Kenny Walter

 (IBD) is expected to significantly rise among the pediatric population in Germany over the next 8 years.

A team, led by Ivana Kern, Department of Health Sciences/Public Health, Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine „Carl Gustav Carus”, TU Dresden, investigated the incidence, prevalence, and future trends of IBD in children and adolescent patients in Saxony, Germany.

The rate of IBD is increasingly globally in the pediatric population in recent years.

In the study, the investigators examined data from the Saxon Pediatric IBD Registry on patients aged up to 15 years from 31 pediatric hospitals and pediatric gastroenterologists between 2000-2014.

There was also an independent survey conducted in 2019 with a registry completeness of 95.7%.

The investigators calculated age-standardized incidence rates per 100,000 person-years and the prevalence per 100,000 children and adolescent patients.

Finally, they performed evaluations in sex and age subgroups and conducted Joinpoint and Poisson regression for trend analyses and projections.

Overall, there were 532 patients diagnosed with IBD included in the epidemiological evaluation, 63.5% (n = 338) with Crohn’s disease, 33.1% (n = 176) with ulcerative colitis, and 3.4% (n = 18) with unclassified IBD.

The results show the 15-year prevalence of IBD was 111.8 (95% CI, 102.3-121.3) per 100,000 individuals, while the age-standardized incidence rates per 100,000 person-years over the whole observation period was 7.5 (95% CI, 6.9-8.1).

The investigators also found trends based on the subtype of IBD in the patient.

The age-standardized incidence rates for Crohn’s disease was 4.8 (95% CI, 4.3-5.3), while the age-standardized incidence rate was 2.5 (95% CI, 2.1-2.9) for ulcerative colitis and 0.3 (95% CI, 0.1-0.4) for unclassified IBD.

The results from the joinpoint regression confirmed a significant increase for IBD overall and Crohn’s disease specifically. The age-standardized incidence rate per 100,000 person-yeas increased from 4.6 (95% CI, 2.8-6.3) in 2000 to 8.2 (95% CI, 7.5-13.6) in 2014 for IBD.

The projected incidence rates for IBD are 12.9 (95% CI, 6.5-25.5) in the year 2025 in Germany and 14.9 (95% CI, 6.7-32.8) in 2030.

This means new diagnoses in Germany would increase by 325% in 2030 compared to 2000, with an expected faster increase in Crohn’s disease compared to ulcerative colitis. There would also be more males than females diagnosed with the disease.

For pediatric patients specifically, the number of new diagnoses is expected to increase to approximately 1584 (95% CI, 1512-1655) in 2025 and to about 1918 in 2030.

“The incidence of IBD in children and adolescents in Saxony increased at a similar rate as in other developed countries during the observation period,” the authors wrote. “Given this trend, the health care system must provide adequate resources for the care of these young patients in the future.”

Current and projected incidence trends of pediatric-onset inflammatory bowel disease in Germany based on the Saxon Pediatric IBD Registry 2000–2014 –a 15-year evaluation of trends

This article was published by our sister publication HCP Live.

Articles

There has been a significant increase of IBD overall and Crohn’s disease specifically in pediatric patients between 2000-2014.

Incidence rates of IBD expected to rise in Germany

New research shows pediatric patients with 

attention deficit/hyperactivity disorder (ADHD)

 are at an increased risk of injuries and hospitalization because of the injuries.

A team, led by Ming-Shang Pai, MS, Department of Psychiatry, Taoyuan Armed Forces General Hospital, evaluated the risk of injuries requiring hospitalization among pediatric patients with and without ADHD and assessed the effects of medication on the risk reduction of patients with ADHD.

Patients with ADHD are often prone to injuries and frequently require treatment with hospital admission.

In the retrospective population-based cohort study, the investigators used data from the Taiwan National Health Insurance Research Database between 2005-2012. There were 4658 patients with ADHD aged 6-18 years included in the study, which were matched with 18,632 sex-, age- and index day-matched non-ADHD control participants.

Each participant was followed until the end of 2013 to compare the risk of injuries requiring hospitalization.

The investigators determined the hazard ratio and confidence intervals after adjusting for confounders using Cox regression analysis.

The results show pediatric patients with ADHD had a significantly higher risk of injuries requiring hospitalization compared to non-ADHD controls (HR, 1.39; 95% CI, 1.12–1.72).

This group also had a higher risk, particularly in males and adolescent subgroups.

Patients with ADHD who were long-term users of ADHD medication also had a lower risk of injuries requiring hospitalization compared to nonusers (HR, 0.51; 95% CI, 0.30–0.85).

“Healthcare providers should be aware of the potential risk of injury in patients with ADHD and highlight the importance of the duration and compliance with medication treatment,” the authors wrote.

 is linked to several different physical health conditions that could remain prevalent throughout life.

ADHD might increase the risk of several other physical health conditions. However, there are very few conditions that have been thoroughly studied in relationship with ADHD and little research on this link in older ADHD patients.

A team, led by Ebba Du Rietz, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, investigated the phenotypic and aetiological associations between ADHD and different physical health conditions across adulthood.

A total of 4.7 million individuals were identified, who formed 4.3 million unique sibling pairs and 1.8 million family clusters. The mean age of the patient population was 47 years old.

Adults with ADHD had increased risk for 34 of the 35 physical conditions, compared to individuals without ADHD. The strongest association was with nervous system disorders including sleep disorder, epilepsy, and dementia (OR, 1.50-4.62) and respiratory diseases, such as asthma and chronic obstructive pulmonary diseases (OR, 2.42.-3.24).

A sex-stratified analysis showed similar patterns between male and female participants.

However, there was a stronger cross-disorder association found between full-siblings than between half-siblings for nervous system, respiratory, musculoskeletal, and metabolic diseases (

Risk of injuries requiring hospitalization in attention deficit hyperactivity disorder and the preventive effects of medication

The results show pediatric patients with ADHD had a significantly higher risk of injuries requiring hospitalization compared to non-ADHD controls.

Patients with ADHD at an increased risk of injuries

 (ADHD) do not suffer from dual-task performance deficits for functions like walking and texting compared to a healthy control group.

A team, led by Tal Krasovsky, Department of Physical Therapy, University of Haifa Pediatric Rehabilitation Department, Sheba Medical Center, evaluated texting and walking performances between pediatric patients with ADHD and a control group, both indoors and outdoors, while also evaluating the role age and symptom severity play in dual-task performance.

Pediatric patients with ADHD have deficits in executive function, as well as motor symptoms including difficulties in gross and fine motor skills and gait stability.

In addition, with the prevalence of cell phones, texting while walking is becoming increasingly common, representing a health risk for people of all ages.

“In modern life people are frequently requested to attend or ignore a myriad of distractors while performing motor tasks such as balancing or walking,” the authors wrote. “Better dual-task performance is related to better EF [9] and thus, it can be expected, that children with ADHD would demonstrate reduced dual-task performance.”

The study included 19 pediatric patients with ADHD and 30 healthy control participants. Each participant walked across an indoor corridor and an outdoor street both with and without texting on a mobile phone. The participants were aged between 10-18 years and owned a mobile phone for more than 6 months.

The team measured walking and texting performance using inertial measurement units and a custom-made mobile application.

The results show no between-group differences in texting or walking performance across the environments. There was also trends found based on the age of the participant.

Older participants had smaller dual-task performance deficits for gait and texting speed in both the ADHD group and the control group.

In addition, participants in the ADHD who had more severe symptoms of hyperactivity had larger dual task costs for gait outdoors (

In addition, individuals with more motor symptoms typed faster under dual-task conditions indoors (

 0.007) but were ultimately less accurate (

“Children with ADHD do not demonstrate deficits in dual-task performance of a texting and walking task indoors or outdoors,” the authors wrote. “The relationship of age, hyperactivity and motor symptoms with texting and walking performance supports a more personalized approach for examination of dual-task performance in children with ADHD.”

ADHD represents the most common neurodevelopmental disorder for pediatric patients. The disease manifests early in life but can persist throughout adulthood.

Pediatric patients with ADHD often show deficits in executive functions, including inhibition, working memory, and motivation regulation. In addition, 30-50% of pediatric patients with ADHD show moto symptoms that could further impact daily activities.

Factors associated with texting and walking performance in children with ADHD: the role of age, environment, and symptom severity,

Pediatric patients with ADHD show no dual-task deficits

Familial history for inflammatory bowel disease should be considered for disease screening programs, according to new data from a Swedish cohort.

A team, led by Jonas F. Halfvarson, MD, Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, estimated the prevalence of familial aggregation of IBD.

“A family history of IBD is a proxy for an individual’s genetic and, in part, environmental risk of developing the disease and has long been recognized as the strongest risk factor for IBD,” the authors wrote. “Therefore, family history is routinely assessed as part of the clinical work-up at diagnosis.”

In the past, several studies have focused on familial clustering of IBD. However, the majority of these studies are based on smaller patient populations without including control groups.

In the nationwide, case-control study, the investigators compared patients with IBD (n = 50,667) to a control group (n = 506,720) between 2003-2017 and examined the odds of having a first-degree relative with IBD by age of diagnosis, type of family history, and IBD subtype. They also assessed the incidence of future IBD in relatives of patients with incident IBD.

Of the patients with IBD, 14,927 had Crohn’s disease and 27,221 had ulcerative colitis, while 8519 had unclassified IBD.

Each patient with IBD was identified from Swedish national registers.

The team calculated odds ratios as estimates of relative risk for IBD in first-degree relatives using logistic regression. They also estimated incidence rates of an incident diagnosis of IBD in first-degree relatives of patients with IBDand in first-degree relatives of matched reference individuals from the general population as the number of events per 1000 person-years.

The investigators found patients with IBD more often had a mother (3.0% vs 0.9%; OR, 3.5; 95% CI, 3.3–3.7), father (2.9% vs 0.8%; OR, 3.5; 95% CI, 3.3–3.7), full sibling (5.3% vs 1.5%; OR, 3.6; 95% CI, 3.4–3.8), and child (2.4% vs 0.9%; OR, 2.6; 95% CI, 2.4–2.8) with IBD.

The overall strength of association was directly related to the number of affected first-degree relatives. This strength was also modified by subtype of IBD and age of diagnosis.

The highest odds ratios were seen in pediatric patients with IBD among a subset of pediatric patients with Crohn’s disease (OR, 10.6; 95% CI, 8.2–13.5) and pediatric-onset ulcerative colitis (OR, 8.4; 95% CI, 6.4–10.9) cases.

The 10-year cumulative incidence of disease for full-siblings was 1.7% of incident patients with IBD, compared to 0.4% among full-siblings of reference individuals.

“The variations in the strength of familial IBD and future risk of IBD in [first-degree relatives] support differences in genetic predisposition and call for targeted approaches in potential screening programs,” the authors wrote.

Age determines the risk of familial inflammatory bowel disease—A nationwide study

Originally published on our sister brand, 

The overall strength of association was directly related to the number of affected first-degree relatives and was modified by IBD subtype and age of diagnosis.



Family history should be taken into account for IBD screenings

 can have a lasting impact on behavioral problems for children at age 10-11 years, according to new research.

In the study, Ariel A. Williamson, PhD, and colleagues, identified whether distinct sleep problem trajectories from infancy through middle childhood were linked to multiple aspects of child well-being at ages 10-11 years.

Williamson et al used data from the first 6 waves of the Longitudinal Study of Australian Children—Birth Cohort, which involved 5107 children recruited at birth.

Each caregiver included in the study reported on sleep problems for the children at each time point; the investigator indexed child well-being outcomes at ages 10-11 years using a combination of caregiver-reported, teacher-reported, and child-completed tasks. The outcomes included emotional and behavioral functioning such as internalizing and externalizing symptoms and self-control, health-related quality of life, cognitive skills, and academic achievement.

The authors identified 5 distinct sleep problem trajectories over time using a latent class analysis. The problems were persistent sleep problems through middle childhood (7.7% of the sample), limited infant or preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%), and no sleep problems (51.9%).

The results showed children with persistent sleep problems had the greatest impairments across the different outcomes, other than cognitive skills (perceptual reasoning), with moderate to large effect sizes.


On the other hand, children with increased middle childhood sleep problems also experienced greater internalizing and externalizing symptoms with a worse quality of life.However, there were few academic impairments in this subgroup of patients.

In addition, the participants with limited infant or preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life. These effects were smaller than the other sleep trajectories.

“The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being,” the authors wrote.

“[F]ew studies have examined the continuity of sleep concerns and their association with developmental outcomes from infancy, when behavioral sleep problems are the most prevalent,” Williamson and colleagues noted. “More research is needed that assesses the impact of sleep problems from infancy through middle childhood, particularly as the first 10–11 years of life is a period of important child development, with the acquisition of foundational psychosocial and cognitive/academic skills and the transition to a formal school setting.”

A version of this article was originally published by our sister publication

1. Williamson AA, Mindell JA, Hiscock H, Quach J. 

Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being