title: Establishment of Health Utility Indices for Post-Infectious Functional Gastrointestinal Disorders in Active Duty US Military.
abstract: BACKGROUND
  Knowledge of disease burden attributable to functional gastrointestinal disorders (FGD) in travelers is lacking, despite the high incidence of travelers' diarrhea (TD) associated with increased FGD risk. One tool for assessing the impact of disease on health-related quality of life is the health utility index (HUI), which values health states based on preferential health outcomes. Health utilities can be used as preference weights in the estimation of quality-adjusted life-years (QALYs).
  
  
  METHODS
  Six months following travel to Egypt or Turkey, 120 US military personnel completed a survey on TD during deployment, health-related quality of life (SF-36), and the onset of functional bowel disorders (Rome II). Elements from the SF-36 were used to develop SF-6D values, which were combined with health state valuations to enable calculation of HUI scores for each subject. Mean index scores were compared across functional outcomes, specific symptoms, and demographic profiles.
  
  
  RESULTS
  The presence of FGD significantly reduced index scores, with irritable bowel syndrome (IBS) and dyspepsia showing the greatest impact (-0.17 and -0.19, respectively) compared with those with no FGD (p < 0.05). Importantly, however, several individuals met multiple FGD outcome definitions. Additionally, a number of symptoms associated with abnormal bowel habits and abdominal pain were associated with reduced index scores regardless of outcome.
  
  
  CONCLUSIONS
  FGD are associated with significant morbidity as assessed by HUIs. Given the strong link between TD and FGD as well as the large number of travelers from the developed to the developing world, additional study is needed to further understand this association and efforts aimed at primary disease prevention are warranted.
authors.affiliation: Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
authors.forename: Chad K
authors.initials: CK
authors.lastname: Porter
authors.affiliation: Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
authors.forename: Nadia
authors.initials: N
authors.lastname: Thura
authors.affiliation: Department of Preventive Medicine and Biometrics, Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, MD, USA.
authors.forename: Carey D
authors.initials: CD
authors.lastname: Schlett
authors.affiliation: Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.affiliation: Department of Preventive Medicine and Biometrics, Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, MD, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.affiliation: Naval Medical Research Center-Asia, Khan Toul Kork, Phnom Penh, Cambodia.
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Monteville
authors.affiliation: Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011315:Preventive Medicine / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012107:Research Design; D018570:Risk Assessment; D014195:Travel; D014421:Turkey / Q000453:epidemiology; D014481:United States / Q000453:epidemiology