Perceptions of the public healthcare system from private-care patients with irritable bowel syndrome with constipation in Spain

Background: Irritable bowel syndrome (IBS) is associated with reduced health-related quality of life. Patients with IBS benefit from positive patient-provider experiences during treatment. However, many continue to suffer from limited symptom relief and hold negative perceptions. Purpose: to identify potential barriers perceived by patients with IBS with constipation (IBS-C) within the the private health care system compared with the care under the public health-care system in Spain. Methods: this is a multicenter, cross-sectional observational study. Patients with previous experience of public healthcare who attended a private consultation with a gastroenterologist due to constipation/abdominal discomfort, with no previous IBS diagnosis and meeting Rome III criteria at the time of survey completion without alarm symptoms, were invited to join the study. Participants completed the Irritable Bowel Syndrome Patient Experience questionnaire, the Irritable Bowel Syndrome Symptom Severity Score questionnaire and the EuroQol five-dimensions questionnaire, reporting their health-related quality of life. Results: seven hundred and seven patients met the study criteria and were evaluated. With regard to public healthcare, patients reported feeling more positive towards their gastroenterologist (62.8% satisfied) than their primary care physician (43.9% satisfied). Patients reported moderate/severe problems with pain/discomfort (61.5%). The majority of patients were treated with fiber (85.3%), laxatives (79.3%) and antispasmodics (54.3%); 47.0% and 11.7% of patients noted little and no improvement, respectively. Conclusions: the perceptions of patients with irritable bowel syndrome and constipation were more positive towards their gastroenterologist than their primary care physician in the public healthcare sector. However, patients were still dissatisfied with the treatment and care received, highlighting the unmet need for improved patient-provider communication to achieve better outcomes

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Perceptions of the public healthcare system from private-care patients with irritable bowel syndrome with constipation in Spain.

BACKGROUND: Irritable bowel syndrome (IBS) is associated with reduced health-related quality of life. Patients with IBS benefit from positive patient-provider experiences during treatment. However, many continue to suffer from limited symptom relief and hold negative perceptions. PURPOSE: to identify potential barriers perceived by patients with IBS with constipation (IBS-C) within the the private health care system compared with the care under the public health-care system in Spain. METHODS: this is a multicenter, cross-sectional observational study. Patients with previous experience of public healthcare who attended a private consultation with a gastroenterologist due to constipation/abdominal discomfort, with no previous IBS diagnosis and meeting Rome III criteria at the time of survey completion without alarm symptoms, were invited to join the study. Participants completed the Irritable Bowel Syndrome Patient Experience questionnaire, the Irritable Bowel Syndrome Symptom Severity Score questionnaire and the EuroQol five-dimensions questionnaire, reporting their health-related quality of life. RESULTS: seven hundred and seven patients met the study criteria and were evaluated. With regard to public healthcare, patients reported feeling more positive towards their gastroenterologist (62.8% satisfied) than their primary care physician (43.9% satisfied). Patients reported moderate/severe problems with pain/discomfort (61.5%). The majority of patients were treated with fiber (85.3%), laxatives (79.3%) and antispasmodics (54.3%); 47.0% and 11.7% of patients noted little and no improvement, respectively. CONCLUSIONS: the perceptions of patients with irritable bowel syndrome and constipation were more positive towards their gastroenterologist than their primary care physician in the public healthcare sector. However, patients were still dissatisfied with the treatment and care received, highlighting the unmet need for improved patient-provider communication to achieve better outcomes.

High Serum Retinol as a Relevant Contributor to Low Bone Mineral Density in Postmenopausal Osteoporotic Women.

There is controversial information about the impact of vitamin A on bone. Some epidemiological studies show that excessive intake of vitamin A, or an excess of serum vitamin A, has related with adverse impact on bone mass; however, other studies did not find these links, and some authors have proposed that this vitamin might promote a better bone health. The present work aims to contribute to clarify the real role of vitamin A in bone tissue. For this purpose, a cross-sectional study of 154 osteoporotic non-treated postmenopausal women (> 65 years old) was carried out. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. We assessed concentrations of serum retinol, osteocalcin, parathyroid hormone, alkaline phosphatase, calcium, and phosphorus. We also studied demographic and anthropometric parameters. Spearman's correlations between retinol levels and other variables found negative correlations with BMD in both lumbar spine (R = - 0.162, P < 0.01) and femoral neck (R = - 0.182, P < 0.01), as well as alkaline phosphatase (R = - 0.110; P < 0.05) and phosphorus (R = - 0.110; P < 0.05). A positive correlation between retinol and fertile window was observed (R = 0.158; P < 0.01). After multivariable adjustment, we still found a negative correlation between serum retinol and BMD, both at the lumbar spine (R = - 0.210; P < 0.01) and at the femoral neck (R = - 0.324, P < 0.001). It is concluded that elevated serum-retinol levels are associated with an increased risk of low bone mass and thus with osteoporotic fractures. Therefore, osteoporosis-risk assessment should include quantification of serum metabolite of vitamin A.

Riesgo de fracturasno vertebrales en mujeres posmenopáusicas en tratamiento antirresortivo / Risk of non-vertebral fractures in postmenopausal women on antiresorptive therapy

Objetivo: Determinar el riesgo de fractura a 5 años en mujeres posmenopáusicas en tratamiento antirresortivo.Sujetos y métodos: Estudio transversal multicéntrico con 2.111 mujeres posmenopáusicas tratadas con antirresortivos en consultas de ginecología. El riesgo de fractura se evaluó mediante el índice FRACTURE. La influencia de los parámetros clínicos sobre la variable principal se evaluó mediante regresión logística y/o lineal, utilizando el programa SAS v9.1.3.Resultados: La edad media ± desviación estándar fue de 61,0 ± 7,9 años y, en los casos en los que se disponía de densitometría (60,5%), la prevalencia de osteopenia fue del 49,4% y la de osteoporosis del 42,4%. El 59,3% realizaba tratamiento con bisfosfonatos. La puntuación en el índice FRACTURE fue < 6 en el 73,4% si se disponía de densitometría; cuando no constaba la densitometría, la mayoría (81,7%) puntuó < 4. El riesgo medio de (fracturas no vertebrales fue del 14,8 ± 5,3% y el de fracturas vertebrales del 4,0 ± 3,0%.Conclusiones: En mujeres posmenopáusicas en tratamiento antirresortivo, el riesgo de fractura no vertebral en los próximos 5 años es tres veces superior al de fractura vertebral (AU)

Objective: To determine the 5-year non-vertebral fracture risk in postmenopausal women on antiresorptive therapy.Subjects and methods: We performed a cross-sectional multicenter study in 2,111 postmenopausal women receiving antiresorptive therapy in gynecological settings. The risk of fracture was evaluated by means of the FRACTURE Index. The influence of clinical parameters on the main variable was evaluated through linear and/or logistic regression, using the SAS v. 9.1.3 program.Results: The mean age ± standard deviation was 61.0 ± 7.9 years. Densitometry was available in 60.5% of the women and showed a prevalence of osteopenia of 49.4% whereas that of osteoporosis was 42.4%. Biphosphonates were used in 59.3% of the women. When densitometry was available, 73.4% scored less than 6 points on the FRACTURE Index, and when densitometry was not available, 81.7% scored less than 4 points. The mean risk of non-vertebral fractures was 14.8 ± 5.3% and that of vertebral fractures was 4.0 ± 3.0%.Conclusions: In this large group of postmenopausal women receiving antiresorptive treatment, the 5-year non-vertebral fracture risk, as assessed by the FRACTURE index, was three times higher than that of vertebral fracture (AU)