3 results on '"Megan Fuller"'
Search Results
2. Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery
- Author
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Caitlin A. Smith, Eustina G. Kwon, Lauren Nicassio, Deb Glazer, Jeffrey Avansino, Megan M. Durham, Jason Frischer, Casey Calkins, Rebecca M. Rentea, Matthew Ralls, Payam Saadai, Andrea Badillo, Megan Fuller, Richard J. Wood, Michael D. Rollins, Kathleen Van Leeuwen, Ron W. Reeder, Katelyn E. Lewis, and Samuel E. Rice-Townsend
- Subjects
Pediatrics, Perinatology and Child Health ,Surgery ,General Medicine - Abstract
Fecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation.A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests.458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients.We observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care.Level III.
- Published
- 2022
3. Urinary continence disparities in patients with anorectal malformations
- Author
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Richard J. Wood, Debra Glazer, Mark P. Cain, Paul A. Merguerian, Matthew W. Ralls, Jennifer Ahn, Katelyn E. Lewis, Megan Fuller, Casey M. Calkins, Rebecca M. Rentea, Belinda H. Dickie, Caitlin A. Smith, Megan M. Durham, Michael D. Rollins, Payam Saadai, Ron W Reeder, Justin Lee, Samuel E. Rice-Townsend, Jason S. Frischer, Lauren Nicassio, and Jeffrey R. Avansino
- Subjects
Pediatrics ,medicine.medical_specialty ,Population ,Urinary Bladder ,Urinary incontinence ,Medicine ,Fecal incontinence ,Humans ,In patient ,education ,Child ,Socioeconomic status ,Retrospective Studies ,education.field_of_study ,Urinary continence ,business.industry ,Retrospective cohort study ,General Medicine ,Anorectal Malformations ,Urinary Incontinence ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Etiology ,Surgery ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Purpose While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM. Methods We performed a multicenter retrospective study of ARM patients evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all patients with ARM 3 years and older. The primary outcome was urinary continence which was categorized as complete (no accidents), daytime (accidents at night), partial (rare or occasional accidents), and none (frequent accidents or no continence). We evaluated for associations between urinary continence and race, sex, age, insurance status, and adoption status, employing Kruskal-Wallis and trend tests. Secondary outcomes included bladder management strategies such as clean intermittent catheterization and continence surgery. P-value Results A total of 525 patients with ARM were included. Overall, 48% reported complete urinary continence, and continence was associated with greater age. For school-aged children (age ≥ 5 years), 58% reported complete continence, while 30% reported none. Public insurance and adoption status were associated with decreased likelihood of incontinence. Conclusions We observed a novel finding of disparities in urinary continence for children with ARM related to insurance and adoption status. Further investigation regarding the etiologies of these inequities is needed in order to affect clinical outcomes.
- Published
- 2021
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