human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery  for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function Aliment Pharmacol Ther 2010 ; 32 : 1228–1239 One hundred and twenty-two r and omly selected patients with ulcerative colitis ( 28 of whom had undergone colectomy )  were interviewed to obtain data on the quality of their family , emotional , social , and professional lives . They were compared with an age- and sex-matched group of patients with acute conditions from the same area . The two groups were similar in marital status , the frequency of severe family or sexual problems , leisure activities , physical and earning capacity , the incidence of mental disorders before the interview , and intake of alcohol and psychopharmacological drugs . A higher proportion of the patients with colitis had had a higher education and belonged to higher socioeconomic groups than the controls , and this difference had been present at the time of diagnosis . These results show that patients with ulcerative colitis seem to adapt themselves well to their condition and suffer few social or professional disabilities Seventy young adults ( 50 with Crohn 's disease ( CD ) and 20 with ulcerative colitis ( UC ) ( from a geographically derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 ( range 5.2 - 29.5 ) years after diagnosis .  Details of  education and employment  were collected as part of a structured clinical interview . Although 57 % had had periods of absence from school of two months or more , their school examination pass rates were similar to those of the healthy population . The achievements of CD patients were consistently better than those of the UC group . In 15 patients , relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations . Extra tuition in hospital had been provided for only four patients , and three others had had privately arranged tuition at home . Fifty per cent proceeded to full time higher education . At the time of review , seven patients were full time students , one was a university research fellow , 47 were in full time and three in part time employment , one was self employed , four were housewives , and only six were involuntarily unemployed . All four unemployed CD patients attributed this to inflammatory bowel disease , but other factors were relevant in the unemployed UC patients . Few had direct evidence of rejection by employers on health grounds , though some did not declare their illness to prospect i ve employers A r and om sample of 170 patients ( 88 men ) with chronic inflammatory bowel disease ( 75 ulcerative colitis ) were first interviewed in 1978 about their employment status , problems at work , and influence of surgery .  Surgery had been carried out on 120 and 53 had an ileostomy . After six years 144 ( 92 % ) of the 156 survivors replied to a follow up postal question naire . Of the initial sample , 122 ( 72 % ) were working and there were only three ( 1 % ) registered unemployed . After six years a similar proportion were working and only seven ( 5 % ) were unemployed . Continuity of employment was good with 57 % in the same job . Changes in work because of health had been made by 72 patients mainly caused by bowel disease . After surgery 10 % completely changed and 22 % modified their work while a few had to retrain or retire . Panproctocolectomy and ileostomy result ed in more changes and longer time off work after surgery than colectomy and ileorectal anastomosis , with 35 % and 17 % respectively off work after one year . Problems at work , in particular general malaise and arthritis were experienced by 34 ( 28 % ) patients . Fewer problems were experienced by patients with a stoma who also had less sickness absence than those without a stoma . Colleagues and employers were usually supportive although some patients encountered discrimination especially those with a stoma or working in the food industry . Few patients had been counselled on their work . In general employment prospect s and time off work were good and employers should be encouraged to take an optimistic and supportive role . Doctors should consider that convalescence after surgery may be longer than they perceive and must provide better counselling for patients Objective To compare the work disability ( WD ) rate in inflammatory bowel disease ( IBD ) patients 10 years after disease onset , with the WD rate in the background population , and to assess whether clinical or demographic factors in the early disease course could predict WD after 10 years disease . Design A large , population -based inception cohort ( the Inflammatory Bowel in South Eastern Norway cohort ) was prospect ively followed up at 1 , 5 and 10 years after diagnosis . At the 10-year follow-up data on WD were collected . Data on  disability pension ( DP )  in the background population were retrieved from public data bases . We calculated overall and age-st and ardised relative risks ( RR ) for  DP .  Logistic regression analysis was used to examine predictive factors . Results A total of 518 patients completed the 10-year follow-up ( response rate 83.5 % ) . The overall disability rate in the IBD population was 18.8 % , and the RR was 1.8 ( 95 % CI 1.4 to 2.3 ) for ulcerative colitis ( UC ) and 2.0 ( 95 % CI 1.4 to 2.7 ) for Crohn 's disease ( CD ) . The RR for DP was highest in patients aged below 40 years while patients aged over 60 years had no increased RR . Steroid treatment at the 1-year follow-up predicted WD after 10 years disease in both CD and UC . In UC , increased C-reactive protein ( CRP ) or erythrocyte sedimentation rate ( ESR ) at diagnosis , early colectomy , and more than two relapses during the first year of the disease also predicted WD . Conclusion Ten years after disease onset IBD patients had an increased RR for DP as compared with the background population . The youngest patients had the highest RR . Markers of severe disease course predicted WD BACKGROUND Crohn 's disease ( CD ) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea , abdominal pain , and fever , which can interfere with a patient 's ability to work and perform daily activities . OBJECTIVE The aim of this study was to assess the validity , reliability , and responsiveness of the Work Productivity and Activity Impairment question naire in CD ( WPAI : CD ) . METHODS The WPAI : CD was tested in CD patients enrolled in a 26-week r and omized clinical trial of cer-tolizumab pegol versus placebo . Discriminative validity of WPAI : CD absenteeism , presenteeism(reduced on-the-job effectiveness ) , overall work productivity loss ( absenteeism + presenteeism ) , and activity impairment scores was assessed relative to 5 measures of disease severity and health status : CD Activity Index ( CDAI ) , Short Form-36 physical component summary ( PCS ) and mental health component summary ( MCS ) scores , Inflammatory Bowel Disease Question naire ( IBDQ ) , and the 5-dimensional EuroQoL health-related quality -of-life visual analog scale ( EQ-VAS ) . Responsiveness was assessed by comparing changes in WPAI : CD scores from baseline to week 26 for patients in remission ( CDAI < 150 points ) versus no remission . St and ardized Response Means ( SRMs ) were calculated to evaluate the magnitude of the changes . RESULTS A total of 662 patients ( mean [ range ] age , 37.4 [ 18 - 77 ] years ; male , 288 [ 43.5 % ] ; white , 629 [ 95.0 % ] ) were enrolled in the study . Patients with CD of the worst severity ( CDAI > median ) showed significantly higher impairment in work ( + 10.5 % ) and activities ( + 10.4 % ) versus patients with " best health " ( no problems ) ( both , P < or = 0.001 ) . Patients with " worst " IBDQ , PCS , MCS , and EQ-VAS scores also showed significantly higher impairments in work ( IBDQ , VAS -24.2 % ; PCS , -24.1 % ; MCS , -15.9 % ; EQ-VAS , -16.5 % ) and activities ( IBDQ , -23.3 % ; PCS , -21.8 % ; MCS , -16.5 % ; EQ-VAS , -17.2 % ) versus " best " scores ( all , P < 0.05 ) . There were significant differences between WPAI : CD impairment scores for patients in remission versus patients failing to achieve remission ( P < 0.05 ) . SRMs were small ( ie , < 0.5 ) in the nonre-mission group , and moderate to large ( ie , > 0.5 ) for patients in remission . CONCLUSIONS The discriminative validity , reliability , and responsiveness of the WPAI : CD were demonstrated . The WPAI : CD may be useful for evaluating drug impact on CD OBJECTIVES :  Hospitalization , surgery , work loss , and impaired quality of life contribute to the cost and burden of care for patients with Crohn 's disease . We examined the impact of remission on patients ' employment , quality of life , and hospitalization and  surgery  in a clinical trial to vali date clinical remission , as defined by the Crohn 's disease activity index ( CDAI ) , as the key treatment goal in managing Crohn 's disease . METHODS : ACCENT I evaluated the efficacy and safety of long-term dosing of infliximab compared to a single dose of infliximab in 573 patients with moderately-to-severely active Crohn 's disease . At wk 54 , employment status was compared between patients in CDAI remission and those not in CDAI remission , for those not employed at baseline . Physical component summary ( PCS ) and mental component summary ( MCS ) scores of the SF-36 question naire were also compared between these two groups . The numbers of Crohn's-related hospitalizations and surgeries were compared among four groups of patients who spent 0–25 % , 25–50 % , 50–75 % , and 75–100 % of time , respectively , in CDAI remission during the study . RESULTS : At baseline , patients had a severely impaired quality of life and a high unemployment rate ( 38.4 % ) . Among the group of patients who were unemployed at baseline , 31 % of those patients who achieved CDAI remission ( CDAI < 150 ) at wk 54 were employed , compared to 16 % who were not in CDAI remission at wk 54 ( p < 0.05 ) . PCS and MCS scores of patients in CDAI remission at wk 54 were significantly higher ( p < 0.0001 ) , indicating better mental and physical functioning , than those of patients not in CDAI remission at wk 54 , and were similar to those of the general U.S. population . Hospitalization and surgery rates decreased as the percentage of time patients were in CDAI remission increased ( p < 0.01 and p < 0.05 , respectively ) . CONCLUSIONS : CDAI remission is associated with reduced hospitalizations and surgeries , increased employment , and normalized quality of life . Sustained CDAI remission should be the key therapeutic goal in managing Crohn 's disease OBJECTIVE To evaluate open-label adalimumab therapy for clinical effectiveness , fistula healing , patient-reported outcomes and safety in Canadian patients with moderate to severe Crohn 's disease ( CD ) who were either naive to or previously exposed to antitumour necrosis factor ( anti-TNF ) therapy . METHODS Patients with moderate to severe CD ( CD activity index [ CDAI ] score of greater than 220 , or Harvey-Bradshaw index [ HBI ] of 7 or greater ) were eligible . Patients received open-label adalimumab as induction ( 160 mg and 80 mg subcutaneously [ sc ] ) at weeks 0 and 2 , respectively and maintenance ( 40 mg sc every other week ) therapy . At or after 
    Output:
    
agent
The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used .
Inflammatory bowel disease patients experience a high burden in work-related outcomes .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery  for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function Aliment Pharmacol Ther 2010 ; 32 : 1228–1239 One hundred and twenty-two r and omly selected patients with ulcerative colitis ( 28 of whom had undergone colectomy )  were interviewed to obtain data on the quality of their family , emotional , social , and professional lives . They were compared with an age- and sex-matched group of patients with acute conditions from the same area . The two groups were similar in marital status , the frequency of severe family or sexual problems , leisure activities , physical and earning capacity , the incidence of mental disorders before the interview , and intake of alcohol and psychopharmacological drugs . A higher proportion of the patients with colitis had had a higher education and belonged to higher socioeconomic groups than the controls , and this difference had been present at the time of diagnosis . These results show that patients with ulcerative colitis seem to adapt themselves well to their condition and suffer few social or professional disabilities Seventy young adults ( 50 with Crohn 's disease ( CD ) and 20 with ulcerative colitis ( UC ) ( from a geographically derived cohort of patients with juvenile onset inflammatory bowel disease were interviewed and examined at a mean of 14 ( range 5.2 - 29.5 ) years after diagnosis .  Details of  education and employment  were collected as part of a structured clinical interview . Although 57 % had had periods of absence from school of two months or more , their school examination pass rates were similar to those of the healthy population . The achievements of CD patients were consistently better than those of the UC group . In 15 patients , relapses of inflammatory bowel disease had adversely affected examination performance or prevented them from sitting school examinations . Extra tuition in hospital had been provided for only four patients , and three others had had privately arranged tuition at home . Fifty per cent proceeded to full time higher education . At the time of review , seven patients were full time students , one was a university research fellow , 47 were in full time and three in part time employment , one was self employed , four were housewives , and only six were involuntarily unemployed . All four unemployed CD patients attributed this to inflammatory bowel disease , but other factors were relevant in the unemployed UC patients . Few had direct evidence of rejection by employers on health grounds , though some did not declare their illness to prospect i ve employers A r and om sample of 170 patients ( 88 men ) with chronic inflammatory bowel disease ( 75 ulcerative colitis ) were first interviewed in 1978 about their employment status , problems at work , and influence of surgery .  Surgery had been carried out on 120 and 53 had an ileostomy . After six years 144 ( 92 % ) of the 156 survivors replied to a follow up postal question naire . Of the initial sample , 122 ( 72 % ) were working and there were only three ( 1 % ) registered unemployed . After six years a similar proportion were working and only seven ( 5 % ) were unemployed . Continuity of employment was good with 57 % in the same job . Changes in work because of health had been made by 72 patients mainly caused by bowel disease . After surgery 10 % completely changed and 22 % modified their work while a few had to retrain or retire . Panproctocolectomy and ileostomy result ed in more changes and longer time off work after surgery than colectomy and ileorectal anastomosis , with 35 % and 17 % respectively off work after one year . Problems at work , in particular general malaise and arthritis were experienced by 34 ( 28 % ) patients . Fewer problems were experienced by patients with a stoma who also had less sickness absence than those without a stoma . Colleagues and employers were usually supportive although some patients encountered discrimination especially those with a stoma or working in the food industry . Few patients had been counselled on their work . In general employment prospect s and time off work were good and employers should be encouraged to take an optimistic and supportive role . Doctors should consider that convalescence after surgery may be longer than they perceive and must provide better counselling for patients Objective To compare the work disability ( WD ) rate in inflammatory bowel disease ( IBD ) patients 10 years after disease onset , with the WD rate in the background population , and to assess whether clinical or demographic factors in the early disease course could predict WD after 10 years disease . Design A large , population -based inception cohort ( the Inflammatory Bowel in South Eastern Norway cohort ) was prospect ively followed up at 1 , 5 and 10 years after diagnosis . At the 10-year follow-up data on WD were collected . Data on  disability pension ( DP )  in the background population were retrieved from public data bases . We calculated overall and age-st and ardised relative risks ( RR ) for  DP .  Logistic regression analysis was used to examine predictive factors . Results A total of 518 patients completed the 10-year follow-up ( response rate 83.5 % ) . The overall disability rate in the IBD population was 18.8 % , and the RR was 1.8 ( 95 % CI 1.4 to 2.3 ) for ulcerative colitis ( UC ) and 2.0 ( 95 % CI 1.4 to 2.7 ) for Crohn 's disease ( CD ) . The RR for DP was highest in patients aged below 40 years while patients aged over 60 years had no increased RR . Steroid treatment at the 1-year follow-up predicted WD after 10 years disease in both CD and UC . In UC , increased C-reactive protein ( CRP ) or erythrocyte sedimentation rate ( ESR ) at diagnosis , early colectomy , and more than two relapses during the first year of the disease also predicted WD . Conclusion Ten years after disease onset IBD patients had an increased RR for DP as compared with the background population . The youngest patients had the highest RR . Markers of severe disease course predicted WD BACKGROUND Crohn 's disease ( CD ) is a chronic inflammatory bowel disease usually diagnosed in early adult life and characterized by unpredictable flares and debilitating symptoms such as diarrhea , abdominal pain , and fever , which can interfere with a patient 's ability to work and perform daily activities . OBJECTIVE The aim of this study was to assess the validity , reliability , and responsiveness of the Work Productivity and Activity Impairment question naire in CD ( WPAI : CD ) . METHODS The WPAI : CD was tested in CD patients enrolled in a 26-week r and omized clinical trial of cer-tolizumab pegol versus placebo . Discriminative validity of WPAI : CD absenteeism , presenteeism(reduced on-the-job effectiveness ) , overall work productivity loss ( absenteeism + presenteeism ) , and activity impairment scores was assessed relative to 5 measures of disease severity and health status : CD Activity Index ( CDAI ) , Short Form-36 physical component summary ( PCS ) and mental health component summary ( MCS ) scores , Inflammatory Bowel Disease Question naire ( IBDQ ) , and the 5-dimensional EuroQoL health-related quality -of-life visual analog scale ( EQ-VAS ) . Responsiveness was assessed by comparing changes in WPAI : CD scores from baseline to week 26 for patients in remission ( CDAI < 150 points ) versus no remission . St and ardized Response Means ( SRMs ) were calculated to evaluate the magnitude of the changes . RESULTS A total of 662 patients ( mean [ range ] age , 37.4 [ 18 - 77 ] years ; male , 288 [ 43.5 % ] ; white , 629 [ 95.0 % ] ) were enrolled in the study . Patients with CD of the worst severity ( CDAI > median ) showed significantly higher impairment in work ( + 10.5 % ) and activities ( + 10.4 % ) versus patients with " best health " ( no problems ) ( both , P < or = 0.001 ) . Patients with " worst " IBDQ , PCS , MCS , and EQ-VAS scores also showed significantly higher impairments in work ( IBDQ , VAS -24.2 % ; PCS , -24.1 % ; MCS , -15.9 % ; EQ-VAS , -16.5 % ) and activities ( IBDQ , -23.3 % ; PCS , -21.8 % ; MCS , -16.5 % ; EQ-VAS , -17.2 % ) versus " best " scores ( all , P < 0.05 ) . There were significant differences between WPAI : CD impairment scores for patients in remission versus patients failing to achieve remission ( P < 0.05 ) . SRMs were small ( ie , < 0.5 ) in the nonre-mission group , and moderate to large ( ie , > 0.5 ) for patients in remission . CONCLUSIONS The discriminative validity , reliability , and responsiveness of the WPAI : CD were demonstrated . The WPAI : CD may be useful for evaluating drug impact on CD OBJECTIVES :  Hospitalization , surgery , work loss , and impaired quality of life contribute to the cost and burden of care for patients with Crohn 's disease . We examined the impact of remission on patients ' employment , quality of life , and hospitalization and  surgery  in a clinical trial to vali date clinical remission , as defined by the Crohn 's disease activity index ( CDAI ) , as the key treatment goal in managing Crohn 's disease . METHODS : ACCENT I evaluated the efficacy and safety of long-term dosing of infliximab compared to a single dose of infliximab in 573 patients with moderately-to-severely active Crohn 's disease . At wk 54 , employment status was compared between patients in CDAI remission and those not in CDAI remission , for those not employed at baseline . Physical component summary ( PCS ) and mental component summary ( MCS ) scores of the SF-36 question naire were also compared between these two groups . The numbers of Crohn's-related hospitalizations and surgeries were compared among four groups of patients who spent 0–25 % , 25–50 % , 50–75 % , and 75–100 % of time , respectively , in CDAI remission during the study . RESULTS : At baseline , patients had a severely impaired quality of life and a high unemployment rate ( 38.4 % ) . Among the group of patients who were unemployed at baseline , 31 % of those patients who achieved CDAI remission ( CDAI < 150 ) at wk 54 were employed , compared to 16 % who were not in CDAI remission at wk 54 ( p < 0.05 ) . PCS and MCS scores of patients in CDAI remission at wk 54 were significantly higher ( p < 0.0001 ) , indicating better mental and physical functioning , than those of patients not in CDAI remission at wk 54 , and were similar to those of the general U.S. population . Hospitalization and surgery rates decreased as the percentage of time patients were in CDAI remission increased ( p < 0.01 and p < 0.05 , respectively ) . CONCLUSIONS : CDAI remission is associated with reduced hospitalizations and surgeries , increased employment , and normalized quality of life . Sustained CDAI remission should be the key therapeutic goal in managing Crohn 's disease OBJECTIVE To evaluate open-label adalimumab therapy for clinical effectiveness , fistula healing , patient-reported outcomes and safety in Canadian patients with moderate to severe Crohn 's disease ( CD ) who were either naive to or previously exposed to antitumour necrosis factor ( anti-TNF ) therapy . METHODS Patients with moderate to severe CD ( CD activity index [ CDAI ] score of greater than 220 , or Harvey-Bradshaw index [ HBI ] of 7 or greater ) were eligible . Patients received open-label adalimumab as induction ( 160 mg and 80 mg subcutaneously [ sc ] ) at weeks 0 and 2 , respectively and maintenance ( 40 mg sc every other week ) therapy . At or after 
    Output:
    