Browsing by Author "deBruyn, Jennifer"
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- ItemOpen AccessEthnic Variations of Pediatric Inflammatory Bowel Disease Within Canada(2021-06-18) Jeong, Jocelyn; deBruyn, Jennifer; Kaplan, Gilaad; Seow, Cynthia; Novak, KerriInflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract with highest prevalence in the Western world. Up to twenty-five percent of those who develop IBD are diagnosed in their childhood or adolescent years. Recent temporal trends in adult and pediatric populations demonstrate increasing incidence in both developed and developing countries. IBD phenotypes may differ between countries and ethnic/racial groups. Therefore, the aim of this thesis is to examine ethnic and phenotypic variation of children newly diagnosed with IBD in Canada. An analysis of all newly diagnosed pediatric IBD patients enrolled in the multicenter national prospective Canadian Children IBD Network (CIDsCaNN) inception cohort was conducted. Children were categorized into eight different ethnic groups using a modified Statistics Canada classification method. Baseline data such as demographic characteristics, disease phenotype and activity, family history of IBD, surgeries, and hospitalizations were compared between Caucasians and different ethnic groups. Our study demonstrated important differences between Caucasian and non-Caucasian children with IBD in Canada in specific phenotypes of IBD, time to diagnosis, disease location and behavior, family history of IBD, and immigrant status. South Asians had higher odds of ulcerative colitis (UC) compared to Caucasians. Caucasians with UC had a significantly longer time to diagnosis compared to non-Caucasians. Non-Caucasians with UC had a significant inverse correlation with shorter time to diagnosis in higher pediatric ulcerative colitis activity index (PUCAI) scores, whereas there was no significant correlation found for Caucasians. Caucasians had higher odds of having a first-degree family member with IBD compared to non-Caucasians. Caucasians had lower odds of being a First- or Second-Generation Immigrant compared to Non-Caucasians. This thesis aims to explore the ethnic and phenotypic variation of children newly diagnosed with IBD in Canada. Some of the findings in this thesis are supported by the existing literature and some differ; differences may be due to the small sample size of specific ethnic groups in this study. Further studies are required to explore the differences in phenotypes between different ethnic groups as well as to understand differences in treatment responses with a goal of moving towards personalized medicine in IBD.
- ItemOpen AccessEvolution of Surgery Risk in Crohn's Disease(2016) Frolkis, Alexandra; Kaplan, Gilaad; Jette, Nathalie; deBruyn, JenniferWhile many individuals with Crohn’s disease require surgery for management, the risks of surgery are not well characterized in population-based studies. Advances in medical management may have influenced the risk of surgery over time. However, studies have not adequately evaluated the effect of smoking on temporal trends in surgery risk for Crohn’s disease. A mixed methodology approach was used to: 1) describe the morbidity and mortality associated with surgery in Crohn’s disease; 2) summarize the risk of first and second surgery in Crohn’s disease; 3) evaluate whether the risk of surgery has changed over time; and 4) assess whether smoking has influenced the risk of surgery in Crohn’s disease. In Alberta, postoperative morbidity (25%) and mortality (1.2%) was high for Crohn’s disease. A systematic review and meta-analysis found that the estimated pooled risk of surgery 10 years after the diagnosis of Crohn’s disease was 46.6% (95% Confidence Interval [CI] 37.7%-57.7%); however, the risk of first surgery in Crohn’s disease was significantly decreasing over time (meta-regression p- value<0.01). Another systematic review and meta-analysis identified that 10 years following the first surgery the estimated pooled risk of a second surgery was 35% (95% CI 31.8%-38.6%) and this risk was also decreasing over time (Cochran Q for subgroup comparison p-value<0.01). Finally, a nationally representative cohort showed that from 1996 to 2009 the risk of first surgery decreased significantly and the proportion of incident Crohn’s disease patients who have never smoked significantly increased annually by an estimated 3% (Risk Ratio [RR] 1.03; 95% CI 1.02-1.04). Furthermore, in older adults (>40 years at diagnosis) smoking was associated with twice the risk of surgery compared to those who did not smoke. The results of this dissertation demonstrate that surgery is associated with significant morbidity and mortality. Reassuringly, the risk of surgery is decreasing over time. In part, this decrease may be explained by fewer Crohn’s disease patients who are smokers at diagnosis. Thus, public health initiatives that reduce the prevalence of smoking in the general population may reduce the burden of Crohn’s disease.
- ItemOpen AccessSerologic Protection to Routine Vaccinations in Children with Inflammatory Bowel Disease(2012) Feng, Sharon; deBruyn, Jennifer