ABSTRACT
INTRODUCTION: Biologic therapy is often used in patients with inflammatory bowel disease (IBD), which includes Crohn's Disease (CD) and ulcerative colitis (UC). While biologic therapy improves outcomes, it is dependent on strict compliance for optimal benefit. Limited information is available to describe IBD infusion therapy compliance and adherence barriers in a rural, geographically dispersed pediatric population. METHODS: Parents/guardians and patients (aged 0-21 years) with a diagnosis of IBD and scheduled biologic therapy infusions were offered a survey consisting of a mix of multiple-choice and open-ended questions. Surveys were offered via in-person paper format or telephone. RESULTS: Of the 27 pediatric patients completing the survey, the mean age was 14 years old (SD 3.7 years) with 19 patients having CD and eight patients with UC. The results showed that more than half of the patients (59%) had to reschedule, miss, or delayed their infusion therapy at least once. Therapy compliance was maintained as patients were able to reschedule a new appointment within two weeks. The most common reasons for missing appointments were forgetfulness and school conflicts. Patients wanting to maintain health and avoid flare-ups were reported as key drivers for therapy. CONCLUSION: Pediatric patients in rural and geographically disperse areas continue to have long commutes and other barriers to IBD specialty care. Forgetfulness and school activities were reported as barriers to biological therapy adherence. Protective factors including knowledge of therapy health benefits, parental involvement, and staff support can help maintain high adherence rates in this population.
ABSTRACT
Copper is a common pollutant in many aquatic environments, particularly those surrounding densely populated areas with substantial anthropogenic inputs. These same areas may also experience changes in salinity due to freshwater discharge and tidal influence. Biota that inhabit near-shore coastal environments may be susceptible to both stressors. Although copper is a noted concern in marine environments, effects of copper and varying salinity on symbiotic cnidarians are only scarcely studied. The sea anemone, Exaiptasia pallida, was used to investigate effects of copper on physiological impairment (i.e. activities of anti-oxidant enzymes) at two different salinities (20 and 25ppt). E. pallida was exposed to a control and three elevated copper concentrations for up to 21d, and copper accumulation and activity of the enzymes: catalase, glutathione reductase, glutathione peroxidase, and carbonic anhydrase were measured in the anemones. Photosynthetic parameters in E. pallida's symbiotic dinoflagellate algae were also quantified. Over the course of the exposure, E. pallida accumulated copper in a concentration-dependent manner. Higher tissue copper concentrations were observed in anemones exposed to the lower salinity water (20ppt), and physiological impairment was observed as a consequence of both increased copper exposure and decreased salinity; however, changes in salinity caused a greater response than copper exposure, at the levels tested. In general, antioxidant enzyme activity increased as a consequence of decreased salinity and/or increased copper exposure. These results clearly demonstrated the influence of two local stressors, at environmentally realistic concentrations, on a sensitive cnidarian, and highlight the importance of characterizing combined exposure scenarios.
