Difficulties in Performing Mesalazine Enemas and Factors Related to Discontinuation Among Patients With Ulcerative Colitis.

Current first-line treatment of ulcerative colitis consists of a combination of mesalazine enemas and oral mesalazine; however, many patients may discontinue mesalazine enemas. In this single-center, cross-sectional study, 165 outpatients with ulcerative colitis completed a self-administered questionnaire regarding the frequency of mesalazine enemas, difficulties in performing these enemas, and factors possibly associated with their discontinuation, as well as patient clinical and demographic characteristics. Of 165 patients, 34 (20.6%) discontinued mesalazine enemas because of a lack of efficacy. Five of the 13 items assessing difficulties were answered affirmatively by the majority of patients. Discontinuation of enema application was associated with a perceived lack of efficacy, four or more bowel movements per day, and lower scores on measurement of the doctor-patient relationship. Application of mesalazine enemas by patients with ulcerative colitis may be improved by discussions with peers and healthcare professionals and by adjusting the frequency of application or the time of starting the enema based on worsening of ulcerative colitis.

Opinions of physicians regarding problems and tasks involved in the medical care system for patients with adult congenital heart disease in Japan.

BACKGROUND: The aim of this study is to summarize the opinions of physicians regarding problems and tasks involved in the medical care system for patients with adult congenital heart disease (ACHD) in Japan. METHODS AND RESULTS: We conducted a semistructured interview with 30 subjects consisting of 13 pediatric cardiologists, 11 cardiovascular surgeons, and six cardiologists who were selected from among the randomly sampled medical facilities meeting each of the following institutional criteria: (1) facilities with ≥50 ACHD outpatients; (2) facilities with ACHD-specialized outpatient clinic; (3) facilities that are members of the Japanese Association of Chirdren's Hospitals and Related Facilities. The interview time was 27-91 minutes (mean, 70.0). The age of the subjects ranged from 36 to 62 years (mean, 46.7), and they had 0.5-34 years (mean, 16.2) of experience in treating congenital heart disease. From an analysis of interview details, the following four themes were extracted (in descending order of the number of comments): "(1) Who should treat ACHD" (comments by 29 subjects), "(2) Centralization of medical care" (comments by 29 subjects), "(3) What is the role of children's hospitals in ACHD?" (comments by 24 subjects), and "(4) Psychosocial problems" (comments by 24 subjects). CONCLUSIONS: Regional ACHD centers need to be established to promote centralization of patients, physicians, and educational function. This will provide higher quality medical service to more patients in the near future.

Attitude of outpatients with neuromuscular diseases in Japan to pain and use of analgesics.

The prevalence of pain and its impact on outpatients with neuromuscular disease, and their attitude towards the use of analgesics were studied. Seventy-eight outpatients at the university hospital, Tokyo, diagnosed with Parkinson's disease, spinocerebellar degeneration, amyotrophic lateral sclerosis, or multiple sclerosis were asked whether they had experienced pain in the preceding week. The Brief Pain Inventory, Japanese version was used to interview participants reporting pain, about its intensity and interference with activities, the way they dealt with it, attitudes to pain and use of analgesics, and desire for treatment. Forty-six participants experienced pain in the preceding week (59%). The mean pain intensity was 4.1 out of 10, and 20% of participants reported that the degree of interference with mobility was at least 6 out of 10. Most participants dealt with their pain without medication, by changing posture frequently or massage. Approximately 80% of participants regarded pain as something they should endure. Half of the participants wanted more information on methods for pain relief. Approximately 80% of participants were anxious about adverse reactions of analgesics. These findings suggest that medical staffs should provide appropriate information and educate their patients.

Moderate dietary temperance effectively prevents relapse of Crohn disease: a prospective study of patients in remission.

The authors examined the influence of diet (dietary fat intake and dietary temperance) on relapse of patients with Crohn disease. A 1-year prospective study of 76 patients with Crohn disease was conducted. The criterion for eligibility was a Crohn Disease Activity Index score of 150 or lower for at least 1 month. The primary end point was defined as the relapse-free interval from the baseline until the first relapse. Fat intake was assessed using a validated diet history questionnaire. The degree of dietary temperance was assessed using a single-item nominal scale. The Cox proportional hazards model was used to evaluate the influence of diet. Crohn disease relapse was seen in 25 patients (33%), and 47 patients (62%) remained in continuous remission. A decreased ratio of n-6 polyunsaturated fatty acid (PUFA) to n-3PUFA (odds ratio = .38; p = .005) was associated with a poor prognosis. Dietary temperance also was significantly associated with prognosis (p = .014). More moderate dietary temperance decreased the risk of relapse (odds ratio = .22; p = .006). Effective prevention of relapse for Crohn disease patients might be achieved through moderate dietary temperance, particularly when the disease condition is unstable.