Health Services Use during Transition from Pediatric to Adult Care for Inflammatory Bowel Disease: A Population-Based Study Using Health Administrative Data.

OBJECTIVES: To evaluate the impact of the transfer from pediatric to adult care on health services use for adolescents with inflammatory bowel disease (IBD). STUDY DESIGN: A population-based retrospective cohort study identified all children diagnosed with IBD from 1994 to 2008 and treated by pediatric gastroenterologists in Ontario, Canada, using health administrative data. Self-controlled case series analyses compared health service use in the 2 years before and 2 years after transfer with adult gastroenterologists, with a 6-month washout period at transfer. Outcomes evaluated included IBD-specific and IBD-related hospitalizations, emergency department use, outpatient visits, and laboratory use. The relative incidence (RI) in the post-transfer period was compared with pretransfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD type: Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: There were 536 patients included in the study (388 CD, 148 UC). Emergency department use rate was higher after transfer for both CD (RI, 2.12; 95% CI, 1.53-2.93) and UC (RI, 2.34; 95% CI, 1.09-5.03), as were outpatient visits (CD: RI, 1.56; 95% CI, 1.42-1.72; UC: RI, 1.48; 95% CI, 1.24-1.76), and laboratory investigations (CD: RI, 1.43; 95% CI, 1.26-1.63; UC: 1.38; 95% CI, 1.13-1.68). There was no change in the hospitalization rate (CD: RI, 0.70; 95% CI, 0.42-1.18; UC: RI, 2.41; 95% CI, 0.62-9.40). CONCLUSIONS: Health services use in Canada increases after transfer from pediatric to adult care for outpatient visits, emergency department use, and laboratory tests, but not hospitalizations. This study has implications for the planning and budgeting of care for adolescents transitioning to adult care.

Voluntary contraction of the tensor tympani muscle and its audiometric effects.

BACKGROUND: The tensor tympani muscle is the largest muscle within the middle ear. Its voluntary contraction is a very unusual event. Only a few papers have documented its audiometric effects. OBJECTIVE: To report an unusual case of voluntary tensor tympani muscle contraction and describe its audiometric effects. CASE REPORT: A 27-year-old man, who presented complaining of voluntarily evoked bilateral tinnitus, was found to be able to voluntarily contract the tensor tympani muscle in both ears simultaneously. Audiograms were performed under conditions of rest and maximal contraction of the tensor tympani muscle. The most remarkable effects were conductive hearing loss at lower frequencies and an increase in middle-ear impedance. CONCLUSION: The importance of the tensor tympani muscle in middle-ear physiology remains unclear. It has been related to the attenuation of sounds produced during the mastication process. Voluntary control over the tensor tympani muscle is an extremely rare event. However, an understanding of the potential audiometric effects of its contraction could aid the diagnosis of hearing disorders.

Estudos dos efeitos do tratamento com teofilina sobre os aspectos cognitivos e emocionais de crianças com asma brônquica / Effects of theophilline on emotional aspects in childrens with bronchial asthma

Os efeitos da teofilina (T) sobre os aspectos emocionais e cognitivos foram avaliados em nove crianças com asma brônquica leve (7 a 13 anos). O estudo foi duplo-cego e cruzado contra placebo (P), por um período de 28 dias cada. As crianças admitidas tinham QI médio (80 a 101) e eram capazes de realizar, de modo adequado, as provas de funçäo pulmonar (PFP). Nos dias 0, 30 e 60 os pacientes foram avaliados por testes psicológicos (Wisc, Bender, Figura Complexa A. Rey e Miss Goodnough/Machouver) e nos dias 15 e 45 foram realizadas as PFP e testados os níveis séricos de T. Durante o estudo, todos os pacientes apresentaram níveis séricos de T superiores a 5 mcg/ml (5 a 18). A avaliaçäo final näo demonstrou alteraçöes nos testes psicológicos e também näo foram relatadas pelos pais desses pacientes alteraçöes comportamentais. Concluindo, constatou-se näo haver T influenciado o comportamento e o aprendizado desse grupo de pacientes, à semelhança do que recentemente foi relatado por Schieper e col., 1991, e por Lindgren e col., 1992