Health-related quality of life in patients with newly diagnosed inflammatory bowel disease: an observational prospective cohort study (IBSEN III)

PURPOSE

This unselected, population-based cohort study aimed to determine the level of health-related quality of life (HRQoL) in patients with Crohn's disease (CD) and ulcerative colitis (UC) at the time of diagnosis compared with a reference population and identify the demographic factors, psychosocial measures, and disease activity markers associated with HRQoL.

METHODS

Adult patients newly diagnosed with CD or UC were prospectively enrolled. HRQoL was measured using the Short Form 36 (SF-36) and Norwegian Inflammatory Bowel Disease Questionnaires. Clinical significance was assessed using Cohen's d effect size and further compared with a Norwegian reference population. Associations between HRQoL and symptom scores, demographic factors, psychosocial measures, and disease activity markers were analyzed.

RESULTS

Compared with the Norwegian reference population, patients with CD and UC reported significantly lower scores in all SF-36 dimensions, except for physical functioning. Cohen's d effect sizes for men and women in all SF-36 dimensions were at least moderate, except for bodily pain and emotional role for men with UC and physical functioning for both sexes and diagnoses. In the multivariate regression analysis, depression subscale scores ≥ 8 on the Hospital Anxiety and Depression Scale, substantial fatigue, and high symptom scores were associated with reduced HRQoL.

CONCLUSION

Patients newly diagnosed with CD and UC reported statistically and clinically significantly lower scores in seven of the eight SF-36 dimensions than the reference population. Symptoms of depression, fatigue, and elevated symptom scores were associated with poorer HRQoL.

[Obstructive lung disease in a department of pulmonary medicine during the period 1979-80]

Trends in the hospital care of patients with obstructive lung disease at the Department of Respiratory Medicine, Vest-Agder Central Hospital are surveyed for the period 1970 to end of 1988. Information was obtained from annals, computerised lists and patient records. The number of beds was reduced from 56-58 during the 1970s to 29 in 1988. The stay in hospital averaged 20 days in 1970 and was down to five days for asthmatics and some ten days for the rest in 1988. Parallel to these changes these were more re-admissions during the 1980s. For a minority of 17 patients admitted to the department in 1988 the number of admissions in the course of the year totalled 165. Mean age increased from 50 years for both sexes in 1970 to 60 years for women and 65 years for men in 1988. Start of symptoms before 20 years of age occurred in less than 20% of the patients, and the frequency of allergics was far below the figures often stated for the whole population. There was a marked discrepancy between the diagnostic labels used by general practitioners and the ones used by general practitioners tendency for general practitioners to label patients as asthmatics more often than the hospital doctors did.

[Response to inhaled bronchodilators in chronic airway obstruction]

OBJECTIVE

To assess the proportion of patients with chronic limited airflow who obtain a meaningful bronchodilatory effect from the betaadrenergic agonist salbutamol and the anticholinergic agent ipratropiumbromide.

PATIENTS

198 patients with varying degrees of airflow limitation. The state of all patients was stable.

METHODS

Spirometry was recorded before inhalation, and ten, 20 and 30 minutes after inhalation of 0.2 mg salbutamol or 0.04 mg ipratropiumbromide.

RESULTS

FVC increased by 0.5 litres or more in 77 patients with salbutamol and in 104 patients with ipratropiumbromide. FEV1 increased by 0.3 litres or more in 76 patients with salbutamol and in 95 patients with ipratropiumbromide. In 77 patients, neither of the drugs caused this improvement in FEV1.

CONCLUSION

In patients with chronic limitation of airflow use of inhaled bronchodilators should be based on the proven clinically significant effect of the drug in question.

[Lung health in middle age. Screening of 40-year old persons in Vest-Agder]

A cross-sectional estimation of lung function was performed on 5,083 subjects of both sexes in 1987. These subjects also completed a self-administered questionnaire (response rate 96.1%). In both sexes FEV1 below the stipulated normal was significantly more common in current smokers than in life-long non-smokers. 23% of the females and 13% of the males reported allergic symptoms. Pollen allergies were experienced by 7% of the females and 5% of the males. 10% of both sexes had experienced asthma or bronchitis as a child. However, only 20% of those who reported childhood asthma or bronchitis still had difficulty in breathing. A low FEV1 was no more common among those who had experienced childhood asthma or bronchitis, or among those who reported allergies, asthma or bronchitis among close relatives, than among those who did not report such potential risk factors. On the other hand, dyspnea was much more common among those who reported the potential risk factors than among those who did not.

Parietal pleural plaques: a comparison between autopsy and X-ray findings

In a series of 402 consecutive autopsies, parietal pleural plaques (PP) were found in 68 individuals above 40 years of age. The frequency of PP was 26.9% in males and 3.1% in females. In 28 cases chest roentgenographs taken shortly before death were available. These films were randomly mixed with chest roentgenographs from 33 subjects who had subsequently died and in whom no PP had been found at autopsy. All films were scrutinized by two experienced readers, ignorant of the case histories and autopsy findings. In less than half the PP cases was this diagnosis suggested from the roentgenological examination. On the other hand, the readers had 13 and 14 cases with positive or uncertain findings in the 33 cases with no PP found at autopsy. There was no correlation between plaque area and plaque thickness (r = 0.037). Plaque thickness influenced the accuracy of roentgenological diagnosis significantly. In this series no oblique views were obtained and the X-rays were of mixed quality.