A Single Educational Intervention Improves Pregnancy-Related Knowledge and Emotional Health Among Women With IBD Who Are Pregnant or Wish to Conceive.

Assessment of health-related quality of life in patients with inflammatory bowel disease in occupied Palestinian territory: a correlation cross-sectional study

An Apple a Day Keeps the Doctor Away: The Effect of a Low-Fat, High-Fiber Diet on Quality of Life, Inflammation, and Dysbiosis in Patients With Ulcerative Colitis

Introduction: One of the most important goals of any treatment for inflammatory bowel disease (IBD) is the overall improvement of the patients' quality of life (QOL), because both Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases, mostly necessitating lifelong drug treatment in order to maintain remission. The poor adherence of patients to the long-lasting medical therapy is one of the most important factors of the treatment failure. Aims: The aim of our study was to assess the medication adherence in connection with the QOL in our patients with IBD in order to identify how the patients' condition affects the attitude to maintenance therapy. Patients and methods: Health-related QOL and medication adherence were measured by questionnaires posted to 150 IBD patients treated at our department. After the assessment of the questionnaires, patients were classified into three groups on the basis of their answers related to the QOL. Relationships between different predictors and the QOL and the medication adherence were statistically analyzed in every group. P values<0.05 were considered statistically significant. Results: 69 IBD patients (23 CD, 46 UC) completed the questionnaires. There was no significant difference between the QOL of CD and UC patients. 23% of the IBD patients were classified into the good, 45% into moderate and 32% into bad groups of QOL. 5-ASA compounds were the most frequently unused therapeutic agents. Forgetfulness was the most common comment of the non-adherence. Disease activity, reduced work productivity, low income and disability were the strongest predictors of QOL impairment. The significantly highest proportion (31%) of non-adherence was observed in the IBD patients being in remission. Summary: IBD contributed to moderate or bad QOL in 77% of our patients. Patients in remission had the highest risk for becoming non-adherent to their prescribed treatment regimen. Improving QOL should be very important in the care of IBD patient; however, without increasing the compliance, there is no chance to modify the long-lasting outcome of IBD.

Patients with inflammatory bowel disease (IBD) suffer physical dysfunction and impaired quality of life (QOL), and need frequent health care. They often lack knowledge about their disease and desire more education. Educational interventions for other chronic diseases have demonstrated reduced health care use and increased knowledge, medication adherence and QOL. Sixty-nine participants were randomly assigned to formal IBD education and standard of care (pamphlets and ad hoc physician education) or standard of care alone. Assessment of IBD knowledge and QOL occurred at baseline, immediately posteducation and eight weeks posteducation. Participants documented medication adherence and health care use in diaries. Patient satisfaction was assessed at the end of the study. The education group had higher knowledge scores (P=0.000), perceived knowledge ratings (P=0.01) and patient satisfaction (P=0.001). There was a lower rate of medication nonadherence and health care use for the education group, but the differences were not significant. QOL indices did not change. Significant correlations were found for increased health care use in patients with poorer medication adherence (P=0.01) and lower perceived health (P=0.05). Formal IBD patient education improves knowledge, perceived knowledge and patient satisfaction. Further study of long-term effects may better demonstrate potential benefits for QOL, medication adherence and health care use.

BackgroundTelemedicine plays an important role in the management of inflammatory bowel disease (IBD), particularly during a pandemic such as COVID-19. However, the effectiveness and efficiency of telemedicine in managing IBD are unclear.ObjectiveThis systematic review and meta-analysis aimed to compare the impact of telemedicine with that of standard care on the management of IBD.MethodsWe systematically searched the PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases on April 22, 2020. Randomized controlled trials comparing telemedicine with standard care in patients with IBD were included, while conference abstracts, letters, reviews, laboratory studies, and case reports were excluded. The IBD-specific quality of life (QoL), disease activity, and remission rate in patients with IBD were assessed as primary outcomes, and the number of in-person clinic visits per patient, patient satisfaction, psychological outcome, and medication adherence were assessed as secondary outcomes. Review Manage 5.3 and Stata 15.1 were used for data analysis.ResultsA total of 17 randomized controlled trials (2571 participants) were included in this meta-analysis. The telemedicine group had higher IBD-specific QoL than the standard care group (standard mean difference 0.18, 95% CI 0.01 to 0.34; P.03). The number of clinic visits per patient in the telemedicine group was significantly lower than that in the standard care group (standard mean difference −0.71, 95% CI −1.07 to −0.36; P<.001). Subgroup analysis showed that adolescents in the telemedicine group had significantly higher IBD-specific QoL than those in the standard care group (standard mean difference 0.42, 95% CI 0.15 to 0.69; I2=0; P.002), but there was no significant difference between adults in the 2 groups. There were no significant differences in disease activity, remission rate, patient satisfaction, depression, self-efficacy, generic QoL, and medication adherence outcomes between the telemedicine and standard care groups.ConclusionsTelemedicine intervention showed a promising role in improving IBD-specific QoL among adolescents and decreased the number of clinic visits among patients with IBD. Further research is warranted to identify the group of patients with IBD who would most benefit from telemedicine.

Medication adherence in inflammatory bowel disease (IBD) is crucial, particularly during pregnancy. Unplanned pregnancies are common; therefore, efforts to maximise adherence should not be restricted to pregnant women. We aimed to assess medication adherence in women with IBD of childbearing age, regardless of their reproduction plans. We performed a multi-centre pilot questionnaire study of women with IBD age 18-45 years. Survey questions included patient demographics, disease history, and validated assessments of IBD and pregnancy knowledge, medication adherence and quality of life. The primary outcome was rates and predictors of medication adherence. In all, 72 women [58.3% Crohn's disease (CD) and 37.5% ulcerative colitis] completed the survey. The median patient age was 30 years [interquartile range (IQR): 24.8-36.0) and 37.5% had children. Medication adherence was high (84%; median Medication Adherence Report Scale: 19.0/20; IQR: 17.0-20.0). Knowledge scores were adequate for both the Crohn's and Colitis Knowledge (CCKnow; median: 15.5/30; IQR: 12.3-18.0) and Crohn's and Colitis Pregnancy Knowledge (CCPKnow; median: 8.0/17; IQR: 4.0-11.0). Disease knowledge was predictive of high medication adherence (CCPKnow: p = 0.02; CCKnow: p ⩽ 0.01). Higher adherence was significantly associated with a diagnosis of CD (p = 0.01), exposure to biological agents (p = 0.03) and immunomodulators (p = 0.04), childbearing after diagnosis with IBD (p = 0.03), and correctly understanding the importance of delivery modality (p = 0.02) and IBD activity in pregnancy (p = 0.01). Following dedicated education at the IBD clinic, medication adherence, disease-specific and pregnancy-specific knowledge in women with IBD of childbearing age tends to be high. Unplanned pregnancies are frequent; therefore, we should aim to maximise medication adherence in all women of childbearing age to optimise maternofoetal outcomes if unexpected pregnancies occur.

Purpose: Depression is common among patients with inflammatory bowel disease (IBD). Less is known about depression in the elderly population with IBD. Within an elderly IBD population, we aimed to 1) assess factors associated with depression and 2) determine whether depression is associated with disease activity, quality of life, or medication adherence. Methods: We identified elderly (≥65 years) individuals within Crohn's and Colitis Foundation of America (CCFA) Partners, an online cohort of over 10,000 patients living with self-reported IBD. Individuals were asked to complete the short- geriatric depression scale (GDS), a 15 question validated tool used to assess depression in the elderly population. A score of ≥5 on this scale suggests depression. We used bivariate statistics to determine whether demographic or disease related factors, disease activity (as measured by the short Crohn's disease activity index (sCDAI) or simple clinical colitis activity index (SCCAI), quality of life (measured by the short inflammatory bowel disease questionnaire (SIBDQ) and medication adherence (measured by the Morisky medication adherence scale (MMAS)) were associated with depression. We then used logistic regression to estimate the independent effects of depression on medication adherence. Results: A total of 359 elderly individuals with IBD completed the GDS. The mean age was 70.2 years (sd 4.7), with a mean disease duration of 25.6 years (sd 17.6). The prevalence of depression was 22.6%. Neither age, disease duration, nor gender differed by depression status. Lower education levels were significantly associated with depression (p=0.001). For both Crohn's disease (CD) and ulcerative colitis (UC), those with depression had significantly increased disease activity when compared to those without (sCDAI 52.5 versus 29, p=0.005 and SCCAI 5 versus 2, p=0.003). Depressed patients also had significantly lower health related quality of life (SIBDQ 4.6 versus 5.7, p<0.001) and lower medication adherence (p=0.01). Those with depression were more likely to have reduced medication adherence, even after controlling for disease activity (OR 2.49; 95% CI 1.26-4.92). Conclusion: Depression is common in this geriatric IBD cohort. Traditional risk factors for depression in the elderly, such as female gender and advancing age, are not associated with depression in geriatric IBD. Depression is independently associated with reduced medication adherence. The short GDS is a feasible tool for depression screening in the elderly IBD population that may allow for improved recognition and outcomes.

Background Telemedicine is not consistently superior to standard care in the management of inflammatory bowel disease (IBD). Non-inferiority is an acceptable outcome if telemedicine improves the efficacy and efficiency of care. Owing to the positive results of the TECCU app (Telemonitoring of Crohn’s Disease [CD] and Ulcerative Colitis [Au]) in a pilot trial1, we aimed to evaluate the time in remission and quality of life (QoL) of IBD patients controlled by telemonitoring (G_TECCU), compared to standard care (G_Control) after 12 weeks. 1Del Hoyo J et al. J Med Internet Res. 2018;20(11):e11602. Methods A 2-arm randomized multicenter study with a non-inferiority design was performed in 29 IBD centers in Spain. Adult IBD patients who initiated therapy with immunosuppressant or biological agents for disease activity were included. Exclusion criteria were: patients with ileorectal/ileo-pouch anal anastomosis, stoma, active perianal disease, no Internet access. Time in remission was evaluated with Harvey-Bradshaw/Walmsley indexes (according to CD]/UC, respectively), fecal calprotectin (FC) and reactive C protein (RCP). QoL was assessed with IBDQ-9, medication adherence with Morisky-Green index and patient satisfaction with a questionnaire derived from CSQ-8. Results We included 157 patients, and 126 were analyzed after 12 weeks of follow-up. The demographic and clinical variables are listed in Table 1. The time in remission was not inferior in patients who used the TECCU app (mean 4.2 weeks [SD 3.8]) compared with patients who received standard care (mean 4.2 weeks [SD 3.2]; difference 0.03 [95%CI -1.21 to 1.27]; p=0.017) (Figure 1). In patients with UC, disease activity improved significantly in both TECCU (mean SCCAI improvement -3.60 [SD 3.25]; p= 0.001) and standard care groups (-3.89 [SD 4.56]; p=0.001;). In patients with CD, clinical activity also improved significantly in both groups (mean Harvey-Bradshaw improvement -1.65 [SD 2.51]; p=0.001 in TECCU; -2.24 [SD 4.15]; p=0.001 in standard care group). Similarly, FC and CRP values improved significantly in both groups (Figure 2). Considering QoL, the IBDQ-9 score improved significantly in TECCU (mean 11.29 [SD15.8]; p&amp;lt;0.001) and standard care groups (16.59 [SD 22.1]; p&amp;lt;0.001). Medication adherence improved significantly in TECCU group and it was superior compared with standard care (Figure 3). Patient satisfaction was superior to 90% in both groups at week 12. Conclusion In IBD patients who initiate biological agents or immunomodulators, TECCU app is not inferior to standard care to maintain remission in the short-term. Telemonitoring with TECCU app associated a higher improvement in medication adherence and an increase in QoL. Long-term results are needed to confirm it.

Tight control of disease activity, medication side effects, and adherence are crucial to prevent disease complications and improve quality of life in patients with inflammatory bowel disease (IBD). The chronic nature and increasing incidence of IBD demand health care innovations to guarantee future high-quality care. Previous research proved that integrated care by telemedicine can improve outcomes of chronic diseases. Currently available IBD telemedicine tools focus on specific patient subgroups. Therefore, we aimed to (1) develop a telemedicine system suitable for all patients with IBD in everyday practice and (2) to test this system's feasibility. With a structured iterative process between patients, dietitians, IBD nurse-specialists, and gastroenterologists, myIBDcoach was developed. During 3 months, myIBDcoach's feasibility was tested by 30 consecutive outpatients with IBD of 3 hospitals. Thereafter, patients and health care providers completed a questionnaire covering satisfaction, accessibility, and experiences with myIBDcoach. MyIBDcoach enables continuous home-monitoring of patients with IBD and optimizes disease knowledge and communication between patients and health care providers. Besides disease activity, medication adherence, and side effects, myIBDcoach monitors malnutrition, smoking, quality of life, fatigue, life-events, work participation, stress, and anxiety and depression and provides e-learnings for patient empowerment. Patients graded the system with a mean of 7.8 of 10, and 93% would recommend myIBDcoach to other patients. We developed myIBDcoach, which enables integrated care for all patients with IBD, regardless of disease severity or medication use. The feasibility study showed high satisfaction and compliance of patients and health care providers. To study myIBDcoach's efficacy, a multicenter randomized controlled trial has been initiated.

Tu1296 Non-Economic Factors Associated With Medication Adherence in Inflammatory Bowel Diseases. It's as Complex as the Individual Patient

The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma. Prospective cohort study. The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014. One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables. Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores. The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.

Introduction Growing evidence suggests that psychological stress can increase activity of inflammatory bowel disease (IBD)1,2,3,4. However there is insufficient access to psychological support services for IBD patients in the UK5. Current evidence demonstrates that psychological therapies improve quality of life in the short term, and supports the efficacy of antidepressant medication6 in improving disease activity. Methods Our digestive disease unit at a major teaching hospital secured funding to pilot a Psychological Support Service for Patients with Inflammatory Bowel Disease (PSSPIBD) to provide outpatient psychological support to patients with IBD. Between October 2015 to March 2017, 85 patients were assessed and treated by PSSPIBD, staffed by a psychiatrist (0.1WTE) and clinical health psychologist (0.3WTE) with special interests in IBD. Referrals were made for patients experiencing psychological difficulties related to their IBD by gastroenterologists, IBD nurses, pharmacists and stoma nurses. Results The most common reason for referral into the service was support adjusting to IBD and its symptoms (e.g. pain, fatigue, incontinence, tolerating uncertainty) (55%), followed by anxiety (30%) and depression (10%). 75% of patients seen were female. We demonstrated improvements across a balanced scorecard of four dimensions: clinical effectiveness, service utilisation, patient satisfaction and referrer satisfaction. Clinical effectiveness was measured through the use of validated questionnaires. Short IBD Questionnaire (SIBD) scores pre- and post-psychological therapy showed significant reductions in symptoms across all domains (p=0.003) with notable improvement in systemic symptoms (fatigue and energy levels) and emotional and social functioning. Statistically significant improvements (p=0.003) were seen in Patient Health Questionnaire (PHQ-9) depression score, and there was a strong trend of improvements in anxiety scores, using Generalised Anxiety Disorder Assessment (GAD-7) and quality of life (p=0.061 using Euro-QoL). Patient and referrer satisfaction with the PSSPIBD was very high: 90% of patients and all referrers completing the feedback rated the service as excellent. Initial data comparing service use in one year before and after engaging with PSSPIBD found a statistically significantly reduction in outpatient appointments by 62.5% (p=0.008) and in CT and MRI scans by 76.2% (p=0.05). Conclusions The pilot PSSPIBD demonstrated significant improvements across all domains, notably symptomatology and service utilisation. There should be increased access to integrated psychological support services with further evidence gathered of success across all domains.

Disease course, stress, attachment, and mentalization in patients with inflammatory bowel disease

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

Inflammatory bowel disease (IBD), represented by Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition that affects all age groups, predominantly in young individuals. Currently, an increase in the prevalence of IBD has been documented, in parallel with the increase in the elderly population. The scarce number of studies that better characterize the impact of IBD on Quality of Life (QoL) in the elderly motivated the present study. To evaluate the impact of IBD on the QoL of elderly people treated at a Tertiary IBD Center. Prospective cross-sectional study that included elderly patients (age ≥60 years) with quiescent or mildly active IBD treated at the HU-UFJF IBD Center between March 2019 and December 2022. Elderly companions without severe comorbidities who attended the consultation with the patients were included as a control group. Sociodemographic and IBD-related characteristics were recorded. QoL was assessed using previously validated questionnaires (WHOQOL-BREF and IBDQ). Patients with IBD with moderate to severe activity, history of recent or imminent hospitalization, serious or opportunistic infections in the last 6 months, previous neoplasia, dementia, and difficulty understanding/fulfilling the questionnaires were excluded. A total of 123 patients were included (74 with IBD and 49 in the control group), with a mean age of 67±6.2 years, 52.7% with CD, and 47.3% with UC. Mild disease activity was observed in 31.1%. Both groups (IBD patients and control) were comparable based on age, sex, BMI, and the Charlson Comorbidity Index. Patients with IBD and controls had similar QoL scores in the different domains assessed by the WHOQOL-BREF. On the other hand, when evaluating the general facet of QoL, IBD patients had significantly lower scores in General QoL (3.71±0.87 versus 4.02±0.62, respectively; P=0.021) and General Health (3.32±1.05 versus 3.69±0.94, respectively; P=0.035). The presence of mildly active IBD negatively impacted the general health score (2.91±0.99 versus 3.47±1.04, respectively; P=0.035) and the physical domain of the WHOQOL-BREF (12.27±2.63 versus 13.86±2.61, respectively; P=0.019) when compared to patients in remission. Conversely, no impact on QoL was observed with the Application of the IBDQ questionnaire regarding the type of the disease (161±38.5 versus 163.1±42.6 for CD and UC, respectively; P=0.84) or the presence of activity (152.5±38.8 versus 166.4±40.5, respectively; P=0.17). No statistically significant differences were found between elderly patients with mildly active or quiescent IBD and elderly patients without IBD when observing global QoL scores. However, IBD negatively impacted the general facet of QoL, just as mild activity was associated with lower scores in general health and the physical domain assessed by the WHOQOL-BREF. Patients with IBD treated with biological therapy had better Qol than those on conventional therapy. Future studies are needed to choose the most appropriate tool for assessing QoL in this population.