CINXE.COM

<!DOCTYPE html> <html > <head> <meta charset="utf-8"> <meta rel="search" type="application/opensearchdescription+xml" href="/open_search.xml" title="Academia.edu"> <meta content="width=device-width, initial-scale=1" name="viewport"> <meta name="google-site-verification" content="bKJMBZA7E43xhDOopFZkssMMkBRjvYERV-NaN4R6mrs"> <meta name="csrf-param" content="authenticity_token" /> <meta name="csrf-token" content="EaQqwJkIoxyVRM4y-eaWgOvn35S856UNiVHAqOtCGDF_sw1KW1GRrxW_Q9uxuLJVhamUFW2biQsjg8gfbJ74uw" /> <meta name="citation_title" content="Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study" /> <meta name="citation_publication_date" content="2020/10/06" /> <meta name="citation_journal_title" content="Journal of Crohn&#39;s and Colitis" /> <meta name="citation_author" content="Costantino De Giacomo" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:url" content="https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study" /> <meta name="twitter:title" content="Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study" /> <meta name="twitter:description" content="Academia.edu is a platform for academics to share research papers." /> <meta name="twitter:image" content="https://0.academia-photos.com/194962700/57393972/45611566/s200_costantino.de_giacomo.png" /> <meta property="fb:app_id" content="2369844204" /> <meta property="og:type" content="article" /> <meta property="og:url" content="https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study" /> <meta property="og:title" content="Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study" /> <meta property="og:image" content="http://a.academia-assets.com/images/open-graph-icons/fb-paper.gif" /> <meta property="og:description" content="Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study" /> <meta property="article:author" content="https://independent.academia.edu/CostantinoDeGiacomo" /> <meta name="description" content="Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study" /> <title>(PDF) Disease Patterns in Pediatric Ulcerative Colitis</title> <link rel="canonical" href="https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study" /> <script async src="https://www.googletagmanager.com/gtag/js?id=G-5VKX33P2DS"></script> <script> window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-5VKX33P2DS', { cookie_domain: 'academia.edu', send_page_view: false, }); gtag('event', 'page_view', { 'controller': "single_work", 'action': "show", 'controller_action': 'single_work#show', 'logged_in': 'false', 'edge': 'unknown', // Send nil if there is no A/B test bucket, in case some records get logged // with missing data - that way we can distinguish between the two cases. // ab_test_bucket should be of the form <ab_test_name>:<bucket> 'ab_test_bucket': null, }) </script> <script> var $controller_name = 'single_work'; var $action_name = "show"; var $rails_env = 'production'; var $app_rev = 'b092bf3a3df71cf13feee7c143e83a57eb6b94fb'; var $domain = 'academia.edu'; var $app_host = "academia.edu"; var $asset_host = "academia-assets.com"; var $start_time = new Date().getTime(); var $recaptcha_key = "6LdxlRMTAAAAADnu_zyLhLg0YF9uACwz78shpjJB"; var $recaptcha_invisible_key = "6Lf3KHUUAAAAACggoMpmGJdQDtiyrjVlvGJ6BbAj"; var $disableClientRecordHit = false; </script> <script> window.require = { config: function() { return function() {} } } </script> <script> window.Aedu = window.Aedu || {}; window.Aedu.hit_data = null; window.Aedu.serverRenderTime = new Date(1739833773000); window.Aedu.timeDifference = new Date().getTime() - 1739833773000; </script> <script type="application/ld+json">{"@context":"https://schema.org","@type":"ScholarlyArticle","author":[{"@context":"https://schema.org","@type":"Person","name":"Costantino De Giacomo","url":"https://independent.academia.edu/CostantinoDeGiacomo"}],"contributor":[],"dateCreated":"2024-04-17","datePublished":"2020-10-06","headline":"Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study","image":"https://attachments.academia-assets.com/113427162/thumbnails/1.jpg","inLanguage":"en","keywords":["Medicine","Population","Internal Medicine","Ulcerative colitis","Disease","Cohort","Clinical Sciences","Confidence Interval","Calprotectin"],"publication":"Journal of Crohn's and Colitis","publisher":{"@context":"https://schema.org","@type":"Organization","name":"Oxford University Press"},"sourceOrganization":[{"@context":"https://schema.org","@type":"EducationalOrganization","name":null}],"thumbnailUrl":"https://attachments.academia-assets.com/113427162/thumbnails/1.jpg","url":"https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study"}</script><style type="text/css">@media(max-width: 567px){:root{--token-mode: Rebrand;--dropshadow: 0 2px 4px 0 #22223340;--primary-brand: #0645b1;--error-dark: #b60000;--success-dark: #05b01c;--inactive-fill: #ebebee;--hover: #0c3b8d;--pressed: #082f75;--button-primary-fill-inactive: #ebebee;--button-primary-fill: #0645b1;--button-primary-text: #ffffff;--button-primary-fill-hover: #0c3b8d;--button-primary-fill-press: #082f75;--button-primary-icon: #ffffff;--button-primary-fill-inverse: #ffffff;--button-primary-text-inverse: #082f75;--button-primary-icon-inverse: #0645b1;--button-primary-fill-inverse-hover: #cddaef;--button-primary-stroke-inverse-pressed: #0645b1;--button-secondary-stroke-inactive: #b1b1ba;--button-secondary-fill: #eef2f9;--button-secondary-text: #082f75;--button-secondary-fill-press: #cddaef;--button-secondary-fill-inactive: #ebebee;--button-secondary-stroke: #cddaef;--button-secondary-stroke-hover: #386ac1;--button-secondary-stroke-press: #0645b1;--button-secondary-text-inactive: #b1b1ba;--button-secondary-icon: #082f75;--button-secondary-fill-hover: #e6ecf7;--button-secondary-stroke-inverse: #ffffff;--button-secondary-fill-inverse: rgba(255, 255, 255, 0);--button-secondary-icon-inverse: #ffffff;--button-secondary-icon-hover: #082f75;--button-secondary-icon-press: #082f75;--button-secondary-text-inverse: #ffffff;--button-secondary-text-hover: #082f75;--button-secondary-text-press: #082f75;--button-secondary-fill-inverse-hover: #043059;--button-xs-stroke: #141413;--button-xs-stroke-hover: #0c3b8d;--button-xs-stroke-press: #082f75;--button-xs-stroke-inactive: #ebebee;--button-xs-text: #141413;--button-xs-text-hover: #0c3b8d;--button-xs-text-press: #082f75;--button-xs-text-inactive: #91919e;--button-xs-icon: #141413;--button-xs-icon-hover: #0c3b8d;--button-xs-icon-press: #082f75;--button-xs-icon-inactive: #91919e;--button-xs-fill: #ffffff;--button-xs-fill-hover: #f4f7fc;--button-xs-fill-press: #eef2f9;--buttons-button-text-inactive: #91919e;--buttons-button-focus: #0645b1;--buttons-button-icon-inactive: #91919e;--buttons-small-buttons-corner-radius: 16px;--buttons-small-buttons-l-r-padding: 20px;--buttons-small-buttons-height: 48px;--buttons-small-buttons-gap: 8px;--buttons-small-buttons-icon-only-width: 48px;--buttons-small-buttons-icon-size: 20px;--buttons-small-buttons-stroke-default: 1px;--buttons-small-buttons-stroke-thick: 2px;--buttons-large-buttons-l-r-padding: 32px;--buttons-large-buttons-height: 64px;--buttons-large-buttons-icon-only-width: 64px;--buttons-large-buttons-icon-size: 20px;--buttons-large-buttons-gap: 8px;--buttons-large-buttons-corner-radius: 16px;--buttons-large-buttons-stroke-default: 1px;--buttons-large-buttons-stroke-thick: 2px;--buttons-extra-small-buttons-l-r-padding: 8px;--buttons-extra-small-buttons-height: 32px;--buttons-extra-small-buttons-icon-size: 16px;--buttons-extra-small-buttons-gap: 4px;--buttons-extra-small-buttons-corner-radius: 8px;--buttons-stroke-default: 1px;--buttons-stroke-thick: 2px;--background-beige: #f9f7f4;--error-light: #fff2f2;--text-placeholder: #6d6d7d;--stroke-dark: #141413;--stroke-light: #dddde2;--stroke-medium: #535366;--accent-green: #ccffd4;--accent-turquoise: #ccf7ff;--accent-yellow: #f7ffcc;--accent-peach: #ffd4cc;--accent-violet: #f7ccff;--accent-purple: #f4f7fc;--text-primary: #141413;--secondary-brand: #141413;--text-hover: #0c3b8d;--text-white: #ffffff;--text-link: #0645b1;--text-press: #082f75;--success-light: #f0f8f1;--background-light-blue: #f4f7fc;--background-white: #ffffff;--premium-dark: #877440;--premium-light: #f9f6ed;--stroke-white: #ffffff;--inactive-content: #b1b1ba;--annotate-light: #a35dff;--annotate-dark: #824acc;--grid: #eef2f9;--inactive-stroke: #ebebee;--shadow: rgba(34, 34, 51, 0.25);--text-inactive: #6d6d7d;--text-error: #b60000;--stroke-error: #b60000;--background-error: #fff2f2;--background-black: #141413;--icon-default: #141413;--icon-blue: #0645b1;--background-grey: #dddde2;--icon-grey: #b1b1ba;--text-focus: #082f75;--brand-colors-neutral-black: #141413;--brand-colors-neutral-900: #535366;--brand-colors-neutral-800: #6d6d7d;--brand-colors-neutral-700: #91919e;--brand-colors-neutral-600: #b1b1ba;--brand-colors-neutral-500: #c8c8cf;--brand-colors-neutral-400: #dddde2;--brand-colors-neutral-300: #ebebee;--brand-colors-neutral-200: #f8f8fb;--brand-colors-neutral-100: #fafafa;--brand-colors-neutral-white: #ffffff;--brand-colors-blue-900: #043059;--brand-colors-blue-800: #082f75;--brand-colors-blue-700: #0c3b8d;--brand-colors-blue-600: #0645b1;--brand-colors-blue-500: #386ac1;--brand-colors-blue-400: #cddaef;--brand-colors-blue-300: #e6ecf7;--brand-colors-blue-200: #eef2f9;--brand-colors-blue-100: #f4f7fc;--brand-colors-gold-500: #877440;--brand-colors-gold-400: #e9e3d4;--brand-colors-gold-300: #f2efe8;--brand-colors-gold-200: #f9f6ed;--brand-colors-gold-100: #f9f7f4;--brand-colors-error-900: #920000;--brand-colors-error-500: #b60000;--brand-colors-success-900: #035c0f;--brand-colors-green: #ccffd4;--brand-colors-turquoise: #ccf7ff;--brand-colors-yellow: #f7ffcc;--brand-colors-peach: #ffd4cc;--brand-colors-violet: #f7ccff;--brand-colors-error-100: #fff2f2;--brand-colors-success-500: #05b01c;--brand-colors-success-100: #f0f8f1;--text-secondary: #535366;--icon-white: #ffffff;--background-beige-darker: #f2efe8;--icon-dark-grey: #535366;--type-font-family-sans-serif: DM Sans;--type-font-family-serif: Gupter;--type-font-family-mono: IBM Plex Mono;--type-weights-300: 300;--type-weights-400: 400;--type-weights-500: 500;--type-weights-700: 700;--type-sizes-12: 12px;--type-sizes-14: 14px;--type-sizes-16: 16px;--type-sizes-18: 18px;--type-sizes-20: 20px;--type-sizes-22: 22px;--type-sizes-24: 24px;--type-sizes-28: 28px;--type-sizes-30: 30px;--type-sizes-32: 32px;--type-sizes-40: 40px;--type-sizes-42: 42px;--type-sizes-48-2: 48px;--type-line-heights-16: 16px;--type-line-heights-20: 20px;--type-line-heights-23: 23px;--type-line-heights-24: 24px;--type-line-heights-25: 25px;--type-line-heights-26: 26px;--type-line-heights-29: 29px;--type-line-heights-30: 30px;--type-line-heights-32: 32px;--type-line-heights-34: 34px;--type-line-heights-35: 35px;--type-line-heights-36: 36px;--type-line-heights-38: 38px;--type-line-heights-40: 40px;--type-line-heights-46: 46px;--type-line-heights-48: 48px;--type-line-heights-52: 52px;--type-line-heights-58: 58px;--type-line-heights-68: 68px;--type-line-heights-74: 74px;--type-line-heights-82: 82px;--type-paragraph-spacings-0: 0px;--type-paragraph-spacings-4: 4px;--type-paragraph-spacings-8: 8px;--type-paragraph-spacings-16: 16px;--type-sans-serif-xl-font-weight: 400;--type-sans-serif-xl-size: 32px;--type-sans-serif-xl-line-height: 46px;--type-sans-serif-xl-paragraph-spacing: 16px;--type-sans-serif-lg-font-weight: 400;--type-sans-serif-lg-size: 30px;--type-sans-serif-lg-line-height: 36px;--type-sans-serif-lg-paragraph-spacing: 16px;--type-sans-serif-md-font-weight: 400;--type-sans-serif-md-line-height: 30px;--type-sans-serif-md-paragraph-spacing: 16px;--type-sans-serif-md-size: 24px;--type-sans-serif-xs-font-weight: 700;--type-sans-serif-xs-line-height: 24px;--type-sans-serif-xs-paragraph-spacing: 0px;--type-sans-serif-xs-size: 18px;--type-sans-serif-sm-font-weight: 400;--type-sans-serif-sm-line-height: 32px;--type-sans-serif-sm-paragraph-spacing: 16px;--type-sans-serif-sm-size: 20px;--type-body-xl-font-weight: 400;--type-body-xl-size: 24px;--type-body-xl-line-height: 36px;--type-body-xl-paragraph-spacing: 0px;--type-body-sm-font-weight: 400;--type-body-sm-size: 14px;--type-body-sm-line-height: 20px;--type-body-sm-paragraph-spacing: 8px;--type-body-xs-font-weight: 400;--type-body-xs-size: 12px;--type-body-xs-line-height: 16px;--type-body-xs-paragraph-spacing: 0px;--type-body-md-font-weight: 400;--type-body-md-size: 16px;--type-body-md-line-height: 20px;--type-body-md-paragraph-spacing: 4px;--type-body-lg-font-weight: 400;--type-body-lg-size: 20px;--type-body-lg-line-height: 26px;--type-body-lg-paragraph-spacing: 16px;--type-body-lg-medium-font-weight: 500;--type-body-lg-medium-size: 20px;--type-body-lg-medium-line-height: 32px;--type-body-lg-medium-paragraph-spacing: 16px;--type-body-md-medium-font-weight: 500;--type-body-md-medium-size: 16px;--type-body-md-medium-line-height: 20px;--type-body-md-medium-paragraph-spacing: 4px;--type-body-sm-bold-font-weight: 700;--type-body-sm-bold-size: 14px;--type-body-sm-bold-line-height: 20px;--type-body-sm-bold-paragraph-spacing: 8px;--type-body-sm-medium-font-weight: 500;--type-body-sm-medium-size: 14px;--type-body-sm-medium-line-height: 20px;--type-body-sm-medium-paragraph-spacing: 8px;--type-serif-md-font-weight: 400;--type-serif-md-size: 32px;--type-serif-md-paragraph-spacing: 0px;--type-serif-md-line-height: 40px;--type-serif-sm-font-weight: 400;--type-serif-sm-size: 24px;--type-serif-sm-paragraph-spacing: 0px;--type-serif-sm-line-height: 26px;--type-serif-lg-font-weight: 400;--type-serif-lg-size: 48px;--type-serif-lg-paragraph-spacing: 0px;--type-serif-lg-line-height: 52px;--type-serif-xs-font-weight: 400;--type-serif-xs-size: 18px;--type-serif-xs-line-height: 24px;--type-serif-xs-paragraph-spacing: 0px;--type-serif-xl-font-weight: 400;--type-serif-xl-size: 48px;--type-serif-xl-paragraph-spacing: 0px;--type-serif-xl-line-height: 58px;--type-mono-md-font-weight: 400;--type-mono-md-size: 22px;--type-mono-md-line-height: 24px;--type-mono-md-paragraph-spacing: 0px;--type-mono-lg-font-weight: 400;--type-mono-lg-size: 40px;--type-mono-lg-line-height: 40px;--type-mono-lg-paragraph-spacing: 0px;--type-mono-sm-font-weight: 400;--type-mono-sm-size: 14px;--type-mono-sm-line-height: 24px;--type-mono-sm-paragraph-spacing: 0px;--spacing-xs-4: 4px;--spacing-xs-8: 8px;--spacing-xs-16: 16px;--spacing-sm-24: 24px;--spacing-sm-32: 32px;--spacing-md-40: 40px;--spacing-md-48: 48px;--spacing-lg-64: 64px;--spacing-lg-80: 80px;--spacing-xlg-104: 104px;--spacing-xlg-152: 152px;--spacing-xs-12: 12px;--spacing-page-section: 80px;--spacing-card-list-spacing: 48px;--spacing-text-section-spacing: 64px;--spacing-md-xs-headings: 40px;--corner-radius-radius-lg: 16px;--corner-radius-radius-sm: 4px;--corner-radius-radius-md: 8px;--corner-radius-radius-round: 104px}}@media(min-width: 568px)and (max-width: 1279px){:root{--token-mode: Rebrand;--dropshadow: 0 2px 4px 0 #22223340;--primary-brand: #0645b1;--error-dark: #b60000;--success-dark: #05b01c;--inactive-fill: #ebebee;--hover: #0c3b8d;--pressed: #082f75;--button-primary-fill-inactive: #ebebee;--button-primary-fill: #0645b1;--button-primary-text: #ffffff;--button-primary-fill-hover: #0c3b8d;--button-primary-fill-press: #082f75;--button-primary-icon: #ffffff;--button-primary-fill-inverse: #ffffff;--button-primary-text-inverse: #082f75;--button-primary-icon-inverse: #0645b1;--button-primary-fill-inverse-hover: #cddaef;--button-primary-stroke-inverse-pressed: #0645b1;--button-secondary-stroke-inactive: #b1b1ba;--button-secondary-fill: #eef2f9;--button-secondary-text: #082f75;--button-secondary-fill-press: #cddaef;--button-secondary-fill-inactive: #ebebee;--button-secondary-stroke: #cddaef;--button-secondary-stroke-hover: #386ac1;--button-secondary-stroke-press: #0645b1;--button-secondary-text-inactive: #b1b1ba;--button-secondary-icon: #082f75;--button-secondary-fill-hover: #e6ecf7;--button-secondary-stroke-inverse: #ffffff;--button-secondary-fill-inverse: rgba(255, 255, 255, 0);--button-secondary-icon-inverse: #ffffff;--button-secondary-icon-hover: #082f75;--button-secondary-icon-press: #082f75;--button-secondary-text-inverse: #ffffff;--button-secondary-text-hover: #082f75;--button-secondary-text-press: #082f75;--button-secondary-fill-inverse-hover: #043059;--button-xs-stroke: #141413;--button-xs-stroke-hover: #0c3b8d;--button-xs-stroke-press: #082f75;--button-xs-stroke-inactive: #ebebee;--button-xs-text: #141413;--button-xs-text-hover: #0c3b8d;--button-xs-text-press: #082f75;--button-xs-text-inactive: #91919e;--button-xs-icon: #141413;--button-xs-icon-hover: #0c3b8d;--button-xs-icon-press: #082f75;--button-xs-icon-inactive: #91919e;--button-xs-fill: #ffffff;--button-xs-fill-hover: #f4f7fc;--button-xs-fill-press: #eef2f9;--buttons-button-text-inactive: #91919e;--buttons-button-focus: #0645b1;--buttons-button-icon-inactive: #91919e;--buttons-small-buttons-corner-radius: 16px;--buttons-small-buttons-l-r-padding: 20px;--buttons-small-buttons-height: 48px;--buttons-small-buttons-gap: 8px;--buttons-small-buttons-icon-only-width: 48px;--buttons-small-buttons-icon-size: 20px;--buttons-small-buttons-stroke-default: 1px;--buttons-small-buttons-stroke-thick: 2px;--buttons-large-buttons-l-r-padding: 32px;--buttons-large-buttons-height: 64px;--buttons-large-buttons-icon-only-width: 64px;--buttons-large-buttons-icon-size: 20px;--buttons-large-buttons-gap: 8px;--buttons-large-buttons-corner-radius: 16px;--buttons-large-buttons-stroke-default: 1px;--buttons-large-buttons-stroke-thick: 2px;--buttons-extra-small-buttons-l-r-padding: 8px;--buttons-extra-small-buttons-height: 32px;--buttons-extra-small-buttons-icon-size: 16px;--buttons-extra-small-buttons-gap: 4px;--buttons-extra-small-buttons-corner-radius: 8px;--buttons-stroke-default: 1px;--buttons-stroke-thick: 2px;--background-beige: #f9f7f4;--error-light: #fff2f2;--text-placeholder: #6d6d7d;--stroke-dark: #141413;--stroke-light: #dddde2;--stroke-medium: #535366;--accent-green: #ccffd4;--accent-turquoise: #ccf7ff;--accent-yellow: #f7ffcc;--accent-peach: #ffd4cc;--accent-violet: #f7ccff;--accent-purple: #f4f7fc;--text-primary: #141413;--secondary-brand: #141413;--text-hover: #0c3b8d;--text-white: #ffffff;--text-link: #0645b1;--text-press: #082f75;--success-light: #f0f8f1;--background-light-blue: #f4f7fc;--background-white: #ffffff;--premium-dark: #877440;--premium-light: #f9f6ed;--stroke-white: #ffffff;--inactive-content: #b1b1ba;--annotate-light: #a35dff;--annotate-dark: #824acc;--grid: #eef2f9;--inactive-stroke: #ebebee;--shadow: rgba(34, 34, 51, 0.25);--text-inactive: #6d6d7d;--text-error: #b60000;--stroke-error: #b60000;--background-error: #fff2f2;--background-black: #141413;--icon-default: #141413;--icon-blue: #0645b1;--background-grey: #dddde2;--icon-grey: #b1b1ba;--text-focus: #082f75;--brand-colors-neutral-black: #141413;--brand-colors-neutral-900: #535366;--brand-colors-neutral-800: #6d6d7d;--brand-colors-neutral-700: #91919e;--brand-colors-neutral-600: #b1b1ba;--brand-colors-neutral-500: #c8c8cf;--brand-colors-neutral-400: #dddde2;--brand-colors-neutral-300: #ebebee;--brand-colors-neutral-200: #f8f8fb;--brand-colors-neutral-100: #fafafa;--brand-colors-neutral-white: #ffffff;--brand-colors-blue-900: #043059;--brand-colors-blue-800: #082f75;--brand-colors-blue-700: #0c3b8d;--brand-colors-blue-600: #0645b1;--brand-colors-blue-500: #386ac1;--brand-colors-blue-400: #cddaef;--brand-colors-blue-300: #e6ecf7;--brand-colors-blue-200: #eef2f9;--brand-colors-blue-100: #f4f7fc;--brand-colors-gold-500: #877440;--brand-colors-gold-400: #e9e3d4;--brand-colors-gold-300: #f2efe8;--brand-colors-gold-200: #f9f6ed;--brand-colors-gold-100: #f9f7f4;--brand-colors-error-900: #920000;--brand-colors-error-500: #b60000;--brand-colors-success-900: #035c0f;--brand-colors-green: #ccffd4;--brand-colors-turquoise: #ccf7ff;--brand-colors-yellow: #f7ffcc;--brand-colors-peach: #ffd4cc;--brand-colors-violet: #f7ccff;--brand-colors-error-100: #fff2f2;--brand-colors-success-500: #05b01c;--brand-colors-success-100: #f0f8f1;--text-secondary: #535366;--icon-white: #ffffff;--background-beige-darker: #f2efe8;--icon-dark-grey: #535366;--type-font-family-sans-serif: DM Sans;--type-font-family-serif: Gupter;--type-font-family-mono: IBM Plex Mono;--type-weights-300: 300;--type-weights-400: 400;--type-weights-500: 500;--type-weights-700: 700;--type-sizes-12: 12px;--type-sizes-14: 14px;--type-sizes-16: 16px;--type-sizes-18: 18px;--type-sizes-20: 20px;--type-sizes-22: 22px;--type-sizes-24: 24px;--type-sizes-28: 28px;--type-sizes-30: 30px;--type-sizes-32: 32px;--type-sizes-40: 40px;--type-sizes-42: 42px;--type-sizes-48-2: 48px;--type-line-heights-16: 16px;--type-line-heights-20: 20px;--type-line-heights-23: 23px;--type-line-heights-24: 24px;--type-line-heights-25: 25px;--type-line-heights-26: 26px;--type-line-heights-29: 29px;--type-line-heights-30: 30px;--type-line-heights-32: 32px;--type-line-heights-34: 34px;--type-line-heights-35: 35px;--type-line-heights-36: 36px;--type-line-heights-38: 38px;--type-line-heights-40: 40px;--type-line-heights-46: 46px;--type-line-heights-48: 48px;--type-line-heights-52: 52px;--type-line-heights-58: 58px;--type-line-heights-68: 68px;--type-line-heights-74: 74px;--type-line-heights-82: 82px;--type-paragraph-spacings-0: 0px;--type-paragraph-spacings-4: 4px;--type-paragraph-spacings-8: 8px;--type-paragraph-spacings-16: 16px;--type-sans-serif-xl-font-weight: 400;--type-sans-serif-xl-size: 42px;--type-sans-serif-xl-line-height: 46px;--type-sans-serif-xl-paragraph-spacing: 16px;--type-sans-serif-lg-font-weight: 400;--type-sans-serif-lg-size: 32px;--type-sans-serif-lg-line-height: 36px;--type-sans-serif-lg-paragraph-spacing: 16px;--type-sans-serif-md-font-weight: 400;--type-sans-serif-md-line-height: 34px;--type-sans-serif-md-paragraph-spacing: 16px;--type-sans-serif-md-size: 28px;--type-sans-serif-xs-font-weight: 700;--type-sans-serif-xs-line-height: 25px;--type-sans-serif-xs-paragraph-spacing: 0px;--type-sans-serif-xs-size: 20px;--type-sans-serif-sm-font-weight: 400;--type-sans-serif-sm-line-height: 30px;--type-sans-serif-sm-paragraph-spacing: 16px;--type-sans-serif-sm-size: 24px;--type-body-xl-font-weight: 400;--type-body-xl-size: 24px;--type-body-xl-line-height: 36px;--type-body-xl-paragraph-spacing: 0px;--type-body-sm-font-weight: 400;--type-body-sm-size: 14px;--type-body-sm-line-height: 20px;--type-body-sm-paragraph-spacing: 8px;--type-body-xs-font-weight: 400;--type-body-xs-size: 12px;--type-body-xs-line-height: 16px;--type-body-xs-paragraph-spacing: 0px;--type-body-md-font-weight: 400;--type-body-md-size: 16px;--type-body-md-line-height: 20px;--type-body-md-paragraph-spacing: 4px;--type-body-lg-font-weight: 400;--type-body-lg-size: 20px;--type-body-lg-line-height: 26px;--type-body-lg-paragraph-spacing: 16px;--type-body-lg-medium-font-weight: 500;--type-body-lg-medium-size: 20px;--type-body-lg-medium-line-height: 32px;--type-body-lg-medium-paragraph-spacing: 16px;--type-body-md-medium-font-weight: 500;--type-body-md-medium-size: 16px;--type-body-md-medium-line-height: 20px;--type-body-md-medium-paragraph-spacing: 4px;--type-body-sm-bold-font-weight: 700;--type-body-sm-bold-size: 14px;--type-body-sm-bold-line-height: 20px;--type-body-sm-bold-paragraph-spacing: 8px;--type-body-sm-medium-font-weight: 500;--type-body-sm-medium-size: 14px;--type-body-sm-medium-line-height: 20px;--type-body-sm-medium-paragraph-spacing: 8px;--type-serif-md-font-weight: 400;--type-serif-md-size: 40px;--type-serif-md-paragraph-spacing: 0px;--type-serif-md-line-height: 48px;--type-serif-sm-font-weight: 400;--type-serif-sm-size: 28px;--type-serif-sm-paragraph-spacing: 0px;--type-serif-sm-line-height: 32px;--type-serif-lg-font-weight: 400;--type-serif-lg-size: 58px;--type-serif-lg-paragraph-spacing: 0px;--type-serif-lg-line-height: 68px;--type-serif-xs-font-weight: 400;--type-serif-xs-size: 18px;--type-serif-xs-line-height: 24px;--type-serif-xs-paragraph-spacing: 0px;--type-serif-xl-font-weight: 400;--type-serif-xl-size: 74px;--type-serif-xl-paragraph-spacing: 0px;--type-serif-xl-line-height: 82px;--type-mono-md-font-weight: 400;--type-mono-md-size: 22px;--type-mono-md-line-height: 24px;--type-mono-md-paragraph-spacing: 0px;--type-mono-lg-font-weight: 400;--type-mono-lg-size: 40px;--type-mono-lg-line-height: 40px;--type-mono-lg-paragraph-spacing: 0px;--type-mono-sm-font-weight: 400;--type-mono-sm-size: 14px;--type-mono-sm-line-height: 24px;--type-mono-sm-paragraph-spacing: 0px;--spacing-xs-4: 4px;--spacing-xs-8: 8px;--spacing-xs-16: 16px;--spacing-sm-24: 24px;--spacing-sm-32: 32px;--spacing-md-40: 40px;--spacing-md-48: 48px;--spacing-lg-64: 64px;--spacing-lg-80: 80px;--spacing-xlg-104: 104px;--spacing-xlg-152: 152px;--spacing-xs-12: 12px;--spacing-page-section: 104px;--spacing-card-list-spacing: 48px;--spacing-text-section-spacing: 80px;--spacing-md-xs-headings: 40px;--corner-radius-radius-lg: 16px;--corner-radius-radius-sm: 4px;--corner-radius-radius-md: 8px;--corner-radius-radius-round: 104px}}@media(min-width: 1280px){:root{--token-mode: Rebrand;--dropshadow: 0 2px 4px 0 #22223340;--primary-brand: #0645b1;--error-dark: #b60000;--success-dark: #05b01c;--inactive-fill: #ebebee;--hover: #0c3b8d;--pressed: #082f75;--button-primary-fill-inactive: #ebebee;--button-primary-fill: #0645b1;--button-primary-text: #ffffff;--button-primary-fill-hover: #0c3b8d;--button-primary-fill-press: #082f75;--button-primary-icon: #ffffff;--button-primary-fill-inverse: #ffffff;--button-primary-text-inverse: #082f75;--button-primary-icon-inverse: #0645b1;--button-primary-fill-inverse-hover: #cddaef;--button-primary-stroke-inverse-pressed: #0645b1;--button-secondary-stroke-inactive: #b1b1ba;--button-secondary-fill: #eef2f9;--button-secondary-text: #082f75;--button-secondary-fill-press: #cddaef;--button-secondary-fill-inactive: #ebebee;--button-secondary-stroke: #cddaef;--button-secondary-stroke-hover: #386ac1;--button-secondary-stroke-press: #0645b1;--button-secondary-text-inactive: #b1b1ba;--button-secondary-icon: #082f75;--button-secondary-fill-hover: #e6ecf7;--button-secondary-stroke-inverse: #ffffff;--button-secondary-fill-inverse: rgba(255, 255, 255, 0);--button-secondary-icon-inverse: #ffffff;--button-secondary-icon-hover: #082f75;--button-secondary-icon-press: #082f75;--button-secondary-text-inverse: #ffffff;--button-secondary-text-hover: #082f75;--button-secondary-text-press: #082f75;--button-secondary-fill-inverse-hover: #043059;--button-xs-stroke: #141413;--button-xs-stroke-hover: #0c3b8d;--button-xs-stroke-press: #082f75;--button-xs-stroke-inactive: #ebebee;--button-xs-text: #141413;--button-xs-text-hover: #0c3b8d;--button-xs-text-press: #082f75;--button-xs-text-inactive: #91919e;--button-xs-icon: #141413;--button-xs-icon-hover: #0c3b8d;--button-xs-icon-press: #082f75;--button-xs-icon-inactive: #91919e;--button-xs-fill: #ffffff;--button-xs-fill-hover: #f4f7fc;--button-xs-fill-press: #eef2f9;--buttons-button-text-inactive: #91919e;--buttons-button-focus: #0645b1;--buttons-button-icon-inactive: #91919e;--buttons-small-buttons-corner-radius: 16px;--buttons-small-buttons-l-r-padding: 20px;--buttons-small-buttons-height: 48px;--buttons-small-buttons-gap: 8px;--buttons-small-buttons-icon-only-width: 48px;--buttons-small-buttons-icon-size: 20px;--buttons-small-buttons-stroke-default: 1px;--buttons-small-buttons-stroke-thick: 2px;--buttons-large-buttons-l-r-padding: 32px;--buttons-large-buttons-height: 64px;--buttons-large-buttons-icon-only-width: 64px;--buttons-large-buttons-icon-size: 20px;--buttons-large-buttons-gap: 8px;--buttons-large-buttons-corner-radius: 16px;--buttons-large-buttons-stroke-default: 1px;--buttons-large-buttons-stroke-thick: 2px;--buttons-extra-small-buttons-l-r-padding: 8px;--buttons-extra-small-buttons-height: 32px;--buttons-extra-small-buttons-icon-size: 16px;--buttons-extra-small-buttons-gap: 4px;--buttons-extra-small-buttons-corner-radius: 8px;--buttons-stroke-default: 1px;--buttons-stroke-thick: 2px;--background-beige: #f9f7f4;--error-light: #fff2f2;--text-placeholder: #6d6d7d;--stroke-dark: #141413;--stroke-light: #dddde2;--stroke-medium: #535366;--accent-green: #ccffd4;--accent-turquoise: #ccf7ff;--accent-yellow: #f7ffcc;--accent-peach: #ffd4cc;--accent-violet: #f7ccff;--accent-purple: #f4f7fc;--text-primary: #141413;--secondary-brand: #141413;--text-hover: #0c3b8d;--text-white: #ffffff;--text-link: #0645b1;--text-press: #082f75;--success-light: #f0f8f1;--background-light-blue: #f4f7fc;--background-white: #ffffff;--premium-dark: #877440;--premium-light: #f9f6ed;--stroke-white: #ffffff;--inactive-content: #b1b1ba;--annotate-light: #a35dff;--annotate-dark: #824acc;--grid: #eef2f9;--inactive-stroke: #ebebee;--shadow: rgba(34, 34, 51, 0.25);--text-inactive: #6d6d7d;--text-error: #b60000;--stroke-error: #b60000;--background-error: #fff2f2;--background-black: #141413;--icon-default: #141413;--icon-blue: #0645b1;--background-grey: #dddde2;--icon-grey: #b1b1ba;--text-focus: #082f75;--brand-colors-neutral-black: #141413;--brand-colors-neutral-900: #535366;--brand-colors-neutral-800: #6d6d7d;--brand-colors-neutral-700: #91919e;--brand-colors-neutral-600: #b1b1ba;--brand-colors-neutral-500: #c8c8cf;--brand-colors-neutral-400: #dddde2;--brand-colors-neutral-300: #ebebee;--brand-colors-neutral-200: #f8f8fb;--brand-colors-neutral-100: #fafafa;--brand-colors-neutral-white: #ffffff;--brand-colors-blue-900: #043059;--brand-colors-blue-800: #082f75;--brand-colors-blue-700: #0c3b8d;--brand-colors-blue-600: #0645b1;--brand-colors-blue-500: #386ac1;--brand-colors-blue-400: #cddaef;--brand-colors-blue-300: #e6ecf7;--brand-colors-blue-200: #eef2f9;--brand-colors-blue-100: #f4f7fc;--brand-colors-gold-500: #877440;--brand-colors-gold-400: #e9e3d4;--brand-colors-gold-300: #f2efe8;--brand-colors-gold-200: #f9f6ed;--brand-colors-gold-100: #f9f7f4;--brand-colors-error-900: #920000;--brand-colors-error-500: #b60000;--brand-colors-success-900: #035c0f;--brand-colors-green: #ccffd4;--brand-colors-turquoise: #ccf7ff;--brand-colors-yellow: #f7ffcc;--brand-colors-peach: #ffd4cc;--brand-colors-violet: #f7ccff;--brand-colors-error-100: #fff2f2;--brand-colors-success-500: #05b01c;--brand-colors-success-100: #f0f8f1;--text-secondary: #535366;--icon-white: #ffffff;--background-beige-darker: #f2efe8;--icon-dark-grey: #535366;--type-font-family-sans-serif: DM Sans;--type-font-family-serif: Gupter;--type-font-family-mono: IBM Plex Mono;--type-weights-300: 300;--type-weights-400: 400;--type-weights-500: 500;--type-weights-700: 700;--type-sizes-12: 12px;--type-sizes-14: 14px;--type-sizes-16: 16px;--type-sizes-18: 18px;--type-sizes-20: 20px;--type-sizes-22: 22px;--type-sizes-24: 24px;--type-sizes-28: 28px;--type-sizes-30: 30px;--type-sizes-32: 32px;--type-sizes-40: 40px;--type-sizes-42: 42px;--type-sizes-48-2: 48px;--type-line-heights-16: 16px;--type-line-heights-20: 20px;--type-line-heights-23: 23px;--type-line-heights-24: 24px;--type-line-heights-25: 25px;--type-line-heights-26: 26px;--type-line-heights-29: 29px;--type-line-heights-30: 30px;--type-line-heights-32: 32px;--type-line-heights-34: 34px;--type-line-heights-35: 35px;--type-line-heights-36: 36px;--type-line-heights-38: 38px;--type-line-heights-40: 40px;--type-line-heights-46: 46px;--type-line-heights-48: 48px;--type-line-heights-52: 52px;--type-line-heights-58: 58px;--type-line-heights-68: 68px;--type-line-heights-74: 74px;--type-line-heights-82: 82px;--type-paragraph-spacings-0: 0px;--type-paragraph-spacings-4: 4px;--type-paragraph-spacings-8: 8px;--type-paragraph-spacings-16: 16px;--type-sans-serif-xl-font-weight: 400;--type-sans-serif-xl-size: 42px;--type-sans-serif-xl-line-height: 46px;--type-sans-serif-xl-paragraph-spacing: 16px;--type-sans-serif-lg-font-weight: 400;--type-sans-serif-lg-size: 32px;--type-sans-serif-lg-line-height: 38px;--type-sans-serif-lg-paragraph-spacing: 16px;--type-sans-serif-md-font-weight: 400;--type-sans-serif-md-line-height: 34px;--type-sans-serif-md-paragraph-spacing: 16px;--type-sans-serif-md-size: 28px;--type-sans-serif-xs-font-weight: 700;--type-sans-serif-xs-line-height: 25px;--type-sans-serif-xs-paragraph-spacing: 0px;--type-sans-serif-xs-size: 20px;--type-sans-serif-sm-font-weight: 400;--type-sans-serif-sm-line-height: 30px;--type-sans-serif-sm-paragraph-spacing: 16px;--type-sans-serif-sm-size: 24px;--type-body-xl-font-weight: 400;--type-body-xl-size: 24px;--type-body-xl-line-height: 36px;--type-body-xl-paragraph-spacing: 0px;--type-body-sm-font-weight: 400;--type-body-sm-size: 14px;--type-body-sm-line-height: 20px;--type-body-sm-paragraph-spacing: 8px;--type-body-xs-font-weight: 400;--type-body-xs-size: 12px;--type-body-xs-line-height: 16px;--type-body-xs-paragraph-spacing: 0px;--type-body-md-font-weight: 400;--type-body-md-size: 16px;--type-body-md-line-height: 20px;--type-body-md-paragraph-spacing: 4px;--type-body-lg-font-weight: 400;--type-body-lg-size: 20px;--type-body-lg-line-height: 26px;--type-body-lg-paragraph-spacing: 16px;--type-body-lg-medium-font-weight: 500;--type-body-lg-medium-size: 20px;--type-body-lg-medium-line-height: 32px;--type-body-lg-medium-paragraph-spacing: 16px;--type-body-md-medium-font-weight: 500;--type-body-md-medium-size: 16px;--type-body-md-medium-line-height: 20px;--type-body-md-medium-paragraph-spacing: 4px;--type-body-sm-bold-font-weight: 700;--type-body-sm-bold-size: 14px;--type-body-sm-bold-line-height: 20px;--type-body-sm-bold-paragraph-spacing: 8px;--type-body-sm-medium-font-weight: 500;--type-body-sm-medium-size: 14px;--type-body-sm-medium-line-height: 20px;--type-body-sm-medium-paragraph-spacing: 8px;--type-serif-md-font-weight: 400;--type-serif-md-size: 40px;--type-serif-md-paragraph-spacing: 0px;--type-serif-md-line-height: 48px;--type-serif-sm-font-weight: 400;--type-serif-sm-size: 28px;--type-serif-sm-paragraph-spacing: 0px;--type-serif-sm-line-height: 32px;--type-serif-lg-font-weight: 400;--type-serif-lg-size: 58px;--type-serif-lg-paragraph-spacing: 0px;--type-serif-lg-line-height: 68px;--type-serif-xs-font-weight: 400;--type-serif-xs-size: 18px;--type-serif-xs-line-height: 24px;--type-serif-xs-paragraph-spacing: 0px;--type-serif-xl-font-weight: 400;--type-serif-xl-size: 74px;--type-serif-xl-paragraph-spacing: 0px;--type-serif-xl-line-height: 82px;--type-mono-md-font-weight: 400;--type-mono-md-size: 22px;--type-mono-md-line-height: 24px;--type-mono-md-paragraph-spacing: 0px;--type-mono-lg-font-weight: 400;--type-mono-lg-size: 40px;--type-mono-lg-line-height: 40px;--type-mono-lg-paragraph-spacing: 0px;--type-mono-sm-font-weight: 400;--type-mono-sm-size: 14px;--type-mono-sm-line-height: 24px;--type-mono-sm-paragraph-spacing: 0px;--spacing-xs-4: 4px;--spacing-xs-8: 8px;--spacing-xs-16: 16px;--spacing-sm-24: 24px;--spacing-sm-32: 32px;--spacing-md-40: 40px;--spacing-md-48: 48px;--spacing-lg-64: 64px;--spacing-lg-80: 80px;--spacing-xlg-104: 104px;--spacing-xlg-152: 152px;--spacing-xs-12: 12px;--spacing-page-section: 152px;--spacing-card-list-spacing: 48px;--spacing-text-section-spacing: 80px;--spacing-md-xs-headings: 40px;--corner-radius-radius-lg: 16px;--corner-radius-radius-sm: 4px;--corner-radius-radius-md: 8px;--corner-radius-radius-round: 104px}}</style><link rel="stylesheet" media="all" href="//a.academia-assets.com/assets/single_work_page/loswp-f29774c14b4e629cbb4375c919ad1c2b2891ac825d0a410ea6339ae17e481a55.css" /><link rel="stylesheet" media="all" href="//a.academia-assets.com/assets/design_system/body-170d1319f0e354621e81ca17054bb147da2856ec0702fe440a99af314a6338c5.css" /><link rel="stylesheet" media="all" href="//a.academia-assets.com/assets/design_system/button-bfbac2a470372e2f3a6661a65fa7ff0a0fbf7aa32534d9a831d683d2a6f9e01b.css" /><link rel="stylesheet" media="all" href="//a.academia-assets.com/assets/design_system/heading-95367dc03b794f6737f30123738a886cf53b7a65cdef98a922a98591d60063e3.css" /><link rel="stylesheet" media="all" href="//a.academia-assets.com/assets/design_system/text_button-d1941ab08e91e29ee143084c4749da4aaffa350a2ac6eec2306b1d7a352d911a.css" /><link crossorigin="" href="https://fonts.gstatic.com/" rel="preconnect" /><link href="https://fonts.googleapis.com/css2?family=DM+Sans:ital,opsz,wght@0,9..40,100..1000;1,9..40,100..1000&family=Gupter:wght@400;500;700&family=IBM+Plex+Mono:wght@300;400&family=Material+Symbols+Outlined:opsz,wght,FILL,GRAD@20,400,0,0&display=swap" rel="stylesheet" /> </head> <body> <div id='react-modal'></div> <div class="js-upgrade-ie-banner" style="display: none; text-align: center; padding: 8px 0; background-color: #ebe480;"><p style="color: #000; font-size: 12px; margin: 0 0 4px;">Academia.edu no longer supports Internet Explorer.</p><p style="color: #000; font-size: 12px; margin: 0;">To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to <a href="https://www.academia.edu/upgrade-browser">upgrade your browser</a>.</p></div><script>// Show this banner for all versions of IE if (!!window.MSInputMethodContext || /(MSIE)/.test(navigator.userAgent)) { document.querySelector('.js-upgrade-ie-banner').style.display = 'block'; }</script> <div class="bootstrap login"><div class="modal fade login-modal" id="login-modal"><div class="login-modal-dialog modal-dialog"><div class="modal-content"><div class="modal-header"><button class="close close" data-dismiss="modal" type="button"><span aria-hidden="true">×</span><span class="sr-only">Close</span></button><h4 class="modal-title text-center"><strong>Log In</strong></h4></div><div class="modal-body"><div class="row"><div class="col-xs-10 col-xs-offset-1"><button class="btn btn-fb btn-lg btn-block btn-v-center-content" id="login-facebook-oauth-button"><svg style="float: left; width: 19px; line-height: 1em; margin-right: .3em;" aria-hidden="true" focusable="false" data-prefix="fab" data-icon="facebook-square" class="svg-inline--fa fa-facebook-square fa-w-14" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512"><path fill="currentColor" d="M400 32H48A48 48 0 0 0 0 80v352a48 48 0 0 0 48 48h137.25V327.69h-63V256h63v-54.64c0-62.15 37-96.48 93.67-96.48 27.14 0 55.52 4.84 55.52 4.84v61h-31.27c-30.81 0-40.42 19.12-40.42 38.73V256h68.78l-11 71.69h-57.78V480H400a48 48 0 0 0 48-48V80a48 48 0 0 0-48-48z"></path></svg><small><strong>Log in</strong> with <strong>Facebook</strong></small></button><br /><button class="btn btn-google btn-lg btn-block btn-v-center-content" id="login-google-oauth-button"><svg style="float: left; width: 22px; line-height: 1em; margin-right: .3em;" aria-hidden="true" focusable="false" data-prefix="fab" data-icon="google-plus" class="svg-inline--fa fa-google-plus fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M256,8C119.1,8,8,119.1,8,256S119.1,504,256,504,504,392.9,504,256,392.9,8,256,8ZM185.3,380a124,124,0,0,1,0-248c31.3,0,60.1,11,83,32.3l-33.6,32.6c-13.2-12.9-31.3-19.1-49.4-19.1-42.9,0-77.2,35.5-77.2,78.1S142.3,334,185.3,334c32.6,0,64.9-19.1,70.1-53.3H185.3V238.1H302.2a109.2,109.2,0,0,1,1.9,20.7c0,70.8-47.5,121.2-118.8,121.2ZM415.5,273.8v35.5H380V273.8H344.5V238.3H380V202.8h35.5v35.5h35.2v35.5Z"></path></svg><small><strong>Log in</strong> with <strong>Google</strong></small></button><br /><style type="text/css">.sign-in-with-apple-button { width: 100%; height: 52px; border-radius: 3px; border: 1px solid black; cursor: pointer; } .sign-in-with-apple-button > div { margin: 0 auto; / This centers the Apple-rendered button horizontally }</style><script src="https://appleid.cdn-apple.com/appleauth/static/jsapi/appleid/1/en_US/appleid.auth.js" type="text/javascript"></script><div class="sign-in-with-apple-button" data-border="false" data-color="white" id="appleid-signin"><span   ="Sign Up with Apple" class="u-fs11"></span></div><script>AppleID.auth.init({ clientId: 'edu.academia.applesignon', scope: 'name email', redirectURI: 'https://www.academia.edu/sessions', state: "fdde5ca6547cefd443898de174c9ee44e61370e196a06c7031f98f64100b63a1", });</script><script>// Hacky way of checking if on fast loswp if (window.loswp == null) { (function() { const Google = window?.Aedu?.Auth?.OauthButton?.Login?.Google; const Facebook = window?.Aedu?.Auth?.OauthButton?.Login?.Facebook; if (Google) { new Google({ el: '#login-google-oauth-button', rememberMeCheckboxId: 'remember_me', track: null }); } if (Facebook) { new Facebook({ el: '#login-facebook-oauth-button', rememberMeCheckboxId: 'remember_me', track: null }); } })(); }</script></div></div></div><div class="modal-body"><div class="row"><div class="col-xs-10 col-xs-offset-1"><div class="hr-heading login-hr-heading"><span class="hr-heading-text">or</span></div></div></div></div><div class="modal-body"><div class="row"><div class="col-xs-10 col-xs-offset-1"><form class="js-login-form" action="https://www.academia.edu/sessions" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token" value="gAFpDVydmNuWRMU4JIaXcZkFHltX8_BcHise4b5Rq_3uFk6HnsSqaBa_SNFs2LOk90tV2oaP3Fq0-RZWOY1Ldw" autocomplete="off" /><div class="form-group"><label class="control-label" for="login-modal-email-input" style="font-size: 14px;">Email</label><input class="form-control" id="login-modal-email-input" name="login" type="email" /></div><div class="form-group"><label class="control-label" for="login-modal-password-input" style="font-size: 14px;">Password</label><input class="form-control" id="login-modal-password-input" name="password" type="password" /></div><input type="hidden" name="post_login_redirect_url" id="post_login_redirect_url" value="https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study" autocomplete="off" /><div class="checkbox"><label><input type="checkbox" name="remember_me" id="remember_me" value="1" checked="checked" /><small style="font-size: 12px; margin-top: 2px; display: inline-block;">Remember me on this computer</small></label></div><br><input type="submit" name="commit" value="Log In" class="btn btn-primary btn-block btn-lg js-login-submit" data-disable-with="Log In" /></br></form><script>typeof window?.Aedu?.recaptchaManagedForm === 'function' && window.Aedu.recaptchaManagedForm( document.querySelector('.js-login-form'), document.querySelector('.js-login-submit') );</script><small style="font-size: 12px;"><br />or <a data-target="#login-modal-reset-password-container" data-toggle="collapse" href="javascript:void(0)">reset password</a></small><div class="collapse" id="login-modal-reset-password-container"><br /><div class="well margin-0x"><form class="js-password-reset-form" action="https://www.academia.edu/reset_password" accept-charset="UTF-8" method="post"><input type="hidden" name="authenticity_token" value="w-UWYuoH0ApzWFC-AnzkIiUeGStVGECNWUMYd89F6c6t8jHoKF7iufOj3VdKIsD3S1BSqoRkbIvzkRDASJkJRA" autocomplete="off" /><p>Enter the email address you signed up with and we'll email you a reset link.</p><div class="form-group"><input class="form-control" name="email" type="email" /></div><input class="btn btn-primary btn-block g-recaptcha js-password-reset-submit" data-sitekey="6Lf3KHUUAAAAACggoMpmGJdQDtiyrjVlvGJ6BbAj" type="submit" value="Email me a link" /></form></div></div><script> require.config({ waitSeconds: 90 })(["https://a.academia-assets.com/assets/collapse-45805421cf446ca5adf7aaa1935b08a3a8d1d9a6cc5d91a62a2a3a00b20b3e6a.js"], function() { // from javascript_helper.rb $("#login-modal-reset-password-container").on("shown.bs.collapse", function() { $(this).find("input[type=email]").focus(); }); }); </script> </div></div></div><div class="modal-footer"><div class="text-center"><small style="font-size: 12px;">Need an account? <a rel="nofollow" href="https://www.academia.edu/signup">Click here to sign up</a></small></div></div></div></div></div></div><script>// If we are on subdomain or non-bootstrapped page, redirect to login page instead of showing modal (function(){ if (typeof $ === 'undefined') return; var host = window.location.hostname; if ((host === $domain || host === "www."+$domain) && (typeof $().modal === 'function')) { $("#nav_log_in").click(function(e) { // Don't follow the link and open the modal e.preventDefault(); $("#login-modal").on('shown.bs.modal', function() { $(this).find("#login-modal-email-input").focus() }).modal('show'); }); } })()</script> <div id="fb-root"></div><script>window.fbAsyncInit = function() { FB.init({ appId: "2369844204", version: "v8.0", status: true, cookie: true, xfbml: true }); // Additional initialization code. if (window.InitFacebook) { // facebook.ts already loaded, set it up. window.InitFacebook(); } else { // Set a flag for facebook.ts to find when it loads. window.academiaAuthReadyFacebook = true; } };</script> <div id="google-root"></div><script>window.loadGoogle = function() { if (window.InitGoogle) { // google.ts already loaded, set it up. window.InitGoogle("331998490334-rsn3chp12mbkiqhl6e7lu2q0mlbu0f1b"); } else { // Set a flag for google.ts to use when it loads. window.GoogleClientID = "331998490334-rsn3chp12mbkiqhl6e7lu2q0mlbu0f1b"; } };</script> <div class="header--container" id="main-header-container"><div class="header--inner-container header--inner-container-ds2"><div class="header-ds2--left-wrapper"><div class="header-ds2--left-wrapper-inner"><a data-main-header-link-target="logo_home" href="https://www.academia.edu/"><img class="hide-on-desktop-redesign" style="height: 24px; width: 24px;" alt="Academia.edu" src="//a.academia-assets.com/images/academia-logo-redesign-2015-A.svg" width="24" height="24" /><img width="145.2" height="18" class="hide-on-mobile-redesign" style="height: 24px;" alt="Academia.edu" src="//a.academia-assets.com/images/academia-logo-redesign-2015.svg" /></a><div class="header--search-container header--search-container-ds2"><form class="js-SiteSearch-form select2-no-default-pills" action="https://www.academia.edu/search" accept-charset="UTF-8" method="get"><svg style="width: 14px; height: 14px;" aria-hidden="true" focusable="false" data-prefix="fas" data-icon="search" class="header--search-icon svg-inline--fa fa-search fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M505 442.7L405.3 343c-4.5-4.5-10.6-7-17-7H372c27.6-35.3 44-79.7 44-128C416 93.1 322.9 0 208 0S0 93.1 0 208s93.1 208 208 208c48.3 0 92.7-16.4 128-44v16.3c0 6.4 2.5 12.5 7 17l99.7 99.7c9.4 9.4 24.6 9.4 33.9 0l28.3-28.3c9.4-9.4 9.4-24.6.1-34zM208 336c-70.7 0-128-57.2-128-128 0-70.7 57.2-128 128-128 70.7 0 128 57.2 128 128 0 70.7-57.2 128-128 128z"></path></svg><input class="header--search-input header--search-input-ds2 js-SiteSearch-form-input" data-main-header-click-target="search_input" name="q" placeholder="Search" type="text" /></form></div></div></div><nav class="header--nav-buttons header--nav-buttons-ds2 js-main-nav"><button class="ds2-5-button ds2-5-button--secondary js-header-login-url header-button-ds2 header-login-ds2 hide-on-mobile-redesign react-login-modal-opener" data-signup-modal="{"location":"login-button--header"}" rel="nofollow">Log In</button><button class="ds2-5-button ds2-5-button--secondary header-button-ds2 hide-on-mobile-redesign react-login-modal-opener" data-signup-modal="{"location":"signup-button--header"}" rel="nofollow">Sign Up</button><button class="header--hamburger-button header--hamburger-button-ds2 hide-on-desktop-redesign js-header-hamburger-button"><div class="icon-bar"></div><div class="icon-bar" style="margin-top: 4px;"></div><div class="icon-bar" style="margin-top: 4px;"></div></button></nav></div><ul class="header--dropdown-container js-header-dropdown"><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/login" rel="nofollow">Log In</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/signup" rel="nofollow">Sign Up</a></li><li class="header--dropdown-row js-header-dropdown-expand-button"><button class="header--dropdown-button">more<svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="caret-down" class="header--dropdown-button-icon svg-inline--fa fa-caret-down fa-w-10" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512"><path fill="currentColor" d="M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z"></path></svg></button></li><li><ul class="header--expanded-dropdown-container"><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/about">About</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/press">Press</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/documents">Papers</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/terms">Terms</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/privacy">Privacy</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/copyright">Copyright</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://www.academia.edu/hiring"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="briefcase" class="header--dropdown-row-icon svg-inline--fa fa-briefcase fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M320 336c0 8.84-7.16 16-16 16h-96c-8.84 0-16-7.16-16-16v-48H0v144c0 25.6 22.4 48 48 48h416c25.6 0 48-22.4 48-48V288H320v48zm144-208h-80V80c0-25.6-22.4-48-48-48H176c-25.6 0-48 22.4-48 48v48H48c-25.6 0-48 22.4-48 48v80h512v-80c0-25.6-22.4-48-48-48zm-144 0H192V96h128v32z"></path></svg>We're Hiring!</a></li><li class="header--dropdown-row"><a class="header--dropdown-link" href="https://support.academia.edu/hc/en-us"><svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="question-circle" class="header--dropdown-row-icon svg-inline--fa fa-question-circle fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zM262.655 90c-54.497 0-89.255 22.957-116.549 63.758-3.536 5.286-2.353 12.415 2.715 16.258l34.699 26.31c5.205 3.947 12.621 3.008 16.665-2.122 17.864-22.658 30.113-35.797 57.303-35.797 20.429 0 45.698 13.148 45.698 32.958 0 14.976-12.363 22.667-32.534 33.976C247.128 238.528 216 254.941 216 296v4c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12v-1.333c0-28.462 83.186-29.647 83.186-106.667 0-58.002-60.165-102-116.531-102zM256 338c-25.365 0-46 20.635-46 46 0 25.364 20.635 46 46 46s46-20.636 46-46c0-25.365-20.635-46-46-46z"></path></svg>Help Center</a></li><li class="header--dropdown-row js-header-dropdown-collapse-button"><button class="header--dropdown-button">less<svg aria-hidden="true" focusable="false" data-prefix="fas" data-icon="caret-up" class="header--dropdown-button-icon svg-inline--fa fa-caret-up fa-w-10" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512"><path fill="currentColor" d="M288.662 352H31.338c-17.818 0-26.741-21.543-14.142-34.142l128.662-128.662c7.81-7.81 20.474-7.81 28.284 0l128.662 128.662c12.6 12.599 3.676 34.142-14.142 34.142z"></path></svg></button></li></ul></li></ul></div> <script src="//a.academia-assets.com/assets/webpack_bundles/fast_loswp-bundle-e5ca05062a7092a8f6f5af11f70589210af26f6a0030f102b0b21b22451b9d41.js" defer="defer"></script><script>window.loswp = {}; window.loswp.author = 194962700; window.loswp.bulkDownloadFilterCounts = {}; window.loswp.hasDownloadableAttachment = true; window.loswp.hasViewableAttachments = true; // TODO: just use routes for this window.loswp.loginUrl = "https://www.academia.edu/login?post_login_redirect_url=https%3A%2F%2Fwww.academia.edu%2F117617249%2FDisease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study%3Fauto%3Ddownload"; window.loswp.translateUrl = "https://www.academia.edu/login?post_login_redirect_url=https%3A%2F%2Fwww.academia.edu%2F117617249%2FDisease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study%3Fshow_translation%3Dtrue"; window.loswp.previewableAttachments = [{"id":113427162,"identifier":"Attachment_113427162","shouldShowBulkDownload":false}]; window.loswp.shouldDetectTimezone = true; window.loswp.shouldShowBulkDownload = true; window.loswp.showSignupCaptcha = false window.loswp.willEdgeCache = false; window.loswp.work = {"work":{"id":117617249,"created_at":"2024-04-17T00:00:18.287-07:00","from_world_paper_id":253023621,"updated_at":"2025-02-01T13:32:26.609-08:00","_data":{"publisher":"Oxford University Press","ai_abstract":"This population-based study investigates disease activity patterns in pediatric patients with ulcerative colitis (UC) during the first five years following diagnosis. Over a third of the cohort exhibited chronically active or chronic intermittent disease courses, with high inflammatory markers evident at diagnosis linked to poorer outcomes. The findings underscore the importance of initial clinical and laboratory assessments in predicting long-term disease trajectories in children with UC.","ai_title_tag":"Disease Patterns in Pediatric Ulcerative Colitis","publication_date":"2020,10,6","publication_name":"Journal of Crohn's and Colitis"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study","broadcastable":false,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [194962700]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "full_page_mobile_sutd_modal"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":113427162,"attachmentType":"pdf"}"><img alt="First page of “Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/113427162/mini_magick20240802-1-iymm65.png?1722623917" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Disease Activity Patterns in the First 5 Years After Diagnosis in Children With Ulcerative Colitis: A Population-Based Study</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="194962700" href="https://independent.academia.edu/CostantinoDeGiacomo"><img alt="Profile image of Costantino De Giacomo" class="ds-work-card--author-avatar" src="https://0.academia-photos.com/194962700/57393972/45611566/s65_costantino.de_giacomo.png" />Costantino De Giacomo</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2020, Journal of Crohn's and Colitis</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">7 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 117617249; const worksViewsPath = "/v0/works/views?subdomain_param=api&work_ids%5B%5D=117617249"; const getWorkViews = async (workId) => { const response = await fetch(worksViewsPath); if (!response.ok) { throw new Error('Failed to load work views'); } const data = await response.json(); return data.views[workId]; }; // Get the view count for the work - we send this immediately rather than waiting for // the DOM to load, so it can be available as soon as possible (but without holding up // the backend or other resource requests, because it's a bit expensive and not critical). const viewCount = await getWorkViews(workId); const updateViewCount = (viewCount) => { try { const viewCountNumber = parseInt(viewCount, 10); if (viewCountNumber === 0) { // Remove the whole views element if there are zero views. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); return; } const commaizedViewCount = viewCountNumber.toLocaleString(); const viewCountBody = document.getElementById('work-metadata-view-count'); if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--detail ds2-5-body-md">AI-generated Abstract</p><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">This population-based study investigates disease activity patterns in pediatric patients with ulcerative colitis (UC) during the first five years following diagnosis. Over a third of the cohort exhibited chronically active or chronic intermittent disease courses, with high inflammatory markers evident at diagnosis linked to poorer outcomes. The findings underscore the importance of initial clinical and laboratory assessments in predicting long-term disease trajectories in children with UC.</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":113427162,"attachmentType":"pdf","workUrl":"https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":113427162,"attachmentType":"pdf","workUrl":"https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. If the signup banner trigger (a 242px-high* invisible div underneath the 'See Full PDF' / 'Download PDF' buttons) // is already fully scrolled above the viewport, show the banner by default // 2. If the signup banner trigger is fully visible, show the banner // 3. If the signup banner trigger has even a few pixels scrolled below the viewport, hide the banner // // * 242px is the empirically determined height of the signup banner. It's better to be a bit taller than // necessary than too short, so it's fine that the mobile (small breakpoint) banner is shorter. // First check session storage for the signup banner's visibility state const signupBannerHidden = sessionStorage.getItem('ds-signup-banner-hidden'); if (signupBannerHidden === 'true') { return; } const signupBanner = document.querySelector('.ds-signup-banner'); const signupBannerTrigger = document.querySelector('.ds-signup-banner-trigger'); if (!signupBannerTrigger) { window.Sentry.captureMessage("Signup banner trigger not found"); return; } let footerShown = false; window.addEventListener('load', () => { const rect = signupBannerTrigger.getBoundingClientRect(); // If page loaded up already scrolled below the trigger (via scroll restoration), show the banner by default if (rect.bottom < 0) { footerShown = true; signupBanner.classList.add('ds-signup-banner-visible'); } }); // Wait for trigger to fully enter viewport before showing banner (ensures PDF CTAs are never covered by banner) const observer = new IntersectionObserver((entries) => { entries.forEach(entry => { if (entry.isIntersecting && !footerShown) { footerShown = true; signupBanner.classList.add('ds-signup-banner-visible'); } else if (!entry.isIntersecting && footerShown) { if (signupBannerTrigger.getBoundingClientRect().bottom > 0) { footerShown = false; signupBanner.classList.remove('ds-signup-banner-visible'); } } }); }); observer.observe(signupBannerTrigger); // Set up signup banner close button event handler: const signupBannerCloseButton = document.querySelector('#ds-signup-banner-close-button'); signupBannerCloseButton.addEventListener('click', () => { signupBanner.classList.remove('ds-signup-banner-visible'); observer.unobserve(signupBannerTrigger); // Store the signup banner's visibility state in session storage sessionStorage.setItem('ds-signup-banner-hidden', 'true'); }); })();</script></div></div></div><div data-auto_select="false" data-client_id="331998490334-rsn3chp12mbkiqhl6e7lu2q0mlbu0f1b" data-doc_id="113427162" data-landing_url="https://www.academia.edu/117617249/Disease_Activity_Patterns_in_the_First_5_Years_After_Diagnosis_in_Children_With_Ulcerative_Colitis_A_Population_Based_Study" data-login_uri="https://www.academia.edu/registrations/google_one_tap" data-moment_callback="onGoogleOneTapEvent" id="g_id_onload"></div><div class="ds-top-related-works--grid-container"><div class="ds-related-content--container ds-top-related-works--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="0" data-entity-id="53097084" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/53097084/Correlation_of_endoscopic_disease_severity_with_pediatric_ulcerative_colitis_activity_index_score_in_children_and_young_adults_with_ulcerative_colitis">Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="62498424" href="https://independent.academia.edu/HeatherLitman">Heather Litman</a></div><p class="ds-related-work--metadata ds2-5-body-xs">World journal of gastroenterology, 2017</p><p class="ds-related-work--abstract ds2-5-body-sm">To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score). We reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed. We identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer scre...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis","attachmentId":70044176,"attachmentType":"pdf","work_url":"https://www.academia.edu/53097084/Correlation_of_endoscopic_disease_severity_with_pediatric_ulcerative_colitis_activity_index_score_in_children_and_young_adults_with_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/53097084/Correlation_of_endoscopic_disease_severity_with_pediatric_ulcerative_colitis_activity_index_score_in_children_and_young_adults_with_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="12868969" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/12868969/Presenting_features_and_disease_course_of_pediatric_ulcerative_colitis">Presenting features and disease course of pediatric ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="31992981" href="https://independent.academia.edu/SalvatoreCucchiara">Salvatore Cucchiara</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Crohn's and Colitis, 2013</p><p class="ds-related-work--abstract ds2-5-body-sm">Clinical variables and disease course of pediatric ulcerative colitis (UC) have been poorly reported. The aim of this study was to retrospectively describe the phenotype and disease course of pediatric onset UC diagnosed at a tertiary referral Center for Pediatric Gastroenterology. Patients and methods: 110 patients with a diagnosis of UC were identified at our Department database. Records were reviewed for disease location and behavior at the diagnosis, family history for inflammatory bowel disease, pattern changes at the follow-up, need of surgery and cumulative risk for colectomy. Results: Thirty-five % of patients had an early-onset disease (0-7 years). At the diagnosis, 29% had proctitis, 22% left-sided colitis, 15% extensive colitis and 34% pancolitis. Fifteen % presented with a rectal sparing, while a patchy colonic inflammation was reported in 18%. Rectal sparing was significantly related to the younger age (p: b 0.05). Disease extension at the follow up was reported in 29% of pts. No clinical variables at the diagnosis were related to the subsequent extension of the disease. The cumulative rates of colectomy were 9% at 2 year and 14% at 5 years. An extensive disease as well as acute severe colitis and corticosteroid therapy at the diagnosis were significantly associated with an increased risk of colectomy. Conclusions: Pediatric UC is extensive and severe at the diagnosis, with an overall high rate of disease extension at the follow-up. Endoscopic atypical features are common in young children. The colectomy rate is related to the location and severity of the disease at the diagnosis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Presenting features and disease course of pediatric ulcerative colitis","attachmentId":45877799,"attachmentType":"pdf","work_url":"https://www.academia.edu/12868969/Presenting_features_and_disease_course_of_pediatric_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/12868969/Presenting_features_and_disease_course_of_pediatric_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="18548667" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/18548667/Severe_Pediatric_Ulcerative_Colitis_A_Prospective_Multicenter_Study_of_Outcomes_and_Predictors_of_Response">Severe Pediatric Ulcerative Colitis: A Prospective Multicenter Study of Outcomes and Predictors of Response</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="38568358" href="https://independent.academia.edu/StevenLeach2">Steven Leach</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gastroenterology, 2010</p><p class="ds-related-work--abstract ds2-5-body-sm">In a prospective study of children with severe ulcerative colitis (UC), we aimed to assess outcomes and to identify predictors of nonresponse to intravenous corticosteroids. METHODS: A total of 128 children (47% males; 12.9 Ϯ 3.9 y) hospitalized for severe UC were enrolled from 10 pediatric centers. Clinical and laboratory data and the Pediatric UC Activity Index (PUCAI) were recorded throughout the admission. Patients were followed up for 1 year postdischarge. RESULTS: Thirty-seven (29%; 95% confidence interval [CI], 22%-37%) children failed intravenous corticosteroids and received, within 10.5 Ϯ 6.4 days, cyclosporine (n ϭ 1; 3%), colectomy (n ϭ 3; 8%), or infliximab (n ϭ 33; 89%). Several predictors were associated with intravenous corticosteroids failure, but the best model included number of stools, amount of blood, age, and new-onset disease (odds ratio [OR], 1.9; 95% CI, 1.1-3.5; OR, 2.5; 95% CI, 1.3-4.6; OR, 1.2; 95% CI, 1.04 -1.36; and OR, 0.27; 95% CI, 0.1-0.7, respectively). The PUCAI, followed closely by the Travis rule, strongly predicted response when compared with other measures (Seo and Lindgren indices, C-reactive protein level, and fecal calprotectin level) (P Ͻ .001). Aiming for sensitivity on day 3, a PUCAI greater than 45 screened for patients likely to fail intravenous corticosteroids (negative predictive value, 94%; positive predictive value, 43%; P Ͻ .001). Aiming for specificity on day 5, a PUCAI score greater than 70 optimally guided implementation of salvage therapy (positive predictive value, 100%; negative predictive value, 79%; P Ͻ .001). Twenty-five of 33 children treated with infliximab responded. The overall cumulative colectomy rate was 9% and 19% by discharge and 1-year, respectively. The day 3 PUCAI score predicted response up to 1 year postdischarge (P Ͻ .001; time to salvage therapy). CONCLUSIONS: The PUCAI, calculated on days 3 and 5 of steroid therapy, can identify patients requiring salvage therapy. Infliximab is an effective therapy in steroid-refractory pediatric UC.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Severe Pediatric Ulcerative Colitis: A Prospective Multicenter Study of Outcomes and Predictors of Response","attachmentId":40123416,"attachmentType":"pdf","work_url":"https://www.academia.edu/18548667/Severe_Pediatric_Ulcerative_Colitis_A_Prospective_Multicenter_Study_of_Outcomes_and_Predictors_of_Response","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/18548667/Severe_Pediatric_Ulcerative_Colitis_A_Prospective_Multicenter_Study_of_Outcomes_and_Predictors_of_Response"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="102854724" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/102854724/Predicting_Outcomes_in_Pediatric_Ulcerative_Colitis_for_Management_Optimization_Systematic_Review_and_Consensus_Statements_From_the_Pediatric_Inflammatory_Bowel_Disease_Ahead_Program">Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease–Ahead Program</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="33043859" href="https://uba.academia.edu/MarinaOrsi">Marina Orsi</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gastroenterology, 2021</p><p class="ds-related-work--abstract ds2-5-body-sm">BACKGROUND & AIMS: A better understanding of prognostic factors in ulcerative colitis (UC) could improve patient management and reduce complications. We aimed to identify evidence-based predictors for outcomes in pediatric UC, which may be used to optimize treatment algorithms. METHODS: Potential outcomes worthy of prediction in UC were determined by surveying 202 experts in pediatric UC. A systematic review of the literature, with selected meta-analysis, was performed to identify studies that investigated predictors for these outcomes. Multiple national and international meetings were held to reach consensus on evidencebased statements. RESULTS: Consensus was reached on 31 statements regarding predictors of colectomy, acute severe colitis (ASC), chronically active pediatric UC, cancer and mortality. At diagnosis, disease extent (6 studies, N ¼ 627; P ¼ .035), Pediatric Ulcerative Colitis Activity Index score (4 studies, n ¼ 318; P < .001), hemoglobin, hematocrit, and albumin may predict colectomy. In addition, family history of UC (2 studies, n ¼ 557; P ¼ .0004), extraintestinal manifestations (4 studies, n ¼ 526; P ¼ .048), and disease extension over time may predict colectomy, whereas primary sclerosing cholangitis (PSC) may be protective. Acute severe colitis may be predicted by disease severity at onset and hypoalbuminemia. Higher Pediatric Ulcerative Colitis Activity Index score and C-reactive protein on days 3 and 5 of hospital admission predict failure of intravenous steroids. Risk factors for malignancy included concomitant diagnosis of primary sclerosing cholangitis, longstanding colitis (>10 years), male sex, and younger age at diagnosis. CONCLUSIONS: These evidence-based consensus statements offer predictions to be considered for a personalized medicine approach in treating pediatric UC.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Predicting Outcomes in Pediatric Ulcerative Colitis for Management Optimization: Systematic Review and Consensus Statements From the Pediatric Inflammatory Bowel Disease–Ahead Program","attachmentId":103013087,"attachmentType":"pdf","work_url":"https://www.academia.edu/102854724/Predicting_Outcomes_in_Pediatric_Ulcerative_Colitis_for_Management_Optimization_Systematic_Review_and_Consensus_Statements_From_the_Pediatric_Inflammatory_Bowel_Disease_Ahead_Program","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/102854724/Predicting_Outcomes_in_Pediatric_Ulcerative_Colitis_for_Management_Optimization_Systematic_Review_and_Consensus_Statements_From_the_Pediatric_Inflammatory_Bowel_Disease_Ahead_Program"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="110970780" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/110970780/Histologic_Correlates_of_Clinical_and_Endoscopic_Severity_in_Children_Newly_Diagnosed_With_Ulcerative_Colitis">Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="72518981" href="https://independent.academia.edu/MarianPfefferkorn">Marian Pfefferkorn</a></div><p class="ds-related-work--metadata ds2-5-body-xs">American Journal of Surgical Pathology, 2017</p><p class="ds-related-work--abstract ds2-5-body-sm">To characterize rectal histology in an inception cohort of children newly diagnosed with ulcerative colitis (UC) and to explore its relationship with clinical indices of disease severity. The PROTECT (Predicting Response to Standardized Pediatric Colitis Therapy) Study enrolled children 17 years of age and younger newly diagnosed with UC. Baseline rectal biopsies were evaluated for acute and chronic inflammation, eosinophilic inflammation (peak eosinophil count &gt; 32 eosinophils/high powered field, eosinophilic cryptitis or abscesses), and architectural/nonarchitectural chronic changes. Correlation with clinical indices including Mayo endoscopy subscore and Pediatric Ulcerative Colitis Activity Index was performed. Rectal biopsies from 369 patients (mean age, 12.9±3.1 y, 50% female) were reviewed. Cryptitis was found in 89%, crypt abscesses in 25%, and eosinophilic inflammation in 58%. Crypt distortion/atrophy was present in 98% of specimens. Higher grades of acute and chronic inf...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis","attachmentId":108622469,"attachmentType":"pdf","work_url":"https://www.academia.edu/110970780/Histologic_Correlates_of_Clinical_and_Endoscopic_Severity_in_Children_Newly_Diagnosed_With_Ulcerative_Colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/110970780/Histologic_Correlates_of_Clinical_and_Endoscopic_Severity_in_Children_Newly_Diagnosed_With_Ulcerative_Colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="74233491" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/74233491/Endoscopic_and_Histologic_Predictors_of_Outcomes_in_Pediatric_Ulcerative_Colitis_Caveat_Emptor">Endoscopic and Histologic Predictors of Outcomes in Pediatric Ulcerative Colitis—Caveat Emptor</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="147967979" href="https://dahphd.academia.edu/lorrainestallard">lorraine stallard</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Frontiers in Pediatrics, 2021</p><p class="ds-related-work--abstract ds2-5-body-sm">The impact of endoscopic and histological mucosal healing on outcomes in adult settings is impressive. Despite many clinical parallels, pediatric ulcerative colitis (UC) is set apart from adult disease in several respects. Many frequently used indices are not fully validated, especially in pediatric settings, and consensus on precise definitions in clinical settings are lacking. Endoscopic mucosal healing is an acceptable long-term treatment goal in pediatrics, but not histologic normalization. Early prediction of disease course in UC may allow treatment stratification of patients according to risks of relapse, acute severe colitis, and colectomy. Putative endoscopic and histologic predictors of poor clinical outcomes in adults have not held true in pediatric settings, including baseline endoscopic extent, endoscopic severity, and specific histologic characteristics which are less prevalent in pediatrics at diagnosis. In this mini-review we appraise predictive endoscopic and histologic factors in pediatric UC with reference to relapse, severe colitis, and colectomy risks. We recommend that clinicians routinely use endoscopic and histologic sores to improve the quality of clinical and research practice. The review summarizes differences between adult and pediatric prediction data, advises special consideration of those with primary sclerosing cholangitis, and suggests areas for future study in this field.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Endoscopic and Histologic Predictors of Outcomes in Pediatric Ulcerative Colitis—Caveat Emptor","attachmentId":82455332,"attachmentType":"pdf","work_url":"https://www.academia.edu/74233491/Endoscopic_and_Histologic_Predictors_of_Outcomes_in_Pediatric_Ulcerative_Colitis_Caveat_Emptor","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/74233491/Endoscopic_and_Histologic_Predictors_of_Outcomes_in_Pediatric_Ulcerative_Colitis_Caveat_Emptor"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="6435359" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/6435359/Development_Validation_and_Evaluation_of_a_Pediatric_Ulcerative_Colitis_Activity_Index_A_Prospective_Multicenter_Study">Development, Validation, and Evaluation of a Pediatric Ulcerative Colitis Activity Index: A Prospective Multicenter Study</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="10156624" href="https://uoi.academia.edu/DavidMack">David Mack</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gastroenterology, 2007</p><p class="ds-related-work--abstract ds2-5-body-sm">Colonoscopic appearance, the primary measure of disease activity in adult ulcerative colitis, is less acceptable to children. Our aim was to develop a noninvasive activity index of pediatric ulcerative colitis. Methods: Item selection was performed judgmentally using a Delphi group of 36 experts in pediatric inflammatory bowel disease. Item weighting was performed by regression modeling using a prospective cohort of 157 pediatric ulcerative colitis patients. Validation was assessed on a separate prospective cohort of 48 children with ulcerative colitis undergoing complete colonoscopy. Responsiveness was evaluated at a follow-up visit of 75 children using effect size statistics and diagnostic utility approaches. Results: A list of 41 items was generated and reduced to 11 by rank order. Two physicians completed the Pediatric Ulcerative Colitis Activity Index (PUCAI) on each of the patients in the weighting cohort. Six clinical items were significant in the regression analysis; the laboratory items and an endoscopic appearance item did not improve the PUCAI performance. In the validation cohort, the PUCAI was highly correlated with the Physician's Global Assessment (r ‫؍‬ 0.91, P < .001), Mayo score (r ‫؍‬ 0.95, P < .001), and colonoscopic appearance (r ‫؍‬ 0.77, P < .001). Correlations were higher than 2 noninvasive adult indices calculated concurrently. Interobserver and test-retest reliability were excellent (intraclass correlation coefficient ‫؍‬ 0.95; 95% CI: 0.93-0.97). Cut-off points were established using receiver operator characteristic curves on the full cohort. Excellent responsiveness was found at repeated visits (effect size ‫؍‬ 1.9, area under the receiver operator characteristic curve ‫؍‬ 0.97). Conclusions: The rigorously developed PUCAI is a noninvasive, valid, highly reliable, and responsive index with which to assess disease activity in pediatric ulcerative colitis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Development, Validation, and Evaluation of a Pediatric Ulcerative Colitis Activity Index: A Prospective Multicenter Study","attachmentId":48869235,"attachmentType":"pdf","work_url":"https://www.academia.edu/6435359/Development_Validation_and_Evaluation_of_a_Pediatric_Ulcerative_Colitis_Activity_Index_A_Prospective_Multicenter_Study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/6435359/Development_Validation_and_Evaluation_of_a_Pediatric_Ulcerative_Colitis_Activity_Index_A_Prospective_Multicenter_Study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="74032042" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/74032042/Outcomes_of_a_National_Cohort_of_Children_with_Acute_Severe_Ulcerative_Colitis">Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="293678" href="https://tcd.academia.edu/TaraRaftery">Tara Raftery</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Frontiers in Pediatrics</p><p class="ds-related-work--abstract ds2-5-body-sm">All Irish children with ulcerative colitis (UC) attend the National Centre for Paediatric Gastroenterology at Our Lady's Children's Hospital, Crumlin. The aim of this study was to determine the outcomes of children with acute severe ulcerative colitis (ASC) and the impact of infliximab on these outcomes following its introduction for this indication in 2011. Methods: A retrospective chart review of all patients admitted with ASC between January 1, 2009 and December 31, 2015 was undertaken. Patients were identified from the departmental database cross-referenced with the hospital inpatient enquiry system. Inpatients with a paediatric ulcerative colitis activity index (PUCAI) of ≥65 were included. Data collected included baseline demographic and laboratory data, concomitant treatments, PUCAI scores on days 3 and 5, second-line treatments, surgery, and discharge outcomes. Infliximab dose, frequency, and available therapeutic drug monitoring results were recorded, along with clinical response outcomes (remission, primary, and secondary loss of response). The cohort was sub-analysed to determine if there was any era effect pre-and post-introduction of infliximab (2009-2010 and 2011-2015, respectively). results: Fifty-five patients (M:F = 1.4:1) were treated for acute severe colitis over the study period (8 in the pre-infliximab and 47 in the post-infliximab era) and 46/55 (86%) had steroid-refractory disease. Of these, 7/8 (88%) required colectomy in the preinfliximab era, compared with 15/47 (36%) in the post-infliximab era. The remission rate with second-line infliximab was 61% at maximal follow-up. There were no identifiable factors that predicted likely success or failure of infliximab, including gender, CRP, day-3 and day-5 PUCAI scores. Of the 33 patients treated with infliximab, dose increase was required in 23/33 (70%); 21/33 (64%) received an accelerated dose schedule, and 9/33 (27%) eventually needed colectomy. Primary and secondary loss of response to infliximab was seen in one and nine patients, respectively. conclusion: This is the first population-based study of the outcomes of severe UC in Irish children, and suggests a higher burden of steroid-refractory disease compared with previous international studies. While infliximab treatment has led to reduction in colectomy rates, a significant proportion of patients lose therapeutic effect.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Outcomes of a National Cohort of Children with Acute Severe Ulcerative Colitis","attachmentId":82332368,"attachmentType":"pdf","work_url":"https://www.academia.edu/74032042/Outcomes_of_a_National_Cohort_of_Children_with_Acute_Severe_Ulcerative_Colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/74032042/Outcomes_of_a_National_Cohort_of_Children_with_Acute_Severe_Ulcerative_Colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="80669795" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/80669795/Natural_history_of_pediatric_ulcerative_colitis_An_Italian_population_based_cohort_study">Natural history of pediatric ulcerative colitis: An Italian population-based cohort study</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="200211395" href="https://independent.academia.edu/mamadougallobalde">mamadou gallo balde</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Digestive and Liver Disease, 2013</p><p class="ds-related-work--abstract ds2-5-body-sm">The natural history of ulcerative colitis (UC) has been poorly described in children. METHODS: In a geographically derived incidence cohort diagnosed from 1988 to 2002, we identifi ed 113 UC patients (age 0-17 years at diagnosis) with a follow-up of at least 2 years. The cumulative risk of colectomy was estimated by the Kaplan-Meier method. Risk factors for disease extension were assessed with logistic regression models, and risk factors for colectomy with Cox hazards proportional models. RESULTS: Median follow-up time was 77 months (46-125). At diagnosis, 28 % of patients had proctitis, 35 % left-sided colitis, and 37 % extensive colitis. Disease course was characterized by disease extension in 49 % of patients. A delay in diagnosis of more than 6 months and a family history of infl ammatory bowel disease were associated with an increased risk of disease extension, with odds ratios of 5.0 (1.2-21.5) and 11.8 (1.3-111.3), respectively. The cumulative rate of colectomy was 8 % at 1 year, 15 % at 3 years, and 20 % at 5 years. The presence of extraintestinal manifestations (EIMS) at diagnosis was associated with an increased risk of colectomy (hazard ratio (HR) = 3.5 (1.2-10.5)). Among the patients with limited disease at diagnosis, the risk of colectomy was higher in those who experienced disease extension than in those who did not (HR = 13.3 1.7-101.7). CONCLUSIONS: Pediatric UC was characterized by widespread localization at diagnosis and a high rate of disease extension. Twenty percent of children had their colon removed after 5 years. The colectomy rate was infl uenced by disease extension and was associated with the presence of EIMS at diagnosis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Natural history of pediatric ulcerative colitis: An Italian population-based cohort study","attachmentId":86975619,"attachmentType":"pdf","work_url":"https://www.academia.edu/80669795/Natural_history_of_pediatric_ulcerative_colitis_An_Italian_population_based_cohort_study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/80669795/Natural_history_of_pediatric_ulcerative_colitis_An_Italian_population_based_cohort_study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="56188905" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/56188905/Risk_factors_and_characteristics_of_extent_progression_in_ulcerative_colitis">Risk factors and characteristics of extent progression in ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="38619165" href="https://independent.academia.edu/MontserratAceituno1">Montserrat Aceituno</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammatory Bowel Diseases, 2009</p><p class="ds-related-work--abstract ds2-5-body-sm">Background: The main objective was to identify risk factors for extent progression in distal ulcerative colitis. The secondary objective was to determine clinical characteristics of disease at the time of progression. Methods: Data were obtained from a prospective database. Distal colitis was defined as disease limited to rectum and sigmoid colon (n ϭ 178), extensive colitis as involvement of at least the descending colon (n ϭ 179), and colitis with progression when there was a change of category from distal to extensive (n ϭ 63). To study clinical characteristics at the time of progression, a nested casecontrol study was performed. Results: Compared to distal colitis, colitis with progression was associated to significantly higher prevalence of extraintestinal manifestations (42.9% versus 15.5%) steroid-refractory course (28.0% versus 2.2%), requirement of thiopurines (44.3% versus 17.3%), cyclosporine (25.4% versus 1.9%), infliximab (9.5% versus 1.2%), surgery (20.6% versus 0.6%), and incidence of neoplasia (6.3% versus 0%). However, these differences appeared after disease progression. Regression analysis demonstrated that preexisting independent predictive factors for progression were younger age at diagnosis (hazard ratio [HR] 0.979 95% confidence interval [CI] 0.959-0.999) and presence of sclerosing cholangitis (HR 12.83, 95% CI 1.36-121.10). The nested case-control study showed that at the time of progression the flare was more severe in cases than in matched controls, with significant differences in markers of disease severity, therapeutic requirements, hospitalizations, and surgery. Conclusions: Patients with distal ulcerative colitis diagnosed at a younger age or with associated sclerosing cholangitis are at higher risk for progression. Disease flare associated with progression follows a severe course with high therapeutic requirements.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Risk factors and characteristics of extent progression in ulcerative colitis","attachmentId":71697618,"attachmentType":"pdf","work_url":"https://www.academia.edu/56188905/Risk_factors_and_characteristics_of_extent_progression_in_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/56188905/Risk_factors_and_characteristics_of_extent_progression_in_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":113427162,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":113427162,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_113427162" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. You can download the paper by clicking the button above.</p></div></div></div></div><div class="ds-sidebar--container js-work-sidebar"><div class="ds-related-content--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="0" data-entity-id="9487751" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/9487751/Severe_paediatric_ulcerative_colitis_incidence_outcomes_and_optimal_timing_for_second_line_therapy">Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="22215362" href="https://uottawa.academia.edu/EricBenchimol">Eric I Benchimol</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gut, 2008</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy","attachmentId":47760788,"attachmentType":"pdf","work_url":"https://www.academia.edu/9487751/Severe_paediatric_ulcerative_colitis_incidence_outcomes_and_optimal_timing_for_second_line_therapy","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/9487751/Severe_paediatric_ulcerative_colitis_incidence_outcomes_and_optimal_timing_for_second_line_therapy"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="1" data-entity-id="126755283" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/126755283/Analysis_of_Using_the_Total_White_Blood_Cell_Count_to_Define_Severe_New_onset_Ulcerative_Colitis_in_Children">Analysis of Using the Total White Blood Cell Count to Define Severe New-onset Ulcerative Colitis in Children</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="35679250" href="https://independent.academia.edu/RobertBaldassano">Robert Baldassano</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Pediatric Gastroenterology &amp; Nutrition, 2020</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Analysis of Using the Total White Blood Cell Count to Define Severe New-onset Ulcerative Colitis in Children","attachmentId":120584997,"attachmentType":"pdf","work_url":"https://www.academia.edu/126755283/Analysis_of_Using_the_Total_White_Blood_Cell_Count_to_Define_Severe_New_onset_Ulcerative_Colitis_in_Children","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/126755283/Analysis_of_Using_the_Total_White_Blood_Cell_Count_to_Define_Severe_New_onset_Ulcerative_Colitis_in_Children"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="2" data-entity-id="29892948" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/29892948/Appraisal_of_the_pediatric_ulcerative_colitis_activity_index_PUCAI_">Appraisal of the pediatric ulcerative colitis activity index (PUCAI)</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="56763369" href="https://independent.academia.edu/LangtonChristine">Christine Langton</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammatory Bowel Diseases, 2009</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Appraisal of the pediatric ulcerative colitis activity index (PUCAI)","attachmentId":50357839,"attachmentType":"pdf","work_url":"https://www.academia.edu/29892948/Appraisal_of_the_pediatric_ulcerative_colitis_activity_index_PUCAI_","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/29892948/Appraisal_of_the_pediatric_ulcerative_colitis_activity_index_PUCAI_"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="3" data-entity-id="117570201" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/117570201/P529_Natural_history_and_management_strategies_of_ulcerative_colitis_UC_in_a_paediatric_population_A_10_year_review_in_a_tertiary_paediatric_gastroenterology_centre">P529 Natural history and management strategies of ulcerative colitis (UC) in a paediatric population: A 10-year review in a tertiary paediatric gastroenterology centre</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="44850349" href="https://independent.academia.edu/LiciaPensabene">Licia Pensabene</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Crohn's and Colitis, 2020</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"P529 Natural history and management strategies of ulcerative colitis (UC) in a paediatric population: A 10-year review in a tertiary paediatric gastroenterology centre","attachmentId":113392959,"attachmentType":"pdf","work_url":"https://www.academia.edu/117570201/P529_Natural_history_and_management_strategies_of_ulcerative_colitis_UC_in_a_paediatric_population_A_10_year_review_in_a_tertiary_paediatric_gastroenterology_centre","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/117570201/P529_Natural_history_and_management_strategies_of_ulcerative_colitis_UC_in_a_paediatric_population_A_10_year_review_in_a_tertiary_paediatric_gastroenterology_centre"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="4" data-entity-id="20484665" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20484665/Ulcerative_colitis_and_clinical_course_Results_of_a_5_year_population_based_follow_up_study_the_IBSEN_study_">Ulcerative colitis and clinical course: Results of a 5-year population-based follow-up study (the IBSEN study)</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="41896169" href="https://uio.academia.edu/Bj%C3%B8rnMoum">Bjørn Moum</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammatory Bowel Diseases, 2006</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Ulcerative colitis and clinical course: Results of a 5-year population-based follow-up study (the IBSEN study)","attachmentId":41397975,"attachmentType":"pdf","work_url":"https://www.academia.edu/20484665/Ulcerative_colitis_and_clinical_course_Results_of_a_5_year_population_based_follow_up_study_the_IBSEN_study_","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/20484665/Ulcerative_colitis_and_clinical_course_Results_of_a_5_year_population_based_follow_up_study_the_IBSEN_study_"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="5" data-entity-id="30404173" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/30404173/Assessing_disease_activity_in_ulcerative_colitis">Assessing disease activity in ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="57953559" href="https://independent.academia.edu/DavidMack6">David Mack</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammatory Bowel Diseases, 2010</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Assessing disease activity in ulcerative colitis","attachmentId":50849645,"attachmentType":"pdf","work_url":"https://www.academia.edu/30404173/Assessing_disease_activity_in_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/30404173/Assessing_disease_activity_in_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="6" data-entity-id="47406163" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/47406163/Clinical_characteristics_of_idiopathic_ulcerative_colitis_in_children">Clinical characteristics of idiopathic ulcerative colitis in children</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="47028631" href="https://independent.academia.edu/DusicaSimic2">Dusica Simic</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Srpski arhiv za celokupno lekarstvo, 2011</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Clinical characteristics of idiopathic ulcerative colitis in children","attachmentId":66513863,"attachmentType":"pdf","work_url":"https://www.academia.edu/47406163/Clinical_characteristics_of_idiopathic_ulcerative_colitis_in_children","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/47406163/Clinical_characteristics_of_idiopathic_ulcerative_colitis_in_children"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="7" data-entity-id="106098146" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/106098146/Parameters_of_a_severe_disease_course_in_ulcerative_colitis">Parameters of a severe disease course in ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="37978121" href="https://independent.academia.edu/WolfgangKruis">Wolfgang Kruis</a></div><p class="ds-related-work--metadata ds2-5-body-xs">World journal of gastroenterology : WJG, 2014</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Parameters of a severe disease course in ulcerative colitis","attachmentId":105385066,"attachmentType":"pdf","work_url":"https://www.academia.edu/106098146/Parameters_of_a_severe_disease_course_in_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/106098146/Parameters_of_a_severe_disease_course_in_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="8" data-entity-id="20484814" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20484814/Clinical_course_and_prognosis_in_ulcerative_colitis_Results_from_population_based_and_observational_studies">Clinical course and prognosis in ulcerative colitis: Results from population-based and observational studies</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42806811" href="https://independent.academia.edu/IKempskiMonstad">I. Kempski-Monstad</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="42006998" href="https://independent.academia.edu/%C3%98isteinHovde">Øistein Hovde</a><span>, </span><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="41896169" href="https://uio.academia.edu/Bj%C3%B8rnMoum">Bjørn Moum</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Annals of Gastroenterology</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Clinical course and prognosis in ulcerative colitis: Results from population-based and observational studies","attachmentId":41398069,"attachmentType":"pdf","work_url":"https://www.academia.edu/20484814/Clinical_course_and_prognosis_in_ulcerative_colitis_Results_from_population_based_and_observational_studies","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/20484814/Clinical_course_and_prognosis_in_ulcerative_colitis_Results_from_population_based_and_observational_studies"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="9" data-entity-id="71876051" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/71876051/Factors_associated_with_early_outcomes_following_standardised_therapy_in_children_with_ulcerative_colitis_PROTECT_a_multicentre_inception_cohort_study">Factors associated with early outcomes following standardised therapy in children with ulcerative colitis (PROTECT): a multicentre inception cohort study</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32448511" href="https://emory.academia.edu/VinTangpricha">Vin Tangpricha</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The Lancet Gastroenterology & Hepatology</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Factors associated with early outcomes following standardised therapy in children with ulcerative colitis (PROTECT): a multicentre inception cohort study","attachmentId":81042537,"attachmentType":"pdf","work_url":"https://www.academia.edu/71876051/Factors_associated_with_early_outcomes_following_standardised_therapy_in_children_with_ulcerative_colitis_PROTECT_a_multicentre_inception_cohort_study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/71876051/Factors_associated_with_early_outcomes_following_standardised_therapy_in_children_with_ulcerative_colitis_PROTECT_a_multicentre_inception_cohort_study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="10" data-entity-id="60027824" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/60027824/Ulcerative_colitis_no_rise_in_mortality_in_a_European_wide_population_based_cohort_10_years_after_diagnosis">Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="37973646" href="https://independent.academia.edu/MortenVatn">Morten Vatn</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Gut, 2007</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Ulcerative colitis: no rise in mortality in a European-wide population based cohort 10 years after diagnosis","attachmentId":73654064,"attachmentType":"pdf","work_url":"https://www.academia.edu/60027824/Ulcerative_colitis_no_rise_in_mortality_in_a_European_wide_population_based_cohort_10_years_after_diagnosis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/60027824/Ulcerative_colitis_no_rise_in_mortality_in_a_European_wide_population_based_cohort_10_years_after_diagnosis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="11" data-entity-id="12440475" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/12440475/Epidemiology_demographic_characteristics_and_prognostic_predictors_of_ulcerative_colitis">Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="31248294" href="https://independent.academia.edu/RaquelRocha20">Raquel Rocha</a></div><p class="ds-related-work--metadata ds2-5-body-xs">World journal of gastroenterology : WJG, 2014</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis","attachmentId":46182832,"attachmentType":"pdf","work_url":"https://www.academia.edu/12440475/Epidemiology_demographic_characteristics_and_prognostic_predictors_of_ulcerative_colitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/12440475/Epidemiology_demographic_characteristics_and_prognostic_predictors_of_ulcerative_colitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="12" data-entity-id="12352598" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/12352598/Review_of_the_disease_course_among_adult_ulcerative_colitis_population_based_longitudinal_cohorts">Review of the disease course among adult ulcerative colitis population‐based longitudinal cohorts</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="31047387" href="https://independent.academia.edu/AndreiaRodrigues23">Andreia Rodrigues</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Inflammatory Bowel …, 2011</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Review of the disease course among adult ulcerative colitis population‐based longitudinal cohorts","attachmentId":46228427,"attachmentType":"pdf","work_url":"https://www.academia.edu/12352598/Review_of_the_disease_course_among_adult_ulcerative_colitis_population_based_longitudinal_cohorts","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/12352598/Review_of_the_disease_course_among_adult_ulcerative_colitis_population_based_longitudinal_cohorts"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="13" data-entity-id="20484780" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/20484780/Ulcerative_colitis_patient_characteristics_may_predict_10_yr_disease_recurrence_in_a_European_wide_population_based_cohort">Ulcerative colitis: patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="41896169" href="https://uio.academia.edu/Bj%C3%B8rnMoum">Bjørn Moum</a></div><p class="ds-related-work--metadata ds2-5-body-xs">The American journal of gastroenterology, 2007</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Ulcerative colitis: patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort","attachmentId":41398042,"attachmentType":"pdf","work_url":"https://www.academia.edu/20484780/Ulcerative_colitis_patient_characteristics_may_predict_10_yr_disease_recurrence_in_a_European_wide_population_based_cohort","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/20484780/Ulcerative_colitis_patient_characteristics_may_predict_10_yr_disease_recurrence_in_a_European_wide_population_based_cohort"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div><div class="ds-related-content--container"><h2 class="ds-related-content--heading">Related topics</h2><div class="ds-research-interests--pills-container"><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="26327" rel="nofollow" href="https://www.academia.edu/Documents/in/Medicine">Medicine</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="64336" rel="nofollow" href="https://www.academia.edu/Documents/in/Population">Population</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="65390" rel="nofollow" href="https://www.academia.edu/Documents/in/Internal_Medicine">Internal Medicine</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="83691" rel="nofollow" href="https://www.academia.edu/Documents/in/Ulcerative_colitis">Ulcerative colitis</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="99773" rel="nofollow" href="https://www.academia.edu/Documents/in/Disease">Disease</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="190203" rel="nofollow" href="https://www.academia.edu/Documents/in/Cohort">Cohort</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="244814" rel="nofollow" href="https://www.academia.edu/Documents/in/Clinical_Sciences">Clinical Sciences</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="1587858" rel="nofollow" href="https://www.academia.edu/Documents/in/Confidence_Interval">Confidence Interval</a><a class="js-related-research-interest ds-research-interests--pill" data-entity-id="2214689" rel="nofollow" href="https://www.academia.edu/Documents/in/Calprotectin">Calprotectin</a></div></div></div></div></div><div class="footer--content"><ul class="footer--main-links hide-on-mobile"><li><a href="https://www.academia.edu/about">About</a></li><li><a href="https://www.academia.edu/press">Press</a></li><li><a href="https://www.academia.edu/documents">Papers</a></li><li><a href="https://www.academia.edu/topics">Topics</a></li><li><a href="https://www.academia.edu/hiring"><svg style="width: 13px; height: 13px; position: relative; bottom: -1px;" aria-hidden="true" focusable="false" data-prefix="fas" data-icon="briefcase" class="svg-inline--fa fa-briefcase fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M320 336c0 8.84-7.16 16-16 16h-96c-8.84 0-16-7.16-16-16v-48H0v144c0 25.6 22.4 48 48 48h416c25.6 0 48-22.4 48-48V288H320v48zm144-208h-80V80c0-25.6-22.4-48-48-48H176c-25.6 0-48 22.4-48 48v48H48c-25.6 0-48 22.4-48 48v80h512v-80c0-25.6-22.4-48-48-48zm-144 0H192V96h128v32z"></path></svg> <strong>We're Hiring!</strong></a></li><li><a href="https://support.academia.edu/hc/en-us"><svg style="width: 12px; height: 12px; position: relative; bottom: -1px;" aria-hidden="true" focusable="false" data-prefix="fas" data-icon="question-circle" class="svg-inline--fa fa-question-circle fa-w-16" role="img" xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512"><path fill="currentColor" d="M504 256c0 136.997-111.043 248-248 248S8 392.997 8 256C8 119.083 119.043 8 256 8s248 111.083 248 248zM262.655 90c-54.497 0-89.255 22.957-116.549 63.758-3.536 5.286-2.353 12.415 2.715 16.258l34.699 26.31c5.205 3.947 12.621 3.008 16.665-2.122 17.864-22.658 30.113-35.797 57.303-35.797 20.429 0 45.698 13.148 45.698 32.958 0 14.976-12.363 22.667-32.534 33.976C247.128 238.528 216 254.941 216 296v4c0 6.627 5.373 12 12 12h56c6.627 0 12-5.373 12-12v-1.333c0-28.462 83.186-29.647 83.186-106.667 0-58.002-60.165-102-116.531-102zM256 338c-25.365 0-46 20.635-46 46 0 25.364 20.635 46 46 46s46-20.636 46-46c0-25.365-20.635-46-46-46z"></path></svg> <strong>Help Center</strong></a></li></ul><ul class="footer--research-interests"><li>Find new research papers in:</li><li><a href="https://www.academia.edu/Documents/in/Physics">Physics</a></li><li><a href="https://www.academia.edu/Documents/in/Chemistry">Chemistry</a></li><li><a href="https://www.academia.edu/Documents/in/Biology">Biology</a></li><li><a href="https://www.academia.edu/Documents/in/Health_Sciences">Health Sciences</a></li><li><a href="https://www.academia.edu/Documents/in/Ecology">Ecology</a></li><li><a href="https://www.academia.edu/Documents/in/Earth_Sciences">Earth Sciences</a></li><li><a href="https://www.academia.edu/Documents/in/Cognitive_Science">Cognitive Science</a></li><li><a href="https://www.academia.edu/Documents/in/Mathematics">Mathematics</a></li><li><a href="https://www.academia.edu/Documents/in/Computer_Science">Computer Science</a></li></ul><ul class="footer--legal-links hide-on-mobile"><li><a href="https://www.academia.edu/terms">Terms</a></li><li><a href="https://www.academia.edu/privacy">Privacy</a></li><li><a href="https://www.academia.edu/copyright">Copyright</a></li><li>Academia ©2025</li></ul></div> </body> </html>