Functional abdominal complaints in pre-school children: parental reports of health-related quality of life

Purpose The aim of this study is to assess the influence of functional abdominal complaints (FAC) on health-related quality of life in a group of Dutch pre-school children. Methods Parents of children aged up to 6.0 visiting the outpatient pediatric department, Erasmus MC-Sophia, Rotterdam, The Netherlands in the period January 2005-December 2006 for functional abdominal complaints during at least 3 months were asked to complete the Infant/Toddler Quality of life Questionnaire (ITQOL), and questions of the abdominal pain index for use by parents to report pain symptoms in pre-school children. ITQOL scale scores of children with FAC were compared against with Dutch reference values. The abdominal pain index was tested for internal consistency and test-retest reliability. Correlations between ITQOL scale scores and abdominal pain index were assessed by Spearman's rank test. Results Results are based on 81 questionnaires completed by parents of children with FAC (response rate 61%). Children had a median age of 46 months (interquartile range 27-59), 48% girls. A significant impact was observed on most aspects of quality of life, particularly for physical functioning, general development, bodily pain, temperament and moods, general health perceptions and parental emotional impact. Parents of children with functional constipation tended to report lower scores than those of children with other FAC. The abdominal pain index appeared to be valid and was significantly correlated with ITQOL scales bodily pain and general health perceptions. Conclusions A substantial lower health-related quality of life is reported in pre-school children with functional abdominal complaints, with effects on physical, emotional and parental domains. The 5-question severity index of abdominal pain appeared a valid tool and may be helpful to quickly assess the severity of abdominal pain in clinical practice

Health-related quality of life in young adults with symptoms of constipation continuing from childhood into adulthood

<p>Abstract</p> <p>Background</p> <p>Children with functional constipation report impaired Health-related Quality of Life (HRQoL) in relation to physical complaints and long duration of symptoms. In about one third of children with constipation, symptoms continue into adulthood. Knowledge on HRQoL in adults with constipation persisting from childhood is lacking.</p> <p>Objectives</p> <p>To assess HRQoL in adults with constipation from early childhood in comparison to that of their peers. Furthermore to gain insight into the specific social consequences related to continuing symptoms of constipation and/or fecal incontinence at adult age.</p> <p>Methods</p> <p>One HRQoL questionnaire and one self-developed questionnaire focusing on specific consequences of symptoms of constipation continuing into adulthood were administrated to 182 adults with a history of childhood constipation. Successful clinical outcome was defined as a defecation frequency three or more times per week with less than two episodes of fecal incontinence per month, irrespective of laxative use. HRQoL of both adults with unsuccessful and successful clinical outcome were compared to a control group of 361 peers from the general Dutch population.</p> <p>Results</p> <p>No differences in HRQoL were found between the whole study population and healthy peers, nor between adults with successful clinical outcome (n = 139) and the control group. Adults with an unsuccessful clinical outcome (n = 43) reported significantly lower HRQoL compared to the control group with respect to scores on bodily pain (mean ± SD 77.4 ± 19.6 versus 85.7 ± 19.5, p = 0.01) and general health (67.6 ± 18.8 versus 74.0 ± 18.1, p = 0.04). Adults with an unsuccessful clinical outcome reported difficulties with social contact and intimacy (20% and 12.5%, respectively), related to their current symptoms. Current therapy in these adults was more often self-administered treatment (e.g. diet modifications) (60.4%) than laxatives (20.9%).</p> <p>Conclusion</p> <p>Overall, young adults with constipation in childhood report a good quality of life, as HRQoL of adults with successful clinical outcome was comparable to that of their peers. However, when childhood constipation continues into adulthood, it influences HRQoL negatively with social consequences in 20% of these adults.</p

Fatores de risco associados ao desmame precoce e ao período de desmame em lactentes matriculados em creches Risk factors associated to early weaning and to weaning period of infants enrolled in daycare centers

OBJETIVO: Avaliar os fatores de risco no processo de desmame de lactentes matriculados em creches. MÉTODOS: Estudo analítico transversal com 56 crianças de nove a 18 meses de idade matriculadas em cinco creches de São Paulo. As mães das crinaças responderam ao questionário pré-testado que abordava questões demográficas, socioeconômicas, de gestação e nascimento, morbidade, aleitamento materno, alimentação complementar (quando/como foram introduzidos novos alimentos) e atividades da criança na creche. Os fatores associados ao desmame precoce e menor período de desmame (variável definida pela diferença entre tempo de aleitamento exclusivo e tempo de aleitamento total) foram avaliados em análises bivariadas. As variáveis com p<0,10 foram ajustadas em modelo conceitual hierárquico de regressão logística. RESULTADOS: Na análise multivariada, foram determinados os seguintes fatores de risco independentes para desmame precoce: renda familiar <3 salários mínimos (OR 3,73; IC95% 1,23-11,34); idade da mãe >25 anos (OR 4,91; IC95% 1,35-17,95); mãe morar sem companheiro (OR 6,42; IC95% 1,28-32,20) e uso de chupeta antes dos 30 dias de vida (OR 8,75; IC95% 1,90-40,23). Os fatores de risco para tempo insuficiente de desmame foram: frequentar creche pública (OR 3,20; IC95% 0,77-14,29) e início tardio do pré-natal (OR 4,13; IC95% 0,70-31,29). CONCLUSÕES: Características relacionadas à família e à instituição creche são fatores de risco para o desmame de crianças institucionalizadas. A abordagem desses determinantes para definir ações de saúde e nutrição é estratégica para favorecer a prática do aleitamento e qualificar o papel da creche como promotora de saúde e nutrição infantil.<br>OBJECTIVE: To evaluate risk factors associated with weaning of infants enrolled in daycare centers. METHODS: Analytical cross-sectional study comprising 56 children aged nine to 18 months in five daycare centers of São Paulo. A pre-tested questionnaire was applied to their mother, including questions on demographics and socioeconomic issues, gestation and birth, illness, breastfeeding, complementary feeding (when and how new foods were introduced) and children activities in daycare centers. Factors associated with early weaning and short weaning period (defined as the difference between exclusive breastfeeding period and total breastfeeding period) were determined by bivariate analyses. Conceptual hierarchical multivariate analysis (logistic regression) was applied. RESULTS: In the multivariate analysis, the independent risk factors for early weaning were: family income <3 minimum wage (OR 3.73; 95%CI 1.23-11.34); mother's age >25 years (OR 4.91; 95%CI 1.35-17.95); mother living without a partner (OR 6.42; 95%CI 1.28-32.20); use of pacifier before 30 days of life (OR 8.75; 95%CI 1.90-40.23). Risk factors for insufficient weaning period were: attending public daycare centers (OR 3.20; 95%CI 0.77-14.29) and late start of prenatal care (OR 4.13; 95%CI 0.70-31.29). CONCLUSIONS: Characteristics related to family and to daycare centers are risk factors for breastfeeding weaning among institutionalized infants. Such factors approach is strategic to define nutrition and health actions for favoring breastfeeding practice and to qualify daycare centers as infant health and nutrition promoters