RESUMO
OBJECTIVE: This study aimed to determine whether having a diagnosis of asthma or allergic rhinitis (AR) increased the risk of being diagnosed with inflammatory bowel disease (IBD) and whether there was increased incidence of these diseases after a diagnosis of IBD. DESIGN: This is a retrospective, historical cohort-based study. We used the administrative data of Manitoba Health and the population-based University of Manitoba IBD Epidemiology Database. We used numbers of prescriptions for drugs used to treat asthma and to treat AR to identify diagnoses of asthma and AR, respectively.We calculated relative risks (RRs) to assess incidence of IBD compared with matched controls after diagnoses of asthma and AR and hazard ratios to determine the incidence of asthma and AR after IBD diagnosis. RESULTS: Compared with controls, a diagnosis of asthma or AR preceding a diagnosis of IBD was increased in cases (RR, 1.62; 95% confidence interval [CI], 1.50-1.75; and RR,â 2.10; 95% CI, 1.97-2.24) with a similar outcome by subtype of IBD (Crohn's disease vs ulcerative colitis) and by sex. On sensitivity analysis, diagnoses of asthma or AR were comparable when considering at least 5, 10, 15 or 20 drug prescriptions. Persons with IBD were more likely to develop asthma or AR than controls after being diagnosed with IBD (hazard ratio for asthma, 1.31, 95% CI, 1.18-1.45; and hazard ratio for AR, 2.62, 95% CI, 2.45-2.80). CONCLUSIONS: The association between asthma, AR, and IBD suggest the possibility that whatever triggers the onset of these atopic diseases may trigger the onset of IBD as well, and aeroallergens are plausible culprits.
This study demonstrates that a preexisting diagnosis of asthma or allergic rhinitis is associated with an increased risk of subsequently developing IBD. These data reinforce the importance of considering that gastrointestinal complaints in patients with asthma and allergic rhinitis may reflect a possible diagnosis of IBD. It also raises the possibility that aeroallergens may be environmental cause(s) of IBD.
Assuntos
Asma , Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Humanos , Estudos Retrospectivos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doença de Crohn/epidemiologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/etiologia , IncidênciaAssuntos
Asma , Coorte de Nascimento , Alérgenos , Asma/epidemiologia , Asma/etiologia , Humanos , LactenteAssuntos
Asma , Hipersensibilidade , Asma/epidemiologia , Criança , Estudos de Coortes , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND: There are no widely accepted prognostic tools for childhood asthma; this is in part due to the multifactorial and time-dependent nature of mechanisms and risk factors that contribute to asthma development. Our study objective was to develop and evaluate the prognostic performance of conditional inference decision tree-based rules using the Pediatric Asthma Risk Score (PARS) predictors as an alternative to the existing logistic regression-based risk score for childhood asthma prediction at 7 years in a high-risk population. METHODS: The Canadian Asthma Primary Prevention Study data were used to develop, compare, and contrast the prognostic performance (area under the curve [AUC], sensitivity, and specificity) of conditional inference tree-based decision rules to the pediatric asthma risk score for the prediction of childhood asthma at 7 years. RESULTS: Conditional inference decision tree-based rules have higher prognostic performance (AUC: 0.85; 95% CI: 0.81, 0.88; sensitivity = 47%; specificity = 93%) than the pediatric asthma risk score at an optimal cutoff of ≥6 (AUC: 0.71; 95% CI: 0.67, 0.76; sensitivity = 60%; specificity = 74%). Moreover, the pediatric asthma risk score is not linearly related to asthma risk, and at any given pediatric asthma risk score value, different combinations of its pediatric asthma risk score clinical variables differentially predict asthma risk. CONCLUSION: Conditional inference tree-based decision rules could be a useful childhood asthma prognostic tool, providing an alternative way to identify unique subgroups of at-risk children, and insights into associations and effect mechanisms that are suggestive of appropriate tailored preventive interventions. However, the feasibility and effectiveness of such decision rules in clinical practice is warranted.
Assuntos
Asma , Asma/diagnóstico , Asma/epidemiologia , Canadá , Criança , Árvores de Decisões , Humanos , Prognóstico , Fatores de RiscoRESUMO
BACKGROUND: The consistently observed male predominance of patients in intensive care units (ICUs) has raised concerns about gender-based disparities in ICU access. Comparing rates of ICU admission requires choosing a normalizing factor (denominator), and the denominator usually used to compare such rates between subpopulations is the size of those subpopulations. However, the appropriate denominator is the number of people whose medical condition warranted ICU care. We devised an estimate of the number of critically ill people in the general population, and used it to compare rates of ICU admission by gender and income. METHODS: This population-based, retrospective analysis included all adults in the Canadian province of Manitoba, 2004-2015. We created an estimate for the number of critically ill people who warrant ICU care, and used it as the denominator to generate critical illness-normalized rates of ICU admission. These were compared to the usual population-normalized rates of ICU care. RESULTS: Men outnumbered women in ICUs for all age groups; population-normalized male:female rate ratios significantly exceed 0 for every age group, ranging from 1.15 to 2.10. Using critical-illness normalized rates, this male predominance largely disappeared; critically ill men and women aged 45-74 years were admitted in equivalent proportions (critical-illness normalized rate ratios 0.96-1.01). While population-normalized rates of ICU care were higher in lower income strata (p < 0.001), the gradient for critical illness-based rates was reversed (p < 0.001). CONCLUSIONS: Across a 30-year adult age span, the male predominance of ICU patients was accounted for by higher estimated rates of critical illness among men. People in lower income strata had lower critical-illness normalized rates of ICU admission. Our methods highlight that correct inferences about access to healthcare require calculating rates using denominators appropriate for this purpose.
Assuntos
Acessibilidade aos Serviços de Saúde/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Idoso , Estado Terminal/epidemiologia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Masculino , Manitoba , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
CONTEXT: It has become commonplace to use family caregivers as proxy responders where patients are unable to provide information about their symptoms and concerns to health care providers. OBJECTIVES: The objective of this study was to determine the degree of concordance between patients' and family members' reports of patient symptoms and concerns at end of life. METHODS: Sample dyads included a mix of patients residing at home, in a nursing home, in a long-term care facility, or in hospice. Diagnoses included patients with amyotrophic lateral sclerosis (n = 75), chronic obstructive pulmonary disease (n = 52), end-stage renal disease (n = 42), and institutionalized, cognitively intact frail elderly (n = 49). Dyads completed the Patient Dignity Inventory (PDI), the modified Structured Interview Assessment of Symptoms and Concerns in Palliative Care, and Graham and Longman's two-item Quality of Life Scale. RESULTS: Concordance was less than 70% for seven of the 25 PDI items, with the lowest concordance (65.1%) for the item "not being able to continue with my usual routines." For all but one PDI item, discordance was in the direction of family members reporting that the patient was worse off than the patient had indicated. Where discordance was observed on the Structured Interview Assessment of Symptoms and Concerns in Palliative Care and Quality of Life Scales, the trend toward family members overreporting patient distress and poor quality of life continued. CONCLUSION: Understanding discordance between patients and family member reports of symptoms and concerns is a valuable step toward minimizing patient and family burden at end of life.
Assuntos
Cuidadores/psicologia , Família/psicologia , Procurador/psicologia , Qualidade de Vida , Doente Terminal/psicologia , Idoso , Feminino , Humanos , Masculino , Satisfação do Paciente , Estudos Prospectivos , Respeito , Estresse Psicológico , Assistência TerminalRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0147607.].
RESUMO
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.
Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Asma/prevenção & controle , Indústria Farmacêutica , National Heart, Lung, and Blood Institute (U.S.) , National Institute of Allergy and Infectious Diseases (U.S.) , National Institute of Environmental Health Sciences (U.S.) , Organizações sem Fins Lucrativos , Animais , Asma/diagnóstico , Asma/epidemiologia , Pesquisa Biomédica , Criança , Conferências para Desenvolvimento de Consenso de NIH como Assunto , Saúde Ambiental , Obtenção de Fundos , Humanos , Estados UnidosRESUMO
OBJECTIVE: The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. DESIGN: A prospective, multi-site approach was used. SETTING: Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. PARTICIPANTS: Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. MAIN OUTCOME MEASURE: In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). RESULTS: Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4-11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. CONCLUSION: People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs.
Assuntos
Cuidados Paliativos , Pessoalidade , Estresse Psicológico , Idoso , Idoso de 80 Anos ou mais , Esclerose Lateral Amiotrófica/psicologia , Idoso Fragilizado , Humanos , Falência Renal Crônica/psicologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/psicologia , Apoio SocialRESUMO
RATIONALE: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few intensive care units (ICUs). OBJECTIVES: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs. METHODS: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a 9-year period, we assessed ICU, hospital, 30-day, and 180-day mortality rates; ICU and hospital lengths-of-stay; Post-hospital use of hospital care, ICU care, outpatient physician care, medications, and home care; and Post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For Post-hospital use variables we compared ICU patients with those admitted to hospitals without the need for ICU care. MEASUREMENTS AND MAIN RESULTS: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within 6 months of ICU admission. Women had higher hospital mortality than men (20.8 vs. 17.8%; P = 0.0008). Among urban residents there was a steady gradient of declining hospital mortality with rising income (P < 0.0001). Mean ICU length of stay was 3.96 days, increasing 0.11 d/yr over the study period (P = 0.001); median ICU length of stay was 2.33 days and did not change over time. In the year after ICU care, 41% were rehospitalized, 10% were readmitted to an ICU, 98% had outpatient physician visits, 96% used prescription medications, and 27% used home care services. Although most of these parameters were statistically higher than for hospitalizations not requiring ICU care, differences were generally small. Among hospital survivors, 2.7% were discharged to chronic care facilities, with 2.5% living in such facilities 3 months later. CONCLUSIONS: Post-hospital medical resource use among ICU survivors is substantial, although similar to that after non-ICU hospitalization. Although the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying Post-hospital supports needed by ICU survivors can be useful for policy makers and others responsible for healthcare planning.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Estado Terminal/mortalidade , Serviços de Assistência Domiciliar/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Renda/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Manitoba , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Readmissão do Paciente/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
PURPOSE: To identify the determinants of short-term and long-term survival in adult patients admitted to intensive care units (ICUs). METHODS: This population-based, observational cohort study included all eleven adult ICUs in the Winnipeg Health Region of Manitoba, Canada, analyzing initial ICU admissions during the period 1999-2010 of all Manitobans ≥17 years old. Analysis included Kaplan-Meier survival curves and multivariable regression models of 30-day mortality and post-90-day survival among those who survived to day 90. We used likelihood ratios to compare the predictive power of clusters of variables in these models. RESULTS: After 33,324 initial ICU admissions, mortality rates within 30 and 90 days were 15.9 and 19.5 %, respectively. The survival curve demonstrated an early phase with a high rate of death, followed by a markedly lower death rate that was only clearly established after several months. 30-day mortality was predominantly determined by characteristics of the acute illness; with its relative contribution set at 1.00, the next largest contributors were age (0.19) and comorbidity (0.16). In contrast, post-90-day mortality was mainly determined by age (relative contribution 1.00) and comorbidity (0.95); the next largest contributor was characteristics of acute illness (0.28). CONCLUSIONS: We observed two phases of survival related to critical illness. Short-term mortality was mainly determined by the acute illness, but its effect decayed relatively rapidly. Mortality beyond 3 months, among those who survived to that point, was mainly determined by age and comorbidity. Recognition of these findings is relevant to discussions with patients and surrogates about achievable goals of care.
Assuntos
Estado Terminal/mortalidade , Fatores Etários , Estudos de Coortes , Comorbidade , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de ChancesRESUMO
OBJECTIVE: To evaluate the association of probiotic supplementation during pregnancy or infancy with childhood asthma and wheeze. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, and Central (Cochrane Library) databases from inception to August 2013, plus the World Health Organization's international clinical trials registry platform and relevant conference proceedings for the preceding five years. Included trials and relevant reviews were forward searched in Web of Science. REVIEW METHODS: Two reviewers independently identified randomised controlled trials evaluating probiotics administered to mothers during pregnancy or to infants during the first year of life. The primary outcome was doctor diagnosed asthma; secondary outcomes included wheeze and lower respiratory tract infection. RESULTS: We identified 20 eligible trials including 4866 children. Trials were heterogeneous in the type and duration of probiotic supplementation, and duration of follow-up. Only five trials conducted follow-up beyond participants' age of 6 years (median 24 months), and none were powered to detect asthma as the primary outcome. The overall rate of doctor diagnosed asthma was 10.7%; overall rates of incident wheeze and lower respiratory tract infection were 33.3% and 13.9%, respectively. Among 3257 infants enrolled in nine trials contributing asthma data, the risk ratio of doctor diagnosed asthma in participants randomised to receive probiotics was 0.99 (95% confidence interval 0.81 to 1.21, I(2)=0%). The risk ratio of incident wheeze was 0.97 (0.87 to 1.09, I(2)=0%, 9 trials, 1949 infants). Among 1364 infants enrolled in six trials, the risk ratio of lower respiratory tract infection after probiotic supplementation was 1.26 (0.99 to 1.61, I(2)=0%). We adjudicated most trials to be of high (ten trials) or unclear (nine trials) risk of bias, mainly due to attrition. CONCLUSIONS: We found no evidence to support a protective association between perinatal use of probiotics and doctor diagnosed asthma or childhood wheeze. Randomised controlled trials to date have not yielded sufficient evidence to recommend probiotics for the primary prevention of these disorders. Extended follow-up of existing trials, along with further clinical and basic research, are needed to accurately define the role of probiotics in the prevention of childhood asthma. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42013004385).
Assuntos
Asma/prevenção & controle , Suplementos Nutricionais , Probióticos/uso terapêutico , Sons Respiratórios/efeitos dos fármacos , Asma/epidemiologia , Feminino , Humanos , Lactente , Gravidez , Probióticos/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Epidemiologic assessment of critically ill people in Intensive Care Units (ICUs) is needed to ensure the health care system can meet current and future needs. However, few such studies have been published. METHODS: Population-based analysis of all adult ICU care in the Canadian province of Manitoba, 1999 to 2007, using administrative data. We calculated age-adjusted rates and trends of ICU care, overall and subdivided by age, sex and income. RESULTS: In 2007, Manitoba had a population of 1.2 million, 118 ICU beds in 21 ICUs, for 9.8 beds per 100,000 population. Approximately 0.72% of men and 0.47% of women were admitted to ICUs yearly. The age-adjusted, male:female rate ratio was 1.75 (95% CI 1.64 to 1.88). Mean age was 64.5 ± 16.4 years. Rates rose rapidly after age 40, peaked at age 75 to 80, and declined for the oldest age groups. Rates were higher among residents of lower income areas, for example declining from 7.9 to 4.4 per 100,000 population from the poorest to the wealthiest income quintiles (p <0.0001). Rates of ICU admission slowly declined over time, while cumulative yearly ICU bed-days slowly rose; changes were age-dependent, with faster declines in admission rates with older age. There was a high rate of recidivism; 16% of ICU patients had received ICU care previously. CONCLUSIONS: These temporal trends in ICU admission rates and cumulative bed-days used have significant implications for health system planning. The differences by age, sex and socioeconomic status, and the high rate of recidivism require further research to clarify their causes, and to devise strategies for reducing critical illness in high-risk groups.
Assuntos
Estado Terminal/epidemiologia , Unidades de Terapia Intensiva , Vigilância da População , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Vigilância da População/métodosRESUMO
BACKGROUND: Prior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient. METHODS: We used administrative data at the Manitoba Centre for Health Policy to evaluate all adult residents of Manitoba, Canada discharged alive from acute care hospitals between April 1, 1990 and February 28, 2009. We identified the rate of leaving AMA, and used multivariable logistic regression to identify socio-demographic and diagnostic variables associated with leaving AMA. RESULTS: Of 1,916,104 live hospital discharges, 21,417 (1.11%) ended with the patient leaving AMA. The cohort contained 610,187 individuals, of whom 12,588 (2.06%) left AMA once and another 2986 (0.49%) left AMA more than once. The proportion of AMA discharges did not change over time. Alcohol and drug abuse was the diagnostic group with the highest proportion of AMA discharges, at 11.71%. Having left AMA previously had the strongest association with leaving AMA (odds ratio 170, 95% confidence interval 156-185). Leaving AMA was more common among men, those with lower average household incomes, histories of alcohol or drug abuse or HIV/AIDS. Major surgical procedures were associated with a much lower chance of leaving the hospital AMA. CONCLUSIONS: The rate of leaving hospital AMA did not systematically change over time, but did vary based on patient and illness characteristics. Having left AMA in the past was highly predictive of subsequent AMA events.
Assuntos
Alta do Paciente/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Alcoolismo/epidemiologia , Feminino , Humanos , Incidência , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
Viruses are a common and important cause of severe community-acquired pneumonia, and may lead to severe respiratory disease and admission to the intensive care unit. Influenza is the most common virus associated with severe viral pneumonia, although other important causes include respiratory syncytial virus, adenovirus, metapneumonia virus, and coronaviruses. Viral pneumonias tend to have a seasonal predilection and are often preceded by a typical viral prodrome. This article focuses on severe influenza pneumonia, including the 2009 H1N1 pandemic, and briefly discusses other causes of severe respiratory disease of viral etiology.
Assuntos
Lesão Pulmonar Aguda/virologia , Antivirais/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Pneumonia Viral , Síndrome do Desconforto Respiratório/virologia , Lesão Pulmonar Aguda/epidemiologia , Doenças Endêmicas , Humanos , Influenza Humana/epidemiologia , Influenza Humana/transmissão , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/epidemiologiaRESUMO
BACKGROUND: Leaving hospital against medical advice may have adverse consequences. Previous studies have been limited by evaluating specific types of patients, small sample sizes and incomplete determination of outcomes. We hypothesized that leaving hospital against medical advice would be associated with increases in subsequent readmission and death. METHODS: In a population-based analysis involving all adults admitted to hospital and discharged alive in Manitoba from Apr. 1, 1990, to Feb. 28, 2009, we evaluated all-cause 90-day mortality and 30-day hospital readmission. We used multivariable regression, adjusted for age, sex, socioeconomic status, year of hospital admission, patient comorbidities, hospital diagnosis, past frequency of admission to hospital, having previously left hospital against medical advice and data clustering (patients with multiple admissions). For readmission, we assessed both between-person and within-person effects of leaving hospital against medical advice. RESULTS: Leaving against medical advice occurred in 21 417 of 1 916 104 index hospital admissions (1.1%), and was associated with higher adjusted rates of 90-day mortality (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.18-2.89), and 30-day hospital readmission (within-person OR 2.10, CI 1.99-2.21; between-person OR 3.04, CI 2.79-3.30). In our additional analyses, elevated rates of readmission and death associated with leaving against medical advice were manifest within 1 week and persisted for at least 180 days after discharge. INTERPRETATION: Adults who left the hospital against medical advice had higher rates of hospital readmission and death. The persistence of these effects suggests that they are not solely a result of incomplete treatment of acute illness. Interventions aimed at reducing these effects may need to include longitudinal interventions extending beyond admission to hospital.
Assuntos
Mortalidade , Cooperação do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Humanos , Modelos Logísticos , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Fatores SocioeconômicosRESUMO
OBJECTIVE: Low physical activity and high sedentary behavior are associated with adverse health outcomes, including asthma. The purposes were to (1) determine if low physical activity and/or high screen time increase the risk of asthma and airway hyperresponsiveness (AHR) in youth and (2) determine if weight status modifies these associations. METHODS: This is a prospective cohort study of healthy weight and overweight Canadian youth. In 2003-2005, 723 youth (8.6 ± 0.5 years; 34.0% asthma, 55.9% boys) were recruited from the 1995 Manitoba Prospective Cohort Study. In 2008-2010, 489 returned for follow-up measures (30.9% asthma, 56.6% boys). The primary exposure variables were parent-reported physical activity and screen time at 8-10 years of age. The primary outcome measures were pediatric allergist-defined asthma and AHR defined as the provocative concentration of methacholine required to induce a 20% fall in forced expiratory volume in 1 second (FEV(1)). RESULTS: Low physical activity (≤2 times weekly) was not associated with asthma or AHR. However, high screen time (≥1 hour/day) was associated with a greater odds of asthma at baseline (odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.20-3.37, p < .01) and follow-up (OR = 2.11, 95% CI = 1.14-3.89, p < .02) versus low screen time. This association was more pronounced among overweight youth (baseline: OR = 3.95, 95% CI = 1.70-9.12, p < .0001; follow-up: OR = 3.22, 95% CI = 1.17-8.86, p < .02). Screen time was not associated with AHR at baseline or follow-up. CONCLUSIONS: High screen time increases the risk of asthma, particularly among overweight youth. Screen time, in addition to physical activity, should be included in clinical assessments of youth with asthma.
Assuntos
Asma/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Exercício Físico , Sobrepeso/epidemiologia , Pesos e Medidas Corporais , Criança , Computadores/estatística & dados numéricos , Feminino , Humanos , Masculino , Manitoba/epidemiologia , Estudos Prospectivos , Características de Residência , Fatores Socioeconômicos , Televisão/estatística & dados numéricosRESUMO
BACKGROUND: In recent decades, children's diet quality has changed and asthma prevalence has increased, although it remains unclear if these events are associated. OBJECTIVE: To examine children's total and component diet quality and asthma and airway hyperresponsiveness (AHR), a proxy for asthma severity. METHODS: Food frequency questionnaires adapted from the Nurses' Health Study and supplemented with foods whose nutrients which have garnered interest of late in relation to asthma were administered. From these data, diet quality scores (total and component), based on the Youth Healthy Eating Index (YHEI adapted) were developed. Asthma assessments were performed by pediatric allergists and classified by atopic status: Allergic asthma (≥1 positive skin prick test to common allergens >3 mm compared to negative control) versus non-allergic asthma (negative skin prick test). AHR was assessed via the Cockcroft technique. Participants included 270 boys (30% with asthma) and 206 girls (33% with asthma) involved in the 1995 Manitoba Prospective Cohort Study nested case-control study. Logistic regression was used to examine associations between diet quality and asthma, and multinomial logistic regression was used to examine associations between diet quality and AHR. RESULTS: Four hundred seventy six children (56.7% boys) were seen at 12.6 ± 0.5 years. Asthma and AHR prevalence were 26.2 and 53.8%, respectively. In fully adjusted models, high vegetable intake was protective against allergic asthma (OR 0.49; 95% CI 0.29-0.84; P < 0.009) and moderate/severe AHR (OR 0.58; 0.37-0.91; P < 0.019). CONCLUSIONS: Vegetable intake is inversely associated with allergic asthma and moderate/severe AHR.
Assuntos
Asma/epidemiologia , Hiper-Reatividade Brônquica/epidemiologia , Comportamento Alimentar , Hipersensibilidade/epidemiologia , Verduras , Adolescente , Asma/fisiopatologia , Estudos de Casos e Controles , Criança , Estudos de Coortes , Registros de Dieta , Feminino , Humanos , Modelos Logísticos , Masculino , Manitoba/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: During puberty, physical activity patterns begin to decline, while sedentary time increases. These changes may be confounded by asthma. The purpose of this study was to gain insight into youths' perceptions of screen time and physical activity by asthma status. METHODS: Four interviews and seven focus groups with boys only or girls only were conducted with 15- to 16-year-old youth enrolled in either of two asthma-focused cohorts in Manitoba, Canada. Using a semi-structured interview guide, youth were asked about their perceptions of physical activity and screen time such as texting, watching television, electronic games, and Internet chatting and about their perceptions of the influence that asthma has on these behaviors. Data were analyzed using thematic coding. RESULTS: Two themes were common to youth with asthma and without asthma: (1) sports are an integral part of youths' lives and (2) screen time is important to youth. Two themes were identified among youth with asthma only: (1) physical activity used to be more difficult and (2) being active and living with asthma. Youth with asthma described physical activity as neither a hindrance to activity nor an excuse for inactivity, although asthma may still present some challenges. They also acknowledged their reliance on screen time for communication and for entertainment. CONCLUSIONS: Youth with asthma believe that physical activity has become increasingly easier as they become older and that being active with asthma, despite its challenges, is a key part of their lives.