Irritable bowel syndrome,gastro-oesophageal reflux disease and dyspepsia: Overlap analysis using loglinear models

Background and study aimsIrritable bowel syndrome (IBS), gastro-oesophageal reflux disease (GERD) and dyspepsia are three most important gastrointestinal disorders which occur frequently together in patients. This study aims to assess the association between IBS, GERD and dyspepsia by using loglinear model analysis.Patients and methodsThis cross-sectional household survey, the purpose of which was to find the prevalence of gastrointestinal symptoms, disorders and the related factors, has been done from May 2006 to December 2007 in Tehran province, Iran. Subjects were interviewed by trained personnel. GERD was diagnosed as the experience of heartburn and/or acid regurgitation at least once a week for the last 3 months. IBS and dyspepsia were diagnosed according to the Rome III criteria. Loglinear models were applied to investigate the simultaneous association between IBS, GERD and dyspepsia.Results77.9% of IBS patients had dyspepsia symptoms and 74.7% had GERD symptoms as well at the same time. As for the other two symptoms, 66% of GERD patients were also suffering from dyspepsia.ConclusionsThese three symptoms frequently overlap; the overlap is systematic and not by chance or random.     

Effect of depression on health care utilization in patients with end-stage renal disease treated with hemodialysis

Background and objectivesDepression is regarded as the most common psychiatric abnormality in patients on hemodialysis (HD) for end-stage renal disease (ESRD). Although several studies have demonstrated a relationship between depression and utilization of health care in ESRD and other chronic illnesses in developing countries, such evidence from hemodialysis patients is lacking in Iran. This study aims to investigate the effect of depression on health care utilization among Iranian hemodialysis patients.DesignA longitudinal study.SettingBaqiyatallah Hospital (Tehran, Iran) between 2005 and 2006.PatientsOf the 70 enrolled hemodialysis patients, 68 finished the study including 19 depressed and 49 non-depressed ones according to the Hospital Anxiety and Depression Scale (HADS).MeasurementsThe subjects' health care utilization in a six-month period was prospectively assessed by recording the hospital admission and home nurse visits, outpatient physician visits, and patients' emergency department visits for any medical reason. The results were subsequently compared between the study groups.ResultsA higher hospital admission rate (94.7% vs. 55.1%, p = .002; Pearson's chi-square test) as well as a higher likelihood of emergency department visits (73.7% vs. 40.8%, p = 0.002; Pearson's chi-square test) was seen in depressed patients. The frequencies of the other types of health care utilization were not statistically different between the two groups (p > 0.05, Pearson's chi-square test).ConclusionDepression in hemodialysis patients is associated with higher rate of hospital admission, and prospective studies should be conducted to assess whether treatment of depression will decrease health care utilization in these patients.     

Direct and indirect medical costs of functional constipation: a population-based study

Background

Constipation causes a large number of medical visits each year and imposes significant financial toll on healthcare systems worldwide. So the present community-based study was conducted in order to estimate attributable direct and indirect costs to functional constipation (FC) and to provide an overview of related physician visits in general population of Iran.

Methods

From May 2006 to December 2007, a total of 19,200 adult persons (aged 16 and above) were drawn randomly in Tehran province, Iran (response rate 94%). Participants who reported any gastrointestinal symptoms (2,790 persons) were referred to assigned physicians to be questioned about symptoms of functional bowel disorders according to the Rome III criteria. Direct and indirect costs to FC were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$).

Results

Of the total 18,180 consenting participants in this study, 435 (2.4%) had FC according to Rome III criteria. Mean total cost of constipation per person was 146.84 PPP$, of which 128.68 PPP$ was related to direct costs and 18.16 PPP$ to indirect costs. Higher educated persons (189.75 PPP$), those above 64?years of age (373.42 PPP$), subjects with BMI of less than 18.5?kg/m² (510.84 PPP$), and widowed persons (258.50 PPP$) had the highest costs.

Conclusions

This study determined that although the economic burden of FC does not seem to be substantial in comparison to other major health problems, it still exacts a substantial toll on the health system for two reasons: chronicity and ambiguity of symptoms.     

Symptoms,endoscopic findings and reflux monitoring results in candidates for bariatric surgery

BackgroundGastroesophageal reflux disease (GERD) is common in patients with obesity. Diagnosing GERD is important as bariatric operations have different influence on GERD. We assessed reflux symptoms and objective findings prior to surgery.MethodsWork-up included esophageal symptoms quantification by VAS-scores, esophagogastroduodenoscopy (EGD) and 24-h impedance-pH (imp-pH) monitoring off PPI therapy. Imp-pH was classified as abnormal if either %time pH < 4 was abnormal, total number of reflux episodes was elevated or symptom index (SI) was positive.ResultsAmong 100 consecutive patients (68F, age 40 ± 11 years, BMI 44.9 ± 6.9 kg/m²) 54% reported heartburn and/or regurgitation, 71% had objective evidence of GERD (38% endoscopic lesions and 33% only abnormal imp-pH results). Imp-pH was superior to EGD in identifying GERD (sensitivity 85% vs. 54%, p < 0.01). Symptomatic and asymptomatic patients had similar prevalence of esophageal lesions (37% vs. 39%) and abnormal imp-pH findings (68% vs. 50%). Sixty nine percent of patients with abnormal %time pH < 4 had a normal number of reflux episodes.ConclusionHalf of patients with obesity reported typical GERD symptoms and >70% had evidence of GERD. Poor acid clearance was the main mechanisms. Since typical reflux symptoms don’t predict objective findings, endoscopy and reflux monitoring should be part of the surgery work-up especially before restrictive procedures.     

The relationship between gastro-oesophageal reflux disease and asthma during childhood

BackgroundThe relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD.MethodSubjects who were evaluated by 24 h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE.ResultsA total of 204 subjects (49.5% male) with a mean age of 7.8 ± 4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24 h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p = 0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p = 0.001).ConclusionAlthough, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.     

Predictors of clinical response of acid suppression in Chinese patients with gastroesophageal reflux disease

BackgroundUp to 40% of patients with gastroesophageal reflux disease fail to respond to proton pump inhibitor therapy.AimsTo determine predictors of clinical response of proton pump inhibitor therapy.MethodsConsecutive patients with gastroesophageal reflux disease were enrolled prospectively. All patients underwent upper endoscopy and 24-h multichannel intraluminal impedance and pH monitoring before receiving esomeprazole 20 mg b.i.d. for 2 months. Multivariate logistic regression analysis was used to determine the independent predictors of clinical response to proton pump inhibitor therapy.ResultsA total of 204 patients with typical reflux symptoms were recruited and screened. Among them 153 patients (mean age 46.3 ± 10.6 years, 51.0% female) completed all the examinations and were assigned to proton pump inhibitor therapy. Ninety-five patients (62.1%) responded to acid suppression after 2 months. Multivariate logistic analysis showed that the predictor for response was pathological distal esophageal acid reflux (P = 0.001). The factors associated with proton pump inhibitor therapy failure were the presence of irritable bowel syndrome alone (P = 0.006), depression (P = 0.005), and overlap of irritable bowel syndrome and functional dyspepsia (P = 0.002).ConclusionsThe clinical response of acid suppression on gastroesophageal reflux disease could be predicted by clinical and pH parameters rather than impedance data.     

Therapy experiences and preferences among patients with anemia: Results of a cross-sectional survey among Italian patients with inflammatory bowel disease

BackgroundAnemia represents one of the most common and often the least treated complications of inflammatory bowel disease (IBD).AimsOur study investigates experiences and preferences concerning anemia treatment in patients with IBD.MethodsIBD patients previously diagnosed with anemia were invited to participate in an anonymous survey between July and September 2015, which assessed demographic and clinical data, and experiences regarding anemia treatment.ResultsA total of 118 IBD patients were invited to participate in the study, of which 100 (85%) were included in the analysis. Seventy-five percent of patients reported a high personal burden related to intravenous therapy, while the majority of companions (76%) declared a moderate burden. The increased importance assigned to the possibility of a single session treatment was significantly associated with age (Beta = 0.01; p = 0.03), working status (Beta = 0.02; p = 0.04), anemia severity (severe vs. mild, Beta = 0.42; p = 0.03), and intravenous treatment (Beta = 0.44; p = 0.001).ConclusionsMost patients reported a high personal and a moderate companions’ burden. Having the possibility of effective single dose intravenous therapy was of great importance. Patients’ perspective provides key information for evaluating the indirect costs of anemia treatment in IBD which, according to the health technology assessment approach, could be useful in a patient centered decision making process.     

Effect of pulmonary hypertension on outcome of pulmonary tuberculosis

BackgroundThis study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis.MethodsNew cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35 mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis.ResultsOf 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35 mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35 mm Hg (p = 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR = 3.1; 95% CI: 1.44–6.75 and OR = 4.4; 95% CI: 2.35–8.17, respectively).ConclusionA significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis.     

Resource utilization during pediatric to adult transfer of care in IBD

BackgroundThe transition from pediatric to adult care for inflammatory bowel disease (IBD) is poorly understood.AimsTo characterize this transfer of care, health resource utilization was assessed.MethodsPatients transferred between 1999 and 2008 were studied. Utilization of health resources one year before transfer and one year after transfer was compared. Resource units assessed included: i) emergency department (ED) visits; ii) hospitalizations; iii) clinic visits; iv) surgical procedures; and v) endoscopies. Secondary outcomes included: i) documentation of patient non-compliance; ii) reason(s) for ED visit; iii) diagnoses most responsible for hospital admission; iv) medications; v) indications for surgery; vi) endoscopic findings; vii) and disease activity.Results95 subjects were identified (48 female), of whom 69 had Crohn's disease (CD) and 26 had ulcerative colitis (UC). The average age of diagnosis was 12.9 years. Over their adult care interval, subjects had fewer clinic visits (2.56 versus 3.05 (p = 0.01)) and more documented non-compliance (43% versus 29% (p = 0.01)). No differences in ED visits (0.15 versus 0.18 (p = 0.71)), hospitalizations (0.13 versus 0.13 (p = 0.23)), surgical intervention (0.03 versus 0.05 (p = 0.53)) or endoscopies (0.37 versus 0.25 (p = 0.11)) were observed. IBD was active 66.7% of endoscopies under pediatric care versus only 23.8% under adult care (p = 0.003). The average activity of CD was also higher during the last year of pediatric care.ConclusionsUnderstanding the transition process can help to develop strategies needed to support patients and their families.     

HEPACONTROL. A program that reduces early readmissions,mortality at 60 days,and healthcare costs in decompensated cirrhosis

Background & aimsDecompensated cirrhosis patients have an elevated incidence of early readmission, mortality and economic burden. The aims of HEPACONTROL were to reduce early readmission and to evaluate its impact on mortality and emergency department visits.Patients and methodsQuasi-experimental study with control group which compared two cohorts of patients discharged after being admitted for cirrhosis-related complications. A prospective cohort (n = 80), who followed the HEPACONTROL program, which began with a follow-up examination seven days after discharge at the Hepatology Unit Day Hospital and a retrospective cohort of patients (n = 112), who had been given a standard follow-up. Outcome variables that were compared between both groups were early readmission rates, the number of emergency department visits post-discharge, financial costs and mortality.ResultsThe rate of early readmission was lower in the group with HEPACONTROL (11.3% vs 29.5%; P = .003). Also, the mean number of visits to the emergency department post-discharge (1.10 ± 1.64 vs 1.71 ± 2.36; P = .035), mortality at 60 days (3.8% vs 14.3%; P = .016), and the cost of early readmission were all lower compared with the group with standard follow-up (P = .029).ConclusionsHEPACONTROL decreases the incidence of early readmission the rate of emergency department visits and mortality at 60 days in patients with decompensated cirrhosis, and it is cost-effective.     

Changes in the management of IBD patients since the onset of COVID-19 pandemic. A path toward the implementation of telemedicine in Spain?

BackgroundCOVID-19 pandemic increased medical services demand aside from interrupting daily clinical practice for other diseases such as inflammatory bowel disease (IBD). Here we present the results of a survey to gain the perception of IBD specialists in their patient-management using telemedicine in their daily practice.MethodsThis was an observational survey study among physicians focused on IBD (gastroenterologist, surgeons, and pediatricians) members of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), the Spanish Association of Gastroenterology (AEG), and the Spanish Association of Coloproctology (AECP), regarding changes of management of IBD patients.ResultsWe received a total of 269 responses to the survey (from May to June 2020). Before the pandemic, nearly all the respondents reported performing very frequently their visits face-to-face (n = 251, 93.3%) while, during the pandemic, the telephone visits were the most frequent visits performed (n = 138, 51.3%). Regarding communication difficulties, 157 (58.4%) respondents reported the impossibility of performing a proper examination as the most relevant issue. Also, 114 (42.4%) respondents considered remote visits more time-consuming than face-to-face visits. Most gastroenterologists (n = 188, 83.2%) considered patients with active perianal disease in special need of face-to-face consultation and more than half of the surgeons (n = 35, 50.7%) reported having performed an immediate postoperative follow-up remotely.ConclusionsMost IBD units have implemented remote visits during the pandemic, but most professionals found them more time-consuming and unsuitable for some disease profiles. Therefore, there is a need for the development of better telemedicine systems that can meet professionals’ and patients’ requirements.     

Diagnostic value of a pattern of exhaled breath condensate biomarkers in asthmatic children

BackgroundDiagnosing asthma in children is a challenge and using a single biomarker from exhaled breath condensate (EBC) showed the lack of improvement in it.ObjectiveThe aim of this study was to assess the diagnostic potential of a pattern of simple chemical biomarkers from EBC in diagnosing asthma in children in a real-life setting, its association with lung function and gastroesophageal reflux disease (GERD).MethodsIn 75 consecutive children aged 5–7 years with asthma-like symptoms the following tests were performed: skin prick tests, spirometry, impulse oscillometry (IOS), exhaled NO (F_ENO), 24-hour oesophageal pH monitoring and EBC collection with subsequent analysis of pH, carbon dioxide tension, oxygen tension, and concentrations of magnesium, calcium, iron and urates.ResultsNo significant differences were found for individual EBC biomarkers between asthmatics and non-asthmatics (p > 0.05 for all). A pattern of six EBC biomarkers showed a statistically significant (p = 0.046) predictive model for asthma (AUC = 0.698, PPV = 84.2%, NPV = 38.9%). None to moderate association (R² up to 0.43) between EBC biomarkers and lung function measures and F_ENO was found, with IOS parameters showing the best association with EBC biomarkers. A significantly higher EBC Fe was found in children with asthma and GERD compared to asthmatics without GERD (p = 0.049).ConclusionsAn approach that involves a pattern of EBC biomarkers had a better diagnostic accuracy for asthma in children in real-life settings compared to a single one. Poor to moderate association of EBC biomarkers with lung function suggests a complementary value of EBC analysis for asthma diagnosis in children.     

The role of illness schemata in self-care behaviors and glycemic control among patients with type 2 diabetes in Iran

AimsThe diabetes illness perception domains outlined by Leventhal’s common-sense model may be weakly associated with hemoglobin A1c (HbA1c) and adherence to diabetes self-care behaviors. However, type 2 diabetes patients’ illness schemata identified by clustering the illness perception domains remain to be explained. This study aimed to describe type 2 diabetes patients’ illness schemata and to examine their association with self-care behaviors and glycemic control in Iran.MethodsA cross-sectional survey was conducted with 200 patients (mean age 59.5 ± 10.3; 70% female) who attended self-management classes at the Iranian Diabetes Society in Tehran. Illness perceptions and self-care behaviors were assessed using the Persian version of the Illness Perception Questionnaire Revised and the Summary of Diabetes Self-Care Activity.ResultsThree clusters of diabetes illness beliefs were identified: “empowered,” “self-condemned,” and “powerless.” “Empowered” participants adhered most rigorously to general diet, fruit and vegetable intake, and exercise, and had the best glycemic control (HbA1c = 7.2%, SD = 0.2), followed by “self-condemned” and then “powerless” participants, who had the lowest adherence and the worst glycemic control (p < 0.0001).ConclusionsThe clustering method for identifying type 2 diabetes patients’ illness schemata is useful for selecting patients who need further care and assistance with adhering to self-care behaviors and glycemic control.     

A structural equation model of the relation between socioeconomic status,physical activity level,independence and health status in older Iranian people

Background and aimHealth status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.MethodsUsing computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007–2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.ResultsThe measurement model yielded a reasonable fit to the data, χ2 = 110.93, df = 38; CFI = 0.97; RMSEA = 0.047, with 90% C.I. = 0.037–0.058. The model fit for the conceptual model was acceptable; χ2 = 271.64, df = 39; CFI = 0.91; RMSEA = 0.084, with 90% C.I. = 0.074–0.093. SES itself was not a direct predictor of HS (β = 0.13, p = 0.059) but it was a predictor of HS either through affecting PA (β = 0.31, p < 0.001) or I (β = 0.57, p < 0.001).ConclusionSocioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.     

The effectiveness of foot care education on people with type 2 diabetes in Tehran,Iran

AimThe aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran.MethodsOne hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20 min education session individually. The mode of the intervention was face-to-face.ResultsThe applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care (P < 0.0001 and P = 0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI ≤ 25) rather than the obese ones.ConclusionsIn conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs.     

The effect of Helicobacter pylori eradication on dyspeptic symptoms,acid reflux and quality of life in patients with functional dyspepsia

BackgroundThe aims of this study were to investigate the effect of Helicobacter pylori eradication on gastroesophageal reflux, gastrointestinal symptoms and quality of life in patients with functional dyspepsia.Methods20 H. pylori positive patients diagnosed as having functional dyspepsia according to Roma-II criteria completed the study period. Esophageal motility testing and pH recordings were obtained from each patient before and at the end of the study period. Each patient's gastrointestinal symptoms were evaluated according to Glasgow dyspepsia score. 36-Item short-form health survey (SF-36) and EDQ5 health survey were obtained form each patient.ResultsH. pylori eradication was accomplished in 13 patients (65%). Glasgow dyspepsia symptom score improved in H. pylori eradicated patients (10.3 vs 7.5, p < 0.05) compared to baseline. Fasting lower esophageal sphincter pressures increased (21.6 vs 25.4 mmHg, p < 0.05) after H. pylori eradication Neither the amplitude of peristaltic contractions in the esophageal body (59.4 vs 57.7 mmHg, p = ns) nor the velocity of peristaltic contractions changed before and after eradication. The percent time of esophageal pH < 4 (0.7 vs 2.6, p < 0.001), reflux events longer than 5 min (0 vs 0.7, p < 0.005) and total reflux number (10.3 vs 19.3, p < 0.005) significantly increased after eradication therapy. In the SF-36 health-related quality of life survey, general health score was 3.5 vs. 3.4, physical activity 25.2 vs. 26.4, physical role 5.9 vs. 6.3, emotional pain 4.6 vs. 4.5, social activity 2.0 vs. 1.9, physical pain 3.4 vs. 3.0, vitality 32.3 vs. 34.6, and mental health 11.9 vs. 11.5, before and at the end of treatment (p = ns), respectively.ConclusionsH. pylori eradication did not influence quality of life in patients with functional dyspepsia. Majority of the patients experienced a significant change in esophageal acid exposure after H. pylori eradication. H. pylori eradication significantly decreases gastrointestinal symptoms, however has no effect on quality of life in patients with functional dyspepsia.     

Association of adiponectin with dietary factors and cardiovascular risk factors in type 2 diabetes mellitus patients

Background and aimAdiponectin, is an adipose tissue-specific adipokine, that circulates in human plasma at high levels, although lower levels are noted with insulin resistance and atherosclerosis. We investigated the relationship of adiponectin concentrations with dietary factors and some of the cardiovascular risk factors in patients with T2DM.Methods and resultsTotally 107 patients with T2DM were recruited from the out patients clinic of Shariati Hospital, Tehran, Iran. Patients were evaluated for laboratory and anthropometric measurements including serum adiponectin, fasting insulin, FPG, OGTT, HbA1c, HOMA-IR, hsCRP, weight, height, BMI and WHR. Nutrients intakes were obtained via 24-h recall from each patient in three successive days. Nutrients and data analysis were done using FPII and SPSS version 13 softwares. The mean of log 10-transformed serum adiponectin concentration was 0.79 ± 0.27 μg/ml. The univariate linear regression analysis could not show any significant relation between the log of serum adiponectin and dietary factors. In multivariate linear regression after multiple adjustment, the log of serum adiponectin was independently associated with WHR (P = 0.02, t = ?2.33), HDL-C (P = 0.050, t = 2.03) and markedly but not significantly with age of patients (P = 0.058, t = 1.92).ConclusionsOur findings showed that WHR, one of the important cardiovascular risk factors, can modulate independently adiponectin levels of T2DM patients in inverse manner. Also, the age of patients and HDL-C levels have marked positive effect on circulating levels of this adipocytokine. Thus, adiponectin might be a useful biomarker to prevent developing CVD in type 2 diabetes.     

Prevalence,characteristics, and acute care utilization of disabled older adults with an absence of help for activities of daily living: Findings from a nationally representative survey

ObjectiveThe aim of this study was to investigate the prevalence, characteristics, and acute care utilization of community dwelling disabled older adults with an absence of help for activities of daily living (ADL).MethodsWe analyzed cross-sectional data from a nationally representative sample of people aged 65 years and over (n = 2904) participating in the 2009 National Health Interview Survey in Taiwan. Disability was defined as self-reporting a lot of difficulty or complete inability to carry out one or more ADL tasks. Participants with disability were asked whether they received help in the form of personal assistance or assistive devices to complete ADL tasks, with a yes response indicating the presence of help and a no response indicating the absence of help. Hospitalization and emergency department visits was assessed as a dichotomous variable (any or none), respectively.ResultsAn absence of available help for ADL disability was reported in 16.6% of disabled older adults. Disabled older adults reporting an absence of help were more likely to be female. After adjustment for other factors, compared to older adults without disability, older adults with disability not receiving help for ADL tasks were highly related to hospitalization (OR = 4.57; 95%CI = [1.51–13.82]) and emergency department visits (OR = 3.52; 95%CI = [1.15–10.76]) during the past year, respectively.ConclusionsWe found that there is high prevalence of absence of help to perform ADL tasks in older adults with disability, and that this absence of help for ADL disability is associated with a greater burden of acute care utilization than those without disability.     

Epidemiología,carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México

Introduction and aimsThere is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups.Materials and methodsUtilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined.ResultsIn 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥ 50 years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥ 50 years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥ 50 years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥ 50 years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis.ConclusionsInflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15 years.