than other students.
Women attending the University of Saskatchewan Student Health Services are being offered human papillomavirus (HPV) vaccination but are not filling their prescriptions. We sought to identify gaps in knowledge of the link between HPV infection, cervical dysplasia, and cervical cancer among women attending the Student Health Services, and to identify barriers to HPV vaccination among this cohort of women.
Women attending the University of Saskatchewan Student Health Services for any reason were invited to complete an 18-question survey. The survey included questions regarding knowledge of the purpose of Pap smears, the role of HPV infection in cervical dysplasia and cancer, and HPV vaccination. The questions were designed to elicit both quantitative and qualitative data. Data analysis included basic descriptive analysis and summarization of qualitative data.
Four hundred surveys were distributed, and 371 (91%) were returned. Eighty-two percent of participants were aware of the HPV vaccine, and 40% ranked their knowledge of HPV as good or very good; however, only 6% correctly answered questions about methods of preventing HPV infection. Participants identified cost (62%), concerns over adverse effects (43%), and lack of knowledge (36%) as barriers to undergoing vaccination. Comments about the HPV vaccine reflected frustration with cost and concerns about adverse effects. When participants were asked if they would undergo vaccination if it were free, 60% responded "yes," 31% responded "maybe," and 8% responded "no."
The young women in our survey had significant gaps in knowledge of HPV infection and prevention, and educational programs must be structured to address these deficits. Institutions promoting vaccination must deal with the barriers of cost and fear of adverse effects.
We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.
We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.
In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.
United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
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Canada provides universal health insurance to all citizens, whereas 47 million Americans are uninsured. There has not been a study comparing access to emergency operative care between the 2 countries. As both countries contemplate changes in health care delivery, such comparisons are needed to guide health policy decisions. The purpose of this study is to determine whether or not there is a difference in access to emergency operative care between Canada and the United States.
All patients diagnosed with acute appendicitis from 2001 to 2005 were identified in the Canadian Institute for Health Information database and the US Nationwide Inpatient Sample. Severity of appendicitis was determined by ICD-9 codes. Patients were further characterized by age, gender, insurance status, race, and socioeconomic status (SES; income). Univariate and multivariate analyses were performed to determine the odds of appendiceal perforation at different levels of SES in each country.
There were 102,692 Canadian patients and 276,890 American patients with acute appendicitis. In Canada, there was no difference in the odds of perforation between income levels. In the United States, there was a significant, inverse relationship between income level and the odds of perforation. The odds of perforation in the lowest income quartile were significantly higher than the odds of perforation in the highest income bracket (odds ratio, 1.20; 95% confidence interval, 1.16-1.24).
The results suggest that access to emergency operative care is related to SES in the United States, but not in Canada. This difference could result from the concern over the ability to pay medical bills or the lack of a stable relationship with a primary care provider that can occur outside of a universal health care system.
OBJECTIVE: To determine the accuracy and describe the quality of nursing documentation of pressure ulcers in a hospital care setting. DESIGN: A cross-sectional survey was used comparing retrospective audits of nursing documentation of pressure ulcers to previous physical examinations of patients. SETTING AND SUBJECTS: All inpatient records (n = 413) from February 5, 2002, at the surgical/orthopedic (n = 144), medical (n = 182), and geriatric (n = 87) departments of one Swedish University hospital. INSTRUMENTS: The European Pressure Ulcer Advisory Panel data collection form and the Comprehensiveness In Nursing Documentation. METHODS: All 413 records were reviewed for presence of notes on pressure ulcers; the findings were compared with the previous examination of patients' skin condition. Records with notes on pressure ulcers (n = 59) were audited using the European Pressure Ulcer Advisory Panel and Comprehensiveness In Nursing Documentation instruments. RESULTS: The overall prevalence of pressure ulcers obtained by audit of patient records was 14.3% compared to 33.3% when the patients' skin was examined. The lack of accuracy was most evident in the documentation of grade 1 pressure ulcers. The quality of the nursing documentation of pressure ulcer (n = 59) was generally poor. CONCLUSIONS: Patient records did not present valid and reliable data about pressure ulcers. There is a need for guidelines to support the care planning process and facilitate the use of research-based knowledge in clinical practice. More attention must be focused on the quality of clinical data to make proper use of electronic patient records in the future.