BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale c...BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale cannot be fully understood due to lack of information.AIM To identify key factors that may explain the variability in case lethality across countries.METHODS We identified 21 Potential risk factors for coronavirus disease 2019(COVID-19)case fatality rate for all the countries with available data.We examined univariate relationships of each variable with case fatality rate(CFR),and all independent variables to identify candidate variables for our final multiple model.Multiple regression analysis technique was used to assess the strength of relationship.RESULTS The mean of COVID-19 mortality was 1.52±1.72%.There was a statistically significant inverse correlation between health expenditure,and number of computed tomography scanners per 1 million with CFR,and significant direct correlation was found between literacy,and air pollution with CFR.This final model can predict approximately 97%of the changes in CFR.CONCLUSION The current study recommends some new predictors explaining affect mortality rate.Thus,it could help decision-makers develop health policies to fight COVID-19.展开更多
Inflammatory bowel disease(IBD)is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population,and up to 25%of IBD patients are diagnosed before 18 years of age.Adolescents with IBD t...Inflammatory bowel disease(IBD)is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population,and up to 25%of IBD patients are diagnosed before 18 years of age.Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services.The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination,with involvement of all key players to ensure proper collaboration of care and avoid interruption in care.This can be challenging and associated with gaps in delivery of care.The pediatric and adult health paradigms have inherent differences between health care models,as well as health care priorities in IBD.The readiness of the young adult also influences this transition of care,with often times other overlaps in life events,such as school,financial independence and moving away from home.These patients are therefore at higher risk for poorer clinical disease outcomes.The aim of this paper is to review concepts pertinent to transition of care of young adults with IBD to adult care,and provides resources appropriate for an IBD pediatric to adult transition of care model.展开更多
BACKGROUND The increased prevalence of inflammatory bowel disease(IBD)among patients with obesity and type 2 diabetes suggests a causal link between these diseases,potentially involving the effect of hyperglycemia to ...BACKGROUND The increased prevalence of inflammatory bowel disease(IBD)among patients with obesity and type 2 diabetes suggests a causal link between these diseases,potentially involving the effect of hyperglycemia to disrupt intestinal barrier integrity.AIM To investigate whether the deleterious impact of diabetes on the intestinal barrier is associated with increased IBD severity in a murine model of colitis in mice with and without diet-induced obesity.METHODS Mice were fed chow or a high-fat diet and subsequently received streptozotocin to induce diabetic-range hyperglycemia.Six weeks later,dextran sodium sulfate was given to induce colitis.In select experiments,a subset of diabetic mice was treated with the antidiabetic drug dapagliflozin prior to colitis onset.Endpoints included both clinical and histological measures of colitis activity as well as histochemical markers of colonic epithelial barrier integrity.RESULTS In mice given a high-fat diet,but not chow-fed animals,diabetes was associated with significantly increased clinical colitis activity and histopathologic markers of disease severity.Diabetes was also associated with a decrease in key components that regulate colonic epithelial barrier integrity(colonic mucin layer content and epithelial tight junction proteins)in diet-induced obese mice.Each of these effects of diabetes in diet-induced obese mice was ameliorated by restoring normoglycemia.CONCLUSION In obese mice,diabetes worsened clinical and pathologic outcomes of colitis via mechanisms that are reversible with treatment of hyperglycemia.Hyperglycemia-induced intestinal barrier dysfunction offers a plausible mechanism linking diabetes to increased colitis severity.These findings suggest that effective diabetes management may decrease the clinical severity of IBD.展开更多
Purpose: To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention comparedto a traditional school calendar (180-day school year distributed across...Purpose: To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention comparedto a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss viaa natural experiment.Methods. Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured inchildren (5—12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 土 2.4 years, 53.1% male, 68.9% African American) from1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- andsex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular EnduranceRun laps completed) were assessed for summer 2017 (May—August 2017), school year 2017/2018 (August 2017—May 2018), and summer 2018(May—August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixedeffects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondaryregression analyses estimated differences in change within and between groups during each time period, separately.Results. Year-round students gained less BMI (difference in A = —0.44, 95% confidence interval (CI): —0.67 to —0.03) and less CRF (differencein △ = — 1.92, 95%CI: —3.56 to —0.28) than students attending a traditional school overall. Compared with traditional students, during both sum・mers, year-round students gained less BMI (summer 2017 difference in A = —0.15, 95%CI: —0.21 to —0.08;summer 2018 difference in△ = —0.16, 95%CI: —0.24 to —0.07) and zBMI (summer 2017 difference in A = —0.032, 95%CI: —0.050 to —0.010;summer 2018 difference in△ = —0.033, 95%CI: —0.056 to —0.009), and increased CRF (summer 2017 difference in A = 0.40, 95%CI: 0.02—0.85;summer 2018 differencein A = 0.23, 95%CI: —0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI andzBMI and increasing CRF compared with year-round students (difference in BMI A = 0.05, 95%CI: 0.03—0.07;difference in zBMI A = 0.012,95%CI: 0.005—0.019;difference in Progressive Aerobic Cardiovascular Endurance Run laps A = —0.43, 95%CI: —0.58 to —0.28).Conclusion'. The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit tochildren's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight andCRF gain/loss were consistent with the structured days hypothesis.展开更多
Background Nutrition interventions aid in implementing healthy eating.Garden-enhanced nutrition intervention programs have been conducted in schools.We sought to assess feasibility of a hospital-based cooking and gard...Background Nutrition interventions aid in implementing healthy eating.Garden-enhanced nutrition intervention programs have been conducted in schools.We sought to assess feasibility of a hospital-based cooking and gardening program.Methods The cohort study implemented a 3-week integrated cooking and gardening program in the United States(Seattle,WA).We recruited participants with ages 8-15 years from ambulatory clinics.We conducted three 3-week series hospitalbased cooking and gardening program.Children and parents were given pre-and post-program(1 year)surveys.The surveys assessed child participation in food preparation and gardening,strengths and weaknesses of the program,and identified parents'opinions towards sustaining healthy behaviors.Results Eighteen children participated in the hospital-based cooking and gardening program.At l-year follow-up,78%of participants were gardening at home and 100%of participants were cooking at home.Conclusions Novel approaches to combat obesity are needed.A hospital-based cooking and gardening program is a novel intervention to consider for nutrition education.展开更多
Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous clos...Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002–2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. Results 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79–0.87,P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62–0.89,P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27–0.42,P < 0.001) were lower as compared to the 1st tertile of hospital volume. Conclusion Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.展开更多
文摘BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale cannot be fully understood due to lack of information.AIM To identify key factors that may explain the variability in case lethality across countries.METHODS We identified 21 Potential risk factors for coronavirus disease 2019(COVID-19)case fatality rate for all the countries with available data.We examined univariate relationships of each variable with case fatality rate(CFR),and all independent variables to identify candidate variables for our final multiple model.Multiple regression analysis technique was used to assess the strength of relationship.RESULTS The mean of COVID-19 mortality was 1.52±1.72%.There was a statistically significant inverse correlation between health expenditure,and number of computed tomography scanners per 1 million with CFR,and significant direct correlation was found between literacy,and air pollution with CFR.This final model can predict approximately 97%of the changes in CFR.CONCLUSION The current study recommends some new predictors explaining affect mortality rate.Thus,it could help decision-makers develop health policies to fight COVID-19.
文摘Inflammatory bowel disease(IBD)is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population,and up to 25%of IBD patients are diagnosed before 18 years of age.Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services.The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination,with involvement of all key players to ensure proper collaboration of care and avoid interruption in care.This can be challenging and associated with gaps in delivery of care.The pediatric and adult health paradigms have inherent differences between health care models,as well as health care priorities in IBD.The readiness of the young adult also influences this transition of care,with often times other overlaps in life events,such as school,financial independence and moving away from home.These patients are therefore at higher risk for poorer clinical disease outcomes.The aim of this paper is to review concepts pertinent to transition of care of young adults with IBD to adult care,and provides resources appropriate for an IBD pediatric to adult transition of care model.
基金The National Institutes of Health under the National Institute of Diabetes and Digestive and Kidney Diseases(NIHNIDDK),No.DK114474(JMS)and No.DK128383(JMS),No.DK131695(KLF),No.DK101997(MWS),No.DK083042(MWS),No.DK089056(GJM)and No.DK124238(GJM)Department of Defense(JMS),No.W81XWH2110635+4 种基金The University of Washington Royalty Research Fund(JMS),No.A139339The NIH-NIDDK T32 Training Grant(KLF),No.DK007742The NIH-National Heart,Lung,and Blood Institute T32 Training Grant(KMA),No.HL007028The NIH-NIDDK–funded Diabetes Research Center,No.P30DK017047The Nutrition Obesity Research Center at the University of Washington,No.P30DK035816.
文摘BACKGROUND The increased prevalence of inflammatory bowel disease(IBD)among patients with obesity and type 2 diabetes suggests a causal link between these diseases,potentially involving the effect of hyperglycemia to disrupt intestinal barrier integrity.AIM To investigate whether the deleterious impact of diabetes on the intestinal barrier is associated with increased IBD severity in a murine model of colitis in mice with and without diet-induced obesity.METHODS Mice were fed chow or a high-fat diet and subsequently received streptozotocin to induce diabetic-range hyperglycemia.Six weeks later,dextran sodium sulfate was given to induce colitis.In select experiments,a subset of diabetic mice was treated with the antidiabetic drug dapagliflozin prior to colitis onset.Endpoints included both clinical and histological measures of colitis activity as well as histochemical markers of colonic epithelial barrier integrity.RESULTS In mice given a high-fat diet,but not chow-fed animals,diabetes was associated with significantly increased clinical colitis activity and histopathologic markers of disease severity.Diabetes was also associated with a decrease in key components that regulate colonic epithelial barrier integrity(colonic mucin layer content and epithelial tight junction proteins)in diet-induced obese mice.Each of these effects of diabetes in diet-induced obese mice was ameliorated by restoring normoglycemia.CONCLUSION In obese mice,diabetes worsened clinical and pathologic outcomes of colitis via mechanisms that are reversible with treatment of hyperglycemia.Hyperglycemia-induced intestinal barrier dysfunction offers a plausible mechanism linking diabetes to increased colitis severity.These findings suggest that effective diabetes management may decrease the clinical severity of IBD.
基金Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R21HD095164
文摘Purpose: To evaluate the potential of a year-round school calendar (180-day school year distributed across 12 months) as an intervention comparedto a traditional school calendar (180-day school year distributed across 9 months) for mitigating children's weight gain and fitness loss viaa natural experiment.Methods. Height, weight, and cardiorespiratory fitness (CRF) (i.e., Fitnessgram Progressive Aerobic Cardiovascular Endurance Run) were measured inchildren (5—12 years old) in 3 schools (2 traditional, 1 year-round, n = 990 students, age = 8.6 土 2.4 years, 53.1% male, 68.9% African American) from1 school district. Structure (represented by the presence of a school day) was the independent variable. Changes in body mass index (BMI), age- andsex-specific BMI z-scores (zBMI), BMI percentile, percent of overweight or obese children, and CRF (Progressive Aerobic Cardiovascular EnduranceRun laps completed) were assessed for summer 2017 (May—August 2017), school year 2017/2018 (August 2017—May 2018), and summer 2018(May—August 2018). Primary analyses examined the overall change in weight and CRF from summer 2017 until summer 2018 via multilevel mixedeffects regression, with group (traditional vs. year-round calendar), time, and a group-by-time interaction as the independent variables. Secondaryregression analyses estimated differences in change within and between groups during each time period, separately.Results. Year-round students gained less BMI (difference in A = —0.44, 95% confidence interval (CI): —0.67 to —0.03) and less CRF (differencein △ = — 1.92, 95%CI: —3.56 to —0.28) than students attending a traditional school overall. Compared with traditional students, during both sum・mers, year-round students gained less BMI (summer 2017 difference in A = —0.15, 95%CI: —0.21 to —0.08;summer 2018 difference in△ = —0.16, 95%CI: —0.24 to —0.07) and zBMI (summer 2017 difference in A = —0.032, 95%CI: —0.050 to —0.010;summer 2018 difference in△ = —0.033, 95%CI: —0.056 to —0.009), and increased CRF (summer 2017 difference in A = 0.40, 95%CI: 0.02—0.85;summer 2018 differencein A = 0.23, 95%CI: —0.25 to 0.74). However, the opposite was observed for the school year, with traditional students gaining less BMI andzBMI and increasing CRF compared with year-round students (difference in BMI A = 0.05, 95%CI: 0.03—0.07;difference in zBMI A = 0.012,95%CI: 0.005—0.019;difference in Progressive Aerobic Cardiovascular Endurance Run laps A = —0.43, 95%CI: —0.58 to —0.28).Conclusion'. The year-round school calendar had a small beneficial impact on children's weight status but not CRF. It is unclear if this benefit tochildren's weight would be maintained because gains made in the summer were largely erased during the school year. Trajectories of weight andCRF gain/loss were consistent with the structured days hypothesis.
文摘Background Nutrition interventions aid in implementing healthy eating.Garden-enhanced nutrition intervention programs have been conducted in schools.We sought to assess feasibility of a hospital-based cooking and gardening program.Methods The cohort study implemented a 3-week integrated cooking and gardening program in the United States(Seattle,WA).We recruited participants with ages 8-15 years from ambulatory clinics.We conducted three 3-week series hospitalbased cooking and gardening program.Children and parents were given pre-and post-program(1 year)surveys.The surveys assessed child participation in food preparation and gardening,strengths and weaknesses of the program,and identified parents'opinions towards sustaining healthy behaviors.Results Eighteen children participated in the hospital-based cooking and gardening program.At l-year follow-up,78%of participants were gardening at home and 100%of participants were cooking at home.Conclusions Novel approaches to combat obesity are needed.A hospital-based cooking and gardening program is a novel intervention to consider for nutrition education.
文摘Background We investigated the effect of hospital volume on percutaneous closure of atrial septal defect/patent foramen ovale (ASD) among pediatric patients. Methods We identified patients undergoing percutaneous closure of ASD with device using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure code 35.52 from the National Inpatient Sample, years 2002–2011. Patients with age ≤ 18 years and primary diagnosis code 745.5 for ASD were included. Hospital volume was calculated using unique identification numbers and divided into tertiles for analysis. Multivariate regression analysis was performed to determine independent predictors of procedure-related complications which were coded using specific codes released by Healthcare Cost and Utilization Project. Results 6162 percutaneous ASD closure procedures were analyzed. There was no mortality associated with percutaneous ASD closure. Cardiac complications (9.5%) were most common. On multivariate analysis, age increment of 3 years decreased the odds of developing complications (OR 0.83, 95% CI 0.79–0.87,P < 0.001). Odds of developing complications in the 2nd (OR 0.74, 95% CI 0.62–0.89,P = 0.007) and 3rd tertiles (OR 0.34, 95% CI 0.27–0.42,P < 0.001) were lower as compared to the 1st tertile of hospital volume. Conclusion Increasing annual hospital volume is an independent predictor of lower complication rates in percutaneous ASD closure cases with no associated mortality in pediatric patients.
