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Sexual function is impaired in women with inflammatory bowel disease (IBD) as compared to normal controls. We examined disease specific determinants of different aspects of low sexual function.~Background~Background~Women with IBD aged 18 to 65 presenting to the university departments of internal medicine and surgery were included. In addition, a random sample from the national patients organization was used (separate analyses). Sexual function was assessed by the Brief Index of Sexual Function in Women, comprising seven different domains of sexuality. Function was considered impaired if subscores were <-1 on a z-normalized scale. Results are presented as age adjusted odds ratios with 95% CI based on multiple logistic regression.~Methods~Methods~336 questionnaires were included (219 Crohn's disease, 117 ulcerative colitis). Most women reported low sexual activity (63%; 17% none at all, 20% moderate or high activity). Partnership satisfaction was high in spite of low sexual interest in this group. Depressed mood was the strongest predictor of low sexual function scores in all domains. Urban residency and higher socioecomic status had a protective effect. Disease activity was moderately associated with low desire (OR 1.8, 95% CI 1.0 to 3.2). Severity of the disease course impacted most on intercourse frequency (OR 2.3, 95% CI 1.4 to 4.7). Lubrication problems were more common in smokers (OR 2.5, 95% CI 1.3 to 5.1).~Results~Results~Mood disturbances and social environment impacted more on sexual function in women with IBD than disease specific factors. Smoking is associated with lubrication problems.~Conclusion~Conclusions [ABSTRACT FROM AUTHOR]

Based on a dynamic life cycle model, this study analyzes health-related risks of consumption and old-age poverty. The model allows for health effects on employment risks, on productivity, on longevity, the correlation between health risks, productivity and preferences, and the financial incentives of the German public insurance schemes. The estimation uses data on male employees and an extended expectation-maximization algorithm. Simulations suggest that health shocks induce average losses in annual consumption of about 10% and account for more than two-thirds of the cases of old-age poverty. Annuity markets that account for differences in the longevity risk by health status can effectively reduce the consumption risks, but only slightly decrease old-age poverty. A policy analysis of minimum pension benefits indicates that a means test mitigates the associated moral hazard problem substantially., (Copyright © 2019 Elsevier B.V. All rights reserved.)

In this paper we investigate the causal effect of years of schooling on health and health-related behavior in West Germany. We apply an instrumental variables approach using as natural experiments several changes in compulsory schooling laws between 1949 and 1969. These law changes generate exogenous variation in years of schooling both across states and over time. We find evidence for a strong and significant causal effect of years of schooling on long-term illness for men but not for women. Moreover, we provide somewhat weaker evidence of a causal effect of education on the likelihood of having weight problems for both sexes. On the other hand, we find little evidence for a causal effect of education on smoking behavior. Overall, our estimates suggest significant non-monetary returns to education with respect to health outcomes but not necessarily with respect to health-related behavior., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: Crohn's disease is a highly distressful chronic disorder, characterized by frequent relapses. A symptom-based disease activity index was developed for use in epidemiological research., Study Design and Setting: One hundred and six consecutive patients presenting to a tertiary referral hospital in Southern Germany in 2004-2005 participated in a questionnaire-based survey. As a reference standard, disease activity was assessed using a clinical index (Crohn's Disease Activity Index [CDAI], based on symptoms reported to physician, laboratory markers, and physician assessed signs). A linear regression equation was calculated based on the survey data on severity of symptoms (dependent variable: CDAI). Survey index scores (S-CDAI) were then calculated using the estimated coefficients for pain, stools, and general well-being in an independent data set., Results: S-CDAI and CDAI showed moderate agreement (kappa=0.57 for relapse vs. remission). High activity (high S-CDAI) correlated negatively with high quality of life (disease specific: Short Inflammatory Bowel Disease Quality-of-Life Questionnaire; r=-0.67; generic: Short Form 36 physical summary score, r=-0.47). Test-retest reliability and sensitivity for change were good (intraclass correlation coefficient 0.81)., Conclusion: A useful, valid, and reliable disease activity score was developed, which will facilitate meaningful survey research in this chronic disorder.

Background: Problems with intimacy and sexual performance are among the major concerns of patients with inflammatory bowel disease (IBD). This study was performed to identify disease-related factors associated with low sexual function in men., Methods: Consecutive patients were surveyed using a standardized questionnaire. A random sample from the national patients' organization was also included. Low sexual function was defined as a score < -1 on a z-normalized scale of the International Index of Erectile Function. Results are presented as adjusted odds ratios (ORs) with 95% confidence interval (CI) based on multiple logistic regression., Results: 280 questionnaires were available for analysis. Scores were similar between the groups and compared with general population means, with the exception of sexual desire. Of the clinical group, 44% felt severely compromised sexually due to their IBD. Erectile function was particularly sensitive to somatic problems (disease activity, OR 2.5, 95% CI: 1.3-4.9; diabetes, OR 7.0, 95% CI: 1.4-35.0). The influence of depressive mood was restricted to aspects of satisfaction (sexual satisfaction, OR 2.3, 95% CI 1.1-4.9; overall satisfaction OR 3.7, 95% CI: 1.7-8.3)., Conclusions: Sexual function was relatively better with longer disease duration and was not affected by the long-term severity of the disease.