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Day AS, Yao CK, Costello SP, Andrews JM, Bryant RV. Food-related quality of life in adults with inflammatory bowel disease is associated with restrictive eating behaviour, disease activity and surgery: A prospective multicentre observational study. J Hum Nutr Diet 2021; 35:234-244. [PMID: 34008222 DOI: 10.1111/jhn.12920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Measuring food-related quality of life (FRQoL) quantifies the psychosocial impact of eating and drinking. FRQoL and associated factors are not well explored in people with inflammatory bowel disease (IBD), despite IBD being a chronic disease affecting the digestive tract. The present study aimed to characterise and identify any patient or disease-related predictors of FRQoL in individuals with IBD. METHODS Adults with a formal diagnosis of IBD were recruited to a prospective multicentre cross-sectional study between April 2018 and December 2019. Participants completed questionnaires measuring FRQoL (FRQoL-29), clinical disease activity (Harvey Bradshaw Index and Simple Clinical Colitis Activity Index), restrictive eating behaviour (Nine-Item Avoidant/Restrictive Food Intake Disorder Screen), mental health (Depression Anxiety Stress Scale-21) and other patient and disease-related variables. A multivariable regression was performed to identify factors associated with FRQoL. RESULTS One hundred and eight participants completed the questionnaires (n = 39, Crohn's disease; n = 69, ulcerative colitis). The mean FRQoL was 79 (95% confidence interval = 75-84) (poor, 0; superior, 145). Poorer FRQoL was observed in those with restrictive eating behaviour associated with fear of a negative consequence from eating (p < 0.0001) and reduced appetite (p < 0.030). Greater FRQoL was observed in those with lower disease activity (p < 0.0001) and previous IBD surgery (p = 0.024). FRQoL was not associated either way by IBD phenotype, duration, or gender. The majority of participants obtained their dietary information from the internet (60%) or gastroenterologist (46%). CONCLUSIONS FRQoL in people with IBD is poorer in those with restrictive eating behaviours and clinically active disease. Interestingly, it was greater in those with previous IBD surgery. Further research is required to validate these associations and explore longitudinal effects of poor FRQoL on patient outcomes and potential strategies for prevention or management of impaired FRQoL in IBD.
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Affiliation(s)
- Alice S Day
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Chu K Yao
- Translational Nutritional Sciences, Department of Gastroenterology, Monash University & Alfred Hospital, Melbourne, VIC, Australia
| | - Samuel P Costello
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jane M Andrews
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia.,Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert V Bryant
- Inflammatory Bowel Disease Services, The Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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Kelso M, Weideman RA, Cipher DJ, Feagins LA. Factors Associated With Length of Stay in Veterans With Inflammatory Bowel Disease Hospitalized for an Acute Flare. Inflamm Bowel Dis 2017; 24:5-11. [PMID: 29272483 DOI: 10.1093/ibd/izx020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reducing hospital costs and risk of complications by shortening length of stay has become paramount. The aim of our study was to identify predictors and potentially modifiable factors that influence length of stay among veterans with inflammatory bowel disease admitted for an acute flare. METHODS Retrospective review of patients admitted to the Dallas VA with an acute flare of their inflammatory bowel disease between 2000 and 2015. Patients with a length of stay of ≤4 days were compared with those whose length of stay >4 days. RESULTS A total of 180 admissions involving 113 patients (59 with ulcerative colitis and 54 with Crohn's disease) were identified meeting inclusion criteria. The mean length of stay was 5.3 ± 6.8 days, and the median length of stay was 3.0 days. On multiple logistic regression analysis, initiation of a biologic, having undergone 2 or more imaging modalities, and treatment with intravenous steroids were significant predictors of longer lengths of stay, even after controlling for age and comorbid diseases. CONCLUSIONS We identified several predictors for longer hospital length of stay, most related to disease severity but several of which may be modifiable to reduce hospital stays, including most importantly consideration of earlier prebiologic testing. Future studies are needed to evaluate the impact of interventions targeting modifiable predictors of length of stay on health care utilization and patient outcomes.
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Affiliation(s)
- Michael Kelso
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Linda A Feagins
- Department of Medicine, VA North Texas Healthcare System, Dallas, Texas.,Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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Mozzi A, Meregaglia M, Lazzaro C, Tornatore V, Belfiglio M, Fattore G. A comparison of EuroQol 5-Dimension health-related utilities using Italian, UK, and US preference weights in a patient sample. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:267-74. [PMID: 27358571 PMCID: PMC4912314 DOI: 10.2147/ceor.s98226] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Weights associated with the EuroQol 5-Dimension 3-Level (EQ-5D-3L) instrument represent preferences for health states elicited from general population's samples. Weights have not been calculated for every country; however, empirical research shows that cross-country differences exist. This empirical study aims at investigating the impact of recently developed Italian weights in comparison with UK and US scores on health-related utility calculation using a sample of patients with Crohn's disease. The study is based on a survey on health-related quality of life in patients (n=552) affected by active Crohn's disease conducted in Italy from 2012 to 2013. Utilities computed through the Italian algorithm (mean: 0.76; SD: 0.20; median: 0.81) are generally higher than US (mean: 0.69; SD: 0.22; median: 0.77) and UK (mean: 0.57; SD: 0.32; median: 0.69) utilities, except for extremely severe health states where US values outweigh the Italian ones. UK preference weights generate the highest number of negative results. All the three value distributions are left-skewed due to very low scores associated with the most serious health states (ie, three or four levels equal to 3). As expected, despite the tariff set considered, more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Kendall's rank correlation between EQ Visual Analog Scale score and EQ-5D-3L index is positive (P<0.0001), even though patients tend to value their health-related quality of life more when responding to EQ-5D-3L questions than on EQ Visual Analog Scale. Regardless of the tariff set considered, ordinary least-square results highlight that more severe disease (Harvey Bradshaw Index >16) reduces the mean conditional EQ-5D-3L index (P<0.0001). Results reveal remarkable differences among the three national tariff sets and especially when severe health states occur, suggesting the need for country-specific preference weights when evaluating utilities, which can be problematic since they have not been calculated for every country yet.
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Affiliation(s)
- Adelaide Mozzi
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Michela Meregaglia
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Milan, Italy
| | | | | | | | - Giovanni Fattore
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
- Centre for Research on Health and Social Care Management (CeRGAS), Bocconi University, Milan, Italy
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Meregaglia M, Banks H, Fattore G. Hospital Burden and Gastrointestinal Surgery in Inflammatory Bowel Disease Patients in Italy: A Retrospective Observational Study. J Crohns Colitis 2015; 9:853-62. [PMID: 26069194 DOI: 10.1093/ecco-jcc/jjv104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUNDS AND AIMS Despite recent advances in medical therapies for inflammatory bowel disease [IBD], little is known about their impact on inpatient management. Our objectives were to explore hospitalisation and surgery trends for all IBD patients in Italy at three time points over 7 years. METHODS National hospital discharge records were retrospectively reviewed for all admissions with a Crohn's disease [CD, 555*] or ulcerative colitis [UC, 556*] diagnosis in 2005, 2008, and 2011. Quantitative variables [mean, standard deviation] and categorical variables [frequencies] were described; comparison among admission-years was made by analysis of variance and chi-square tests. A multivariate logistic regression analysis was performed to identify predictors of surgery risk regarding demographics, inpatient management, and clinical features; p-values ≤ 0.05 were considered statistically significant. RESULTS Overall, 109657 hospitalisations occurred over the 3 years, with a decreasing trend observed in UC admissions. Mean age was higher in UC [50.1±19.7] than in CD [43.2±21.9]. The number of paediatric admissions rose from 3637 to 4372 between 2005 and 2011. An increasing proportion of CD [from 12.4% to 14.6%] and UC [from 5.8% to 8.0%] admissions reported a digestive system-related, surgical diagnosis-related group in the same period; overall, gastrointestinal surgical admissions increased from 3299 to 3964. In regression analysis, male gender, age, admission year, northern university hospital, disease localisation, and cancer as independent factors significantly affected the likelihood of surgery. CONCLUSIONS Despite a reduction in total IBD hospitalisations, surgical and paediatric admissions rose over time. Further study is needed to clarify benefits associated with new drugs in terms of inpatient management.
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Affiliation(s)
- Michela Meregaglia
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Helen Banks
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Giovanni Fattore
- CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Ebringer A, Rashid T, Tiwana H, Wilson C. A possible link between Crohn's disease and ankylosing spondylitis via Klebsiella infections. Clin Rheumatol 2006; 26:289-97. [PMID: 16941202 DOI: 10.1007/s10067-006-0391-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 06/20/2006] [Accepted: 06/27/2006] [Indexed: 02/06/2023]
Abstract
Crohn's disease (CD) is an immune-mediated gastrointestinal inflammatory disease, which could arise from an interplay between genetic and environmental factors. Klebsiella microbes were suggested to have a vital role in the initiation and perpetuation of the disease through the mechanism of molecular mimicry. This proposition is based on the results of various studies where significantly elevated levels of antibodies against the whole bacteria or preparations from Klebsiella microbes and antibodies to collagen types I, III, IV, and V were detected in patients with CD and patients with ankylosing spondylitis (AS). Molecular similarities were found between Klebsiella nitrogenase and HLA-B27 genetic markers and between Klebsiella pullulanase and collagen fibers types I, III, and IV. Furthermore, significantly positive correlations and cross-reactivity binding activities were observed between anti-Klebsiella and anticollagen antibodies among patients with CD and AS. Early treatment of CD patients with anti-Klebsiella measures is proposed, which may involve the use of antibiotics and low starch diet together with other traditionally used immunomodulatory, immunosuppressive, or biologic agents.
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Affiliation(s)
- Alan Ebringer
- School of Biomedical and Health Sciences, King's College London, 150 Stamford Street, London, SE1 9NN, UK.
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Retrospective analysis of 515 cases of Crohn's disease hospitalization in China: nationwide study from 1990 to 2003. J Gastroenterol Hepatol 2006; 21:1009-15. [PMID: 16724987 DOI: 10.1111/j.1440-1746.2006.04140.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of the present paper was to investigate the status of Crohn's disease hospitalization in China. METHODS Medical records of hospitalized Crohn's disease came from 22 medical centers across China during 1990-2003 and were retrospectively reviewed. Every incident case was recorded in detail on a regular comprehensive datum form by investigators in person. Clinical manifestations, examinations and therapeutic status were analyzed. RESULTS A total of 515 cases of Crohn's disease were found. The ratio of patients with Crohn's disease to total hospitalized patients has increased steadily year by year. Endoscopy was performed in 348 patients (67.57%). Barium meal or enema was performed in 221 patients (42.91%). Histological examination (endoscopical or surgical biopsy) was performed in 340 patients (66.02%). Reasonable treatment strategies were used for 435 patients (84.47%). The evaluation of quality of life for 54/303 patients (17.82%) was poor. CONCLUSIONS This retrospective, hospital-based study shows that the number of patients with Crohn's disease in China has steadily increased over a period of 14 years. Further population-based epidemiological studies specifically focusing on risk factors are needed. The diagnosis of Crohn's disease and therapeutic strategy require improvement.
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