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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Positive health: An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders
Anja H W M Lemlijn-Slenter, Karolina A P Wijnands, Gijs van der Hamsvoort, Luuk P van Iperen, Nico Wolter, Angelique E de Rijk, Ad A M Masclee
Anja H W M Lemlijn-Slenter, Karolina A P Wijnands, Luuk P van Iperen, Angelique E de Rijk, Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, Maastricht 6200 MD, Limburg, Netherlands
Anja H W M Lemlijn-Slenter, Nico Wolter, Ad A M Masclee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Nutrition and Translational Research in Metabolism, Maastricht 6200 MD, Limburg, Netherlands
Anja H W M Lemlijn-Slenter, Karolina A P Wijnands, Gijs van der Hamsvoort, Social Medical Affairs, Employee Insurance Agency (UWV), Heerlen 6400 AC, Limburg, Netherlands
Anja H W M Lemlijn-Slenter, Karolina A P Wijnands, Angelique E de Rijk, Department of Research, Academic Knowledge Center Work and Health South-East Netherlands (AKAG-ZON), Heerlen 6400 AC, Limburg, Netherlands
Author contributions: Masclee AAM, de Rijk AE, Wijnands KAP and Wolter N designed the research study; Lemlijn-Slenter AHWM and Wolter N collected data; data analyses were performed by van der Hamsvoort G, van Iperen LP and Lemlijn-Slenter AHWM; Lemlijn-Slenter AHWM, de Rijk AE and Masclee AAM wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee in a written statement specifying that the Medical Research Involving Human Subjects Act (WMO) did not apply to this study (METC 2019-1324, Maastricht UMC +, Maastricht).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/licenses/by-nc/4.0/ Corresponding author: Anja HWM Lemlijn-Slenter, MD, Insurance Physician, Researcher, Department of Social Medicine, Faculty of Health, Medicine and Life sciences, Care and Public Health Research Institute Maastricht University, PO Box 616, Maastricht 6200 MD, Limburg, Netherlands.
a.lemlijn@maastrichtuniversity.nl
Received: March 1, 2024
Revised: June 5, 2024
Accepted: June 24, 2024
Published online: July 28, 2024
Processing time: 144 Days and 16 Hours
BACKGROUND
The concept of positive health (PH) supports an integrated approach for patients by taking into account six dimensions of health. This approach is especially relevant for patients with chronic disorders. Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders are among the top-6 of the most prevalent chronically affected organ systems. The impact of chronic GI-HPB disorders on individuals may be disproportionally high because: (1) The affected organ system frequently contributes to a malnourished state; and (2) persons with chronic GI-HPB disorders are often younger than persons with chronic diseases in other organ systems.
AIM
To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders.
METHODS
Prospective, observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GI-HPB disorder attending the Outpatient Department of the Maastricht University Medical Center. Validated questionnaires and data from patient files were used to quantify the six dimensions of PH. Internal consistency was tested with McDonald’s Omega. Zero-order Pearson correlations and t-tests were used to assess associations and differences. A P value < 0.05 was considered significant.
RESULTS
The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders. Intercorrelation scores between the six dimensions were only very weak to weak, forcing us to quantify each domain separately.
CONCLUSION
All six dimensions of PH are impaired in the GI-HPB patients. Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.
Core Tip: Patients with chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders experience complaints in every dimension of positive health (PH). We described and quantified these complaints and compared the outcomes with norm scores and other chronic diseases. We found that GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders.
