Predictors Of Health Care Seeking Research Articles

A cross-sectional study on factors associated with health care seeking for acute respiratory infection and fever in children under-five in Zambia.

mortality in under-five children remains a significant challenge in developing countries, including Zambia, where pneumonia and malaria account for twenty percent of under-five deaths. Poor health care seeking is one of the contributors to the high mortality rates. This study examined the predictors of health care seeking for acute respiratory infection (ARI) and fever among under-five children in Zambia. the study used a population based cross-sectional survey program evaluation dataset with sample size of 12,507 households from 28 districts. Binary logistic regression was used to examine the determinants of appropriate care seeking for ARI or fever, ARI, and fever. the prevalence of fever or ARI in children under five was 22.9%, ARI 12.9%, and fever 13.4%. Educational status and non-participation in positive deviance hearth (PDH) were significant predictors in those with fever or ARI. Children whose household head had secondary education or higher were 4.5 times more likely to seek care than those whose household head did not have any education. Among those with ARI, educational status, women empowerment in decision-making and growth monitoring and promotion (GMP) were significant predictors while for fever only GMP was a significant predictor. over two thirds of caregivers sought care appropriately for fever or ARI. Only educational status and GMP were associated with more than one appropriate care seeking outcome. Through GMP services, policymakers can improve healthcare seeking behavior in children under five.

Health Care Seeking Behavior for Common Childhood Illnesses in Jeldu District, Oromia Regional State, Ethiopia.

BackgroundEven though health care seeking interventions potentially reduce child mortality from easily treatable diseases, significant numbers of children die without ever reaching a health facility or due to delays in seeking care in Ethiopia. This study aimed to assess health care seeking behavior for common childhood illnesses and associated factors.MethodsA community-based cross-sectional study was conducted in Jeldu District from January to February 2011. A systematic sampling method was used for sample selection. Data were collected from 422 caregivers with under-five children who experienced diseases within six weeks before the survey. Interviewer administered structured and pre-tested questionnaire which were used to collect data. Data entry and cleaning were carried out using Epi Info version 3.5.1 and analyzed using SPSS version 16. Descriptive analysis was done to determine the magnitude of health care seeking behavior. Multivariate logistic regression analyses were performed to identify associated factors.ResultsA total of 422 caregivers of under-five children were participated in the study giving an overall response rate of 97.5%. Three hundred fifteen (74.6%) children sought care from health facilities for all conditions. However, only 55.4% of them were taken to health facilities as first source treatment during their illness and prompt care was also very low (13.7%). Marital status of the caregivers (AOR = 2.84; 95%CI: 1.62–4.98), number of symptoms experienced by the child (AOR = 2.04; 95%CI: 1.24–3.36) and perceived severity of the illness (AOR = 3.20; 95%CI: 1.96–5.22) were predictors of health care seeking behavior.ConclusionHealth care seeking behavior for childhood illnesses was delayed and decision to seek care from health facilities was influenced by worsening of the illnesses. Thus, community level promotion of prompt health care seeking is essential to enhance the health care seeking behavior for child hood illnesses in the locality.

Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania.

Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within twoyears preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95% confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95% CI 0.09-0.58), and the mid-low level (RRR 0.27, 95% CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95% CI 1.27-6.71, mid-level RRR 2.71, 95% 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women.

Managing constipation in colostomates

Gastrointestinal NursingVol. 13, No. 9 Skills in PracticeManaging constipation in colostomatesSuzanne McDonald, Vicky Wilson, Elaine Wiseman, Tracey HollandSuzanne McDonaldSearch for more papers by this author, Vicky WilsonSearch for more papers by this author, Elaine WisemanSearch for more papers by this author, Tracey HollandSearch for more papers by this authorSuzanne McDonald; Vicky Wilson; Elaine Wiseman; Tracey HollandPublished Online:19 Nov 2015https://doi.org/10.12968/gasn.2015.13.9.15AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Burch J (2006) Caring for the older ostomate: an update. Nursing & Residential Care 8(3): 117–20. doi: https://doi.org/10.12968/nrec.2006.8.3.20558 Link, Google ScholarBurch J (2008) Stoma care and the role of the healthcare assistant. British Journal of Healthcare Assistants 2(12): 607–9. doi: https://doi.org/10.12968/bjha.2008.2.12.32054 Link, Google ScholarBurch J (2011) Resuming a normal life: holistic care of the person with an ostomy. Br J Community Nurs 16(8): 366–73 Link, Google ScholarColostomy Association (2014) Problematic stomas. Constipation. http://tinyurl.com/nzupjv7 (accessed 4 November 2015) Google ScholarFulham J (2008) A guide to caring for patients with a newly formed stoma in the acute hospital setting. Gastrointestinal Nursing 6(8): 14–23. doi: https://doi.org/10.12968/gasn.2008.6.8.31425 Link, Google ScholarHale EM, Smith E, St James J, Wojner-Alexandrov AW (2007) Pilot study of the feasibility and the effectiveness of a natural laxative mixture. Geriatr Nurs 28(2): 104–11 Crossref, Google ScholarKyle G (2010) The older person: management of constipation. Br J Community Nurs 15(2): 58–64 Link, Google ScholarNational Institute for Health and Care Excellence (2015) Constipation. http://tinyurl.com/pumfwxq (accessed 4 November 2015) Google ScholarNorton CNunwa ATaylor CWilliams JWhayman KWilliams J, eds. (2008) Oxford Handbook of Gastroentestinal Nursing. Oxford University Press, Oxford Google ScholarPare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L (2001) An epidemiological survey of constipation in Canada: definitions, rates, demographics and predictors of health care seeking. Am J Gastronenterol 96(11): 3130–7 Crossref, Google ScholarPeate I (2003) Nursing role in the management of constipation; use of laxatives. Br J Nurs 12(19): 1130–6 Link, Google ScholarPorrett T, McGrath A (2005) Stoma Care: Essential Clinical Skills for Nurses. Blackwell Publishing Ltd, Oxford Google ScholarRang HP, Ritter JM, Flower RJ, Henderson G (2011) Rang and Dale's Pharmacology. 7th edn. Churchill Livingstone, London Google ScholarWorld Health Organization (2004) Fruit and Vegetables for Health. Report of a joint FAO/WHO Workshop, 1–3 September 2004, Kobe, Japan. http://tinyurl.com/pysu32w (accessed 4 November 2015) Google Scholar FiguresReferencesRelatedDetailsCited byStoma-related complications and treatmentsJennie Burch11 August 2018 | Nursing and Residential Care, Vol. 20, No. 9Complications of stomas: Their aetiology and managementJennie Burch2 August 2017 | British Journal of Community Nursing, Vol. 22, No. 8 2 November 2015Volume 13Issue 9ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 19 November 2015 Published in print 2 November 2015 Information© MA Healthcare LimitedPDF download

Health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya

In Kenya, as in other developing countries, diarrhea is among the leading causes of child mortality. Despite being easy to prevent and treat, care seeking for major child illnesses including diarrhea remains poor in the country. Mortality due to diarrhea is even worse in informal settlements that are characterized by poor sanitary conditions and largely unregulated health care system among other issues. The study aims to examine the health care seeking practices of caregivers of children under 5 with diarrhea in two informal settlements in Nairobi, Kenya. The article used data from a maternal and child health (MCH) prospective study conducted between 2006 and 2010. Results show that more than half (55%) of the caregivers sought inappropriate health care in the treatment of diarrhea of their child. Of the 55%, about 35% sought no care at all. Use of oral rehydration solution and zinc supplements, which are widely recommended for management of diarrhea, was very low. The critical predictors of health care seeking identified in the study are duration of illness, informal settlement of residence, and the child's age. The study showed that appropriate health care seeking practices for childhood diarrhea remain a great challenge among the urban poor in Kenya.

Health care seeking for abdominal bloating and visible distention

While knowledge has accumulated regarding health care seeking in several functional gastrointestinal disorders (FGIDs), little is known about health care seeking in those with bloating and distention. To identify predictors of health care seeking for bloating and distention. The validated Talley Bowel Disease Questionnaire was mailed to a cohort selected at random from the population of Olmsted County, Minnesota; 2259 subjects (53% females; mean age 62 years) answered questions about bloating and distention. The complete medical record of each respondent was reviewed. Logistic regression was used to compare consulting for bloating and distention with consulting for other GI symptoms, and nonconsulters. A total of 131 (6%) subjects in the community consulted a physician for bloating or distention. Older age [odds ratio (OR), 1.8; 95% confidence interval (CI): 1.5, 2.1], higher somatic symptom scores (OR, 2.0; CI: 1.4, 2.8), lower education level (OR, 2.7; CI: 1.2, 5.6), early satiety (OR, 2.0; CI: 1.1, 3.8) and abdominal pain (OR, 2.4; CI: 1.6, 3.7) were associated with people seeking health care for bloating or distention vs. non-consulters. Similarly, older age (OR, 1.4; CI: 1.2, 1.7), chronic constipation (OR, 2.0; CI: 1.2, 3.2) and visible distention (OR, 3.0; CI: 1.8, 4.9) had greater odds of presenting for bloating or distention compared with presenting for other GI symptoms; somatic symptoms were not a predictor (OR, 1.1; CI: 0.8, 1.5). Factors that lead people to present for bloating and distention are similar to those for other GI symptoms visits; however, specific biological rather than somatic features may predict visits for bloating and distention.

Non-ulcer Dyspepsia and Duodenal Eosinophilia: An Adult Endoscopic Population-Based Case-Control Study

Functional abnormalities of the duodenum have been observed in non-ulcer dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer dyspepsia. A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. The odds ratio for non-ulcer dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, >/=22, relative to <22) was 11.7 (95% confidence interval, 3.9-34.9), adjusting for age, sex, and H pylori; similar results were observed in D2 (odds ratio = 7.3; 95% confidence interval, 2.9-18.1). A significant association with the number of eosinophil clusters was detected in the duodenum, with higher values in non-ulcer dyspepsia (P < .01). By immunostaining with major basic protein antibody in a subset of duodenal biopsy specimens, eosinophil degranulation was observed in non-ulcer dyspepsia (7 of 15 vs 0 of 5 controls; P = .11). Gastric eosinophil counts were overall not significantly increased in non-ulcer dyspepsia vs controls. Early satiety was associated with eosinophilia in D1 (P = .01) and D2 (P = .02), adjusting for age, sex, and H pylori. Duodenal eosinophilia may characterize a subset of adults with non-ulcer dyspepsia.

ASGE guideline: guideline on the use of endoscopy in the management of constipation

Constipation is a common symptom affecting 2% to 27% of the population and resulting in about 2.5 million physician visits in the United States. 1 Sonnenberg A. Koch T.R. Physician visits in the United States for constipation: 1958-1986. Dig Dis Sci. 1989; 34: 606-611 Crossref PubMed Scopus (278) Google Scholar , 2 Pare P. Ferrazzi S. Thompson W.G. Irvine E.J. Rance L. An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol. 2001; 96: 3130-3137 Crossref PubMed Google Scholar The prevalence of constipation is higher in women than in men 3 Heaton K.W. Radvan J. Cripps H. Mountford R.A. Braddon F.E. Hughes A.O. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992; 33: 818-824 Crossref PubMed Scopus (527) Google Scholar and increases with age. 4 Johanson J.F. Sonnenberg A. Koch T.R. Clinical epidemiology of chronic constipation. J Clin Gastroenterol. 1989; 11: 525-536 Crossref PubMed Scopus (195) Google Scholar Low socioeconomic status, physical inactivity, a history of sexual abuse, and depression have all been reported as risk factors for constipation. 5 Everhart J.E. Go V.L. Johannes R.S. Fitzsimmons S.C. Roth H.P. White L.R. A longitudinal survey of self-reported bowel habits in the United States. Dig Dis Sci. 1989; 34: 1153-1162 Crossref PubMed Scopus (338) Google Scholar

Is Health Care Seeking for Irritable Bowel Syndrome and Functional Dyspepsia a Socially Learned Response to Illness?

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15-2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking.

Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities.

To determine the predictors of health care seeking, assess the types of health care professional consulted and to calculate the work absenteeism rates and interruptions to daily activities among non-cardiac chest pain patients. A total of 212 patients who presented to a Tertiary Hospital Emergency Department over a 1-year period with acute chest pain were assessed according to a standard diagnostic protocol and completed the Chest Pain Questionnaire (CPQ). In the previous 12 months prior to presentation to the Emergency Department, 78% of patients had seen a health care professional for chest pain. The main health care professionals seen were general practitioners (85%), cardiologists (74%) and gastroenterologists (30%). Work absenteeism rates because of non-cardiac chest pain were high (29%) as were interruptions to daily activities (63%). Multiple logistic regression found that acid regurgitation was the only independent predictive symptom associated with consulting for non-cardiac chest pain (OR = 3.97, 95% CI: 1.25-12.63). Consulting for chest pain is common is this group of patients. The type of health care professional seen appears to be moderated by the frequency and severity of reflux symptoms among these chest pain patients. Work absenteeism and interruptions to daily activities is high among chest pain sufferers.

The predictors of health care seeking behavior in obsessive-compulsive disorder

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non—health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly worse levels of QOL in psychological health and level of independence domains. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals’ ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD.

Prevalence of irritable bowel syndrome in Hong Kong.

As part of a public education program, the Hong Kong Society of Gastrointestinal Motility studied the prevalence of irritable bowel syndrome (IBS) in the community, which was based on the recently published Rome II criteria. The distribution of diarrhea or constipation-predominant IBS subtypes, the prevalence of bowel symptoms and the predictors of health-care seeking were also studied. Among 1797 randomly selected respondents, 1000 successful telephone interviews (56%) were conducted from August 2000 to December 2000, using a validated questionnaire in Chinese that looked into demographic data and various bowel symptoms during the past year. The 12-month prevalence of IBS as defined by the Rome II criteria in Hong Kong was 6.6%. The female to male ratio was 1.3:1, but this ratio was the same in the control group. The distribution of IBS patients into diarrhea predominant, constipation predominant, and non-specific subtypes was 27, 17 and 56%, respectively. The predominant symptom in the IBS group was pain (54.5%), followed by urgency (15%), abdominal distension (15%) and diarrhea (11%). Forty-seven percent of IBS patients sought medical attention and only 21% of them knew that they had IBS. Moderate to severe pain severity (odds ratio 3.7, 95% CI 1.02-13) and mucus in stool (odds ratio 3.57, 95% CI 1.18-10.7) were associated with health-care seeking in univariate analysis. The prevalence of bowel symptoms such as urgency, straining, feeling of incomplete defecation, mucus in stool and abdominal distension ranged from 11 to 41%. The prevalence of IBS in Hong Kong was 6.6%, and the female to male ratio was similar to the control group. The majority was of non-specific IBS subtype. Gross underdiagnosis (21%) by Western practitioners was noted.

An epidemiological survey of constipation in canada: definitions, rates, demographics, and predictors of health care seeking.

The prevalence of functional constipation is highly variable among epidemiological surveys and may relate to the definitions applied. We estimated the population prevalence of self-reported, Rome I-defined, and Rome II-defined constipation in Canada and determined the variables that best predicted health care seeking. A research firm was employed to conduct a random digit dial national survey, inviting household members at least 18 yr of age to participate in a study assessing personal health issues. The sample was stratified to ensure that each region of Canada was represented. Data collection involved three stages: 1) recruitment of participants by phone, 2) mailing of the questionnaire, and 3) data retrieval through a follow-up phone call. The Rome II questionnaire was used to derive the prevalence of functional constipation using both Rome I and Rome II criteria. Of the 1149 participants, 27.2% self-reported constipation within the past 3 months, and 16.7% and 14.9% had functional constipation according to Rome I and II, criteria, respectively. For all three definitions, the rate for women was close to twice that for men. Approximately 34% of those with self-reported constipation had visited a physician for it, versus 26.3% of Rome II subjects. In a regression model, subjects self-reporting in the past 3 months were more likely to have seen a doctor for their constipation (odds ratio 2.47, p < 0.01) and significantly more women than men (35.6% vs 19.5%, p < 0.05). Functional constipation and related health care seeking are common in the Canadian population and are strongly determined by the definition used. The Rome II criteria for this disorder seem to be satisfactory, but modifications may be considered to allow for constipated subjects taking laxatives and to increase the number of qualifying symptoms.

An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking

OBJECTIVES:The prevalence of functional constipation is highly variable among epidemiological surveys and may relate to the definitions applied. We estimated the population prevalence of self-reported, Rome I–defined, and Rome II–defined constipation in Canada and determined the variables that best predicted health care seeking.METHODS:A research firm was employed to conduct a random digit dial national survey, inviting household members at least 18 yr of age to participate in a study assessing personal health issues. The sample was stratified to ensure that each region of Canada was represented. Data collection involved three stages: 1) recruitment of participants by phone, 2) mailing of the questionnaire, and 3) data retrieval through a follow-up phone call. The Rome II questionnaire was used to derive the prevalence of functional constipation using both Rome I and Rome II criteria.RESULTS:Of the 1149 participants, 27.2% self-reported constipation within the past 3 months, and 16.7% and 14.9% had functional constipation according to Rome I and II, criteria, respectively. For all three definitions, the rate for women was close to twice that for men. Approximately 34% of those with self-reported constipation had visited a physician for it, versus 26.3% of Rome II subjects. In a regression model, subjects self-reporting in the past 3 months were more likely to have seen a doctor for their constipation (odds ratio 2.47, p < 0.01) and significantly more women than men (35.6% vs 19.5%, p < 0.05).CONCLUSIONS:Functional constipation and related health care seeking are common in the Canadian population and are strongly determined by the definition used. The Rome II criteria for this disorder seem to be satisfactory, but modifications may be considered to allow for constipated subjects taking laxatives and to increase the number of qualifying symptoms.

Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors.

Health care use is a costly outcome of the irritable bowel syndrome (IBS) and nonulcer dyspepsia (NUD), but the predictors of this behavior remain poorly defined. We aimed to systematically review the literature to determine which symptoms and psychosocial factors drive health care seeking in these disorders. A broad based MEDLINE and Current Contents search between 1966 and 2000 identified 44 relevant publications. References from these articles were also reviewed. The literature suggests that symptom severity is an important factor, but only explains a small proportion of the health care seeking behavior associated with these disorders in population-based studies. Psychosocial factors including life event stress, psychological morbidity, personality, abuse and abnormal illness attitudes and beliefs have been found to characterize those that seek help versus those that do not. The role of other psychosocial factors such as social support, coping style and knowledge about illness are as yet undetermined. A model for health care seeking for IBS and NUD, with an emphasis on psychosocial factors is presented, but remains to be tested.

Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking

Objective: Little data on rectal bleeding in the U.S. population are available. We therefore sought to assess the prevalence of different types of rectal bleeding, their association with potential risk factors including other colonic symptoms, and predictors of health care seeking in a U.S. community. Methods: We used a crossectional survey by mail, applying a previously validated self-report symptom questionnaire. Our population comprised an age- and gender-stratified random sample of Olmsted County, Minnesota residents aged 20–64 yr. Results: In total, 1643 responded (77%). Rectal bleeding was reported by 235 subjects (age- and gender-adjusted prevalence, 15.5 per 100; 95% confidence interval [CI], 13.6–17.4); 218 found blood on wiping, 74 noted blood coating the stools, and 46 reported dark blood mixed in the stools. The prevalence of rectal bleeding was significantly higher in younger persons (18.9%, 20–40 yr vs 11.3% > 40 yr; p < 0.001). By stepwise logistic regression analysis, constipation (odds ratio [OR] = 3.03; 95% CI, 2.09–4.41) and diarrhea (OR = 1.90; 95% CI, 1.25–2.84) were independent predictors of rectal bleeding. Among those with rectal bleeding, 13.9% (95% CI, 9.6–19.1%) had visited a physician for bowel problems in the prior yr; only a history of abdominal surgery was an independent predictor of physician visits but this explained just 15.9% of the deviance. Conclusions: In otherwise healthy young and middle-aged persons, approximately one in seven have a history of rectal bleeding and this is more frequent in younger people; only a minority seek health care and this is not related to symptom status.

Predictors of health care seeking for irritable bowel syndrome: a population based study

Background—It has been suggested that psychological factors rather than symptoms drive subjects with irritable bowel syndrome (IBS) to seek medical care, but this issue has not been tackled in a...

Epidemiology of colonic symptoms and the irritable bowel syndrome

Functional gastrointestinal disease is believed to be very common, but reports of its prevalence have not usually evaluated random community samples, and validated questionnaires have not been used to elicit symptoms. The prevalence of specific colonic symptoms and the irritable bowel syndrome among representative middle-aged whites was determined from a defined population, and the impact of these symptoms on presentation for medical care was measured. An age-and sex-stratified random sample of 1021 residents of Olmsted County, Minnesota, aged 30–64 years, was obtained. All subjects were mailed a valid self-report questionnaire that identified gastrointestinal symptoms and functional gastrointestinal disorders. The response rate was 82% (n = 835). The age-and sex-adjusted prevalence of abdominal pain (more than six times in the prior year) was 26.2 per 100 (95% confidence interval, 23.1–29.2). The prevalence of chronic constipation (hard stools and straining and/or < 3 stools per week > 25% of the time) was 17.4 (95% confidence interval, 14.8–20.0), whereas the prevalence of chronic diarrhea (loose watery stools, and/or > 3 stools per day > 25% of the time) was 17.9 (95% confidence interval, 15.3–20.5). The prevalence of abdominal pain and disturbed defecation was similar in women and men, except that infrequent defecation and straining at stool were more common in women. Using the Manning symptom criteria to identify irritable bowel syndrome (≥ 2 of 6 symptoms in those with abdominal pain more than six times in the prior year), the prevalence of irritable bowel syndrome was 17.0 per 100 (95% confidence interval, 14.4–19.6). Overall, 71 persons (9%) reported visiting a physician for abdominal pain or disturbed defecation in the prior year; a subset of variables related to pain severity were the best predictors of health care seeking after adjustment for age and gender. However, these accounted for only 22% of the log likelihood. In conclusion, more than one third of an unselected middle-aged population reported chronic abdominal pain or disturbed defecation, and more than one in six had symptoms compatible with the irritable bowel syndrome. Only a minority had presented for medical evaluation; moreover, the characteristics of the abdominal complaints did not explain the seeking of health care in most cases.