Hospitalization rates of children by developmental disability, maternal nativity, and Indigenous status: the complexity of intersectionality

Asthma is a major cause of morbidity in children and adults. Imperial County has reported among the highest asthma hospitalization rates in the state. Factors such as poverty, access to care, poor selfmanagement skills, and ethnocultural beliefs may influence asthma exacerbations. Provider and adult asthmatic attitudes, beliefs, and practices regarding asthma were examined using a mixed-methods approach: a survey to evaluate provider conformance with national guidelines, and focus groups targeting medical practitioners and adult asthmatics. Half of all providers who treat asthmatics completed a self-administered survey about asthma diagnosis; clinical monitoring of patients; treatment; patient education; and practice guidelines. Provider focus groups further explored survey results. Adult asthmatics participated in Spanishlanguage focus groups exploring cultural beliefs, attitudes, and practices. El asma es la mayor causa de morbilidad entre niños y adultos. El Condado de Imperial ha reportado las tazas más altas de hospitalización a causa de asma en el estado. Factores como la pobreza, acceso a cuidado médico, falta de experiencia sobre como manejar la enfermedad, y creencias étnicas y culturales pueden tener una influencia en las exacerbaciones del asma. Las actitudes, creencias, y prácticas de proveedores de atención médica y adultos concerniente al asma fueron examinadas utilizando varios métodos: una encuesta con el fin de evaluar el nivel de conformidad de los proveedores según las pautas establecidas a nivel nacional, y grupos foco con médicos y adultos con asma. La mitad de los proveedores que proveen atención a asmáticos completaron una encuesta acerca del diagnosis de asma; el monitoreo clínico de los pacientes; administración de tratamiento; educación a los pacientes; y pautas establecidas para proveer atención a pacientes con asma. Los grupos foco con los proveedores exploraron aun más los resultados de las encuestas. Los adultos con asma participaron en grupos foco dirigidos en español para explorar más a fondo las creencias culturales, actitudes y prácticas.

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Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.243.pag ◽

2015 ◽

Vol 24 (3) ◽

pp. 287-292 ◽

Cited By ~ 5

Author(s):

Petra A. Golovics ◽

Laszlo Lakatos ◽

Michael D. Mandel ◽

Barbara D. Lovasz ◽

Zsuzsanna Vegh ◽

...

Keyword(s):

Ulcerative Colitis ◽

Cox Regression ◽

Diagnostic Procedures ◽

Population Based ◽

Disease Course ◽

Inception Cohort ◽

Disease Extent ◽

Cox Regression Analysis ◽

Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

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